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Patients often seek general medical care from specialists
When adults have a fever, nasal congestion or a common condition such as asthma, many seek medical care from a specialist rather than a primary care physician. The percentage of patients visiting specialists for such care, however, has remained fairly steady over a decade. In 2007, 43% of patients with such symptoms or illnesses visited a specialist, nearly unchanged from the 42% who did so in 1999, according to a research letter published online Aug. 20 in Archives of Internal Medicine. Specialists included internal medicine sub-specialists, neurologists and obstetrician-gynecologists. The number of patients seeking primary care from specialists “is remarkably higher than we expected,” said lead study author Minal S. Kale, MD. “It points to an ongoing issue with how our primary care is delivered.” Possibly contributing to the findings is the belief by some patients that specialists are better able to treat specific conditions than general physicians, said Dr. Kale, a [Read more]
73% of patients worry about medical errors, poll says
Nearly three-quarters of patients say they are concerned about the potential for medical errors, according to a poll that sheds light on public perceptions of patient safety. Three in 10 patients said they had experience with a medical error, either personally or through a close friend or family member. Twenty-one percent reported having been misdiagnosed by a physician, said the Wolters Kluwer Health survey of 1,000 American adults released Aug. 15. Wolters Kluwer is a Philadelphia-based publisher of medical journals and maker of point-of-care clinical software. It is unclear whether patient concerns about medical errors have worsened with time. A November 2004 poll of 2,014 adults conducted on behalf of the Kaiser Family Foundation and other organizations found that 34% reported that they or a loved one had experienced a medical error. Fifty-five percent said the quality of care had improved or stayed the same since the 1999 Institute of Medicine report “To Err is Human, [Read more]
Good intentions aside, public health strategies vary in effectiveness
Some of the most widely promoted public health interventions are not necessarily the most effective. For example, there isn’t enough research to conclude whether nutrition labels on food packages and calorie counts on menus encourage healthier eating, said an American Heart Assn. scientific statement published online Aug. 20 in Circulation. “It’s a little surprising the evidence wasn’t that strong, considering how much attention [they have] gotten,” said statement chair Dariush Mozaffarian, MD, DrPH. The AHA report, which was written by a group of 13 internists, pediatricians and public health professionals, highlights 43 population-based strategies that improve diet, increase physical activity and reduce tobacco use. It also identifies interventions with less-robust evidence on their effectiveness. The report found that effective approaches include health warnings on cigarette packages, policies that make nutritious food more affordable and improving sidewalk des [Read more]
SGR repeal cost estimate drops to $245 billion
Reduced projected Medicare spending for the next decade has lowered the estimated cost of repealing Medicare’s sustainable growth rate formula that helps determine physician pay. Eliminating the SGR and freezing Medicare doctor pay rates over 10 years would cost $245 billion, according to new projections from the Congressional Budget Office. Officials previously had estimated that nearly $300 billion would be needed for a pay freeze. But with slower expected growth in program spending, the SGR formula — which decreases doctor pay when predetermined spending limits are exceeded — would not lower doctor rates as much and thus would be less costly to reverse. Lawmakers said they will work to prevent a scheduled 27% SGR reduction to Medicare pay before it takes effect in 2013. Congress also faces other significant year-end fiscal challenges, including expiring tax cuts and automatic reductions of federal defense and non-defense spending. Determining ways to pay for an SGR re [Read more]
Patient safety law protects some documents in court case
A New Jersey appellate court has upheld as constitutional a state law that protects the confidentiality of documents related to medical errors in order to improve patient safety. The court clarified how broadly such protection extends, saying investigative and analytical material created in compliance with the New Jersey Patient Safety Act is “absolutely protected.” However, documents generated for other purposes are subject to existing discovery rules. For doctors and hospitals, the ruling is an educational guideline for how best to structure Patient Safety Act processes within health facilities, said Melinda Martinson, assistant general counsel for the Medical Society of New Jersey, which was not involved in the case. “The bottom line is physicians need to know whether they’re strictly within the confines of the [Patient Safety Act] procedures,” she said. “It is possible that those involved in a PSA evaluation could believe that their discussions are confidential [Read more]
NQF draws on AMA toolkit to gauge patient-friendly communication
The National Quality Forum in August endorsed a dozen measures of physician group and hospital performance in improving communication with patients who have poor health literacy or limited English proficiency. Seven of the metrics were developed by the American Medical Association’s Ethical Force Program and are used as part of its Communication Climate Assessment Toolkit. The toolkit, publicly launched in 2008, features surveys to be used with patients, executive leaders, physicians, nurses and nonclinical staff. Patients grade their experiences in understanding elements such as signage, forms, receptions and their communications with doctors and other health professionals. The survey of staff asks for their assessment of how well the health system or clinic does in providing interpreter services and training. “Effective, patient-centered communication is critical in delivering quality health care, but illness, fear, low literacy and diverse languages and cultures can mak [Read more]
State medical society reports improvements in access to care
In Massachusetts, it may be more challenging to get care from a primary care physician than a specialist. Health care access in the state is improving, but about half of internists and family physicians still are not accepting new patients, according to a study released Aug. 8 by the Massachusetts Medical Society. In 2012, 50% of family physicians said they were taking new patients, a slight increase from 47% in 2011 and 46% in 2010. Acceptance of new patients among internists was 51% in 2012, compared with 49% in 2011. Four surveyed specialties reported much higher acceptance rates of new patients: 84% for cardiologists; 86% for obstetricians-gynecologists; 92% for gastro-enterologists; and 98% for orthopedic surgeons. The medical society’s study examined physician acceptance of new patients and Medicare and Medicaid coverage, as well as wait times for new patient appointments. The results were based on 830 telephone interviews with physician offices representing seven s [Read more]
Blood type could help identify heart disease risk
Educating patients about their blood type and the health risks associated with it could help prevent cardiovascular disease, a study says. People with blood type AB (7% of the U.S. population) have a 23% increased risk of developing coronary heart disease compared with those who have type O blood, said a study published online Aug. 14 in Arteriosclerosis, Thrombosis and Vascular Biology. Researchers didn’t examine the biological processes behind blood type and heart disease risk. But they said type AB is linked to inflammation, which might affect the function of blood vessels. Blood type A is associated with higher levels of low-density lipo-protein cholesterol. “While people cannot change their blood type, our findings may help physicians better understand who is at risk for developing heart disease,” said study senior author Lu Qi, MD, PhD, assistant professor in the Dept. of Nutrition at Harvard School of Public Health in Boston. A patient’s blood type also can b [Read more]
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