Missed Opportunities for Prevention
Two new reports from the Agency for Healthcare Research and Quality find that physicians often miss opportunities to offer preventive and counseling services. It is the fourth consecutive year in which AHRQ has compiled data on 40 core quality measures for the National Healthcare Quality Report. Among the agency's findings: Only 52% of adults reported undergoing recommended colorectal cancer screening, and fewer than half of obese adults reported receiving diet counseling. Only 48% of patients with diabetes received blood sugar screens or foot and eye exams. The overall quality of care improved by almost 8% in hospitals, but by only 3% in ambulatory settings and by 1% in nursing homes and home health settings, according to AHRQ. The agency attributed quality improvement in hospitals to initiatives established by the Centers for Medicare and Medicaid Services. In a separate study—the National Healthcare Disparities Report—AHRQ found that blacks received poorer quality care than did whites in 73% of the core measures. Furthermore, Hispanics received poorer quality of care in 77% of the measures, and low-income people in 77% of the measures.
Drug Ads Play on Emotions
A new study shows that prescription drug advertising on television is rarely educational, and mostly uses emotional appeals to entice consumers. Dominick Frosch, Ph.D., of the University of California, Los Angeles, and colleagues analyzed ads shown during prime time and evening news hours over 4 consecutive weeks on four major broadcast networks. The sample included ads for 7 of the top 10 best-selling prescription drugs for 2004, and included reminder ads (the “ask your doctor” ads, which do not have to be factual) and product claim ads (which must include product risks). A positive emotional appeal—such as a character who's happy after taking the product—was used by 95% of the claim ads and 100% of the reminder ads. The claim ads did provide some educational information, such as detailing how to use the drug or enumerating some of the potential risks and benefits, the authors said. But, they concluded, direct-to-consumer advertising “often presents best-case scenarios that can distort and inflate consumers' expectations about what prescription drugs can accomplish.” Their analysis appeared in the January/February issue of the Annals of Family Medicine. Former Food and Drug Commissioner David Kessler said in an accompanying editorial that “although none of these findings are surprising, they should be disturbing.”
Back Pain Program to Begin
Physicians and chiropractors who provide high-quality back pain care will soon be able to be recognized under a program sponsored by the National Committee for Quality Assurance (NCQA). The program will identify physicians and chiropractors who follow 16 evidence-based criteria, including performing a thorough patient assessment, offering recommendations for appropriate physical activity, and avoiding unnecessary imaging. Criteria also include patient education and shared decision making about surgery and alternatives with the patient. “How back pain is treated varies tremendously from practice to practice, [such that] where you go for your care is as important as what is causing your problem,” NCQA President Margaret E. O'Kane said in a statement. The program was designed with input from experts in orthopedics, neurosurgery, primary care, and public health, as well as from health plans and employers. NCQA will begin accepting applications for the program in April.
Antidepressant Side Effects Vary
Second-generation antidepressants generally have similar rates of effectiveness but have variable side effects, according to an AHRQ analysis. On average, about 61% of patients will experience at least one side effect from taking a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), according to the analysis. However, the type of side effect varies by drug. For example, the SNRI venlafaxine (Effexor) is associated with more reports of nausea and vomiting than are SSRIs, according to AHRQ. The antidepressant trazodone (Desyrel), on the other hand, is associated with higher rates of somnolence than are some similar drugs. Researchers at AHRQ analyzed 293 published studies to compare the risks and benefits of second-generation antidepressants in the treatment of major depressive disorder, dysthymia, and subsyndromal depression. “Second-generation antidepressants provide hope for many of the millions of Americans who struggle with depression,” Dr. Carolyn Clancy, AHRQ director, said in a statement. “But often, trying to find the right drug is trial and error, and in many cases relief is temporary or comes with serious side effects. It's clear we need more evidence to help patients and their doctors make the best choices.” The study is available at