Ladapo et al evaluated the cost-effectiveness of smoking cessation interventions that incorporate follow-up contact in patients hospitalized with acute myocardial infarction (AMI). Previous research has demonstrated that follow-up contact is inexpensive and effective, but it is not considered a quality measure by Medicare and few hospitals actually practice it. Ladapo et al estimate that adding follow-up contact after discharge to the care of the 327 600 smokers who will be hospitalized this year with AMI will create 50 230 new quitters, prevent 1380 nonfatal AMIs, save 7860 lives, and cost $5050 per quality-adjusted life year.
Using a nationally representative survey of practicing physicians, O’Malley and Reschovsky examined primary care physicians' (PCPs) and specialists' perceptions of communication about referrals and consultations. They then identified modifiable practice characteristics associated with reported communication. Physicians who did not receive timely communication about referrals and consultations were more likely to report that their ability to provide high-quality care was threatened. The 3 practice characteristics consistently associated with both PCPs and specialists reporting communication about referrals and consultations were “adequate” visit time with patients, receipt of quality reports about patients with chronic conditions, and nurse support for monitoring patients with chronic conditions.
Fried et al conducted focus groups with primary care clinicians to understand how they approach treatment decision making for older persons who have multiple medical conditions. The clinicians expressed concerns about their patients' ability to adhere to the complex regimens deriving from guideline-directed care. Participants listed a number of barriers to making good treatment decisions, including lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. Clinicians' experiences suggest that to improve decision making they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, better integration with their subspecialist colleagues, and an altered reimbursement system.
Lee and Vielemeyer looked at the Infectious Diseases Society of America (IDSA) guidelines, published between 1994 and May 2010. Current guidelines were reviewed and individual recommendations tabulated based on their quality of underlying evidence. Only 14% of all found 4218 individual recommendations had level I evidence (at least 1 randomized controlled trial), while 55% were supported by level III evidence, ie, expert opinion only. Updated guidelines saw an increase in individual recommendations; this was, however, mostly linked to level II and III evidence. Until more data from well-designed controlled clinical trials become available, clinicians and policy makers should remain cautious when using current IDSA guidelines as the sole source guiding decisions in patient care.
Comparison of 5 recently updated guidelines with their respective previous versions.
Over the past several years, a growing number of pharmaceutical and medical device companies have been publicly reporting payments to physicians. This article is among the first to analyze this new information. Using the data supplied by 5 orthopedic device manufacturers, Chimonas et al identified physicians who received consulting payments of $1 million or more; they next examined recipients' publications in the field of orthopedics to determine whether readers were informed of the company tie and the sums involved. The findings demonstrate in compelling fashion that the answer is usually no. The availability of company data, the authors conclude, should provide the opportunity to strengthen disclosure practices and move the medical profession to a system of full, verifiable transparency.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2011;171(1):10. doi:10.1001/archinternmed.2010.472