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Highlights from AHCPR's July Research Activities

Media Advisory: July 24, 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.

Quinolone Antibiotics Reduce Infections in Cancer Patients Undergoing Chemotherapy

Intensive chemotherapy weakens cancer patients' immune system leaving patients more susceptible to infection. An estimated 50 percent to 90 percent of patients develop an infection during intensive chemotherapy. However, the rate of infection can be dramatically reduced with prophylactic use of quinolone antibiotics, says a new AHCPR-supported study. Researchers at the New England Medical Center performed a meta-analysis of 18 trials with 1,408 cancer patients undergoing chemotherapy. Patients who received quinolones had 46 percent fewer infections overall than patients who received no prophylactic antibiotics. Results were similar when quinolones were compared with another frequently used prophylactic antibiotic, trimethoprim/sulfamethoxazole. However, researchers found no reduction in infection-related deaths.

["Efficacy of quinolone prophylaxis in neutropenic cancer patients: A meta-analysis," by Eric A. Engels, M.D., M.P.H., Joseph Lau, M.D., and Michael Barza, M.D., in the March 1998 Journal of Clinical Oncology 16(3), pp. 1179-1187.]

Missed Appointments Are Linked to Shorter Breast Cancer Survival Among Black Women

Black women are more likely than are white women to be diagnosed with later-stage breast cancer and die sooner of the disease. Missed appointments, rather than factors related to race, seem to account for these differences, and black women are more likely to miss appointments than white women, concludes an AHCPR-supported study. Roy Penchansky, D.B.A., of the University of Michigan, and fellow researchers found that nearly four times as many black women (15 percent vs. 4 percent) missed two or more scheduled appointments before the identification of breast cancer symptoms, which nearly tripled their risk of being diagnosed at a later stage. Helping women keep their appointments and alleviating barriers to compliance with their treatment will increase cancer survival, suggests Dr. Penchansky. These findings are based on a retrospective review of the clinical records of 246 women receiving care for breast cancer at three health maintenance organizations.

["Disaggregating the effects of race on breast cancer survival," by Dr. Penchansky, Daniel L. Howard, Ph.D., and Morton B. Brown, Ph.D., in the March 1998 Family Medicine 30(3), pp. 228-235.]

Today's Primary Care Doctors Spend More Time With Children, but Also Prescribe More Medications

Primary care physicians (PCPs) are spending 2 minutes more during each visit with a child (14 vs. 12 minutes) than they did 15 years ago. They spend the extra time providing more preventive services, such as vaccinations and counseling. In an AHCPR-supported study, researchers from Harvard Medical School and the Massachusetts General Hospital used data from the National Ambulatory Care Surveys from 1979 to 1994 to analyze more than 58,000 visits by children and adolescents to 2,000 PCPs. They found that PCPs also are prescribing antibiotics more often than they did in the past—during one-third of visits today compared with one-fourth of visits previously. PCPs also are prescribing Ritalin for attention deficit disorder 140-fold more often than they did 15 years ago. But there is no clear evidence that wider use of these medications is appropriate, notes Timothy Ferris, M.D., M.Phil., of Massachusetts General Hospital, the study's lead author.

["Changes in the daily practice of primary care for children," by Dr. Ferris, Demet Saglam, M.A., Randall S. Stafford, M.D., and others, in the March 1998 Archives of Pediatric and Adolescent Medicine 152, pp. 227-233.]

Study Examines Physicians' Prescribing Behavior

Financial ties to and gifts from drug companies may alter physicians' prescribing patterns, but physicians do not seem to recognize the potential influence, concludes AHCPR researcher, Anthony D. So, M.D., M.P.A., who reviewed studies on the topic. In one study, doctors who requested that specific drugs be added to the hospital pharmacy were substantially more likely to have accepted money (e.g., for educational conferences or other purposes) from the companies that made the drugs. In another study, doctors maintained that they placed little weight on drug advertisements, but results showed that in fact commercial rather than scientific sources of drug information dominated their drug choices. In a third study, 46 percent of medical students saw no problem with taking $50 from a drug company, but 85 percent felt it improper for a politician to do so.

["Free gifts: Redundancy or conundrum?" by Dr. So in the March 1998 Journal of General Internal Medicine 13, pp. 213-215.]

Other articles in Research Activities include findings on:

Health problems and barriers to care for the very old.
Influence of HIV symptoms on quality of life.
Role of public insurance in financing AIDS care.
Medication use for low back pain.
Malpractice fears and prostate cancer screening practices.
Ethnic differences in attitudes about smoking.
How and why patients personally adjust diabetes treatment.
Insurance coverage problems for growth hormone treatment.
Research agenda for emergency care.
Earlier discharge of hospitalized pneumonia patients.
Problems with doctors' history-taking skills.
Managed care strategies to limit referral to specialists.
Use of a video to teach CPR.
Improving scorecards on hospital and physician care.
Social impact of genetic tests for cancer susceptibility.
Changes in use of advance care planning in nursing homes.

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

Internet Citation:

Highlights from AHCPR's July Research Activities. Media advisory, July 24, 1998. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/news/press/high0798.htm