Research roundup: Successful medical homes; shortage of HIV doctors; boosting use of $4 generic drugs

Mar 19 2011

Every Friday, Jennifer Evans compiles this selection of recently-released health policy studies and briefs.

Archives of Internal Medicine: Potential Savings From Greater Use of $4 Generic Drugs - Discounted generic prescription drug programs ($4 per 30-day supply or $10 per 90-day supply) are currently offered at several retail stores. Researchers found that about half the people in the survey filled a prescription during 2007 and about half of those people used a drug that is available as a generic for $4. But less than 6 percent  buying those drugs purchased them in the $4 programs offered by the retailers. "The societal savings would be $5.8 billion in 2007 if all potential users switched to a $4 program," the authors note, which they point out would be a savings of 2.5 percent of the nation's total health expenditures (Zhang, Zhou and Gellad, 3/14).

Institute of Medicine: HIV Screening And Access To Care - "More than 200,000 people living with HIV/AIDS in the United States do not know they are infected. Increased HIV testing may help identify these individuals, reducing the chance that they will spread HIV to others and improving their health outcomes," according to this major report that examines the growing shortfall of providers who offer HIV services and a lack of provider training in HIV issues, and proposes strategies to fill these holes. "To meet the growing demand for care, the committee concludes that more practitioners need training in HIV/AIDS treatment and care; and their hospitals, clinics, and health departments must receive sufficient funding to maintain their staff and support screening effort (3/16).

Annals of Family Medicine: Progress Of Ontario's Family Health Team Model: A Patient-Centered Medical Home - This paper describes the development, implementation and reimbursement scheme for Ontario Family Health Team (FHT) model. About 170 of the interdisciplinary teams serve 2 million people in Ontario. "If the current US primary care practice model continues as it is today, 44,000 additional family physicians and general internists would be needed in 2025 simply to maintain current numbers of visits for each adult as the population increases and ages," the authors write. "To achieve this goal would require an immediate increase of about 3,000 family medicine and general internal medicine graduates annually. An increase of this magnitude seems unlikely, but wide adoption of patient-centered medical homes could be part of the workforce solution by providing a desirable workplace for needed physicians, nurse practitioners, and physician assistants" (Rosser, Colwill, Kasperski and Wilson, 3/15).

Archives of Internal Medicine: The Effect Of Guided Care Teams On The Use Of Health Services - This study examines guided care - a model of interdisciplinary primary care - for patients 65 years and older who were suffering from more than one chronic illness. The researchers write: "Eight services of a guided care nurse working in partnership with patients' primary care physicians were provided: comprehensive assessment, evidence-based care planning, monthly monitoring of symptoms and adherence, transitional care, coordination of health care professionals, support for self-management, support for family caregivers, and enhanced access to community services. Outcome measures were frequency of use of emergency departments, hospitals, skilled nursing facilities, home health agencies, primary care physician services, and specialty physician services." They concluded: "Guided care reduces the use of home health care but has little effect on the use of other health services in the short run" (Boult et al., 3/14).

Centers for Disease Control and Prevention: Enhancing Use Of Clinical Preventive Services Among Older Adults - This report examines clinical preventive services for adults 65 and older and highlights gaps in their use. "Of all the preventive services featured in this Report, the largest gap in use can be found for osteoporosis screening by women aged 65 years and older," with 62 percent of black women and 54 percent of American Indian/Alaska Native women reporting having never received an osteoporosis screen compared to 33 percent of white women, the report states. "Gaps in use for five of the remaining recommended services - colorectal cancer and diabetes screening, influenza and pneumococcal immunizations, and smoking cessation counseling - are somewhat smaller but still significant." The CDC notes that "[c]ontributors to and supporters of this report agree that the use of such services should be a high priority of community and health systems alike" (3/14).

Journal of the American Medical Association: Geographic Variation In Diagnosis Frequency And Risk Of Death Among Medicare Beneficiaries -Researchers analyzed the average number of nine chronic conditions (cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure, and dementia) diagnosed in Medicare beneficiaries in 306 hospital referral regions in the U.S. in 2007. The authors report: "As the number of diagnoses of chronic conditions increased in individual patients, there was an associated increased risk of death. However, as the number of diagnoses increased among geographically defined populations ... there was little relationship with population-based mortality." They offer several theories for the differences between the groups (Welch et al., 3/16).

Kaiser Family Foundation: CHIP Enrollment: December 2009 Data Snapshot - "This report provides the latest data on Children's Health Insurance Program (CHIP) enrollment and policy trends nationally and across the states through December 2009, based on survey responses and data provided by CHIP directors in all 50 states and the District of Columbia. The report finds that for the first time in program history CHIP enrollment exceeded 5 million." According to the brief, the number of children enrolled in CHIP increased in 34 states and the District of Columbia, with the largest increase in 2009 taking place in Texas and the largest percentage growth taking place in Montana (3/10).