San Antonio Metropolitan Health District is watching several emerging medical priorities for this upcoming legislative session that affect or address the incidence and prevalence of diabetes mellitus and staphylococcal infections resistant to methicillin, and maintaining health services for women.
Although these are not new issues per se, new trends indicate an increasing severity and urgency that warrant specific attention.
Diabetes mellitus, affecting approximately 8 percent of the population of the United States with an equal number estimated as undiagnosed cases, now affects more than 1.3 million within our own state. An additional 343,000 Texans are believed to have undiagnosed diabetes. Conservative estimates rank diabetes as the sixth leading cause of death in Texas and it is the fourth leading cause of death among the state’s African Americans and Hispanics.
Medical literature reports that better control of the disease improves health, reduces complications and lowers the cost of services. As a result, Metro Health is attempting to better control diabetes by developing a diabetic registry.
The concept calls for all labs in the city to be required to electronically report all hemoglobin A1C (HbA1C) values and send them to the patient’s practitioners if control is poor. The information also is used to direct education programs for providers and for the San Antonio community. Only two other HbA1C registries exist in the U.S. – in New York City and the state of Vermont.
Another of Metro Health’s specific concerns that may benefit from improved reporting methods is the Methicillin-resistant staphylococcus aureus (MRSA) that shows significant increases in frequency and severity. Community-acquired MRSA has a variety of clinical presentations ranging from skin infections, abscesses and cellulitis to sepsis, pneumonia and endocarditis, among others.
Although the course of these infections can be relatively benign when caught early and treated properly, studies now show that the majority of MRSA infections are not treated effectively until after the failure of one or more therapies. Furthermore, deaths have been directly attributable to community-acquired MRSA infections, as well as nosocomial infections.
In order to understand the scope of the problem in our community, the district needs a system of data collection that will uniformly describe cases and allow us to implement appropriate interventions at the earliest possible point. To this end, Metro Health is working to make MRSA a reportable disease. Armed with such information, it can move forward with plans to assist providers in detecting and treating MRSA and efforts to educate the general population on effective, preventive measures. Together, we will be able to show that the current increasing trend in MRSA cases can be curtailed.
Another important issue for the health district is maximizing access to preventive care and birth control for low-income women. As the Medicaid Women’s Health Program expansion is implemented, many women will still need access through the current federally funded programs (Titles V, X and XX). Metro Health officials believe these funding streams should not be diminished by set-asides for non-medical services offering alternatives to abortion, nor should there be arbitrary set-asides that threaten traditional and longstanding service providers such as the San Antonio Metropolitan Health District and University Health System.
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