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CVS Caremark research: Many consumers confused about potential changes to U.S. healthcare system

BY Antoinette Alexander

WOONSOCKET, R.I. — The majority of consumers who would be eligible for new healthcare coverage under the Patient Protection and Affordable Care Act have never heard of the state-based healthcare exchanges — where they will have to shop for coverage beginning in 2014 — while more than half said they believe they will need help in understanding healthcare insurance terms and descriptions, and navigating the healthcare system, according to new research from CVS Caremark.

"Despite all the news coverage about healthcare reform, these survey results clearly show that consumers are confused about the potential changes to our healthcare system," said Helena Foulkes, CVS Caremark EVP and chief healthcare strategy and marketing officer. "While awareness of the new law may grow over the next year as new services are put in place, consumers need help understanding the coming changes and support on how to sign up and participate in the exchanges."

The survey found that 78% of consumers who would be eligible for new healthcare coverage under the Patient Protection and Affordable Care Act have never heard of the state-based healthcare exchanges, where they will have to shop for coverage beginning in 2014. In addition, 60% of respondents said they believe they will need help in understanding healthcare insurance terms and descriptions and navigating the complex healthcare system.

In addition, the respondents listed doctors as the most credible source for talking about exchanges, followed by pharmacists, nurse practitioners and independent insurance consultants.

"CVS Caremark’s tremendous geographic reach across the U.S., our integrated approach to health care and the accessibility of our pharmacists and nurse practitioners — among the most trusted of advisers according to this survey — give us a variety of effective touch points with healthcare consumers," Foulkes said. "Given our focus on helping people on the path to better health, we expect to play an active role in meeting consumers’ needs in an expanding healthcare system and will be talking with government, healthcare advocates and other organizations to see how we can be an active participant in providing information and services to these consumers."

The survey was conducted online and respondents included more than 1,000 consumers; 70% of those surveyed currently have no healthcare coverage and 30% are covered by individual insurance policies. The survey did not include people with employer-sponsored insurance, or people currently covered by Medicare or Medicaid.


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Acme Markets opens store in Bryn Mawr, Pa.

BY Allison Cerra

MALVERN, Pa. — Supervalu banner Acme Markets has opened a new store in Bryn Mawr, Pa.

Construction of the new store began in 2011, which touts 37,000 sq. ft., the Bryn Mawr Acme was designed to provide customers a greater selection and variety, while offering a fresh, new feel to their shopping experience both inside and outside the store.

"Acme has a long-standing history in Bryn Mawr and our goal was to make this new store a destination for the community," Acme president Keith Wyche said. "A lot of hard work went into the planning and building of this location to ensure the Acme tradition of providing customers the quality products and premium customer service they expect from us. I’m proud to see this new flagship location come to life."

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Study linking calcium to increased CVD risk contains many confounding factors

BY Michael Johnsen

ZURICH, Switzerland — While headlines in the past two weeks warned consumers that calcium supplementation could increase the risk of cardiovascular disease, authors of the study that prompted those headlines — published last month in the peer-reviewed journal Heart — identified four significant confounding factors in the design of the study.

For example, the dietary data contained measurement errors and could not adequately account for long-term variation in calcium intake due to changes in diet.

In addition, most of the clinical trials included in the above-mentioned meta-analyses measured daily intake of equal to or more than 1,000 mg of calcium in its elemental form. The recommended dietary allowance of calcium established by the National Institutes of Health’s Office of Dietary Supplements ranges between 1,000 mg and 1,300 mg in adults.

McNeil Nutritional’s Viactiv, a brand well-known as a calcium supplement, supplies 1,000 mg of calcium daily in its Viactiv Calcium Plus D formulation and 200 mg of calcium daily in its Viactiv Multi-Vitamin formulation.

According to the ODS, about 43% of the U.S. population — including almost 70% of older women — use dietary supplements containing calcium, increasing calcium intakes by about 330 mg/day among supplement users. According to NHANES 2003-2006 data, mean total calcium intakes from foods and supplements range from 918 mg to 1,296 mg per day.

Not all calcium consumed actually is absorbed in the gut, the ODS noted. "Humans absorb about 30% of the calcium in foods, but this varies depending upon the type of food consumed." Other factors that also affect calcium absorption include the amount of calcium consumed — calcium absorption decreases as intake increases; age — net calcium absorption is as high as 60% in infants and young children who are building bones, but that decreases to absorption rates of between 15% and 20% in adulthood; vitamin D intake, which improves calcium absorption — that’s a factor that would be difficult to account for in a clinical study let alone a meta-analysis of a group of studies because the body generates vitamin D when exposed to sunlight; and foods with high levels of oxalic acid, which inhibits calcium absorption. Those foods include spinach, collard greens, sweet potatoes, rhubarb and beans.

Another limitation identified by the authors: the study only excluded patients who had had a heart attack, stroke or mini stroke and did not exclude individuals with other pre-existing cardiovascular conditions. However, authors suggested this "incomplete exclusion" would only have minor implications as heart attacks and strokes account for the "vast majority of cardiovascular disease."

"Lastly, it needs to be noted that 44.5% of vitamin/mineral users in this study did not report the names of their supplements and we therefore only identified a limited number of calcium supplement users, who accounted for 3.6% of all cohort participants," the authors added. "This prevalence is lower than that observed in a small German elderly population (about 8% in men and 27% in women). It is also lower than the prevalence (11%) reported by a U.S. national survey. It is possible that the unreported calcium supplementation would affect the accuracy of our results if identified calcium supplement users had a different cardiovascular risk profile than unidentified calcium supplement users."

The Council for Responsible Nutrition, in a statement issued the day the study was published, identified another confounding factor. "The original study wasn’t designed to measure cardiovascular events; consequently confounding factors for cardiovascular disease were not equally distributed across the study groups," noted Taylor Wallace, senior director scientific and regulatory affairs for CRN. "So, for example, the calcium supplement group had a population with a greater incidence of high cholesterol at baseline, and also included more smokers who were more likely to smoke for a longer duration. The association between smoking and heart disease is well-established," Wallace noted. "[And] in terms of considering the relative risk, of the 851 individuals taking supplements containing calcium, only seven events occurred in users of supplements containing only calcium."

The study was named an "editor’s pick" by Heart and made available for viewing without charge. The study can be viewed in its entirety here.


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