In the News for the Week of 8-17-04
Clinical news in the headlines
- Highlights of Annals of Internal Medicine
- Judge dismisses residents' suit against the Match
- CMS expands number of drugs in discount demonstration project
- Former Regent details need to align IT incentives
- Federal aid for immigrant care has strings attached
- New ACP book focuses on treating headache
- College calls for testing, warning labels for herbal supplements
Clinical news in the headlines
The following articles appear in this week's Annals of Internal Medicine. Full text is available to College members and subscribers online.
Elastic compression stockings reduce DVT complications. A new study has found that wearing below-the-knee elastic compression stockings every day reduced patients' chances of developing complications from deep vein thrombosis (DVT) for up to two years. One of every three to four patients with DVT develop complications, which range from swelling to chronic pain and leg sores.
At the end of two years, patients who wore the stockings every day reduced their incidence of complications from 49% to 26%, while their incidence of severe complications was reduced from 12% to 3.5%. More...
Heart resynchronization can improve quality of life. A meta-analysis of published clinical trials found that an expensive and new procedure--cardiac resynchronization therapy--improved the quality of life for patients with heart failure and was relatively safe. A cost-effectiveness study found that the procedure costs about $90,000 per quality-adjusted life-year saved, compared to medical therapy. More…
Physicians performing too many surveillance colonoscopies. Close to 350 surveyed gastroenterologists and general surgeons reported doing follow-up colonoscopies after removing noncancerous polyps much more often then accepted guidelines recommend. Authors say the findings raise concerns that physicians are not following evidence-based guidelines and that overuse of surveillance colonoscopy reduces scarce money and manpower resources. More…
Diabetes care in VA system better than in managed care. A study of more than 8,200 patients in five VA medical centers and eight managed care organizations found that the VA system delivered significantly better diabetes care. Researchers found that VA patients received more blood tests, eye and foot exams, and counseling about aspirin use and had better cholesterol control. Patients in both systems had poor blood pressure control. More…
A federal judge last week dismissed all claims in a class-action suit brought by several former residents against the National Resident Matching Program, several medical associations and more than two dozen medical schools and teaching hospitals.
The two-year old suit claimed the Match and the other defendants violated antitrust protections by curtailing competition among teaching hospitals and depressing residents' wages. Earlier this year, Congress passed a law giving teaching hospitals antitrust immunity.
In his action last week, the judge cited that new law, pointing out that it nullified most of the suit's claims, according to the Aug. 13 Modern Physician. The plaintiffs are considering an appeal.
Modern Physician is online.
The CMS last week announced that it had added two more drugs to the list of medications that will be included in a demonstration project for Medicare beneficiaries who lack prescription drug coverage. All of the drugs treat patients with serious diseases, such as cancer, rheumatoid arthritis and multiple sclerosis.
The demonstration project was originally announced earlier this year. In addition to getting discounts on the 20 drugs already being offered in the project, patients can also get discounts on pegvisomant (Somavert) for acromegaly, replacing octreotide (Sandostatin); and mesna (Mesnex) tablets to replace intravenous mesna. The project is designed to save Medicare money by encouraging patients to switch from drugs administered in physicians' offices to less expensive ones patients can take at home.
The CMS hopes to enroll 50,000 Medicare beneficiaries in the project, offering them as much as 90% off the cost of the drugs being offered, according to an Aug. 13 CMS press release.
Patients who enroll and are accepted in the program by Sept. 30 can begin receiving discounted medications by Oct. 18. If more than 50,000 beneficiaries apply, the CMS will randomly select those who will participate.
Information about the project, including downloadable application forms, is online.
Patients can also call CMS customer service representatives at 1-866-536-5387 for help completing application forms.
A former ACP Regent recently told a Congressional committee considering health information technology that physicians' adoption of technology suffered from a serious misalignment of financial incentives.
Edward H. Shortliffe, MACP, director of medical informatics services at New York Presbyterian Hospital in New York, testified that while physicians are expected to invest in information technology, the parties that will reap the benefits of that investment will be health plans, purchasers and patients.
That is particularly true, Dr. Shortliffe said, when physicians have no nationally accepted standards or product certification programs to ensure the quality of information technology products. Dr. Shortliffe's remarks were made last month to the Health Subcommittee of the House Committee on Energy and Commerce.
To remedy the situation, Dr. Shortliffe recommended financial incentives for physicians who implement information technology systems; a federal program to set and adopt information technology standards; a rigorous product certification mechanism; and training for experts who can design and evaluate health care information technology systems.
Dr. Shortliffe's testimony and that of other subcommittee witnesses is online.
In related news, a program in Washington state that depends on physicians investing in electronic medical records (EMRs) and is considered a model for improving chronic care has been found to improve patient outcomes, but lead to less revenue for physicians.
The program, which is funded by the Robert Wood Johnson Foundation, assigns nurses and creates electronic medical records for patients with diabetes and congestive heart failure, according to the Aug. 11 New York Times. Patients reported lower glucose levels and more stable congestive heart failure. However, physicians are getting reimbursed for fewer office visits and have to absorb the costs of the EMRs, with each participating physician losing about $2,000 a year.
The New York Times is online.
Hospital personnel must ask emergency department patients about their immigration status for hospitals to receive $1 billion in federal aid earmarked for emergency care for undocumented immigrants.
States with large undocumented immigrant populations, such as California and Texas, had sought the federal aid for years before it was approved by Congress last year, according to the Aug. 10 New York Times. However, a new guideline requires hospitals to ask questions about immigration status to ensure the money is being used as intended.
Hospitals are concerned that complying with the rule might cost them more than they will receive in aid, while immigrant groups contend that the rule may discourage undocumented immigrants from seeking care, possibly leading to wider spread of communicable diseases. Hospitals would be required to keep information on patients' immigration status on file and make it available to federal auditors.
The federal aid will be made in four annual installments of $250 million for services provided starting Oct. 1. The largest annual amounts will go to California ($72 million), Texas ($48 million) and Arizona ($42 million).
The New York Times is online.
A new College publication gives primary care physicians a basic reference on how to care for and manage patients with headache.
"Headache," a new addition to ACP's popular Key Diseases series, gives special emphasis to the "Big Three" headache disorders: migraine, tension-type and cluster headaches. After defining and distinguishing each disorder, the book gives recommended treatment strategies with concise, evidence-based algorithms.
The book also focuses on managing patients with daily or frequent headaches, one of the most challenging clinical situations for primary care physicians. Other topics include medication overuse and misuse, complementary and alternative treatments, headache in special populations such as children and adolescents, and the "difficult" headache patient.
The 304-page book, which was edited by Elizabeth W. Loder, FACP, and Vincent T. Martin, MD, is available to members for $29, $32 for non-members.
You can find more information or order online. You can also order by phone at 800-523-1546, ext. 2600 (refer to product #330300430).
The College is urging the FDA to take a much more active role to protect consumers against herbal supplements, which are not regulated or tested in humans before they are marketed.
In an Aug. 9 letter to the FDA's acting commissioner, College President Charles K. Francis, FACP, urged the FDA to require pre-market safety testing of all herbal supplements. While herbal supplement manufacturers currently do not have to report side effects, the letter stated, the College is also calling for requiring manufacturers to do so.
And until pre-marketing studies are available, ACP is advocating for warnings on supplement packages, indicating that the benefits and risks of supplement products "have not been scientifically evaluated," the letter said.
ACP's letter is online.
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A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis. He has had progressive pain in his left knee with activity, which limits his ability to hike. The patient has similar pain in the right knee, but it is less severe. He reports no recent morning stiffness. He is able to climb two or three flights of stairs without chest pain or shortness of breath. He has no other medical problems and reports no additional symptoms. Medications are methotrexate and folic acid. Following a physical exam and lab tests, what is the next best step in management?
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