Welcome to the Core Update
AC Health’s roundup of the patient-centered research and news every healthcare professional needs to make their practice succeed.
CDC Recognizes Covid-19 “Long Haulers” and Recommends Longer Outpatient Rehabilitation
What’s Going On
We’ve discussed “long haulers” — former Covid-19 patients who experience lingering health problems for weeks or months after their initial recovery — for a while. Now, though, it’s no longer simply anecdotal: The CDC officially recognized the potential for “post-COVID-19 conditions” this week.
Specifically, post-Covid patients had greater pain, struggles with physical activities, and physical endurance compared to their control patients from January 2020 through March 2021. They were also more likely to be diagnosed with generalized muscle weakness or fatigue — 72.7% versus the 42.3% of the control patients.
Finally, Covid-19 long haulers were slightly more likely than the control population to report “fair or poor overall mental health” at 19.1% versus 15.3%.
Why This Matters
It’s always nice when science supports the common-sense observations in the field that medical providers and therapists have been watching for at least a year now.
In addition to the validation, the CDC mentions the average extra visits and longer “therapy duration” that long haulers typically need, compared to the control group of patients for identical diagnosis and treatments:
- 9 visits versus 5 visits (median)
- 35 days of treatment versus 27 days of treatment (median)
So, you should plan for about twice as many sessions and appointments for post-Covid-19 patients, and maybe a third as long overall treatment, than you schedule for “regular” patients.
Blended Professions: Using Mindfulness Techniques to Combat Pain and PTSD
What’s Going On
A recent article from Practical Pain Management reviewed how various “mindfulness” techniques can assist with seemingly unrelated physical maladies such as chronic pain, as well as assisting with PTSD treatments.
As defined by Dr. Cosio and Dr. Demyan, the writers of this particular article, “mindfulness” typically relates to a meditation or practice that uses “nonjudgmental awareness” to help center and observe a user’s current state.
Specifically, MBSR — “mindfulness-based stress reduction” — is a treatment course designed for chronic pain. Studies show that MBSR helps mitigate and reduce pain from migraines, the back and other chronic conditions by “selectively alter[ing] the unpleasantness of pain” while increasing the patient’s tolerance for discomfort overall.
Why This Matters
“Mind over matter” is more than just a nice saying, it seems.
Practicing meditation and other MBSR techniques as part of a patient’s treatment — either during a session to wind down, or assigned to practice at home — may help a patient work through lingering pain to achieve a better quality of life faster than physical therapies alone.
It’s worth a try, at least!
Can CBD Really Help Athletes Sleep and Recover?
What’s Going On
Capitalizing on the possibly latest and greatest pharmacological trend of the last decade, this article discusses the impact that CBD — a hemp-derived product with no THC, a la marijuana — might have on athletes’ sleep and body recovery after practice.
Basically:
- Athletes need more sleep than the average person to help their bodies recover from greater physical stresses due to practice and competition.
- Athletes’ joints and muscles are in particular need of increased recovery and reduced inflammation, to cut down on pain and reduce the risk of injury.
- CBD anecdotally helps patients as part of a good sleeping habit, particularly for older athletes, and without the risk of “getting high” with THC.
Why This Matters
Right off the bat, this isn’t a study or research survey; the article even admits it as such. (“To be clear, there is no completed, peer-reviewed research on CBD for athletes as it pertains to sleep.”)
And, it’s sponsored by a known CBD brand in the space, so all of the product recommendations are clearly skewed toward their own shelves, regardless of immediate application. (We were surprised that bath bombs made its way into an article for athletes, though we’re sure athletes enjoy a good soak as much as the next person!)
However, the known — or at least strongly suspected — impacts of CBD to assist regular sleep and its support of overworked muscles or joints seems to be a natural application to professional or enthusiast athletes.
If CBD can help athletes recover better from the stresses of training, then it may make sense for athletic trainers and coaches to recommend a small dose to athletes in addition to their regular, healthy sleep habits as an added boost — particularly for older athletes who struggle more with recovery than their younger counterparts.
Can CBD Really Help Athletes Sleep and Recover?
What’s Going On
An article in Forbes this week highlighted a March 2021 study reviewing the “naturalistic use of mescaline” — the psychedelic chemical in peyote — and its “self-reported” effects on patients.
Researchers anonymously surveyed 452 adults to ask about their personal use of mescaline (read: peyote) and its impacts on various disorders, including depression, anxiety, PTSD, and addictions.
Most of the research subjects — 68-86%, depending on the condition — who used peyote also self-reported “subjective improvement” after their “most memorable mescaline experience.”
Finally, the subjects who felt they had a “spiritually significant or meaningful experience” using peyote were the ones who were most likely to say their conditions had improved.
Why This Matters
The March 2021 peyote survey is a double-edged sword. On the one hand, there’s not much researchers can do in the middle of a global pandemic to find answers on whether a currently (mostly) illegal drug can help patients improve.
So, a self-reported survey is better than nothing, and certainly offers some interesting connections to follow up on. A“spiritual experience” with peyote and its possible alleviation of patients’ mental disorders is among the most curious observations.
(Would it have to be mescaline? Or, could similar hallucinogens produce the same effect? What about non-drug induced religious or “spiritual” experiences?)
However, patients weren’t monitored to track realized progress in their conditions. Instead, they were only asked if they “felt” better after peyote.
Chances are, the improvement rates and realized changes will adjust as more researchers pursue the findings in “controlled, longitudinal clinical trials.”
But, the seed of success is planted. Now, all we can do is wait and see if it grows into a tree of pharmaceutical progress for mental health patients — or a cactus, as the case may be.
California Budgets Dyadic Care Reimbursement for Medicaid in 2022
What’s Going On
California is about to be the first state to let providers bill for “dyadic care” to treat both children and adults on Medi-Cal, the state’s Medicaid program.
Historically, children’s therapists and physicians were reluctant to offer counseling or therapy as part of the child-patient’s treatment, since insurance programs typically wouldn’t pay for the adult’s counseling off of the child’s diagnosis.
However, many child providers and experts agree that helping parents through their own mental struggles and challenges is just as important as helping children through theirs.
California’s new 2021-2022 state budget allocates $800 million over 4 years for this new dyadic care.
So, starting in 2022, adult caregivers going to a pediatric primary care physician can get screened for depression, addiction, or otherwise offered whole family therapy. And, brand-new moms will get additional post-partum care, along with their infants.
Analysis done by advocates of dyadic care appear to show Medicaid savings twice-over what was spent for other patients, as the dyadic care model can help cut off bigger problems down the line that require more expensive and longer treatments.
Children were also eight times more likely to get screenings and twice as likely to attend well visits if their parents got services, too.
Why This Matters
For therapists and clinicians in California who accept Medicaid reimbursement, the inclusion of dyadic care on such a large scale for 2022 makes it a fascinating opportunity for you to treat the whole family — not just a single patient.
And, for providers who aren’t in California, this news may prompt you to consider how you can include additional service packages to care for every member of the family.
For example, if you only treat geriatric patients now, why not extend a slightly reduced rate to their caregivers to help head health problems off at the pass? If you only see child athletes right now, then maybe create a formal sports family package, too.
