Below is information about articles being published in the July 16 issue of Annals of Internal Medicine. The information is not intended to substitute for the full articled as a source of information. Annals of Internal Medicine attribution is required for all coverage.
Long-term use of alternate-day, low-dose aspirin may reduce risk for colorectal cancer in healthy women. Evidence has recently emerged that daily aspirin may help to prevent several types of cancer, including colorectal, but there is little evidence for an alternate-day dosing strategy. Between 1994 and 1996 researchers randomly assigned 38,876 women aged 45 years or older to take either 100 mg of aspirin or placebo every other day. Participants were sent annual supplies of monthly calendar packs containing aspirin or placebo. At six and 12 months and then yearly through the trial end in March 2004, patients were mailed questionnaires to determine adherence, adverse effects, nonstudy aspirin use, clinical end points, and risk factors. At the end of the intervention period, women were invited for further annual follow up with an opt-out option. Posttrial follow-up for those who did not opt out continued through March 2012. The researchers found that long-term use of alternate-day, low dose aspirin reduced the risk for colorectal cancer but was associated with increased risk for gastrointestinal bleeding. According to the authors, these findings should influence future recommendations on prophylactic aspirin use.
A study of community-based outpatient practices suggests that use of commercially available electronic health records (EHRs) may slow the growth of health care costs in the short term. Since 2009, the federal government has allocated billions of dollars in financial incentives to encourage physicians and hospitals to achieve “meaningful use” of EHRs. It is believed that meaningful use of EHRs should lead to higher-quality, lower cost care by avoiding inefficiencies, inappropriate care, and medical errors. However, empirical evidence about the effect of EHRs on health care costs has been conflicting. Researchers compared medical claims for 47,979 patients who received most of their care from providers who adopted EHRs in experimental pilot communities (806 ambulatory care clinics) with those for 130,603 patients in matched control communities. Practices were a mix of primary and specialty care, and used commercially available EHRs to perform the core clinical tasks that are required of physicians in the first stage of meaningful use. In the 18 months after adoption, the researchers saw ambulatory cost savings of 3 percent projected savings per member per month (PMPM) and reductions in ambulatory radiology costs. If sustained for a sufficiently long period, these could translate to substantial savings. The author of a related editorial writes that EHRs are unlikely to be the solution to reducing health care costs, nor should they be. The author asserts that EHRs are essential to implementing new models of health care delivery such as the patient-centered medical home and accountable care organizations. Financial savings will be driven by the new models, and not EHRs.