Annals of Internal Medicine Tip Sheet for Nov. 20, 2007, Issue

1. Physicians Spend Much Time Outside Patient Visits Providing Unreimbursed Care

A new study found that physicians caring for older adults spent nearly eight hours a week on patient care in addition to office visits (Article, p. 693). This time may be spent talking with families or ordering medicines or specialist care. Medicare pays physicians only for face-to-face visits.

At an average of 6.7 minutes of care provided outside of office visits for every 30 minutes seeing a patient, approximately one-fifth of the geriatricians’ care was provided without pay.

An editorial writer says that the findings for geriatricians are applicable to all adult primary care (Editorial, p. 730). The writer describes two reform proposals that would pay for currently unreimbursed time. “If physicians are to improve their care coordination performance, they need time to do the work and must be paid for the work,” he says.

2. New Study: Lumbar Supports Reduced Low Back Pain but Not Sick Days

A new randomized controlled trial found that health care workers with existing low back pain given one of four lumbar supports and counseling about healthy work methods had less pain than a control group that received only the counseling (Article, p. 685).

The lumbar-support groups did not have fewer work absences than the control group.

3. Head-to-Head Comparison of Arthritis Drugs Did Not Find a Clear Winner

A systematic review of published literature of drugs for rheumatoid arthritis showed no clinically important differences in efficacy among two major classes of drugs, synthetic disease-modifying antirheumatic drugs (DMARDS) and anti-tumor necrosis factor drugs.

The DMARDs evaluated were methotrexate, leflunomide, and sulfasalazine. The anti-tumor necrosis factor drugs were adalimumab, etanercept, and infliximab.

Researchers found that in patients previously receiving a single drug, combination therapy with DMARDs improved response rates, but available evidence does not indicate which combination strategy is best.

Note: This article is released early online at the Web site of Annals of Internal Medicine www.annals.org. It will appear in the Jan. 15, 2008, print edition of the journal.

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