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16 November 1999 Annals of Internal Medicine Tip Sheet

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 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

Less Aggressive Treatment of Ill Elderly Does Not Contribute To Higher Death Rates

Studies have shown that seriously ill older adults receive less aggressive treatment and have higher short-term mortality rates than younger adults. A new analysis of data from the SUPPORT study (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) found that less aggressive treatment does not explain the survival disadvantage of seriously ill elderly (Article, p. 721). An editorial says that although SUPPORT has "failed to identify how to improve care at the end of life," it has revealed the complexity of caring for terminal illnesses (Editorial, p. 780). The editorial says that "more such 'negative'studies" are needed and that, regardless of the results, they should be adequately funded through the dissemination phase.

Name-Based Surveillance of HIV Infection Has Less Effect Than Many Believe

Reporting HIV-infected patients by name did not result in the patients getting more timely care or in more partners being notified of possible exposure to HIV, a survey found (Medicine and Public Issues, p. 775). On the other hand, the study found "no evidence that name-based surveillance of HIV infection was a substantial barrier to seeking health care promptly after a positive test result."

Physician Report Cards Should Account for Patients' Education Level

Managed care organizations and providers often evaluate physicians using data on patients' physical and mental health status and their reported satisfaction with the physicians. A new study of 100 primary care physicians and 50 patients seen by each physician found that the patients' ranking of the care received was affected by their education levels (Article, p. 745). A higher level of patient education was associated with greater satisfaction.

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