Research roundup: Prevention task force PSA testing recommendations often ignored; Medicaid expansion for minorities; ER and aging population

Jul 12 2013

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Population Aging And Emergency Departments: Visits Will Not Increase, Lengths-Of-Stay And Hospitalizations Will – The authors examined how the growing number of elderly Americans would affect the large and increasing part of non-catastrophic outpatient care. Using Census Bureau and nationally representative survey data, researchers quantified the number of ED visits that would occur if the demographic structure of the U.S. population changed, but everything else remained the same. "We observed that it is actually infants and young adults, not the elderly, who account for the largest number of ED visits," the authors write, and conclude: However, the data do predict increases in visit lengths and the likelihood of hospitalization. As a result, the aggregate amount of time patients spend in EDs nationwide will increase 10 percent faster than population growth. This means that ED capacity will have to increase by 10 percent, even without an increase in the number of visits. Hospital admissions from the ED will increase 23 percent faster than population growth, which will require hospitals to expand capacity faster" (Pallin et al., 7/8).

Annals Of Family Medicine: Telephone Outreach To Increase Colon Cancer Screening In Medicaid Managed Care Organizations: A Randomized Control Trial – As screening rates for colorectal cancer (CRC) increased over time, the number of deaths related to the disease declined. But among Hispanic, African American, low-income, and immigrant populations, the screening rates remain low. Researchers at Dartmouth Hitchcock Medical Center examined whether an 18-month telephone outreach by three Medicaid managed care organizations in New York (MMCO) could increase screening rates. They provided support and information  to more than 500 randomly-selected patients. "CRC screening telephone outreach was successfully delivered using internal MMCO resources rather than externally funded research staff, with CRC screening rates from one-third higher to nearly double among women receiving the intervention," the authors write. They conclude: "This study shows that MMCOs, key players in the delivery of health care to publicly insured and underserved populations, can successfully implement interventions to increase CRC screening, reducing health care disparities among a difficult to reach population"(Dietrich et al., 7/9).

American Journal Of Preventive Medicine: Prostate-Specific Antigen Testing: Men's Responses To 2012 Recommendation Against Screening – The U.S. Preventive Services Task Force (USPSTF) has recommended against prostate-specific antigen (PSA) testing for middle-aged men with no history of prostate cancer. Researchers aimed to assess the level of awareness regarding the new recommendation among men aged 40-74. After surveying 1,089 men, they found that while 62 percent agreed with the recommendation, only 13 percent said they would not get a PSA test ini the future, while "54% were non-intenders
(they planned to not follow the U.S. Preventive Services Task Force recommendation and get a
prostate-specific antigen test in the future; and 33% were undecided." The authors conclude that "consumers are favorably disposed to PSA testing, despite new evidence suggesting that the harms outweigh the benefits. The new USPSTF recommendation against PSA testing in all men may be met with resistance" (Squiers et al., 7/9).

Kaiser Family Foundation: The Impact Of Current State Medicaid Expansion Decisions On Coverage By Race And Ethnicity – The June 2012 U.S. Supreme Court decision on the federal health law gave states the choice to expand Medicaid. As of July 1, 24 states are moving forward in expanding their Medicaid programs and six are considering it. In this issue brief, researchers analyzed 2011 survey data to determine the implications resulting from states' decision to reject or proceed in expanding Medicaid. "[P]eople of color will be disproportionately impacted by state decisions to expand Medicaid; the impact of current state Medicaid expansion decisions varies widely by race and ethnicity, Blacks are at highest risk of continuing to face coverage gaps due to state decisions not to expand at this time; and expansion decisions by a few key states have significant implications for coverage across races and ethnicities," the authors write (Artiga and Stephens, 7/2).

Here is a selection of news coverage of other recent research:

Medpage Today: GAO Says No To Ditching Paper Drug Labeling
Eliminating paper drug labeling such as package inserts in favor of e-labels could compromise the availability of information for some patients, physicians, and pharmacists, a government study found. Stakeholders provided no consensus on the advantages or disadvantages of relying on drug labeling available only electronically,the Government Accountability Office (GAO) said in a report Monday. Drug manufacturers have supported eliminating paper labels, whereas patient advocates suggest it could adversely affect public health (Pittman, 7/11).

NPR: After FDA Approval, Drugmakers Often Miss Study Mark
Since 2007, the Food and Drug Administration has had the power to require drugmakers to continue studying the safety of their pills or other medicines as a condition for approving them in the first place. Before then, the studies were largely voluntary and many never got done. So how's the mandatory approach going? Kevin Fain, a research fellow at Johns Hopkins Bloomberg School of Public Health, and some colleagues took a look at the five-year period ending in 2011. ... before the FDA got new powers there were over a thousand studies -; more than half of those the agency expected to be performed-; that hadn't been started by drugmakers. That number fell to 775 studies, or about 44 percent, in 2011. ... The analysis appears in JAMA (Naudziunas, 7/11).

Oregonian: Residents Who Complete Rural Rotation More Likely To Work In Rural Areas
Surgical residents who complete a rotation in a rural area are far more likely to later practice in a rural area, according to a study published this month. Researchers from Oregon Health & Science University looked at data from residents at OHSU who had completed the school's year-long rural rotation. They found that those who did the rotation were both far more likely to later practice in a rural area, and also to enter into general surgery practice (Karlamangla, 7/10).

Related KHN story: Wanted: Mavericks And Missionaries To Solve Mississippi's Doc Shortage (Hess, 4/26)

Medscape: Telehealth Safe for Some Postoperative Evaluations
Hands-on ambulatory surgery in some instances can be followed by hands-off telehealth assessments for postoperative patient, according to a new prospective case series from the Palo Alto Veterans Administration Health System in northern California. The study, by certified medical assistant Kimberly Hwa, MMS, PA-C, and Sherry M. Wren, MD, a professor of general surgery at Stanford Medical School in California, suggests telehealth can safely substitute for the standard postoperative clinic visit while maintaining a high level of patient satisfaction. The study was published online July 10 in JAMA Surgery (Brice, 7/10).

Medscape: Physicians Urged to Ask Elderly Patients About Guns
The medical imperative to talk to patients about gun ownership and hence gun safety -; an imperative challenged by Florida and Wisconsin lawmakers -; usually centers on the need to prevent a small child from discovering, say, a loaded Glock in Dad's dresser. However, physicians also should inquire about guns in the homes of geriatric patients who may be at a higher risk for a gun-related fatality -; particularly suicide -; because of dementia, delusions, memory problems, and depression, according to an article by a healthcare attorney published online yesterday in the Annals of Internal Medicine (Lowes, 7/11).