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In This Issue of Archives of Internal Medicine
Sep 26, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(17):1525. doi:10.1001/archinternmed.2011.421

The US territories—Puerto Rico, American Samoa, the Northern Mariana Islands, Guam, and the US Virgin Islands—are home to 5 million residents, almost all of whom self-identify as racial/ethnic minorities. However, the US territories are often excluded from national reports of health care equity and quality. Comparing hospital performance on core process measures for patients hospitalized for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNE), hospitals in the US territories (n = 57) have significantly lower performance on all core process measures than hospitals in the US states (n = 4799). Hospitals in the US territories also have significantly higher 30-day mortality rates than hospitals in the states. Overall, this study highlights the need to improve health care outcomes in the US territories as part of the national effort to tackle racial/ethnic health care inequities.

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This study assessed the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on completion of health care proxy, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of 3 arms: EMR reminder alone, EMR reminder plus panel manager, or usual care. During a 1-year study period, EMR reminders were effective in helping physicians deliver higher-quality care. Electronic medical record reminders alone facilitated significant improvement in influenza and pneumococcal vaccination rates, while EMR reminders with panel management facilitated significant improvement in health care proxy designation and osteoporosis screening rates.

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Some believe that a substantial amount of US health care is unnecessary, suggesting that it would be possible to control costs without rationing effective services. Between June and December 2009, Sirovich et al conducted a nationally representative mail survey of US primary care physicians randomly selected from the American Medical Association Physician Masterfile. Forty-two percent of US primary care physicians believe that patients in their own practice are receiving too much care; only 6% said they were receiving too little. Malpractice reform, realignment of financial incentives, and more time with patients could remove pressure on physicians to do more than they feel is needed.

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More frequent patient-provider encounters for patients with diabetes may lead to faster hemoglobin A1c (HbA1c), blood pressure, and low-density lipoprotein cholesterol (LDL-C) control and improve outcomes, but there are no guidelines for how frequently patients should be seen. This study by Morrison et al examined 26 496 patients with diabetes and elevated HbA1c, blood pressure, and/or LDL-C level, who were treated by primary care physicians at 2 teaching hospitals in eastern Massachusetts from 2000 to 2009. They found that encounters with physicians once every 1 to 2 weeks greatly decreased the median time to control of elevated HbA1c, blood pressure, and LDL-C level, compared with those with encounters every 3 to 6 months, as currently practiced by most physicians. These findings suggest that biweekly primary care provider encounters were associated with fastest achievement of HbA1c, blood pressure, and LDL-C targets for patients with diabetes.

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Lucas et al accessed data from the Nurses' Health Study, a large cohort of US women, to examine prospectively whether caffeine consumption or intake of certain caffeine-containing beverages is associated with depression risk. During 10 years of follow-up (1996-2006), the authors identified 2607 incident cases of depression. Compared with women consuming caffeinated coffee less frequently (≤1 cup/wk), multivariate relative risk (RR) of depression was 0.85 (95% CI, 0.75-0.95) for those consuming 2 to 3 cups/d and 0.80 (95% CI, 0.64 to 0.99; P value for trend, <.001) for those consuming 4 cups/d or more. In this large longitudinal study, Lucas et al found that depression risk decreases with increasing caffeinated coffee consumption.

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