Addiction treatment is seldom coordinated with general medical care,
despite the high prevalence of medical disorders among patients with substance
abuse or dependence. Two randomized controlled trials reported in this issue
of THE JOURNAL compare usual treatment of addiction disorders in specialized
settings with treatment integrated with primary care or provided by primary
care physicians. Weisner and colleaguesArticle found that abstinence outcomes in
an integrated care group, in which primary care was included in the addiction
treatment program, were similar to those in an independent care group, in
which substance abuse treatment and primary care were provided separately.
But among patients with substance abuse–related medical conditions,
integrated care was associated with better abstinence outcomes and was cost-effective.
Fiellin and colleaguesArticle, in a study of patients with opioid dependency stable
on methadone maintenance, found that outcomes among those transferred to office-based
methadone treatment provided by primary care physicians were generally comparable
to those among patients who continued usual care in a narcotic treatment program.
In an editorial, Stein and FriedmannArticle discuss generalist-specialist collaboration
in the care of patients with addictive disorders and other chronic diseases.
Cost-sharing, which has been shown to influence the use of health care
resources, varies among US prescription drug plans for elderly persons. In
this analysis of data from the 1997 Medicare Current Beneficiary Survey, Federman
and colleaguesArticle found that elderly Medicare beneficiaries with coronary heart
disease who did not have drug coverage had larger out-of-pocket drug expenditures
and lower use of statins compared with elderly Medicare patients with employer-sponsored
drug coverage. In a commentary, BodenheimerArticle discusses factors that have contributed
to the increase in pharmaceutical expenditures during the 1990s and proposes
ways to make prescription drugs affordable for elderly persons.
Skin testing with purified protein derivative of tuberculin is widely
used to detect latent Mycobacterium tuberculosis
infection despite its known limitations as a diagnostic test. Mazurek and
colleagues compared an interferon γ (IFN-γ) assay, an in vitro
test that detects cell-mediated immunity to tuberculin, with tuberculin skin
testing in a group of adults with varying risks of M tuberculosis infection or documented or suspected active tuberculosis (TB). The
IFN-γ assay was comparable to tuberculin skin testing overall and specifically
in its ability to detect latent M tuberculosis infection.
It was less affected by prior BCG vaccination and discriminated responses
due to nontuberculous mycobacteria.
Advanced diagnostic testing, including computed tomography, ultrasonography,
and laparoscopy, has become increasingly available for the evaluation of patients
with equivocal signs of appendicitis. In this analysis of data from Washington
state, however, Flum and colleagues found that the frequency of misdiagnosis
leading to unnecessary appendectomy did not change between 1987 and 1998.
New models of the interaction between depression and other medical illnesses.
Recognition of the importance of design innovations and modifications
on the delivery of health care and on individual well-being has resulted in
improving living conditions for elderly people at home as well as making hospital
stays more comfortable and resource-efficient.
A study among patients admitted to an intensive care unit indicates
that repeated measurement of the Sequential Organ Failure Assessment (SOFA)
score provides reliable prediction of mortality.
In this study of women planning to conceive, the estimated day of blastocyst
implantation occurred after the first day of the next expected menses in 10%
of pregnancies, and in these cases, pregnancy most likely would not be detected
using human chorionic gonadotropin–based tests performed on the first
day of the missed period.
For your patients: Information about pregnancy testing.
This Week in JAMA. JAMA. 2001;286(14):1677. doi:10.1001/jama.286.14.1677