Highlights from AHCPR's March Research Activities

Media Advisory: April 22, 1999

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.

Improving Communication with Patients Needs to Be Major Focus for Hospitalist Systems

Hospitals are beginning to use "hospitalists," a dedicated group of specialists in inpatient medicine, in place of a patient's primary care or outpatient physician during hospitalization. However, the impact of this new speciality on patient care is unknown. The authors of an AHCPR-supported study conclude that this new approach requires increased attention to patient education and physician-patient communication. The study was conducted at Brigham and Women's Hospital, which at the time of the study, did not have a hospitalist system. The researchers found that patients hospitalized for chest pain whose regular physicians remained involved in their hospital care were less likely to report communication problems regarding tests (20 percent vs. 31 percent), level of activity after discharge (42 percent vs. 51 percent), and health habits (31 percent vs 38 percent). Steven R. Simon, M.D., M.P.H., of Harvard Medical School, the study's lead author, concludes that regular physicians may communicate better with their patients because they know them well, but that communication problems are common even among patients cared for by their own doctors. However, he notes that hospitalist systems may provide opportunities for improving communication problems with all patients.

["Communication problems for patients hospitalized with chest pain," Dr. Simon, Thomas H. Lee, M.D., M.Sc., Lee Goldman, M.D., M.P.H., and others, in the December 1998 Journal of General Internal Medicine 13, pp. 836-838.]

Nearly Half of Home Health Care Clients Have Unmet Needs Such as Household and Nutritional Support

People using home health care often need support services to help with nutrition, housework, and other routine activities to enable them to continue to live alone in their own homes. Yet, nearly half of home health care clients receive only some or none of the support services they need, according to a study supported by AHCPR. The researchers collected data on 2,013 home health clients of 12 non-profit Massachusetts home health agencies in 1993. Overall, 85 percent of clients needed one or more support services. Of the nearly half who had an unmet need, 80 percent required three or more services that were not being provided. The services with the highest unmet need were mental health, with 56 percent not receiving needed services, social work (45 percent), and speech therapy (51 percent).

["Home alone: Unmet need for formal support services among home health clients," Cindy Parks Thomas, P.A, M.S. and Susan M. Payne, Ph.D., in the Home Health Care Services Quarterly 17(2), pp. 1-20, 1998.]

Lack of Same-day Access to a Primary Care Provider Prompts Many HMO Patients to Seek More Costly Urgent Care

Improvement in HMO organization and scheduling systems to facilitate same-day access to primary care providers could reduce use of HMO urgent care services and increase patient satisfaction, concludes a study supported by AHCPR. Many health maintenance organizations (HMOs) that employ their own staff typically are open from 9 a.m. to 5 p.m. on weekdays with any urgent care center open from 7 a.m. to 9 p.m., seven days a week. Harvard Medical School researchers, supported by AHCPR, surveyed adults for their reasons for seeking care at the urgent care department of a large, urban HMO health center. Although some of the urgent care visits occurred after regular business hours, others occurred at the same time HMO physicians were seeing patients. When asked why they came to the urgent care center rather than seeing their usual doctor, 47 responded that the primary care offices were closed, 27 percent cited the constraints of work or childcare, and 25 percent said they were unable to get an appointment with their doctor.

["Discontinuity of care: Urgent care utilization within a health maintenance organization," by Anna. E. Plauth, M.D., M.P.H. and Steven D. Pearson, M.D., M.Sc., in the November 1998 issue of The American Journal of Managed Care 4, pp. 1531-1537.]

Physicians Vary Widely in Providing Heart Disease Prevention Services to Their Patients

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 41 percent of all deaths. Although physicians can play an important role in preventing CVD by screening, counseling, and/or prescribing appropriate medications to reduce risk factors, their provision of these services varies widely by speciality, according to a study funded in part by AHCPR. Massachusetts General Hospital researchers Randall S. Stafford, M..D., Ph.D., and David Blumenthal, M.D., M.P.P., analyzed nearly 31,000 adult visits to a national random sample of 1,521 physicians and used mathematical models to estimate the independent effects of physician and patient characteristics on CVD prevention services, including blood pressure measurement, cholesterol testing, weight and smoking cessation counseling, and use of lipid-lowering medications. As compared with general internists, cardiologists were the most likely to provide CVD preventive services (odds ratio (OR) of 1.65; 1 is equal odds), and obstetricians/gynecologists (OR, 0.68 to 0.82) were less likely to provide CVD prevention services, as were family physicians (OR, 0.64 to 0.74), general practitioners (OR 0.53 to 0.63), other medical specialties (OR, 0.59 to 0.72), and surgeons (0.05 to 0.06).

["Specialty differences in cardiovascular disease prevention practices," by Drs. Stafford and Blumenthal, in the Journal of the American College of Cardiology 32, pp. 1238-1243, 1998.]

Other articles in Research Activities include findings on:

• Cost of medications for children with AIDS.
• Increasing use of corticosteroids prior to preterm births.
• Relationship between hypothyroidism and sleep apnea.
• Factors affecting postoperative delirium.
• Effect of hospital experience on knee replacement outcomes.
• Complications of IV heparin to prevent second strokes.
• Prevalence of hereditary hemochromatosis.
• Barriers to early diagnosis of prostate cancer.

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

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Internet Citation:

Highlights from AHCPR's March Research Activities. Media advisory, April 22, 1999. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/news/press/pr1999/high0399.htm

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