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Research Highlights
Investigators from Group Health Center for Health Studies continue to publish findings in epidemiology, health services, behavioral health, and clinical research, addressing a wide and evolving range of clinical and public health issues. Abstracts of several recent studies are excerpted below. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. Studies of the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. Researchers sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use. …This study was based on a cross-sectional, national, random-digit-dial household telephone survey in 1998 designed to identify adult patients and parents of children with current asthma. …Conclusion: In the United States use of appropriate asthma therapy remains inadequate. Strategies to increase use of anti-inflammatory therapy among patients with asthma are needed. These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged. Adams RJ, Fuhlbrigge A, Guilbert T, Lozano P, Martinez F. The Journal of Allergy and Clinical Immunology 2002 Jul;110(1):58–64. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. This study describes initial testing of the Assessment of Chronic Illness Care (ACIC), a practical quality-improvement tool to help organizations evaluate the strengths and weaknesses of their delivery of care for chronic illness in six areas: community linkages, self-management support, decision support, delivery system design, information systems, and organization of care. …Organizational teams enrolled in 13-month quality-improvement collaboratives focused on care for chronic illness…completed the ACIC at the beginning and end of the collaborative using a consensus format that produced average ratings of their system's approach to delivering care for the targeted chronic condition. …Conclusion: These results and feedback from teams suggest that the ACIC is responsive to health care quality-improvement efforts and may be a useful tool to guide quality improvement in chronic illness care and to track progress over time. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Health Services Research 2002 Jun;37(3):791–820. Identifying postmenopausal women at high risk of fracture in populations: a comparison of three strategies. This study described the prevalence of risk factors for women at high risk of fracture in a population-based sample of postmenopausal women who were not using hormone replacement therapy (HRT), to demonstrate how the estimated prevalence of women at high risk of future fracture is affected by the different criteria used for classification, and to characterize the populations identified and missed by each of the criteria… Conclusions: Prevalence of women at high risk of fracture not using HRT varies notably depending on the criteria used for identification. The criteria used to identify women to target for primary and secondary prevention of osteoporotic fractures has major implications for population-based prevention strategies. Buist DS, LaCroix AZ, Manfredonia D, Abbott T. Journal of the American Geriatrics Society 2002 Jun;50(6):1031–8. Childhood vaccinations and risk of asthma. A few previous studies have suggested that childhood vaccines, particularly whole cell pertussis vaccine, may increase the risk of asthma. Researchers evaluated the suggested association between childhood vaccinations and risk of asthma. Methods: Cohort study involving 167,240 children who were enrolled in four large health maintenance organizations during 1991 to 1997, with follow-up from birth until at least 18 months to a maximum of 6 years of age. …Conclusion: There is no association between diphtheria, tetanus and whole cell pertussis vaccine, oral polio vaccine or measles, mumps and rubella vaccine and the risk of asthma. The weak associations for Hib and hepatitis B vaccines seem to be at least partially accounted for by health care utilization or information bias. DeStefano F, Gu D, Kramarz P, Truman BI, Iademarco MF, Mullooly JP, Jackson LA, Davis RL, Black SB, Shinefield HR, Marcy SM, Ward JI, Chen RT; Vaccine Safety Datalink Research Group. The Pediatric Infectious Disease Journal 2002 Jun;21(6):498–504. Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Self-management is an essential but frequently neglected component of chronic illness management that is challenging to implement. Available effectiveness data regarding self-management interventions tend to be from stand-alone programs rather than from efforts to integrate self-management into routine medical care. This article describes efforts to integrate self-management support into broader health care systems change to improve the quality of patient care in the Chronic Illness Care Breakthrough Series. We describe the general approach to system change (the Chronic Care Model) and the more specific self-management training model used. The process used in training organizations in self-management is discussed, and data are presented on teams from 21 health care systems participating in a 13-month-long Breakthrough Series to address diabetes and heart failure care. Available system-level data suggest that teams from a variety of health care organizations made improvements in support provided for self-management. Improvements were found for both diabetes and heart failure teams, suggesting that this improvement process may be broadly applicable. Lessons learned, keys to success, and directions for future research and practice are discussed. Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckham V, Wagner EH. Annals of Behavioral Medicine 2002 Spring;24(2):80–7. Is the use of benzodiazepines associated with incident disability? This study examined the association between benzodiazepine use and incident disability with an emphasis on elucidating whether the underlying health conditions that result in benzodiazepine use (confounding factors) or intrinsic adverse effects of benzodiazepine use were responsible for functional decline. …Conclusions: A modestly increased risk for decline in physical function was associated with benzodiazepine use, especially of anxiolytic agents. The health conditions that result in benzodiazepine use may be more important in the pathogenesis of disability than benzodiazepine use itself. Although there are many reasons for avoiding benzodiazepines in older adults, it is still unclear whether use contributes independently to functional decline. Gray SL, LaCroix AZ, Blough D, Wagner EH, Koepsell TD, Buchner D. Journal of the American Geriatrics Society 2002 Jun;50(6):1012–8. Retrospective population-based assessment of medically attended injection site reactions, seizures, allergic responses and febrile episodes after acellular pertussis vaccine combined with diphtheria and tetanus toxoids. Since 1997 diphtheria-tetanus toxoids-acellular pertussis (DTaP) vaccines have been recommended for the five dose pertussis vaccination series. To assess rates of medically attended injection site reactions (ISRs), seizures, allergic responses and febrile episodes after Tripedia DTaP vaccine administered in the context of routine care, researchers conducted a retrospective assessment among the population of Group Health Cooperative from 1997 through 2000. …Conclusions: The low rate of febrile seizures and other serious events confirms the safety of DTaP vaccine. The risk of medically attended ISRs was highest with DTaP given as the fifth dose, and whole arm reactions were reported, but medically attended ISRs were relatively uncommon and were self-limited. Jackson LA, Carste BA, Malais D, Froeschle J. The Pediatric Infectious Disease Journal 2002 Aug;21(8):781–786. Use of alternative therapies for menopause symptoms: results of a population-based survey. The objective of this study was to describe self-reported prevalence of the use of alternative therapies for menopause symptoms and subject characteristics associated with their use…. A telephone survey of 886 women aged 45–65 years (87.2 percent response rate) was conducted at Group Health Cooperative in Washington state. …Women were asked about eight alternative therapies and their use for menopause symptoms. The proportion of women who used each therapy was 76.1 percent for any therapy, 43.1 percent for stress management, 37.0 percent for over-the-counter alternative remedies, 31.6 percent for chiropractic, 29.5 percent for massage therapy, 22.9 percent for dietary soy, 10.4 percent for acupuncture, 9.4 percent for naturopath or homeopath, and 4.6 percent for herbalists. The proportion of women who used it to manage menopause symptoms was 22.1 percent for any therapy, 9.1 percent for stress management, 13.1 percent for over-the-counter alternative remedies, 0.9 percent for chiropractic, 2.6 percent for massage therapy, 7.4 percent for dietary soy, 0.6 percent for acupuncture, 2.0 percent for naturopath or homeopath, and 1.2 percent for herbalists. Among women who used these therapies, 89–100 percent found them to be somewhat or very helpful. …Conclusion: The use of alternative therapies for menopause symptoms is common, and women who use them generally find them to be beneficial. Physicians should routinely ascertain perimenopausal women's use of alternative therapies. Newton KM, Buist DS, Keenan NL, Anderson LA, LaCroix AZ. Obstetrics and Gynecology 2002 Jul;100(1):18–25. Depression-related costs in heart failure care. Behavioral factors may play a role in heart failure care costs by increasing hospital readmission rates. This study sought to estimate the effect of depression on health care costs for patients hospitalized for heart failure. METHODS: A three-year retrospective cohort study of a staff-model health maintenance organization. Following a first hospitalization with a primary diagnosis of HF, 1098 health maintenance organization patients were evaluated. Median annualized health care costs for 3 depression groups were identified: (1) no depression (n = 672; cost, $7474), (2) antidepressant prescription only (n = 312; cost, $11 012), and (3) antidepressant prescription and depression diagnosis recorded (n = 114; cost, $9550). … RESULTS: …costs were 26 percent higher in the antidepressant prescription only group and 29 percent higher in the antidepressant prescription and depression diagnosis recorded group when compared with the no depression group (both P<.001). Increased inpatient and outpatient utilization contributed to the increased costs. Conclusion: Costs of care for patients hospitalized for heart failure are significantly higher for patients with evidence of depression. Sullivan M, Simon G, Spertus J, Russo J. Archives of Internal Medicine 2002 Sep 9;162(16):1860–6. Screening mammograms by community radiologists: Variability in false-positive rates. Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. The researchers studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist and/or testing characteristics. …Conclusion: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic-examination screening. Elmore JG, Miglioretti DL, Reisch LM, Barton MB, Kreuter W, Christiansen CL, Fletcher SW. Journal of the National Cancer Institute 2002;94:1373–80. |
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