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ABSTRACTS
Award-winning Research Papers From the
American
Academy of Family Physicians 2001 Scientific Assembly
Effect
of a Primary Care Physician-focused, Population-based
Approach to Blood Pressure Control
SK
Maue, ML Rivo, B Weiss, EW Farrelly, S Brower-Stenger
Background
and Objectives: A large majority of hypertensive patients
are cared for in primary care settings, and most of
them do not have adequately controlled blood pressure.
AvMed Health Plan, a large Florida-based, nonprofit,
physician network health maintenance organization, initiated
a program to assist primary care physicians to achieve
a greater degree of blood pressure control in their
hypertensive patients. Concomitantly, a study was designed
to determine whether this physician-focused intervention
improved blood pressure control in these patients. Methods:
Data were collected from pharmacy claims and medical
charts for random samples of treated hypertensive patients
prior to and following a 6-month educational intervention
aimed at providers. Analysis of the data sets was conducted
to determine what percentage of subjects achieved target
blood pressure goals before and after the intervention.
Results: At baseline, 41% of the total population had
achieved a target blood pressure of <140/90 mm Hg;
52% achieved this goal following the intervention. When
target blood pressure goals were defined as <140/90
mm Hg for nondiabetic subjects and <130/85 mm Hg
for diabetic subjects, 36% of the total population achieved
target blood pressure goals at baseline; 47% achieved
these goals following the intervention. Conclusions:
A physician-focused intervention significantly improved
blood pressure control in diabetic and nondiabetic hypertensive
patients enrolled in AvMed Health Plan.
(Fam
Med 2002;34(7):508-13.)
Effects
of Flow Sheet Implementation on Physician Performance
in the Management of Asthmatic Patients
G
Ruoff
Background
and Objectives: This project focused on increasing compliance,
in a large family practice group, with quality indicators
for the management of asthma. The objective was to determine
if use of a flow sheet incorporating the Global Initiative
for Asthma (GINA) guidelines could improve compliance
with those guidelines if the flow sheet was placed in
patients’ medical records. Methods: After review
and selection of 14 clinical quality indicators, physicians
in the practice implemented a flow sheet as an intervention.
These flow sheets were inserted into the records of
122 randomly selected patients with asthma. Medical
records were reviewed before the flow sheets were placed
in the records, and again approximately 6 months later,
to determine if there was a change in compliance with
the quality indicators. Results: Improvement of documentation
was demonstrated in 13 of the 14 quality indicators.
Conclusions: The results indicate that compliance with
asthma management quality indicators can improve with
the use of a flow sheet.
(Fam
Med 2002;34(7):514-7.)
Adult
Inpatient Training for a Family Practice Residency:
A University- Versus a Community-based Setting
R
Zoorob, V Malpani, S Malpani
Background and Objectives: Some educators have expressed
concern about the quality of inpatient training received
by family practice residents in community-based residency
programs because of insufficient patient numbers and
resources in those programs. This study compared the
number, diagnoses, and lengths of stay of patients seen
by first-year family practice residents in a large inner-city,
university-based medical center’s internal medicine
service versus those in a family practice teaching service
in a smaller, community-based suburban regional hospital.
Methods: The adult inpatient training services of the
two training sites were compared for 6 months to determine
if any differences existed between the sites in patients’
age, gender, primary and secondary diagnoses, average
length of hospital stay, or in the number of monthly
admissions. Results: A total of 247 patients were admitted
to the teaching service of the suburban community hospital,
while 317 patients were admitted to the teaching service
at the university hospital. The average length of stay
for the suburban hospital was 6.1 days and 5.7 days
at the university hospital. A total of 107 different
diagnoses were made on admission at Kenner Regional
Medical Center, while 90 were made at University Hospital.
Chest pain/angina was the most frequent diagnosis encountered
at admission at both hospitals. Conclusions: Based on
the two inpatient services studied, a broad variety
of diagnoses and patient demographics are encountered
at community-based hospitals, with similar numbers of
patients, lengths of stay, and variation in diagnoses
in comparison to an urban-based university hospital.
The results indicate that there can be adequate numbers
of patients and diagnostic variability to permit effective
inpatient teaching at community-based hospitals.
(Fam
Med 2002;34(7):518-21.)
Herbal
Cancer Cures on the Web: Noncompliance
With the Dietary Supplement Health and Education Act
RA
Bonakdar
Background
and Objectives: A significant portion of the US population
uses the Internet to obtain health information; nearly
half of Internet users admit that this information influences
decisions about their health care and medical treatments.
Concurrently, approximately one third of the population
uses herbal supplements; a higher percentage is noted
for subgroups of cancer patients. The Dietary Supplement
Health and Education Act (DSHEA) of 1994 contained regulatory
standards for herbal supplements, including restricting
any claims for disease prevention, treatment, or cure.
This study determined the degree of compliance with
the DSHEA, as applied to Internet sites focusing on
the subject of herbal supplements and cancer. Methods:
Internet searches were conducted using six popular search
engines and three master search engines in October–December
2000 using the linked terms herb and cancer. The Internet
sites identified through this search process were examined
for categories of information including claims regarding
prevention, treatment, or cure; commercial nature; DSHEA
and physician consultation warnings; country of origin;
and use of research and testimonials. Additionally,
commercial sites were reviewed to identify tactics used
to promote products or services. Results: Each of the
six primary search engines provided between 11,730 and
58,605 matches for herb and cancer. Further cross matching
with the three master search engines identified 70 non-repeating
sites that appeared on all three master search engines.
Of these 70 sites, nine were irrelevant matches or no
longer functioning. Of the remaining 61, 34 (54%) were
commercial sites (CS) and 27 (42.8%) were noncommercial
sites (NCS). Of the CS surveyed, prevention, treatment,
and cure were discussed 92%, 89%, and 58%, respectively.
CS provided testimonials, physician consultation recommendations,
and DSHEA warnings 89%, 38.8%, and 36.1% of the time,
respectively. CS provided research with references 30.6%
of the time versus 92.6% of the time in NCS. All international
commercial sites surveyed claimed herbal cancer cures.
Conclusions: Although the DSHEA was enacted and amended
to decrease unlawful claims of disease prevention, treatment,
and cure, the results of this study indicate that such
claims are prevalent on commercial Internet sites. A
majority of sites claim cancer cures through herbal
supplementation with little regard for current regulations,
and such claims were more common on sites operated from
outside the United States.
(Fam
Med 2002;34(7):522-7.)
Health
Care Utilization and Costs of Alzheimer’s Disease:
The Role
of Comorbid Conditions, Disease Stage, and Pharmacotherapy
H
Fillit, JW Hill, R Futterman
Background
and Objectives: Studies on the relationship between
Alzheimer’s disease (AD) and health care costs
have yielded conflicting results. This study analyzed
the relationship between co-morbid conditions and health
care utilization and costs for patients with AD and
estimated costs by stage of disease and receipt of pharmacotherapy.
Methods: We conducted a retrospective analysis of administrative
data for 1,366 patients with AD and 13,660 age-gender
matched controls enrolled in a large Medicare managed
care organization (MCO). Co-morbid conditions were based
on the diagnostic classifications from the Charlson
co-morbidity index. Health care costs and utilization
for MCO-covered services for cases were compared to
controls. We used presence of complications of AD associated
with later-stage disease to classify patients as having
earlier- or later-stage AD. Results: After controlling
for co-morbid conditions, age, and gender, annual costs
were $3,805 higher for AD patients, resulting in excess
costs of $5 million to the MCO. For seven of the 10
most prevalent co-morbidities for AD patients, adjusted
costs were higher for AD patients compared with controls
with the same condition. Higher costs were attributable
to higher inpatient and skilled nursing facility costs.
Costs for patients classified as earlier-stage AD were
44% higher than controls and significantly higher for
eight of 10 co-morbid conditions when compared with
controls with the same conditions. Costs for AD patients
receiving treatment by a cholinesterase inhibitor were
$2,408 lower than AD patients not receiving therapy.
Conclusions: Utilization and costs for patients with
AD were higher compared to controls and were substantially
higher for patients with both AD and co-morbid diseases
commonly targeted for disease management. Earlier-stage
AD and receipt of pharmacotherapy were associated with
lower costs. These findings indicate that better treatment
and care management of AD could reduce the costs of
co-morbid illnesses commonly suffered by AD patients.
(Fam
Med 2002;34(7):528-35.)
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