Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
One way to reduce crowding in emergency departments is to postpone care for patients who don't have serious illness. Seventy-five such patients who sought care in the emergency department were randomly assigned to receive care the next day in a hospital clinic. Emergency department care was not postponed for the other 81 patients (Article, p. 707). Those with deferred care had health outcomes comparable to the group who remained in the emergency department for care. The authors suggest that such a triage system, which provides patients with non-serious illness the opportunity to receive care the following day, may reduce frequent overcrowding of hospital emergency departments and provide less-expensive treatment. An editorial says that deferred care is one solution to emergency department overcrowding, but a health care system in which people with chronic diseases have their own doctor care would be better (Editorial, p. 764).
In a study of 263 arthritis patients taking methotrexate, a standard anti-arthritis drug, a group randomly assigned to receive an additional anti-arthritis drug, leflunomide, had fewer joint symptoms, less intense pain, and functioned better than those who took methotrexate and a placebo or dummy pill (Article, p. 726). About 90 percent of both groups reported some side effects, but diarrhea and abnormal liver tests were more common with combined therapy than with methotrexate alone. The authors caution that patients should receive careful monitoring for drug-related liver damage. Nonetheless, combination therapy with leflunomide and methotrexate is a logical alternative for patients who do not respond fully to methotrexate alone, they say.
(Brief Communication, p. 734).