Where Is Health Care Going?

2007-12-27T19:21:48+00:00

John Goodman, president of J O Goodman & Associates, Inc. – Heart And Vascular Business Consultants, discusses the woes of the American health care system.

jogoodmanassociates.com

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Statement of Need/Program Overview

Sleep-related disorders affect between 50 and 70 million Americans of all ages. A core symptom of sleep disturbances is excessive sleepiness, or difficulty maintaining wakefulness and an intense drive for sleep even under inappropriate circumstances. Excessive sleepiness can have far-reaching personal and societal impact including impaired interpersonal relationships, loss of productivity and increased rated of accidents. Isolating the etiology of excessive sleepiness is challenging for primary care practitioners, as this condition is associated not only with sleep-related disorders, but myriad other illnesses including neurologic, psychiatric and general medical conditions. This activity will provide practical strategies for the recognition and diagnosis of excessive sleepiness and will enable clinicians to implement an appropriate management plan that may include nonpharmacologic, pharmacologic, and specialty referral as options.

Educational Objectives

After completing this activity, the participant should be better able to:

Recognize and assess behavioral and circadian rhythm sleep disorders in patients presenting with the complaint of excessive daytime sleepiness

Target Audience

This activity has been designed to meet the educational needs of family practitioners and primary care providers involved in the management of patients with sleep disorders.

Faculty

Michael J. Thorpy, MD
Sleep-Wake Disorders Center
Professor of Neurology
Montefiore Medical Center
Bronx, New York

Karl Doghramji, MD
Jefferson Sleep Disorders Center
Philadelphia, Pennsylvania

Acitvity Sponsorshop

This activity is sponsored by Primary Care Network.

The sponsor can be contacted online via: http://www.primarycareed.com

Accreditation/Designation Statement

Primary Care Network is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Primary Care Network designates this educational activity for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Additional Acitvity Details

Media: Internet

Release date: March 1, 2010

Expiration date: March 1, 2011

Estimated time to complete activity: 0.25 hours

Acknowledgment of Commercial Support

This activity is supported by an unrestricted educational grant from Cephalon, Inc.

Disclosure of Conflicts of Interest

Primary Care Network assesses conflict of interest with their instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PCN for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PCN is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

*Name of Faculty or Presenter*	*Reported Financial Relationship*
Michael Thorpy, MD	Advisory Board: Cephalon, GlaxoSmithKline, Jazz, sanofi-aventis Consultant: Cephalon Speakers Bureau: Cephalon, Jazz, sanofi-aventis
Karl Doghramji, MD	Consultant: Azur, GlaxoSmithKline, sanofi-aventis, Sepracor Speakers Bureau: Boehringer Ingelheim, Forest Laboratories, GlaxoSmithKline, Jazz, sanofi-aventis, Sepracor, Takeda Stock/Shareholder: Merck

In accordance with PCN policy, all content is reviewed by external independent peer reviewers for balance, objectivity and commercial bias. The peer reviewers, staff, and other individuals who control content have no relevant financial relationships to disclose.

The following PCN planner and manager, Sandy Bihlmeyer, MEd, CCMEP, hereby states that she or her spouse/life partner does not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following BetterCME planner and manager, William C. Lloyd III, MD, hereby states that he or his spouse/life partner does not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Method of Participation

There are no fees for participating and receiving CME credit for this activity. During the period March 2010 through March 2011, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the posttest by recording the best answer to each question in the online answer key; 4) complete the online evaluation form; 5) an online statement of credit will be issued immediately upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Primary Care Education, Primary Care Network, and Cephalon, Inc., do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Primary Care Education, Primary Care Network, and Cephalon, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Technical Requirements

A broadband internet connection
Operating system: Microsoft Windows 98 or later; Mac OS X
Web browser: Microsoft Internet Explorer 6.0 or later; Mozilla Firefox 1.5 or later; Apple Safari
Adobe Flash Player 9.0 or later (Available at: get.adobe.com/flashplayer/)

Bibliography

Benca RM, et al. Mood disorders. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, PA: Elsevier/Saunders; 2005:1311-1326.
Carskadon MA, et al. Normal human sleep: an overview. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, PA: Elsevier/Saunders; 2005:13-23.
Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25:117-129.
Hatoum HT, Kania CM, Kong SX, et al. Prevalence of insomnia: a survey of the enrollees at five managed care organizations. Am J Manag Care. 1998;4:79-86.
Kapur V. Strohl KP, Redline S, et al. Underdiagnosis of sleep apnea syndrome in US communities. Sleep. 2002;6:49-54.
Kushida CA, Nichols DA, Simon RD, et al. Symptom-based prevalence of sleep disorders in an adult primary care population. Sleep Breath. 2000;4:9-14.
National Sleep Foundation. 2007 Annual Report: Waking America to the Importance of Sleep.
National Sleep Foundation. 2005 Sleep in America Poll. http://www.sleepfoundation.org/article/sleep-america-polls/2005-adult-sleep-habits-and-styles. Accessed January 9, 2010.
Office of the United States Surgeon General. Frontiers of Knowledge in Sleep & Sleep Disorders: Opportunities for Improving Health and Quality of Life. http://www.nhlbi.nih.gov/meetings/slp_carmona.pdf. Text of remarks made March 29, 2004. Accessed January 9, 2010.
Passarella S, Duoung MT. Diagnosis and treatment of insomnia. Am J Health Syst Pharm. 2008;65:927-934.
Roth T, Roehrs TA. Etiologies and sequelae of excessive daytime sleepiness. Clin Ther. 1996;18:562-576.
Stores G. Clinical diagnosis and misdiagnosis of sleep disorders. J Neurol Neurosurg Psychiatry. 2007;78:1293-1297.
Thorpy MJ, Lieberman JA III, Roth T, Owens GS. Patient identification. Am J Manag Care. 2007;13:S132-S139.
Toh KL. Basic science review on circadian rhythm biology and circadian sleep disorders. Ann Acad Med Singapore. 2008;37:662-668.
Walsh JK, et al. Pharmacologic treatment of primary insomnia. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, PA: Elsevier/Saunders; 2005:749-760.
Zeman A, Britton T, Douglas N, et al. Narcolepsy and excessive daytime sleepiness. BMJ. 2004;329(7468):724-728.

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