News in brief - Jan. 16, 2006

Trust helps motivate patients - Decline requests for Tamiflu - GERD treatment strategies - Diabetes control lowers cardiovascular risks

Trust helps motivate patients

Among patients with an existing relationship with a physician, those who trust their doctors are less likely to put off care when they need it or to have unmet medical requirements, says a study in last month's Health Services Research. "Increasing patients' trust in a physician may be associated with improvement among patients in two important areas: getting care promptly and getting needed health care," the authors wrote.

Researchers analyzed data from the Community Tracking Study Household Survey, a national study by the Center for Studying Health System Change designed to track changes in the health care system. Among minorities, the poor and the uninsured, there was no connection between trust and delaying care.

Decline requests for Tamiflu

In the wake of news reports about the emergence and potential threat of avian influenza, patients are increasingly asking for prescriptions for oseltamivir to stockpile the drug in case the disease hits here, but physicians should tell them no, say several papers in the New England Journal of Medicine last month.

"An individual physician has no obligation to prescribe oseltamivir in response to a patient's request," wrote the authors of one perspective piece.

This advice comes as more and more evidence suggests that overuse of this drug is leading to the development of resistance, including one paper in the same issue of the NEJM that documented two deaths in Vietnam. Both deaths were associated with a variant of the virus that was no longer susceptible to the drug.

The American Medical Association has issued statements against stockpiling because of fears that it would lead to resistance and reduce available supplies needed if a pandemic occurs. The Centers for Disease Control and Prevention and several state public health departments also have issued guidelines calling for the drug to be prescribed primarily to treat seasonal influenza in those at the highest risk of dying.

GERD treatment strategies

Drugs can be as effective as surgery for managing gastroesophageal reflux disease, according to a Dec. 14, 2005, report by the Agency for Healthcare Research and Quality.

The report is the first to result from a comparative effectiveness review, a new AHRQ program that compares alternative treatments for health conditions.

The report, "Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease," compares treatment approaches for chronic, uncomplicated GERD, where the condition is likely to require life-long management but does not involve more serious disease of the esophagus.

For the majority of patients, proton pump inhibitors can be as effective as surgery at relieving symptoms and improving quality of life, according to the report. And although surgery is sometimes chosen to remove the need to take medications, the evidence is unclear that medications will be unnecessary in the future.

AHRQ's new program was created to help patients and physicians select among treatments by reviewing existing studies and comparing the outcomes of different treatments. Nine more reviews are under way.

Diabetes control lowers cardiovascular risks

Intensive glucose control lowers the risk of heart disease and stroke by about 50% in people with type 1 diabetes, according to a study in the Dec. 22, 2005, New England Journal of Medicine. The findings are based on a follow-up study of patients who took part more than a decade ago in the Diabetes Control and Complications Trial.

"We see a greater reduction in cardiovascular events from intensive blood glucose control than from drugs that lower blood pressure and cholesterol," said Saul Genuth, MD, professor of medicine at Case Western University and chair of the follow-up study, Epidemiology of Diabetes Interventions and Complications.

"The benefits of intensive control strongly reinforce the message that this therapy should begin as early as possible and be maintained as long as possible," Dr. Genuth said.

During the original trial, which took place between 1983 and 1989, conventional treatment consisted of one or two insulin injections a day with daily urine or blood glucose testing. For the follow-up study, participants who were randomly assigned to intensive treatment were asked to keep glucose levels as close to normal as possible. That meant trying to keep hemoglobin A1c readings at 6% or less with at least three injections a day or with an insulin pump guided by frequent self-monitoring.