Lifestyle interventions targeting prevention of (further) weight gain may have better long-term success than when aimed at weight loss. ter Bogt et al evaluated the effects of computer-guided lifestyle counseling by nurse practitioners (NPs) compared with usual care by general practitioners (GP-UC) after 3 years of follow-up. In a randomized controlled trial conducted within primary care, 457 participants were enrolled. In this study, lifestyle counseling by NPs did not lead to significantly better prevention of weight gain compared with GP-UC. Weight maintenance was achieved in 60% of both groups. A significant difference was found between the NP and GP-UC groups for fasting glucose level but not for lipid levels and blood pressure.
Post et al evaluated whether patient reports of physician acknowledgment of the overweight patient's weight status are associated with patient perceptions of their own weight and desires to lose weight from the 2005-2008 National Health and Nutrition Examination Survey. Overweight participants were more than 8 times as likely to perceive themselves as overweight, more than 7 times more likely to desire to lose weight, and about 2½ times as likely to have attempted to lose weight in the previous 12 months if they were ever told by their physician that they were overweight. However, fewer than one-half of overweight and fewer than two-thirds of obese participants had ever been told by their physicians that they were overweight. This is an important intervention point that is being missed by many physicians.
Resources for Enhancing Alzheimer's Caregiver Health–Department of Veterans Affairs (REACH VA) was implemented in response to a Congressional mandate to test caregiver interventions in the VA health care system. REACH VA took a proven behavioral intervention for dementia caregivers from research to clinical practice. The home- and telephone-based intervention focuses on education, support, and skills building to help caregivers manage their own stress and patient dementia behaviors. This national clinical translation achieved outcomes similar to the REACH II randomized controlled trial. During 6 months, caregivers reported significantly decreased burden, depression, impact of depression on daily life, caregiving frustrations and abusive behaviors, and number of troubling patient dementia-related behaviors. REACH VA is currently being used in the VA system, in community agencies, and in Administration on Aging state-based research translations. This model of caregiver support can inform public policy in providing assistance to caregivers.
Black-owned barbershops are rapidly gaining traction as potential community partners for health promotion programs targeting hypertension as well as diabetes, prostate cancer, and other diseases that disproportionately affect black men. In this cluster-randomized controlled trial of 17 black-owned barbershops, Victor et al found that an enhanced intervention program, in which barbers continuously monitored blood pressure and actively promoted physician follow-up with personalized gender-specific messages, resulted in improved blood pressure control among black male barbershop patrons with hypertension. Projected health care cost savings from fewer hypertension-related cardiovascular complications would substantially offset intervention costs.
Previous research has documented striking variations in the care and outcomes of patients across geographic regions of the United States and the world, but until now little was known about hospital-level differences in the care and outcomes of patients with sepsis. Lagu et al report that, for patients with sepsis, there were significant variations in hospital-level spending and mortality rate across a nationwide sample of 309 hospitals, but higher spending did not improve outcomes. A subset of sampled hospitals consistently achieved better-than-expected mortality rates at lower-than-expected costs, and further study of the strategies of these hospitals may help to identify potential opportunities to improve the value of sepsis care.
Standardized cost residuals vs standardized mortality rates at 309 US hospitals.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2011;171(4):279. doi:10.1001/archinternmed.2011.24