JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, June 27, 2005
MOST PRIMARY CARE PHYSICIANS BELIEVE ANNUAL PHYSICAL EXAMINATIONS ARE VALUABLE
GREATER USE OF EVIDENCE-BASED MEDICINE NEEDED IN U.S. OUTPATIENT CARE
WOMEN WANT INFORMATION, OPPORTUNITY TO PARTICIPATE IN DECISION FOR FIRST MAMMOGRAM
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 27, 2005
Media Advisory: To contact Allan V. Prochazka, M.D., M.Sc., call Deborah Mendez-Wilson at 303-724-1523.
MOST PRIMARY CARE PHYSICIANS BELIEVE ANNUAL PHYSICAL EXAMINATIONS ARE VALUABLE
CHICAGO—Current practice guidelines that recommend against routine annual physicals for adults without specific symptoms of illness may not be widely accepted by primary care physicians, according to a study in the June 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Current evidence-based guidelines, developed in the last 20 years, do not recommend a routine annual physical examination and testing for asymptomatic adults, suggesting instead more selective screening based on the patient's personal and family history and overall risk assessment, according to background information in the article. Despite these guidelines, the authors report, a high percentage of the general public desires an annual physical examination and extensive testing. The current attitudes of primary care physicians toward annual physical examinations have not been previously assessed.
Allan V. Prochazka, M.D., M.Sc., of the Denver Veterans Affairs Medical Center, and colleagues conducted a survey of the attitudes and practices regarding annual physical examinations of a random sample of primary care physicians (PCPs) including physicians specializing in internal medicine, family practice and obstetrics/gynecology who were located in the metropolitan areas of Boston, Denver and San Diego.
Of the 783 primary care physicians responding to the survey 65 percent believed an annual physical examination is necessary in addition to seeing patients for acute medical conditions and chronic medical illnesses. "...most (94 percent) believed that an annual physical examination improved the physician-patient relationship and provided valuable time for counseling on preventive health behaviors. Nearly all physicians (88 percent) indicated that they performed annual physical examinations. Seventy-eight percent believed that such an examination was expected by most patients," the researchers report.
"Surprisingly, in view of the current evidence, 74 percent thought that an annual physical examination improved the detection of subclinical illness [illness without symptoms]," the authors report. "Sixty-six percent believed that annual physical examinations are covered by insurance, 63 percent thought they were of proven value, and 55 percent disagreed with the statement that such examinations were not recommended by national organizations."
"It is clear that, despite national organizations no longer recommending annual examinations and lack of evidence supporting routine laboratory testing in asymptomatic individuals, the public desires such examinations and PCPs continue to believe in the value of these examinations," the authors write. "However, the PCPs in this study are very much in favor of the annual physical examination. Thus, there is a lack of concordance between the guidelines and those who would implement the guidelines. This is a critical challenge for achieving national prevention goals, because many of those on the front lines of primary care do not appear to accept the targeted recommendations of the guidelines."
(Arch Intern Med.
2005;165:1347-1352. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver.
EDITORIAL: THE ANNUAL PHYSICAL
Are Physicians and Patients Telling Us Something?
In an editorial accompanying these studies, Patrick G. O'Malley M.D., M.P.H., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and Philip Greenland, editor of the Archives of Internal Medicine, suggest that there are many potential reasons for the discordance between evidence and practice regarding the annual physical examination. "One possibility is that patients and their physicians value something about what the annual physical provides that the evidence has failed to address," they write. "In particular, it may well be that the patient-physician relationship is what is being valued. Meaningful relationships take time, and the current culture of health care does not explicitly value time spent on developing relationships between patients and physicians. ... Perhaps the annual physical has become the forum to serve that purpose, in addition to providing opportunities to address the other items of health care not provided by our current standards of visit frequency and time."
"We need a new, up-to-date research agenda to explore the value of relationship-centered care," Drs. O'Malley and Greenland write. "...we think that there may be something valuable to the annual physical that patients and physicians are telling us indirectly, and if we pay heed to this message and explore it, there may be potential for improving the relationship between patients and physicians and ultimately health care outcomes in ways we might not even imagine. First let us study it, before we abandon it on the basis of there being no evidence in support of it. It is still part of our culture, as demonstrated by the nice work of Prochazka et al and others. We need to understand why."
(Arch Intern Med.
2005;165:1333-1334. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 27, 2005
Media Advisory: To contact corresponding author Randall S. Stafford, M.D., Ph.D., call Susan
Ipaktchian at 650-725-5375.
GREATER USE OF EVIDENCE-BASED MEDICINE NEEDED IN U.S. OUTPATIENT CARE
CHICAGO—Although the quality of outpatient care in the United States has improved over the last decade, greater use of evidence-based medicine is needed, however, and quality of care is not significantly associated with the patient's racial or ethnic background, according to a study in the June 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
The recently released National Healthcare Quality Report (NHQR) identified a variety of areas where health care has markedly improved across time and is now reaching or surpassing national performance goals, as well as many more areas where the quality of health care delivery is suboptimal, according to background information in the article. Its companion document, the National Healthcare Disparities Report, demonstrated that racial, ethnic, and socioeconomic disparities in health care are national problems. However, the authors suggest, limited use has been made of readily available national survey data to measure quality of care and racial disparities in outpatient settings.
Jun Ma, M.D., Ph.D., and Randall S. Stafford, M.D., Ph.D., of Stanford University School of Medicine, Stanford, Calif., used data from the two national surveys of outpatient care to assess overall performance and racial/ethnic disparities in private physician offices and hospital outpatient departments in 1992 and 2002. The researchers examined 23 outpatient quality indicators, including appropriate antibiotic use, treatment of depression, avoiding unnecessary screening and avoiding inappropriate medications in the elderly. Quality indicator performance was defined as the percentage of applicable visits receiving appropriate care.
In 2002, mean performance was 50 percent or more of applicable visits for 12 quality indicators, seven of which were in the areas of appropriate antibiotic use and avoiding unnecessary routine screening. Overall, the researchers found, changes between 1992 and 2002 were modest, with significant improvements in six indicators: treatment of depression (47 vs. 83 percent), statin use for hyperlipidemia [high blood lipid levels] (10 vs. 37 percent), inhaled corticosteroid use for asthma in adults (25 vs. 42 percent), and children (11 vs. 36 percent), avoiding routine urinalysis during general medical examinations (63 vs. 73 percent), and avoiding inappropriate medications in the elderly (92 vs. 95 percent). "We observed that similar, although less than optimal, care is being provided on a per-visit basis regardless of patient racial/ethnic background," the authors write.
"This study contributes to the ongoing efforts to develop a national system for measuring and reporting the quality of outpatient health care in the United States," the authors write. "The present findings suggest that large gaps exist between actual clinical practices and evidence-based recommendations in many areas of outpatient care. We found limited evidence that these performance gaps are closing as a result of proliferating evidence-based practice guidelines."
(Arch Intern Med.
2005;165:1354-1361. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Agency for Healthcare Research and Quality, Rockville, Md.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 27, 2005
Media Advisory: To contact Larissa Nekhlyudov, M.D., M.P.H., call John Lacey at 617-432-0442.
WOMEN WANT INFORMATION, OPPORTUNITY TO PARTICIPATE IN DECISION FOR FIRST MAMMOGRAM
CHICAGO—Women in their 40s considering their first screening mammogram want information on potential harm and benefits and want to participate in the decision-making process, according to a study in the June 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Routine screening mammograms are often recommended for women beginning at age 40, but primary care clinicians are encouraged to inform their patients of the benefits and potential harms of the procedure and to invite them to share in the decision making, according to background information in the article. Previous studies suggest that women overestimate the risk of breast cancer and the benefits of screening and are unaware of possible harm, the authors write. In addition, little is known about how much involvement women want in decision making about initiating screening.
Larissa Nekhlyudov, M.D., M.P.H., of Harvard Medical School, and colleagues surveyed women age 40 to 44 scheduled for their first screening mammogram. Women were asked to rate the importance to them of elements of information about the mammogram and their preferences for involvement in decision making, ranging from making the decision alone to having the decision made by her clinician alone.
Most of the 96 women surveyed preferred their primary care practioner as their main source of information about the screening mammogram. The women were particularly interested in logistical information before their mammogram, such as which steps to take following an abnormal mammogram (89 percent), how they would be contacted (75 percent) and how quickly (71 percent). They were also interested in potential harms, of false-positive results (84 percent) and false-negative results (82 percent). Being informed about the benefits of screening and about breast cancer risk were also rated as important. Information about pain and cost were desired less often.
When asked about their preferences for involvement in screening decisions, seven (eight percent) preferred that the decision be made by the woman herself, 35 (38 percent) preferred that the decision be made by the woman after considering her medical professional's opinion, 43 (46 percent) preferred that the woman and her clinician share the decision, and, eight (nine percent) preferred that the clinician make the screening decision. None preferred the clinician to make all medical decisions.
"Women have specific information needs before initiating screening mammography, including the logistics, harms, and benefits, and prefer to participate in the decision-making process," the authors conclude. "Effective methods for communicating desired information and involving women in the decision-making process should be developed. It needs to be determined when the information should be provided and by whom."
(Arch Intern Med. 2005;165:1370-1374. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a cancer prevention training grant from the National Cancer Institute, Bethesda, Md.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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