Volume 15, Issue 2, Spring 2003
- UW/GHC thiazide study sheds new light on a popular diuretic
- MacColl Institute staff take part in national policy forums
- Ballweg chairs Research Advisory Board
- Larson calls for steps to preserve the physician-patient relationship
- Research highlights
- New funding
UW/Group Health study sheds new light on a popular diuretic
Hydrochlorothiazide (HCTZ)—a widely used and inexpensive high-blood-pressure drug once suspected of having bad effects on blood cholesterol—actually poses no such threat when given in low doses to healthy adults, according to researchers from the University of Washington and Group Health Cooperative.
That's good news for individuals at risk for multiple health problems, including osteoporosis. Previous studies by the same research team showed that, in addition to lowering high blood pressure, HCTZ lowered patients' risk of hip fractures and increased their bone mineral density.
Still, many physicians have been hesitant to prescribe HCTZ and other similar "thiazide diuretics" to some patients because of long-held beliefs that these drugs could increase the amount of harmful cholesterol in the blood, leading to cardiovascular problems. But this new study—conducted over a three-year period among 320 Group Health members aged 60 to 79—offers reassurance that the drug, when used in low doses by healthy patients, does not lead to increased risk.
Why was the link between thiazide diuretics and cholesterol a concern in the first place? Some past studies of higher doses of the drugs found that thiazides failed to significantly decrease the incidence of coronary artery disease events, explains Susan M. Ott, MD, professor of medicine at the University of Washington and the lead author of the study. This led some investigators to suggest that thiazide diuretics worsen coronary artery disease by causing adverse changes in blood cholesterol levels. However, nearly all these studies had been conducted among people with high blood pressure.
But this new study, released today in the Journal of the American Geriatrics Society, was the largest long-term study of thiazide diuretics among patients with normal blood pressure. While high doses of thiazides can increase bad cholesterol, said Ott, this study showed that 12.5 milligram and 25 milligram doses had minimal effects on cholesterol metabolism in healthy older adults.
Ott said the findings are important in light of recent research showing the harmful effects of estrogen, which many women had been taking to prevent hip fractures. "We need to find a safe, gentle drug that can be taken over a long period of time to stop bone loss," said Ott. "More studies are needed to learn the long-term effects of thiazides, but this study shows that it's certainly a candidate."
Andrea LaCroix, PhD, senior investigator at Group Health's Center for Health Studies, and co-author of the article, agrees. "The goal of our research has been to look at these medications and see how they affect multiple conditions in older people." she said. "I think it's very reassuring to find that one of the least expensive and most effective drugs for lowering blood pressure in older people is also one of the safest and well tolerated."
MacColl Institute staff take part in national policy forums
Leaders from the MacColl Institute at Group Health Center for Health Studies continue to contribute to significant national and international health-policy discussions. Some recent examples:
- Institute Director Ed Wagner, MD, was invited to testify before
the U.S. House of Representatives Committee on Ways and Means' Subcommittee
on Health on February 25. Wagner described how the MacColl Institute's
chronic care model can benefit the health of large populations while
reducing costs. He also presented five recommendations to Congress and the
Centers for Medicare and Medicaid Services for eliminating barriers to
chronic care management in Medicare. His written testimony is available at
http://waysandmeans.house.gov/hearings.asp?formmode=view&id=96.
- Wagner recently served on two Institute of Medicine (IOM)
committees that issued reports with important implications for the health
care industry and public health. One report, titled "A Shared
Destiny: Community Effects of Uninsurance," provides an in-depth,
evidence-based analysis of the uninsurance problem and its effects on the
individual, the family, and whole communities. Released March 10, the
report is designed to help lay groundwork for more informed and productive
public debate about health care coverage.
The second report, titled "Fostering Rapid Advances in Health: Learning from System Demonstrations," identifies promising approaches to key challenges facing the U.S. health care system and recommends demonstration projects to test their effectiveness. Released November 19, 2002, this report was featured in the medical journal Lancet and on a segment of NPR's "Fresh Air."
Both reports are available at www.nas.edu.
- Institute Manager Brian Austin contributed to another IOM report—"Priority Areas for National Action: Transforming Health Care Quality"—issued January 7. A successor to "Crossing the Quality Chasm," this report identifies 20 areas that offer the greatest opportunities for rapid and substantial improvements in the quality of health care. It's also available on www.nas.edu.
Ballweg named chair of Group Health's Research Advisory Board
Group Health Trustee Ruth Ballweg has been named chair of the new Group Health Research Advisory Board, which met for the first time January 16. The Board, which is appointed by Group Health's president and chief executive officer, is responsible for assessing the quality, innovation, and relevance of Group Health research in enhancing quality of care and within Group Health and nationally.
A physician assistant, Ballweg brings a broad perspective as a health care practitioner, administrator, and consumer. Locally, she's the director of MEDEX Northwest, the University of Washington School of Medicine's Physician Assistant Program. Nationally, she serves on the DHHS' Advisory Committee on Training in Primary Care Medicine and Dentistry. She also has plenty of experience at Group Health, having served on the Board of Trustees, chaired the Cooperative's Ethics Council and served on its Quality Committee, Strategic Planning and Finance Committee, and the Group Health Options Board. She holds a master's degree in public administration from the University of Washington.
Larson calls for steps to preserve the physician-patient relationship
"Preserving the Physician-Patient Relationship in a Challenging Medical Marketplace" is the topic of an article by CHS Director Eric Larson, MD, in the March issue of American Journal of Medicine, published by the Association of Professors of Medicine. Larson argues that the health care system's tendency to undervalue medicine's "cognitive services" in favor of procedural and specialty services undermines ongoing doctor-patient relationships. Loss of such relationships "is usually a source of inefficiency and can have devastating consequences to patients," he writes. He calls for a greater commitment to increased access for the uninsured and more adequate funding for ongoing primary- and chronic-care services.
Research highlights:
Study describes factors that affect mammograms' accuracy: The accuracy of screening mammograms increases as women age and as their breasts became more fatty and less dense, according to a CHS study that appears in the February 5 issue of Annals of Internal Medicine. Titled "Individual and Combined Effects of Age, Breast Density, and Hormone Replacement Therapy Use on the Accuracy of Screening Mammography," the study also found that hormone therapy negatively affected accuracy by increasing breast density and making mammograms harder to read. Researchers from seven institutions in the Breast Cancer Surveillance Consortium were involved in the NCI-funded study, which looked at mammograms from 329,000 women. CHS assistant investigator Diana Miglioretti, PhD, was the lead biostatistician on the study.
Domestic violence is linked to higher total health care costs: A Group Health/UW/Harborview study published in the January issue of the American Journal of Preventive Medicine found that domestic violence is related to significant increases in health care costs and utilization of all types of care. Women whose medical records show a history of domestic violence have total utilization and costs that are 1.6 to 2.3 times higher than women without a record of domestic violence. Robert S. Thompson, MD, GHP's director of Preventive Care and a CHS senior investigator, was the lead Group Health researcher.
Pediatrics proves to be a good venue for stop-smoking intervention: Pediatric clinics are good places to help low-income women quit smoking, according to a CHS/UW study that appears in the March issue of The Archives of Pediatrics and Adolescent Medicine. Women who received a brief intervention during their children's clinic visits and up to three follow-up phone calls had quit rates twice as high as a control group. The CHS study team was led by former CHS director Susan Curry, PhD, now director of the Health Policy and Research Centers at the University of Illinois at Chicago. Study sites were Group Health's Rainier Medical Center, Odessa Brown Children's Clinic, Harborview Children and Teens Clinic, and UW Physicians' Pediatric Care Center at Roosevelt.
Study shows high rates of ineffective condom use: A high percentage of young women who are at risk for sexually transmitted diseases (STDs) are using condoms ineffectively according to a recent study conducted by Group Health Center for Health Studies and Duke University. Published in the December 2002 issue of the medical journal, AIDS Care, the study found that 44 percent of the 779 female condom-users surveyed had delayed using condoms until after intercourse began. Also, some 19 percent reported condoms breaking or slipping during intercourse. The study was funded by a grant from the National Institute of Mental Health. Group Health investigators were Diane Civic, PhD, Delia Scholes, PhD, Laura Ichikawa, MS, and Lou Grothaus, MA.
New Funding:
Among grants and contracts recently received by Group Health Center for Health Studies:
Cost effectiveness of systematic depression treatments: With a one-year, $100,000 grant from the Robert Wood Johnson Foundation, researchers will use data from nine different studies to more accurately estimate cost-effectiveness of depression treatment and the effects of depression treatment on costs to employers (work absence and work disability). The study will examine how depression treatment affects various components of health care costs and will consider changing costs of antidepressants due to generic pricing. Principal investigator: Greg Simon, MD.
COMVAX efficacy: A $76,000 contract with Merck will be used to evaluate the effect of the introduction of COMVAX vaccine at Group Health on rates of invasive Hemophilus b disease. Principal investigator: Robert L. Davis, MD.
Adherence intervention for incarcerated people with HIV: This grant will fund the design and testing of a telephone-delivered adherence intervention for incarcerated people with HIV. The project is funded for three years by National Institute of Mental Health at $1.5 million. Sheryl L. Catz, PhD, who joined the Center in December, is the principal investigator.
Healthy Steps in Integrated Delivery Systems: A grant of $471,844 from Kaiser Permanente will fund an additional sixth year of this ongoing study that uses the health care system to help parents increase parenting skills. The lead researcher is Robert S. Thompson, MD.