Approximately 20% to 50% of patients do not adhere to medical therapy. Kripalani et al performed a systematic review to summarize, categorize, and estimate the effect size of 37 randomized controlled trials to improve long-term medication adherence. They found that all behavioral interventions that reduce dosing demands, most behavioral strategies involving monitoring and feedback, and many multisession informational interventions were effective in improving adherence. Fewer techniques, however, were able to demonstrate an improvement in clinical outcomes.
Although randomized trials have demonstrated a benefit of aspirin in reducing the incidence of cardiovascular events as well as some forms of neoplasia, it remains unclear whether, on balance, long-term use of aspirin affects the risk of mortality, especially among women. To address this question, Chan et al examined the association between aspirin, used in a broad range of doses, and mortality in a large cohort of women over 24 years of follow-up. Overall, low to moderate doses of aspirin were significantly associated with a lower risk of all-cause mortality, particularly among older women and those with a greater number of cardiac risk factors. It appeared that relatively short-term aspirin use (within 5 years) was associated with a lower risk of death from cardiovascular disease, whereas a more modest benefit for death from cancer was not evident until more than a decade of use.
Hozawa et al examined whether differences in risk factors explain why African Americans have a higher cardiovascular disease incidence rate than do whites. The higher cardiovascular disease rate in African Americans was due largely to a high frequency of elevated cardiovascular disease risk factors. African Americans without any risk factors had low a rate of cardiovascular disease.
In this study, the breast cancer screening rate improved from 55.3% to 64.3% for a large population of female patients by practice redesign. Appointment secretaries proactively managed the breast cancer screening needs of their population of patients using an information technology application to help identify the patients in need of screening and a Web-based application to manage this process. The practice redesign was cost-effective; no physician time was required for the scheduling of the screening test. The screening rates further improved to 71% after the completion of study, when the process was further enhanced and made available for all the 11 119 female patients in the practice. As primary care physicians struggle to deliver all the recommended preventive services and chronic disease monitoring for their population of patients, using information technology applications and involving the office staff in delivering the needed preventive services are recommended options.
Interleukin 2 (IL-2) along with potent antiretroviral agents increased CD4 T cell counts in patients with moderately advanced human immunodeficiency virus type 1 and may decrease clinical events. Patients with CD4 T-cell counts from 50/μL to 350/μL received specified highly active antiretroviral therapy (HAART) for 12 weeks and then intravenous or subcutaneous IL-2 or HAART alone for 72 more weeks. The IL-2 recipients had significantly greater increases in CD4 T-cell counts at weeks 60 and 84. In addition, larger percentages of IL-2 recipients had 50% or greater increases in CD4 T-cell counts at 60 weeks (primary end point). New AIDS-defining clinical events occurred more frequently in the HAART-alone group. In this moderately advanced patient population, IL-2 expanded CD4 T-cell counts without increasing plasma human immunodeficiency virus RNA levels. Further studies of IL-2 to evaluate its influence on clinical progression appear warranted and are ongoing.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2007;167(6):531. doi:10.1001/archinte.167.6.531