EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 28, 2003
To contact Kenneth T. Horlander, M.D., call Joyce Freeman at 706/812-8831.

DEATHS DUE TO BLOOD CLOTS IN THE LUNGS DECREASED APPROXIMATELY 30 PERCENT FROM 1979 TO 1998

CHICAGO—Deaths due to pulmonary thromboembolism (PTE, a blood clot blocking the flow of blood in the lungs) have decreased over the past 20 years, according to an article in the July 28 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

PTE can have significant health consequences including death, according to the article. Previous studies estimating the death rates associated with PTE have varied widely. It is estimated that as many as 50,000 to 100,000 people die of PTE annually in the United States.

Kenneth T. Horlander, M.D., of Clark-Holder Clinic, LaGrange, Ga., and colleagues looked at death certificates listing PTE as the cause of death. The death certificates were from the Multiple-Cause Mortality Files compiled by the National Center for Health Statistics from 1979 to 1998.

The researchers found that of 42,932,973 death certificates studied, 572,773 (1.3 percent) had PTE listed, and 194,389 of them (33.9 percent) listed PTE as the underlying cause of death. The researchers calculated that the rate of deaths due to PTE decreased from 191 per million deaths in 1979 to 94 per million deaths in 1998, decreasing 56 percent for men and 46 percent for women.

The researchers also found that over the study period, the death rates for African Americans were consistently 50 percent higher than those for whites, and those for whites were 50 percent higher than those for people of other races (Asian, American Indian, etc.). Overall, death rates were consistently 20 percent to 30 percent higher among men than women.

"The results of our study demonstrate that PTE is the underlying cause of death in approximately one third of death certificates that list PTE, and annual PTE mortality has decreased about 30 percent from 1979 to 1998," write the researchers.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 28, 2003
To contact Richard L. Kravitz, M.D., M.S.P.H., call Janet Dolan at 916/734-9048.

PATIENTS' REQUESTS FOR CLINICAL SERVICES INFLUENCE DOCTORS' BEHAVIOR

CHICAGO—Patients' requests for various clinical services are pervasive and influential, according to an article in the July 28 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the study, consumer empowerment in health care is increasingly accepted as inevitable, right, and potentially beneficial, however, the need to control health care costs is also important. Requests are an important example of how patients can influence medical visits.

Richard L. Kravitz, M.D., M.S.P.H., of University of California, Davis, Sacramento, Calif., and colleagues investigated patients' contributions to healthcare resource use and quality by studying their requests and physician responses at doctor visits.

The researchers surveyed patients and physicians and audiotaped 559 patient visits to 45 doctors in 2 healthcare systems between January and November 1999. All the patients had a new problem or significant health care concern. The researchers tallied requests for physician action; odds of patients' requesting tests, referrals or new prescriptions; odds of physicians ordering diagnostic tests, making specialty referrals or writing new prescriptions; patient satisfaction; and physicians' perceptions of the visits.

After reviewing the audiotapes, the researchers found that the 559 patients made 545 requests for physician action. Twenty-three percent requested at least 1 diagnostic test, specialty referral or new prescription medication. Requests for diagnostic tests were more common among new patients. The researchers also found that requests for any clinical service were more common among patients experiencing greater health-related distress and less common among patients of cardiologists. Physicians also reported that visits during which patients requested diagnostic tests were more demanding than visits at which no requests for diagnostic tests were made.

"In this study of problem-driven visits, patients made direct codable requests for clinical resources in about 25 percent of primary care encounters but only 8 percent of cardiology visits," the researchers write. "The differences persisted after adjusting for various factors that might on a theoretical basis be expected to influence request behavior. The observation that request density is not uniform across specialties suggests that the consumer movement has greater traction within some quarters of the health care system than others."