Research roundup: Reform's impact on health spending; Cultural/Racial differences in medicine; Swine flu lessons

May 29 2010

Commonwealth Fund: The Impact Of Health Reform On Health Spending - This issue brief "projects the effect of national reform on total national health expenditures and the insurance premiums that American families would likely pay. We estimate that, on net, the combination of provisions in the new law will reduce health care spending by $590 billion over 2010-2019 and lower premiums by nearly $2,000 per family. Moreover, the annual growth rate in national health expenditures could be slowed from 6.3 percent to 5.7 percent" (Cutler, Davis, and Stremikis, 5/21).

Archives of Internal Medicine: Perceptions Of Race/Ethnic Discrimination In Relation To Mortality Among Black Women - "The life expectancy of black Americans is, on average, 5.0 years less than that of other Americans," write the authors of this study that analyzed "48,924 participants in the Black Women's Health Study (mean age, 40.5 years) for 8 years." They report there is "no association between reports of perceived racism and all-cause mortality. The risk estimates for women who reported the highest levels of perceived racism relative to those who reported the lowest were below 1.0 for cardiovascular mortality and greater than 1.0 for cancer mortality but not statistically significant," but conclude that longer follow-up and "further work is warranted in this complex area of research because continued race/ethnic disparities in mortality are not entirely explained by traditional risk factors" (Albert et al., 5/24).

American Heart Association: Patients In Stroke Belt Satisfied With Care, But Many Doctors Lack Cultural Awareness - Two surveys presented at the American Heart Association's 11th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke examine the experiences documented by patients and healthcare providers living in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia - a region known as the "nation's Stroke belt," according to an American Heart Association press release. The patient survey included 1,189 patients, more than 85 percent of whom reported they were satisfied with the care they received from their primary care physician.

Nonetheless, the abstract concludes: "Many [primary care physicians] in the South inadequately assess cultural health determinants and underutilize optimal communication methods. These gaps may have adverse consequences when white physicians care for black patients with CV risk factors, but may not be apparent to either party. Interventions that enhance cultural sensitivity and promote physician skill in effective communication and cross-cultural brokering may strengthen treatment alliances to reduce CV risk and reduce disparities in stroke" (Yancy et al, 5/27).

Archives of Internal Medicine: Impact Of The ALLHAT/JNC7 Dissemination Project On Thiazide-Type Diuretic Use - The authors analyzed two national databases - "a physician survey of medications reported for hypertension and a pharmacy dispensing database on antihypertensive medications" to examine if it's possible to change "national prescription prescribing practices." Trained "academic detailers" provided face-to-face education about the findings of the 2002 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and subsequent 2003 report by the Joint Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). 

While "[n]ationally, thiazide-type diuretic use did not increase between 2004 and 2008," the authors conclude "that there was a statistically significant increase in thiazide-type diuretic prescribing that was geographically associated with clinical investigator-centered academic detailing aimed at increasing use of thiazide-type diuretics," which can help prevent high blood pressure (Stafford et al., 5/24).

New England Journal of Medicine: The Public's Response To The 2009 H1N1 Influenza Pandemic -- The authors write: "Given the crucial role that the public plays in containing or spreading illness and in seeking related medical care, we have examined the public's response to the 2009 H1N1 pandemic and relevant public health recommendations through a comprehensive review of available data from [20] national public opinion polls conducted by telephone between April 2009 and January 2010."

"Our review of these data suggests that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both. More work may need to be done to understand the basis of these beliefs and to address them in the case of a serious influenza outbreak. Polls during the 2009 H1N1 pandemic also suggest that public health communication efforts related to other personal influenza-prevention behaviors were effective in reaching a large swath of the public" (SteelFisher, Blendon, Bekheit and Lubell, 5/19)