Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.
There is no magic pill for weight loss. Some studies have shown that obese patients can achieve greater weight-loss success with a combination of pharmacotherapy and a lifestyle modification program that includes a low-calorie diet, increased physical activity, and behavioral changes. Researchers measured weight loss in 376 obese patients taking a daily dose of sibutramine to determine which method of delivering support for a lifestyle modification program would produce the most weight loss. Patients were randomly assigned to high-frequency face-to-face counseling, low-frequency face-to-face counseling, high-frequency telephone counseling, high-frequency e-mail counseling, or no dietician contact. After six months, the patients assigned to high-frequency telephone contact with a dietician lost the same amount of weight as those assigned to high-frequency face-to-face counseling. Researchers conclude that telephone counseling could be a viable and cost-effective way for primary care physicians to help their obese patients lose more weight.
Coronary heart disease is the leading cause of death in the United States. Statins lower cholesterol and prevent coronary heart disease events and mortality. However, statins are expensive and sometimes cause side effects, so physicians and policymakers find it difficult to determine who should receive them. The Adult Treatment Panel III (ATP III) developed recommendations on when and how to treat high cholesterol with statins. They recommended statins for patients with higher cholesterol and more risk factors for coronary heart disease. Because of poor adherence to ATP III guidelines, researchers sought to determine the strategy’s cost, complexity, and efficiency. They found that while the guidelines are complex, they are relatively cost-effective in comparison with alternatives and would be the preferred strategy if statin pill costs are moderate. However, if statin pill costs were lower, extending statin use to lower-risk patients as well would be better. The public health benefit of wider statin use could justify the substantial economic investment.
HIV affects more than one million people in the United States. Every year, about 20,000 new infections are caused by individuals who are unaware that they are infected with HIV. Timely identification of undiagnosed cases of HIV can help prevent further transmission. According to CDC guidelines, all patients should be offered HIV screening without requiring health care settings to obtain written consent or provide prevention counseling. However, state laws may make it difficult for physicians to adhere to these guidelines. Researchers systematically reviewed and analyzed laws in all 50 states and Washington D.C. to determine which states’ laws would interfere with implementing the guidelines. They found that 34 states and Washington D.C. had laws that were either consistent or neutral to the recommendations, allowing for full implementation. The other 16 states had laws that would preclude implementation of one or more of the novel provisions for HIV screening. While state laws are evolving toward greater compliance with the CDC recommendations, the authors urge policymakers, provider groups, consumer advocates, and other stakeholders to review their state laws and advocate for amending laws that interfere with implementing the CDC recommendations.
Primary care physicians must coordinate care for their patients with other specialists who care for the same patients. Efficient care coordination is critical because it may improve health outcomes and reduce costs, especially for patients with multiple chronic conditions. However, coordination may be particularly difficult in the fee-for-service Medicare program, which lacks defined provider networks, providers designated to guide referrals, systems to track referrals, and explicit incentives to coordinate care. Researchers analyzed survey data from 2,284 primary care physicians and Medicare claims for their patients. For every 100 patients they cared for, physicians must interact with as many as 99 other physicians in 53 different practices. Models that try to improve patient care, such as the patient-centered medical home, must have systems that support the coordination of care.
The FDA has recognized the need to improve direct-to-consumer (DTC) ads. Currently, DTC prescription drug ads typically fail to provide basic information that consumers need to make good decisions, such as how well the drug works and the frequency of adverse effects. Researchers conducted two randomized trials to see if providing consumers with a drug facts box (a table quantifying outcomes with and without the drug) would improve knowledge and affect patient judgements about which prescription drugs are more effective. Researchers found that after reading the ads with fact boxes, consumers made better choices between drugs for current symptoms. In addition, they were better informed about the actual benefit of drugs intended for prevention. This report is an early release, and will appear on www.annals.org on February 17. The article will appear in print in the April 21 issue of Annals of Internal Medicine.