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Highlights from the March/April Research Activities

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Media Advisory: April 13, 1998

The Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

Physician Counseling Can Help Patients Quit Smoking

A smoker is more likely to quit smoking when counseled by his or her physician to quit and offered nicotine replacement therapy. But most physicians often fail to ask patients about their smoking status or advise those who do smoke to quit, falling far short of national goals and guidelines for physicians to identify and counsel each patient who smokes, concludes an AHCPR-supported study by Boston researchers. It shows that physicians' treatment of smokers improved little in the first half of the 1990s. Physicians asked patients if they smoked at 67 percent of all visits in 1991, a proportion that did not increase over time. Smoking counseling by physicians increased from 16 percent of smokers' visits in 1991 to 29 percent in 1993 (a year after the nicotine patch was introduced), and then decreased to 21 percent in 1995. Nicotine replacement therapy followed a similar pattern. These findings are based on analysis of 1991-1995 data from the National Medical Ambulatory Care Survey, an annual survey of a random sample of U.S. office-based physicians.

["National patterns in the treatment of smokers by physicians," Anne N. Thorndike, M.D., Nancy A. Rigotti, M.D., Randall S. Stafford, M.D., Ph.D., and Daniel E. Singer, M.D., in the February 25, 1998 Journal of the American Medical Association 279(8), pp. 604-608.]

If Doctors Advised Each of Their Patients Who Smoked To Quit, 1.7 Million More Persons Would Quit Smoking Each Year

Each year, about 5 percent of current smokers quit. If doctors would ask every patient whether he or she smokes and advise those who smoke to quit, an additional 1.7 million people would quit smoking each year. Among those who quit, 60 percent would do so because of combination therapy—that is, counseling and use of the nicotine patch. The researchers estimate that 19 percent of smokers who receive full counseling would quit, and that intensive counseling by smoking cessation specialists would increase this figure to 23 percent. The odds of quitting would increase by nearly twofold with the addition of nicotine gum and two- to threefold with use of the nicotine patch. The researchers modeled these interventions, which were recommended by AHCPR's smoking cessation guideline, and assumed that they would be provided to 75 percent of U.S. smokers 18 years and older, the proportion of smokers who have previously tried to quit.

["Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation," by Jerry Cromwell, Ph.D., William Bartosch, M.P.A., Michael C. Fiore, M.D., M.P.H., and others, in the December 3, 1997, Journal of the American Medical Association, 278(21), pp. 1759-1766.]

Ordering More Diagnostic Tests and Monitoring Procedures Would Not Result in Fewer Malpractice Suits for Omissions

If doctors ordered more diagnostic tests and monitoring procedures than they do now in order to avoid law suits (one type of defensive medicine), they would actually avert very few malpractice suits. In fact, the average specialist would be sued for omitting a necessary diagnostic test once every 59 years, estimates an AHCPR-supported study. Although malpractice suits for omission are uncommon, they are more often associated with significant patient injury and death and are harder to defend than other malpractice suits. The likelihood of payment for omission-related claims was more than twice that of other claim types, and the median payment for such a claim was $34,000 greater than for other claims. These findings are based on review of claims in 15 specialties during 1977-1989, from a database of a malpractice insurer in one state.

["Omission-related malpractice claims and the limits of defensive medicine," by Richard L. Kravitz, M.D., John E. Rolph, Ph.D., and Laura Petersen, M.P.H., in the December 1997 Medical Care Research and Review 54(4), pp. 456-471.]

Use of Physical Restraints Has Declined in Nursing Homes, but They Remain a Fact of Life for Some Residents

One out of four nursing home residents in 1993 was physically restrained with either wrist or ankle restraints, restrictive vests, or geri-chairs. This is a 30 percent reduction (36 percent vs. 26 percent) from the number of nursing home residents who typically were restrained prior to passage of the 1987 Nursing Home Reform Act (NHRA), according to an AHCPR-supported study. On the other hand, the use of restraints continues to be more likely for certain types of residents: those with physical or cognitive impairment and those who take antipsychotic medication, have a history of falls, or have problems with mobility. Facilities located in areas with prospective Medicaid reimbursement policies were more likely to use restraints. Current Medicaid reimbursement may not be sufficient to facilitate care alternatives mandated by the NHRA, suggests Vincent Mor, Ph.D., of Brown University. He and colleagues merged 1990 and 1993 Health Care Financing Administration evaluation data with corresponding Medicare and Medicaid survey data on a total of 268 facilities in 10 states to examine resident and facility factors associated with restraint use.

["Risk factors for physical restraint use in nursing homes: Pre- and post-implementation of the Nursing Home Reform Act," by Nicholas G. Castle, Ph.D., Barry Fogel, M.D., and Vincent Mohr, Ph.D., in The Gerontologist 37(6), pp. 737-747, 1997.]

Other findings in Research Activities:

  • Outcomes important to Alzheimer's patients and their families.
  • Treatment differences between cardiologists and general physicians.
  • Differences in specialist use by managed care and other patients.
  • Benefits of bone marrow transplantation for leukemia patients.
  • Medication that reduces risk of death for certain heart disease patients.
  • Aggressive ER management of chest pain patients.
  • Impact of managed care on long-term care.
  • Relevance of health care organization to patient outcomes.
  • Differences in how black and white patients assess their health.
  • The benefits of speaking the same language as your doctor.
  • Use of dental sealants among Medicaid-insured children.
  • How chance contributes to prostate cancer detection.
  • Importance of nursing staff mix on care delivery and outcomes.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).

The information on this page is archived and provided for reference purposes only.

 

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