MEDFORD, Ore. – En Oregon unos programas están ayudando a la gente con su salud fuera del marco tradicional de cuidados primarios. La enseñanza sobre dieta y nutrición es un componente clave para mantener saludable a la gente.

El consultorio médico juega un papel importante en el cuidado de la salud, pero la vida fuera de ese consultorio es lo más importante para la salud general de una persona. Es por eso que varias organizaciones de todo Oregon están integrando otros servicios al cuidado general.

“La Clínica Wellness Center” de Medford es tanto centro comunitario como oficina médica. Ofrece espacio para hacer ejercicio y clases de atención plena ("mindfulness"), yoga y acupuntura, además de tres suites de atención primaria.”

La Clínica también es sede de clases de cocina, reconociendo que las dietas sanas son clave para los estilos saludables de vida. Jillian Robinette, administradora de prácticas en el Centro de Bienestar La Clínica, dice que enfocarse en la nutrición también se traduce en prácticas saludables en otras partes de la vida de la gente.

“Tener una mentalidad más pendiente de lo que voy a comer hoy, cómo paso mi día, cómo me enfoco en mis actividades, se vincula con un yo más actual y más alerta de su cuerpo, su energía, su atención plena. Así que hemos visto una mejor salud en general en nuestros pacientes.”

La Clínica también ofrece una despensa móvil de comida y clases de alimentación sana en español. Atiende a miembros del “Oregon Health Plan”, el programa Medicaid del estado. CareOregon aporta fondos para el “Wellness Center”. Atender determinantes sociales como la dieta y el ejercicio es obligatorio para las Organizaciones de Atención Coordinada (“Coordinated Care Organizations”), que manejan el Plan de Salud de Oregon (“Oregon Health Plan”) en las comunidades locales.

Hogge es director del centro médico “La Clínica” y da clases de Cocina de Prescripción, una clase de cocina para personas con necesidades crónicas de salud. Hogge dice que el centro de bienestar llega a trabajar fuera del cajón tradicional de atención primaria.

“Es muy fácil y rápido recetarle al paciente una medicina para la presión arterial, pero eso no siempre es la respuesta correcta. Sabemos que si prevenimos y tratamos de arreglar esos detalles en la forma de vida, ayudaremos a evitar complicaciones más delante.”

Autumn Akers, trabajadora de salud comunitaria en CareOregon, imparte la clase de seis semanas Cocinar Importa (“Cooking Matters”) en una tienda Fred Meyer de Portland. El programa es una colaboración entre Care Oregon, Freed Mayer y el Banco de Alimentos de Oregon (“Oregon Food Bank”) para ayudar a la gente a preparar sus comidas caseras. También se enfoca en la educación sobre nutrición para los oregonianos de bajos recursos, dando a los asistentes una bolsa de abarrotes al final de cada clase, para combatir la inseguridad alimentaria. Akers dice que los médicos de primer nivel le mandan pacientes a ella, y la lista de espera crece y crece.

“Ya les enseñamos de la A a la Z y realmente sólo empoderamos a la gente a de veras querer hacer el cambio. Quieren probar las espinacas. Quieren lavar un tomate. Quieren poder ser saludables, y eso ya es un paso adelante.”


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.