After several years of the same CHP member identification cards, change is coming! We have created new ID cards for both our commercial and Medicare members. These new cards will be more durable than the current cards - eliminating the need for our members to order a replacement card because the card cannot be read.

You can see samples of the front of each card below. They are different for Medicare and Commercial members so that offices can recognize the card at a glance. The Commercial cards have the Centerville Health Center; Medicare cards have the Governor’s Square Health Center.

The new cards also have a magnetic stripe on the back. We have done this for possible future use in the providers' offices. The only information stored on the card is your member ID number, your name, and your date of birth; the cards cannot be read by any other card readers (such as ATM or bank machines). There is no information on the cards regarding claims or other sensitive information.

Please be aware that cards for your family may come in multiple envelopes. We can only mail two pairs of cards per envelope so some families may find that their cards are in two or more envelopes. They should arrive within a day or so of each other; if you haven't received the missing card(s) within 2 or 3 days, please call our member services department at 850-383-3311 (Medicare members, call 850-523-7441) for replacements

If you have any questions after receiving your new ID card, please call CHP Member Services at 850-383-3311; Medicare members, call 850-523-7441 (TTY/TDD users call 850-383-3534). You can also reach us toll-free at 1-877-247-6512 (TTY/TDD 1-800-955-8771).

Nancy Van Vessem, MD

Chief Medical Officer

Everyone who is part of the CHP network wants patients to have good clinical outcomes. The crucial first step for any medical problem is talking to the patient, and the second step is examining the patient. The easiest way to get off on the wrong track is to skip or short-cut these essentials.

While technology has helped in the diagnostic process, all technology has limitations and needs to be considered in light of the first two steps or, specifically, what the patient is experiencing.

A suggestion often seen on a report of a CT scan, x-ray, or MRI is that the ordering physician correlate (compare to see if it makes sense) the imaging findings with the clinical situation of the patient. The reason this is such a good idea is that oftentimes abnormalities are seen on imaging studies that have nothing to do with the patient’s symptoms, or the imaging study cannot be used to make a definite diagnosis. Let’s look at some examples.

Knee Pain: An article published in the New England Journal of Medicine in September, 2008, showed that when knee MRIs were done in middle-aged and elderly persons, a cartilage tear was found in 63% of people with knee pain, BUT 60% of people in the same age group without knee pain also had a cartilage tear. The take-home message? Just because you have a cartilage tear doesn’t mean it has anything to do with your knee pain. Clinical correlation is the key.

Multiple Sclerosis: A study, published in the British Medical Journal in 2006, compiled the results from 29 previous clinical studies that assessed MRI results along with patient outcomes. Its findings were that, with a first episode of a neurological symptom, MRIs had “limited utility for both ruling in and ruling out multiple sclerosis.” The most important information came from the clinical course of the patient. With regard to multiple sclerosis, a second episode of neurological symptoms occurring at least a month after the first episode is necessary to make the diagnosis.

Low Back Pain: Low back MRIs (noted in the back pain article) are another example of how imaging studies can potentially lead down a path of treatment that may not yield good clinical results: “65 out of 100 adults without any back pain have abnormalities such as arthritis and bulging discs.” These imaging results make early clinical correlation problematic and can lead to inaccurate associations between chronic asymptomatic findings and acute pain.

COPD: The final example is Chronic Obstructive Pulmonary Disease (COPD), also called chronic bronchitis and emphysema. If COPD becomes severe, changes may appear on a chest x-ray, but for mild and moderate cases, the chest x-ray can easily appear normal. The way to diagnosis COPD is, once again, the duration of the patient’s symptoms, such as cough, along with pulmonary function testing (PFT) to measure the function of the lungs, rather than viewing the anatomy of the lungs. So the next time you hear from someone who smokes that they are fine because their chest x-ray is normal, ask them if they have had the appropriate history and testing that diagnoses COPD. As with many medical conditions, earlier diagnosis of COPD leads to more treatment options. Not being able to breathe is a bad outcome.

It’s not that there is anything wrong with images; it’s just that a picture doesn’t tell the patient’s story. Patients have to do that, and the best place to start is with your primary care physician. The last thing that anyone wants is to treat a radiological abnormality but end up with no relief from an underlying medical condition because the image told a different story. Remember, too, that keeping track of your symptoms in a diary—knowing the details of what you are experiencing—is invaluable to getting to the right next step.

Back and neck pain happen commonly, and if you haven’t had an episode yet, it’s likely there is one in your future. The bad news is it can hurt a lot; the good news is that fewer than 1 out of 100 people with new-onset back pain has a serious condition such as infection, fracture, or cancer. Also, human backs have the capacity to heal themselves. Even if a disc is herniated, studies have shown that the condition tends to regress over time, with partial to complete resolution after six months in two-thirds of people.

To give CHP members improved treatment options for back and neck pain, early in 2008 we opened the network to include the Back and Neck Program through the Center for Orthopedics and Sports Physical Therapy (COSPT). We are receiving positive feedback from members and physicians regarding the success of this exercise program, which reduces pain, improves function, and teaches patients how to strengthen their backs to avoid future episodes of pain.

The January and November 2008 issues of HealthLine, posted here, have more details. If you and your PCP feel that the Back and Neck Program may be appropriate for you, you can make an appointment by calling

(850) 656-1837.

Another tool in the tool box for back pain is Health Coaching. Excellent DVDs from the Foundation for Informed Decision Making are available at no additional charge, explaining what research shows about acute (recent onset) and chronic low back pain. In addition, the Health Coaching Dialog Center web site, accessible via www.capitalhealth.com, has a “health crossroads” module under the Health Information tab, providing great information about how to get better. CHP wants you to be able to choose the course of action most likely to lead to healing. Specifically, we want you to participate in informed decision making to better understand the risks and benefits of available choices. You can obtain the DVDs on back pain and other conditions by calling a Health Coach at (850) 383-3400. On a national level, increasing numbers of patients are discovering that education, support, and conservative therapy provide relief from painful symptoms, while reducing the need for habit-forming pain medication and surgery. Several groups, such as the American College of Physicians and the American Pain Society, have produced evidence-based clinical guidelines that encourage patients to seek conservative care from their physicians, keep active, and take over-the-counter pain medication.

Unless serious symptoms are also present, such as incontinence or fever, imaging studies are not recommended unless, after six weeks, the pain is still severe and not improving with active participation in conservative care. The reason is that 65 out of 100 middle-aged to older adults with no back pain show abnormalities such as bulging discs and arthritis on imaging studies. The older you are, the greater the chances that your back x-ray or MRI is already abnormal even though you have no symptoms. The take home point is that you do not want to undergo procedures directed to a problem that isn’t the cause of your pain.

In order to facilitate evidence-based care for neck and back pain, requests for outpatient MRIs of the cervical and lumbar spine will require precertification by Capital Health Plan. This will be phased in starting February 16, 2009. The most important test for back pain is evaluation: taking a history and performing an appropriate physical exam. These will be required elements prior to imaging.

If you are suffering with sudden onset or persistent back or neck pain, you should contact your primary care physician for evaluation and management. After evaluation, your PCP may elect to help you manage your pain in a number of ways, including referral to the Back and Neck Program at the Center for Orthopedic and Sports Physical Therapy and to a Health Coach.

This question comes up all the time: “My child is up to date on shots. What is the need for a check-up?” Shots are not the only reasons for annual check-ups. In fact, the American Academy of Pediatrics recommends yearly physicals from ages two to six years, at eight and ten years, and then annually thereafter. Here are important reasons why.

Young Children. While children between ages two and six are usually not big eaters, it is still important to look at their growth and diet. Kids who are overweight by age five are much more likely to be overweight as teenagers and adults. This predisposes them to all the related adult health risks such as diabetes, high blood pressure, heart disease, and strokes. By plotting weight, height, and Body Mass Index (BMI), we can be sure they are growing appropriately.

Young children develop rapidly. Children need to be screened for language development and fine and gross motor problems that, if found, can be addressed before the child starts school.

During well visits we can also reinforce car or booster seat use and gun and water safety. Accidents, including drowning, are the leading cause of death for kids two to six.

Teens. Adolescence has its own set of problems for parents and teens. Puberty comes at different times for different kids, which can cause concerns of growing too soon or not soon enough. The doctor can talk about what to expect during puberty: increased appetite, moodiness, increased sleep requirement, and, for girls, periods. Discussions can be started about peer pressure, cigarettes, alcohol, drugs, driving, and difficulties at school. Your doctor may want to speak with your teenager in private.

Also, the doctor will screen your child for curvature of the spine (scoliosis), anemia, high cholesterol, diabetes, depression, and other familial diseases.

New Vaccines. And while you may think that your child is up to date on vaccines, recommendations are changing all the time. In the last two years, new vaccines for meningococcal disease (Menactra) and human papilloma virus (Gardisil) have been recommended for eleven- to twelve-year-olds. A second chicken pox vaccine is now required for kindergarten. Just last year, flu shots were recommended for all children between six months and eighteen years.

Taking your child to his or her physician works for health in so many ways. Make an appointment today.

The CHP Champions program is off to a thriving start for 2009. Hearing the Champions buzz for several years, and seeing more children involved, the community wants to learn more. Parents are asking: “What is the Champions program? Where is it offered? How can my child get involved? Is it really free?” CHP loves those questions.

Already 6,000 Students. CHP Champions, in a nutshell, offers children the opportunity to experience a healthy lifestyle today and tomorrow—while having fun—through regular fitness activities. The program began in August 2006 with voluntary, free physical activities before or after school in nine local elementary schools. Our goal was expanding the program to all students in Leon, Gadsden, Jefferson, and Wakulla counties by fall 2010. CHP Champions is now in all local counties: 54 sites, well over 6,000 regularly participating students, and more than 150 coaches. These men and women not only lead energetic, enjoyable activities, but also set positive role examples for our children. With the support of community partnerships, Champions is well on its way to meeting that 2010 goal.

Community Involvement. The program’s success stems from the key support of area school districts and community organizations. Wakulla County Senior Citizen Council, working with Wakulla County Schools, offers Champions in after-school programs of four elementary schools. The Boys and Girls Clubs of Jefferson County conduct Champions for elementary and middle school students. Gadsden and Leon counties’ school districts offer the program in all after-school elementary programs, as well as in part of the middle-school physical education curriculum. Leon County Schools has expanded Champions to ninth-grade high school students taking the required HOPE class.

Alex Stemle, vice-president of CHP Champions, says, “The collaboration of the Champions program and middle and high school teachers has allowed the schools an opportunity to creatively address the Sunshine State Standards for Florida Department of Education, while increasing the quality of workout sessions through moderate to vigorous physical activity.”

For More Information. Each school and community organization participating in CHP Champions has a “Champions contact.” This staff member can provide all enrollment information, program times, and dates. You can also contact Alex Stemple at 850-671-3278 or chp.champions@gmail.com. The goal of CHP Champions is to offer this free and fun program to all children who want to join in.

True or false: Green mucus is indicative of a bacterial infection that requires an antibiotic.

FALSE. Green mucus does not mean that an infection is bacterial, as this can also occur with a viral infection. Since antibiotics do not work on viral infections, green mucus does not necessarily mean that you need an antibiotic.

True or false: If a cold lasts longer than a week, an antibiotic is typically needed.

FALSE. Research shows that cold symptoms often last longer than one week.

True or false: Antibiotics may not help you get better, but they can’t hurt.

FALSE. The misuse of antibiotics not only contributes to antibiotic resistance (making these drugs less effective when you truly need them), but it can also lead to serious side effects.

Cold and flu season is upon us, and many patients will mistakenly head to their doctor for an unnecessary antibiotic. Before you head to the doctor hoping to leave with an antibiotic in hand, consider the information below to help ensure safe and appropriate antibiotic use.

Who do antibiotics help? Antibiotics only kill bacteria—they do NOT kill viruses. Since most illnesses (for example, the common cold, most coughs/bronchitis, the flu, and most sore throats) are caused by viruses, antibiotics may not get rid of the infection or make you feel better any faster. In fact, there’s only a 1 in 4,000 chance that an antibiotic will help most acute upper respiratory infections.

What are the risks associated with antibiotics? Antibiotics, like other drugs, have side effects that can range from being a nuisance to being more serious. For example, did you know that 1 in 4 patients taking an antibiotic will experience diarrhea, 1 in 50 patients will experience a skin reaction, and 1 in 1,000 patients will end up in the emergency room? In addition, inappropriate antibiotic use promotes more resistant infections which may make these agents less likely to work when you truly need them.

How do I know when to call my doctor? Some symptoms that require contacting your physician are fever over 100.5º, shortness of breath, skin rash, and an extremely sore or red throat with white or yellow patches. However, when in doubt, call your doctor to see if an antibiotic is needed, but don’t be disappointed if you don’t receive a prescription. By avoiding an unnecessary antibiotic, you’ll be doing your part to ensure antibiotics remain effective when you truly need them to work.

Source: Antibiotic overuse. Pharmacist’s Letter/Prescriber’s Letter 2008: 24(10):241006.