Take your medication

Following up what I wrote about patients not taking their medication, comes this retrospective study. It concludes that diabetics who do not adhere to their oral antihyperglycemic medication have more than twice the risk of hospitalization. More concerning was the percentage of patients who did not take medication for potentially serious conditions (diabetes, hypertension, and an elevated cholesterol):

The proportion of enrollees who were nonadherent to ...

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"New Blood Test Advised for Diabetes Patients". Quite a headline. This is the media's interpretation of an article in this week's Annals of Internal Medicine. This "new" test is in fact, the hemoglobin A1c - which is a standard test in monitoring diabetes control. The title should have been "A new use for an old test".

The study suggests that cardiovascular (CV) disease ...

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The grass is always greener . . .

It seems like Americans and Canadians want each other's health care system. Improved access for Canadians. Universal coverage for Americans. Medpundit weighs in earlier this week. Dr. Centor gets to the root of the problem:

Health care costs are increasing everywhere because we can do so much more than we could 10 years ago. Our diagnostic tests have improved - but at increased cost. ...

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The hidden cost of medications

From the Archives of Internal Medicine, comes this story:

About one-third of chronically ill adults who underuse medications because of the costs associated with buying the drugs, never tell their health care practitioners . . .

The underuse of essential medications, including cholesterol-lowering medications, heart medications, asthma medications and antipsychotics, has been associated with increased emergency department visits, nursing home admissions, acute psychiatric hospitalizations, and a decrease in self-reported ...

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With focus on the former president's successful heart surgery, there is more interest than ever in screening for heart disease. Lots of business for hospitals:

"I'd imagine that the phones are ringing off the hook at every cardiology practice in the city," said Dr. Peter Buttrick, cardiology chief at the University of Illinois Medical Center. "There certainly is more public awareness of heart disease this week than there was ...

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With media focus on Bill Clinton's impending bypass surgery, the INTERHEART study that I briefly alluded to recently has received an early-release from the Lancet.

Some observations:
1) Smoking and a poor cholesterol ratio accounts for the majority of risk.
2) Psychosocial factors ("stress") plays a significant role.
3) The cholesterol ratio they used was the ApoB/ApoA1 ratio. What does this mean? From UptoDate:

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Risk factors for heart disease

In a study that will be published in The Lancet shortly, comes the most definitive look at risk factors causing heart disease. Some key observations:

* 90% of the risk factors can be prevented
* risk factors are similar across different regions and race

So, what are the risk factors? Here they are, in order of importance:

1) poor HDL/LDL ratio
2) smoking
3) diabetes

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Exercise stress testing

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week's issue of the Journal of the American College of Cardiology.


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Morning news rounds

I have an extra half-hour this morning before I see patients, so here are some interesting stories to start your day.

Despite tort reform, some physicians are leaving high-risk practice.

An article on people who steal physician identities.

I do some work at the VA, so I see first-hand many of the primary care physician shortages (6+ month wait in some cases). With a ...

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Time is money

Interesting study from Vanderbilt University.  Paying physicians to take more time with patients.  I guess it would make sense if there was a correlation between improved patient outcomes and the length of the visit.  

A small number of physicians at Vanderbilt University Medical Center, Nashville, are taking part in a study to find out if it's more cost effective in the long run to pay doctors to take more ...

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