July 17, 2007, Issue No. 234
AHRQ News and Numbers
One-fourth of uninsured U.S. women between the ages of 18 and 64 reported not having had a Pap smear within the last 3 years when surveyed in 2005. This was double the 11 percent rate for women with private insurance and more than the 15 percent rate for women covered by Medicaid or any other public insurance. [Source: Agency for Healthcare Research and Quality, MEPS, Use of the Pap Test as a Cancer Screening Tool Among Women Age 18-64, U.S. Civilian Noninstitutionalized Population, 2005, Statistical Brief #173.]
Today's Headlines:
- While most diabetes drugs provide similar glucose control, some offer important advantages, new review shows
- National Advisory Council meeting scheduled for July 20
- New AHRQ study finds Mexicans' access to primary care limited overall, but worse in rural areas
- Study finds electronic health records alone don't aid patient care
- Study shows antibiotics may not prevent UTI's from recurring in children and may cause resistance
- New study on the effect of dietary counseling for weight loss
- AHRQ-funded study explores the value of health information to communities
- Michigan electronic medical records project provides lessons learned for data exchange
- AHRQ audio podcast focuses on teen births, NICUs, and the State Snapshots
- AHRQ in the professional literature
1. While Most Diabetes Drugs Provide Similar Glucose Control, Some Offer Important Advantages, New Review Shows
Most oral medications prescribed for type 2 diabetes are similarly effective for reducing blood glucose, but the drug metformin is less likely to cause weight gain and may be more likely than other treatments to decrease so-called bad cholesterol, according to an AHRQ-funded report. The report summarizes the effectiveness, risks, and estimated costs for 10 drugs: acarbose (sold as Precose), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Micronase, DiaBeta, Glynase PresTab), metformin (Glucophage, Riomet, Fortamet), miglitol (Glyset), nateglinide (Starlix), pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia). Earlier scientific reviews have highlighted some differences between medications, but AHRQ's new analysis is the first to summarize evidence on the effectiveness and adverse events for all approved oral medications commonly used in the United States for type 2 diabetes. The report, Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults with Type 2 Diabetes, completed by the AHRQ's Johns Hopkins University Evidence-based Practice Center in Baltimore, is the newest analysis from AHRQ's Effective Health Care program. Select to read our press release and select to access the report. In addition, a version of the analysis was posted in the online version of Annals of Internal Medicine.
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2. National Advisory Council Meeting Scheduled for July 20
The AHRQ National Advisory Council is scheduled to meet on Friday, July 20, at AHRQ's Eisenberg Conference Center in Rockville, MD. The Council will discuss updates for AHRQ's National Healthcare Quality Report and National Healthcare Disparities Report, hold a preliminary discussion on quality measurement, and discuss leveraging private-sector innovation for safety and quality. Select to read the press release.
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3. New AHRQ Study Finds Mexicans' Access to Primary Care Limited Overall, but Worse in Rural Areas
Working-age Mexicans in rural areas of the United States are even less likely to have a usual source of medical care than either their white neighbors or Mexicans living in urban areas, according to a new study. The researchers found that Mexicans in non-metropolitan areas are roughly one-third less likely than rural whites to have a usual source of care. By comparison, Mexicans in urban areas are about a quarter less likely to have a usual source of medical care than urban whites. According to the researchers, led by AHRQ's Terceira A. Berdahl, Ph.D., despite the increased movement of Hispanics into non-metropolitan areas, few studies have investigated whether the health care access disparity between Hispanics and whites is worsened by living in a rural area. The article, "Access to Health Care for Nonmetro and Metro Latinos of Mexican Origin in the United States," was published in the July 2007 issue of Medical Care. Select to read the abstract in PubMed®.
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4. Study Finds Electronic Health Records Alone Don't Aid Patient Care
While electronic health record systems hold promise for helping improve the quality of health care and reducing medical errors, a new AHRQ-funded study has found that they do not in and of themselves improve quality. The study, published in the July 9 issue of the Archives of Internal Medicine, which examined how electronic health records affect quality of care in the doctor's office setting, found that EHRs were not associated with better quality care. Researchers suggest that implementation of EHR systems must be accompanied by other quality improvement undertakings in order to be successful. Select to read the abstract in PubMed®.
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5. Study Shows Antibiotics May Not Prevent UTI's from Recurring in Children and May Cause Resistance
Prescribing antibiotics to prevent urinary tract infection from recurring in children under age 6 appears to have no effect and may increase the risk of drug resistance, according to a new AHRQ-funded study. The study, "Recurrent Urinary Tract Infection: Risk Factors and Effectiveness of Prophylaxis in a Primary Care Cohort," was published in the July 11 issue of JAMA. The American Academy of Pediatrics currently recommends daily preventive antibiotics if a child has vesicoureteral reflux, a condition in which urine flows backward from the bladder towards the kidneys. It has been postulated that this reflux increases the risk of repeated urinary tract infections and infection-related scarring of the kidneys. However, the investigation by AHRQ's University of Pennsylvania Center for Education and Research on Therapeutics found that the majority of the children in the study had milder grades of vesicoureteral reflux and these were not associated with increased risk of recurrent urinary tract infection. The researchers, led by Patrick Conway, M.D., also found no association between giving antibiotics to prevent an infection from recurring and the risk of recurrent urinary tract infection. But they did find significant increased risk of resistant infection in those children who were exposed to preventive antibiotics. Select to read the abstract in PubMed®.
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6. New Study on the Effect of Dietary Counseling for Weight Loss
Several important systematic reviews show that dietary-based lifestyle modification efforts can significantly improve body weight and decrease related medical problems according to a new study published in the July 3 issue of Annals of Internal Medicine. The average weight change due to dietary counseling compared with usual care is unclear, particularly over the long term. Researchers led by Michael L. Dansinger, MD, at AHRQ's Tufts-New England Medical Center Evidence-based Practice Center systematically reviewed published data on the net effect of dietary-based counseling compared with usual care over time. Select to read the abstract in PubMed®.
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7. AHRQ-Funded Study Explores the Value of Health Information to Communities
What is the value of health information to a community? Potentially, a great deal, in terms of both health care quality and costs. The trick, is not to share too much too fast, because information overload can undermine the best of intentions. David F. Lobach, M.D., Ph.D., of the Division of Clinical Informatics in the Department of Community and Family Medicine at Duke University Medical Center in Durham, N.C., and his colleagues have found that health care providers can absorb only so much new information at once. Visit AHRQ's Health IT Web site to read about Dr. Lobach's study.
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8. Michigan Electronic Medical Records Project Provides Lessons Learned for Data Exchange
When it comes to implementing information technology in health care settings, the lessons learned from addressing technological and cultural challenges can be just as valuable as the easier barriers that need to be overcome. Ten critical access hospitals in Michigan's Upper Peninsula are working together to create a regional health information network that will allow for the communication of patient data with physicians. The network is designed to solve a major barrier to improving the quality care in a place where access to advanced health care services can be difficult. Visit AHRQ's Health IT Web site to read about the project.
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9. AHRQ Audio Podcast Focuses on Teen Births, NICUs, and the State Snapshots
In a varied program, this week's Healthcare 411 audio podcast includes AHRQ data that show that the rate of teenage and younger girls giving birth in U.S. hospitals has dropped; research that found very small infants have a greater rate of survival in very busy neonatal intensive care units; and an interview with Ed Kelley, Ph.D., about AHRQ's State Snapshots, which are based on AHRQ's NHQR. Select to listen to the 10-minute program. In addition, a new 90-second radio spot features Ethan Balk, M.D., Associate Director of the AHRQ Tufts-New England Medical Center Evidence-Based Practice Center, who explains the findings about current clinical evidence on renal artery stenosis and announces a new consumer guide that is designed to help people with renal artery stenosis understand the disease and discuss options with their health care providers. Select to listen to the radio program. Select to read the transcript. You can listen to the audio program directly through your computer if it has a sound card and speakers and can play MP3 audio files, or you can download it to a portable audio device. In any case, you will be able to listen at your convenience. To access any of AHRQ's podcasts and special reports or to sign up for a free subscription to the series and receive notice of all future AHRQ podcasts, visit our Healthcare 411 series main page.
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10. AHRQ in the Professional Literature
We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.
Stitzenberg KB, Thomas NE, Ollila DW. Influence of provider and practice characteristics on melanoma care. Am J Surg 2007 Feb; 193(2);206-212. Select to read the abstract in PubMed®.
FitzGerald JD, Boscardin WJ, Hahn BH, et al. Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery. Health Serv Res 207 Feb; 42(1 Pt 1):25-44. Select to read the abstract in PubMed®.
Kominski GF, Varon SF, Morisky DE, et al. Costs and cost-effectiveness of adolescent compliance with treatment for latent tuberculosis infection: results from a randomized trial. J Adolesc Health 2007 Jan; 40(1):61-68. Select to read the abstract in PubMed®.
Feudtner C, Santucci G, Feinstein JA, et al. Hopeful thinking and level of comfort regarding providing pediatric palliative care: a survey of hospital nurses. Pediatrics 2007 Jan; 119(1);e186-e192. Select to read the abstract in PubMed®.
Yelin E, Trupin L, Katz P, et al. Work dynamics among persons with systemic lupus erythematosus. Arthritis Rheum 007 Feb 15; 57(1):103-108. Select to read the abstract in PubMed®.
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Contact Information:
Please address comments and questions to Nancy Comfort at Nancy.Comfort@ahrq.hhs.gov or (301) 427-1866.
Current as of July 2007
Internet Citation:
AHRQ Electronic Newsletter. July 17, 2007, Issue No. 234. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/enews/enews234.htm
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