Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.
Diabetes Care Has Improved in Past 10 Years, but Americans Have a Long Way to Go
People with Mild Hypertension Can Successfully Make and Sustain Lifestyle Changes that Reduce Risk for Heart Disease
Large Study Uses New Quality of Care Measures and Finds Most Patients Get Good Care
Editorial: Individual Physician is Key to Large Health System Improvement
1.) Diabetes Care Has Improved in Past 10 Years, but Americans Have a Long Way to Go
According to a new study, diabetes care in the past 10 years has improved, but, still, two in five people with diabetes have poor control of cholesterol, one in three have poor blood pressure control and one in five has poor control of blood sugar levels (Article, p. 465). Researchers, using data from two national population-based surveys, looked at the proportion of Americans with diabetes who had adequate control of blood sugar, blood pressure and cholesterol levels, and who had recommended yearly eye and foot examinations. This article in its entirety is available to the public at www.annals.org.
2) People with Mild Hypertension Can Successfully Make and Sustain Lifestyle Changes That Reduce Risk for Heart Disease
In an 18-month study to measure the effect of positive lifestyle changes on blood pressure control, 810 adult volunteers with borderline or mild hypertension were assigned to one of three groups: 1) repeated counseling with specific goals for how much weight to lose, how much to exercise and how much salt and alcohol to consume; 2) counseling plus instructions for eating a DASH diet (Dietary Approaches to Stop Hypertension), which recommends quantities of fruits and vegetables and low-fat dairy products and low amounts of fat and salt; and 3) advice only on lifestyle change (Article, p. 485). Participants in the first two counseling groups lost more weight, had better diets and were less likely to have hypertension after 18 months than those who got only advice. These groups had lower blood pressure than the advice-only group, but the differences were not statistically significant. Authors say that lifestyle changes that reduce heart-damaging conditions, such as high blood pressure, while not easy, can be achieved and maintained.
3.) Large Study Uses New Quality of Care Measures and Finds Most Patients Get Good Care
The authors propose measuring the quality of care by seeing if doctors change treatment when the patient isn't doing well (Article, p. 475). They studied appropriate modification of therapy for 253,238 adult chronically ill patients with poor control of hypertension, poor control of cholesterol levels and/or diabetes and found that in an eight-month period many patients had their therapy modified and, thus, seemed to receive clinically appropriate care. The retrospective cohort study looked at health records in a large health care system. Sixty-four percent of patients with poorly controlled systolic blood pressure had therapy changes; 71 percent of those with poorly controlled diastolic blood pressure had therapy changes, 56 percent of those with poorly controlled low-density lipoprotein cholesterol levels and 66 percent of those with poorly controlled hemoglobin A1(c) levels had changes. The most frequent changes in therapy were adding drugs and increasing drug dosages.
4.) Editorial: Individual Physician is Key to Large Health System Improvement
Editorial writers, which include the chief medical officer of the U.S. Department of Veterans Affairs health system, say that in the past decade, many clinical trials have shown the importance of controlling America's big three chronic conditions: high blood pressure, bad cholesterol levels and diabetes -- and that many of the risk factors for these conditions, such as overweight, inactivity, poor diet, poor control of blood sugar and LDL cholesterol, are intertwined (Editorial, p. 525). The authors describe how the U.S. Department of Veterans Affairs health system managed to systemize care for more than one million veterans with diabetes and overcame "clinical inertia" to deliver diabetes care "similar to and generally exceeding" commercial health care plans and fee-for-service Medicare. One lesson was that "while a healthcare system may initiate momentum for change, clinicians are essential change agents for local quality improvement efforts." The writers offer five "simple" goals appropriate for health care professionals, practices and private and public health care systems alike.