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Medscape
19-05-2025
- Health
- Medscape
How to Handle Noncompliant Patients on GLP-1 RAs for Obesity
Primary care practices are seeing an uptick in patients inquiring about glucagon-like peptide 1 receptor agonist (GLP-1 RA) medications due to both media hype and sizzle-reel stories they see on social media. If your patients start an appointment with their own agenda about wanting a prescription for these medications, there are ways to pause the pressure and pivot to other options first. Here is how to better handle noncompliant patients who may not want to follow your advice. How to Offer Other Proactive Measures Understanding the goals of your patients can help alleviate some pushback from the start of an appointment. Amy J. Sheer, MD, MPH 'When discussing GLP-1 receptor agonists or any ant-obesity medication, clinicians (should) approach the conversation with a combination of empathy, education, and clear guidance,' said Amy J. Sheer, MD, MPH, associate professor of medicine, Division of General Internal Medicine, University of Florida (UF) College of Medicine and UF Health Shands Hospital in Gainesville, Florida. To begin, the medical professional should systematically review the patient's past medical history, medications, weight history, nutrition (24-hour diet recall), physical activity and limitations, and their health goals, she noted. 'But, if a patient appears irritated that you are taking the time to do a thorough history, it is best to explain that knowing their specific goals can help in many ways, including which pharmacotherapy is safe and most effective for them and prescribing the medication most likely to be covered,' Sheer also shared. Sheer described how she takes the time to discuss the challenges so that patients can get a better grasp of expectations. 'I explain to my patients briefly the pathophysiology around weight loss and why weight loss and maintenance are so difficult — hormonal control, etc.,' she continued. 'I tell my patients that all people need to have a healthy diet and be physically active to be healthy. We all need to do this, whether we are on pharmacotherapy for weight loss or not.' In some cases, patients get very pushy. They said, 'Can you get my insurance to cover these?' To begin with, Sheer said to be honest about the outcome. 'Tell the patient, 'Maybe' and 'We will try.' Have a plan A and plan B, and write it in your notes so you remember,' she advised. Also, suggest that your patient research their own insurance company's formulary by logging into their insurance portal to see what's possibly covered. 'I write down the names of the medications of interest, such as Saxenda, Wegovy, or Zepbound. Often, when a patient calls their insurance, they are given incorrect information — they are told their insurance covers Mounjaro and Ozempic and to have their physician prescribe this — but the patient does not have diabetes, so this will not work,' she said. Also, when a patient calls, Sheer said, they will be told to have their physician prescribe an acute otitis media with codes that do not make sense, like hypertension. What they need is to look at their formulary. Streamlining the Process To assist patients who are suitable candidates, here are some strategies: Stay on indication. Sheer said coverage for GLP-1 RA is complicated and changing rapidly based on the indications. 'Clinicians should prescribe the pharmacotherapy best suited for the patient based on their comorbidities. This gives the best chance of coverage. Long gone are the days of getting Ozempic or Mounjaro for weight loss — the patient must have diabetes. It is a waste of time to prescribe a diabetes medication for weight loss because it will not get approved,' she said. Have an appeal letter ready to submit. 'I have an appeal letter for the common GLP-1 RA for weight loss that I will submit for patients who get denials,' said Sheer. 'These can work, and templates of these letters can be found online.' Brintha Vasagar, MD, MPH Is there a recommended process? Brintha Vasagar, MD, MPH, a family physician with Progressive Community Health Centers in Milwaukee, reported how GLP-1RAs should be considered in patients with obesity (body mass index [BMI] > 30 or BMI > 27 with one or more weight-related comorbidities) who have not reached their weight loss goals after 3-6 months of lifestyle efforts. 'A review of medications which can contribute to weight gain and bloodwork to evaluate for other causes of weight gain can be helpful,' outlined Vasagar. 'Comorbidities can be helpful in deciding which GLP-1 RA would be most beneficial for each specific patient.' What other tips can medical professionals suggest? Clinicians prescribing these medications must be comfortable advising about healthy nutrition, including goals for protein, fiber, and water intake, recommended Sheer. 'Also, they should feel comfortable giving a weight loss goal range, which I usually tell my patients is 1-2 pounds a week, depending on their BMI, starting weight, comorbidities, nutrition, and physical activity,' she explained. 'I tell my patients that when they lose weight, they do not just lose fat — they lose fat, muscle, and bone. We must try to target fat. Exercise and nutrition help target the fat, lose more weight healthily, strengthen bones, and ultimately keep weight off.' Why a discussion about side effects is vital. It is important to review the most common side effects, which are gastrointestinal and include nausea, constipation, diarrhea, and increased reflux. 'Also, you should ask the patient about their personal history of pancreatitis and personal or family history of medullary thyroid cancer,' Sheer reported. What happens if the patient is truly noncompliant? If after your patient has received the prescribed medication, they are not returning to your practice for check-ins, some physicians are taking a firm approach. 'At Novant Health Bariatric Solutions, we have a 6-month cutoff rule. If the patient is noncompliant with our program, their appointments, or their medication, we will not provide another prescription,' said David Voellinger, MD, bariatric surgeon at Novant Health Bariatric Solutions – Elizabeth in Charlotte, North Carolina. What else should you be telling your patients? Voellinger told patients that obesity is a chronic, relapsing, multifactorial disease that must be treated in a multimodal fashion in a multidisciplinary program including lifestyle management, medical management, surgical management, or integrative management. 'Every patient requires a different individual approach, and each patient responds differently to treatment,' he stated. 'We try to use the lowest effective dosage of medication possible to minimize side effects.' GLP-1 RAs are great medications to help with weight loss and are particularly effective in decreasing 'food noise' and the cravings and desires to eat, Voellinger said. 'But they can also be dangerous if not used correctly and used as part of a comprehensive program. They are not a magic bullet or quick fix for weight issues.'
Yahoo
14-05-2025
- Health
- Yahoo
Jacksonville has its first stroke treatment ambulance, study says it's not always cost-effective
Mayor Donna Deegan and the Jacksonville Fire Rescue Department just cut the ribbon on northeast Florida's first 'mobile stroke treatment unit,' an ambulance given to the city by UF Health. UF Health says the ambulances can help provide immediate, potentially life-saving care to people having a stroke and get the specific kind of care they need through the ambulance's stroke-oriented emergency medical equipment and staff onboard. The city put more than $855,000 in funding toward seven new, full-time JFRD positions to keep the ambulance running. Action News Jax reviewed new numbers from JFRD showing only a fraction of the calls it's responded to in the last few years were actually for strokes: - 2021: 147,701 total EMS calls; 3,339 dispatched as stroke - 2022: 146,716 total EMS calls; 3,543 dispatched as stroke - 2023: 144,327 total EMS calls; 3,630 dispatched as stroke - 2024: 143,929 total EMS calls; 3,497 dispatched as stroke Read: Roads closed in Jacksonville Beach as firefighters respond to fire on Shetter Avenue JFRD told Action News Jax not all of the calls dispatched as a stroke actually turned out to be a stroke, meaning only a portion of those calls ended up being for people having a stroke. On average, the numbers show the department has responded to 10 stroke calls per day since 2021. We also discovered a recent study from the American Heart Association, which says that, although these ambulances do provide life-saving care, they are not always cost-effective. The study, which covers international research, said they cost millions to purchase and operate every year and that only a portion of the calls they are dispatched to are for actual strokes, not to mention that only a portion of those calls require the emergency medical equipment onboard. Action News Jax asked the city how this particular unit will be worth the cost for the staffing to operate it. We were told it will be mainly serving northwest Jacksonville, a district it calls a hotspot for strokes. >>> STREAM ACTION NEWS JAX LIVE <<< 'These communities have been underserved for a long time, especially this one. And I think it's incredibly important that we give folks who live on this side of town the same opportunity to be healthy as people in other parts of town and have all the time,' Mayor Deegan said. The ambulance is going to be based out of JFRD Station 64, located on Harts Road on the north side. It's worth noting JFRD runs on a roughly $400 million budget, and it says the $855,000+ for the staff working the ambulance will become an annual cost [DOWNLOAD: Free Action News Jax app for alerts as news breaks] [SIGN UP: Action News Jax Daily Headlines Newsletter] Click here to download the free Action News Jax news and weather apps, click here to download the Action News Jax Now app for your smart TV and click here to stream Action News Jax live.
Business Journals
23-04-2025
- Health
- Business Journals
UF Health reaches agreement with United Healthcare
THE REMAINDER OF THIS ARTICLE IS FOR PREMIUM MEMBERS The new multiyear agreement with United Healthcare will be effective May 5. UF Health officials recently announced the signing of a new multiyear agreement with United Healthcare, effective May 5, in which UF Health hospitals and physicians will once again be in the United provider network for patients in Gainesville, Jacksonville, St. Johns and Central Florida. 'This new agreement provides thousands of United patients continuous access to premier compassionate, academic-quality health care throughout Northeast, North Central and Central Florida,' said Dr. Stephen J. Motew, president and system CEO of the UF Health clinical enterprise, in a release. 'We appreciate the patience of our communities and are thankful for all the hard work our health care team has devoted to our tradition of excellence in caring for our patients.' The new arrangement is designed to reduce administrative overhead, improve efficiency and enhance care management, UF Health said in the release. GET TO KNOW YOUR CITY Find Local Events Near You Connect with a community of local professionals. Explore All Events 'The contract provides UF Health physicians and caregivers acceptable terms and relief from administrative obstacles,' said Dr. Marvin Dewar, CEO and chief medical officer of UF Health Physicians. 'We want to protect patients' access to the expert care they know and trust, now and in the future.' Those enrolled in the following plans will have network access to all UF Health's hospitals, facilities and physicians, beginning May 5: UnitedHealthcare employer-sponsored commercial plans UnitedHealthcare Community Plan of Florida (Medicaid) This agreement also restores network access to UF Health Flagler Hospital, facilities and physicians for people enrolled in UnitedHealthcare Medicare Advantage plans, including Dual Special Needs Plans. All other UF Health hospitals and physicians throughout the state continue to participate in UnitedHealthcare's Medicare Advantage network. The deal comes after another recent agreement was reached with UF Health Flagler Hospital and Aetna. The hospital returned to in-network status April 1 with a new multi-year agreement. Sign up here for the Business Journal's free morning and afternoon daily newsletters to receive the latest business news impacting the First Coast, and download our free app to get breaking news alerts on your phone. Hospitals Licensed beds Rank Prior Rank Hospital Name/URL 1 1 Northeast Florida State Hospital 2 2 UF Health Jacksonville 3 3 Ascension St. Vincent's Riverside Cancer Program View this list
Yahoo
01-04-2025
- Yahoo
Twitch streamer shows support for JSO officer injured in shooting
Internet personality Zack 'Asmongold' Hoyt is showing support for a Jacksonville Sheriff's officer after body cam footage appears to show the officer listening to the streamer moments before last month's officer-involved shooting. On March 12, Officer A.C. Gaulding attempted to conduct a traffic stop at the intersection of Trout River Boulevard and Ribault Avenue. Gaulding was shot in the foot during the shooting, while the suspect, 33-year-old Brandon White, was killed. Weeks later, JSO released body cam footage leading up to the shooting, which appeared to include Officer Gaulding listening to the popular streamer while driving and before exiting his vehicle. 'This is the average Asmongold viewer. Hero police officer who takes down an armed gunman,' joked Hoyt to his viewers. 'He might be watching now, I hope he's doing well.' When asked by a viewer if the streamer if he is pro-police, Hoyt says 'I am massively pro-police, I completely support the police. Absolutely.' 'I hope he gets better, and he's just a traditional, everyday Asmongold viewer,' says the popular streamer. Asmongold is a YouTuber and Twitch streamer with over 5 million subscribers across multiple channels, where he plays video games and provides social and political commentary. Officer Gaulding was discharged from the hospital less than a week after the shooting. In a post on social media, JSO says, 'Leaving the hospital with the support of his team, Jacksonville Sheriff's Officer A.C. Gaulding continues to recover from getting shot during a traffic stop last Wednesday morning. Fellow officers and friends cheered him on as he left UF Health post-surgery on Thursday, a day after a man wearing body armor armed with a rifle and handgun shot him in the foot. Officer Gaulding returned fire, killing the shooter. The case remains under investigation. We'd like to thank our wonderful community for the support for our officer during this difficult time, especially the medical professionals at UF Health and our brothers and sisters at Jacksonville Fire and Rescue. Please join us in wishing Officer Gaulding the absolute best as he heals.' WOKV reached out to JSO for a comment, and because this is an active investigation, they are unable to comment as of this posting.
Yahoo
18-03-2025
- Yahoo
Jacksonville police release video of officer wounded in shootout leaving hospital
Walking with the aid of crutches, his leg heavily bandaged up to his calf, Jacksonville officer A.C. Gaulding left the hospital. He smiled as his fellow officers cheered him on. >>> STREAM ACTION NEWS JAX LIVE <<< Jacksonville Sheriff's Office released the video Monday of Gaulding leaving the UF-Health following his surgery last week. The 15-year JSO veteran, was shot in the foot March 12 following a traffic stop that turned into a shootout. Jacksonville Sheriff T.K. Waters said they man Gaulding pulled officer was wearing a bulletproof vest and was armed with multiple guns. Gaulding pulled him over in the area of Trout River Boulevard and Ribault Avenue. JSO said the suspect pulled into a driveway, attempted to get out of the car, and then began firing rounds at Gaulding. Read: Man killed by Jacksonville officer after police say he fired at officer during traffic stop Gaulding returned fire striking the man multiple times. He was taken to the hospital where he was pronounced dead. A video posted on JSO's Facebook page showing Gaulding leaving the hospital states: Leaving the hospital with the support of his team, Jacksonville Sheriff's Officer A.C. Gaulding continues to recover from getting shot during a traffic stop last Wednesday morning. Fellow officers and friends cheered him on as he left UF Health post-surgery on Thursday, a day after a man wearing body armor armed with a rifle and handgun shot him in the foot. Officer Gaulding returned fire, killing the shooter. The case remains under investigation. We'd like to thank our wonderful community for the support for our officer during this difficult time, especially the medical professionals at UF Health and our brothers and sisters at Jacksonville Fire and Rescue. Please join us in wishing Officer Gaulding the absolute best as he heals. [DOWNLOAD: Free Action News Jax app for alerts as news breaks] [SIGN UP: Action News Jax Daily Headlines Newsletter] Click here to download the free Action News Jax news and weather apps, click here to download the Action News Jax Now app for your smart TV and click here to stream Action News Jax live.
