Below is information about an article being published in the June 11 issue of Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
The United States Preventive Services Task Force (USPSTF) concludes that current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. Child abuse and neglect affected more than 680,000 children in the U.S. in 2011, and an estimated 1,570 died as a result of maltreatment. Survivors of abuse face potentially significant health, emotional, and behavioral consequences of abuse. Physicians and other health care providers who care for children and families are uniquely poised to identify children at risk for abuse and neglect during well checks and other visits. Researchers reviewed studies published since 2004 when the Task Force last published recommendations on child abuse and neglect to determine the effectiveness of primary care relevant interventions on child abuse and neglect outcomes. The researchers found that most child maltreatment prevention programs studied and recommended by others focus on home visitation, which is generally considered to be a community-based service provided to at-risk families. The evidence for interventions in primary care is limited and inconsistent, and therefore insufficient to make a recommendation. Although there are concerns regarding the possible harms of interventions for child maltreatment, such as dissolution of families, legal concerns, and an increased risk of further harm to the child, the researchers found limited evidence of these harms.
Diabetes patients on Medicare Part D are two to three times more likely to be prescribed brand-name drugs than comparable patients receiving care within the U.S. Department of Veterans Affairs (VA), at an added cost of about $1 billion a year. Medicare and the VA have a significantly different approach to drug prescribing. Medicare contracts with more than 1,000 private insurance companies, each using a distinct formulary and cost-sharing arrangement for prescribing drugs. The VA uses a single formulary and all veterans have the same cost-sharing arrangement. Medication choice plays a large role in spending, with brand-name drugs costing significantly more than generics. Diabetes is a common, chronic condition with high medication use and a wide range of available therapies. Researchers analyzed health records for 1,061,095 Medicare Part D beneficiaries and 510,485 veterans aged 65 years or older with diabetes to compare overall and regional rates of brand-name drug use. Of the four medication groups commonly used by patients with diabetes, Medicare beneficiaries were more than twice as likely as VA patients to use brand-name drugs in almost every region of the country. The researchers estimated that had patterns of medication use in Medicare patients mirrored those of the VA for these medications in patients with diabetes alone, the program could have saved more than $1 billion in 2008. Since strong evidence shows similar effectiveness of generic versus brand-name drugs among the diabetes drug classes included in the study, switching to generics would improve efficiency without harming quality of care or access to effective medicines.