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In This Issue of Archives of Internal Medicine
March 14, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(5):378. doi:10.1001/archinternmed.2011.42
Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine

Opioid addiction can be effectively treated with buprenorphine in primary care settings, but this treatment remains underused. Alford et al describe 5 years of experience in treating opioid addiction in an urban academic primary care practice with collaboration between nurse care managers and generalist physicians. At 12 months, 51% of patients (196 of 382) underwent successful treatment (ie, retention or taper after 6 months). Of patients remaining in treatment at 12 months, 93% were no longer using illicit opioids or cocaine. Patients who, on admission, were older, employed, and used illicit buprenorphine had significantly higher odds of treatment success. Collaborative care proved to be an effective model for providing and monitoring treatment of opioid addiction using buprenorphine.

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The Effect of Guided Care Teams on the Use of Health Services

In the guided care model, 2 to 5 primary care physicians partner with a colocated registered nurse to provide comprehensive care to community-dwelling patients who have several chronic conditions and complex health care needs. This article reports the effects of guided care on patients' use of health services during the first 20 months of a multisite, cluster-randomized trial (n = 850). Across the entire study population, guided care reduced episodes of home health care by 30% (95% confidence interval [CI], 7%-47%). In a preplanned analysis of a 40% subsample (Kaiser Permanente patients), guided care reduced skilled nursing facility admissions by 47% (95% CI, 11%-69%) and days by 52% (95% CI, 16%-72%).

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Development and Validation of a Brief Cognitive Assessment Tool: The Sweet 16

Cognitive impairment can have a negative impact on the overall health and quality of life for older adults, but it is often unrecognized. Furthermore, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, Fong et al created a new cognitive assessment tool, the Sweet 16, which correlated highly with the Mini-Mental State Examination (MMSE) (Spearman r, 0.94; P < .001). Validated against an independent gold standard for dementia, the area under the curve is 0.84 for the Sweet 16 and 0.81 for the MMSE (P = .06). Across a range of education levels, the area under the curve for higher education (≥12 years) for the Sweet 16 was 0.90 and for the MMSE, 0.84 (P = .03). The Sweet 16 is simple, quick to administer, and will be available via open access.

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Association of Alcohol Intake With Pancreatic Cancer Mortality in Never Smokers

Alcoholic beverage consumption is causally related to a number of cancers including oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast. However, it has never been linked definitively to pancreatic cancer despite the fact that heavy alcohol consumption is a cause of acute and chronic pancreatitis. The lack of convincing evidence is in part due to concerns about study design and potential residual confounding by smoking. The American Cancer Society's Cancer Prevention Study II is a large prospective study of more than 1 million adults, which began in 1982. After 26 years of follow-up, liquor consumption of 3 or more drinks per day was associated with an excess risk of pancreatic cancer mortality after adjustment for smoking history, as well as in lifelong never smokers. Overall, the design and size of this study help to resolve concerns about inconsistencies observed in other studies of the alcohol-pancreatic cancer association.

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Comparative Effectiveness of Goal Setting in Diabetes Care

Group medical visits are an innovative method of potentially improving diabetes control. This study compared a group clinic approach to diabetes and nutrition education with a novel clinician-led, patient-centered group medical clinic model: Empowering Patients in Care (EPIC). The 12-week EPIC model engages small groups of diabetic patients in learning to set personalized goals for diet and exercise changes, home monitoring of blood pressure and sugar, and managing complex medication regimens. In addition, the EPIC groups focus on integrating those goals into daily action plans and empowering participants to talk to their physicians and caregivers about their challenges and success. In this study, participants in the EPIC groups had significant improvements in hemoglobin A1c (HbA1c) levels immediately following the active intervention compared with participants in the diabetes education groups and these differences persisted at 1-year follow-up. Primary care–based diabetes group clinics that include structured goal-setting approaches with self-management can significantly improve diabetes control after intervention and maintain improvements for at least 1 year.

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