Research Roundup: Medical homes; Drug samples and prescribing; The health law and disparities; Women's health; CBO projections

Sep 24 2010

Institute of Medicine: Women's Health Research: Progress, Pitfalls, and Promise -"Substantial progress has been made since the expansion of investment in women's health research. Research findings have changed the practice of medicine and public-health recommendations in several prominent contexts, including changes in standards of care for women. There have also been decreases in mortality in women from breast cancer, heart disease, and cervical cancer. In other contexts, however, there has been less progress..."

The report includes several recommendations, including a call for the "US government agencies and other relevant organizations [to] sustain and strengthen their focus on women's health, including the spectrum of research that includes genetic, behavioral, and social determinants of health," and "mainstream women's health research—in such a way that differences between men and women and differences between subgroups of men and women are routinely assessed in all health research" (Nancy Adler/Committee on Women's Health Research/Board on Population Health, 9/23).

Health Affairs/Robert Wood Johnson Foundation: Patient-Centered Medical Homes - "Patient-centered medical homes hold great promise to revitalize primary care, capitalize on investment in health IT, and encourage use of preventive care," according to this policy brief (.pdf) that examines the concept of the patient-centered medical home, including the elements required for such distinction. The brief provides details about the outcomes of seven patient-centered medical home demonstration projects and plans for future Medicare projects, while noting that "some experts argue that in addition to adopting the patient-centered medical home model, payment reform will have to be put in place before the benefits can be captured fully. (Cassidy, 9/14).

Kaiser Family Foundation: Health Reform And Communities Of Color: Implications For Racial And Ethnic Health Disparities - "This issue brief examines the key provisions of the 2010 health reform law that will expand health coverage and are likely to improve access to care for people of color, as well as some of the other provisions that will likely have either a direct or indirect impact on health disparities." The new law "contains some provisions specific to health disparities," such as "provisions [that] focus on improving data collection on race, ethnicity, primary language, geographic area, and disability. .... Some of the provisions pertinent to racial and ethnic health disparities included in the health reform law rely on grants and demonstration projects. Due to fiscal constraints, it is likely that many people will be left out of the grantmaking process. Demonstration projects are helpful to gather knowledge where little exists, but unless the successful findings are incorporated into existing programs and unless new programs are generated to put the knowledge of what works into practice, it is unlikely that these projects will contribute as much as they could towards the reduction in racial and ethnic health disparities" (9/15).

The Heritage Foundation: The Uncertainty of Health Care Projections - The authors of this brief focus "on the idea that the CBO could be wrong in its estimates" about the financial effects of the new health law. They examine the individual mandate, Medicare cuts, future new taxes and administrative costs, among other elements of the law. The authors conclude: "By rule, CBO has to score what the legislation says will happen. Other policymakers are not bound by such rigid constraints and can take into account other factors, such as popularity among politicians and voters. Thus certain provisions (such as the Medicare cuts) may never come to pass due to politics. ... Forecasting is a difficult business, and beliefs that the health care bill will lower budget deficits are precarious" (Blase, Hederman Jr. and Winfree, 9/23).

Annals of Family Medicine: Effect Of Drug Sample Removal On Prescribing In A Family Practice Clinic - This study examines the changes in physician prescribing patterns over 18 months at a small private practice clinic in central Oregon after it restricted visits from pharmaceutical representatives and the physicians stopped accepting and distributing drug samples.  Drug makers nationally spend more than $25 billion on promotional activities and previous studies have shown that "industry detailing and drug samples have a strong impact on prescribing behavior." 

The researchers found that the restrictions "produced modest reductions in branded drug use" that varied by the type of drug. Overall "use of promoted agents decreased by 1.43% while non-promoted branded agents increased by 3.04%. ... Relative to the control group, prescriptions of promoted cholesterol-lowering drugs and antidepressants were reduced by approximately 9.98% and 11.34%, respectively. [But] Overall, average prescription drug costs increased" (Hartung et al., September/October).