Table of Contents
The Issue in Brief
Richard H. Glazier , and colleagues
Background Does universal coverage of physician services reduce socioeconomic disparities in health care? If so, to what degree? Researchers in Canada, which has universal coverage of necessary physician services, examined equity in the use of those services.
What This Study Found Universal health insurance appears to reduce income inequities but not education-related disparities in physician services. Those with higher levels of education are more likely to see specialists, to be frequent visitors to the doctor, and to bypass primary care to reach specialists compared with those with lower levels of education.
Implications
- One explanation for the study findings may be that patients with higher levels of education have better health knowledge, which leads to greater demand for care and better ability to navigate the health care system.
- The authors suggest that policy makers consider the advantage of providing universal physician coverage as a means to reduce income inequities, although this strategy alone is unlikely to eliminate educational disparities in use of physician services.
Children�s Receipt of Health Care Services and Family Health Insurance Patterns
Jennifer E. DeVoe , and colleagues
Background Research has shown that children with health insurance have better access to care than uninsured children; however, less is known about how parents' insurance coverage affects their children�s care. This study examined relationships between different family insurance patterns and children�s access to health care and preventive medical services.
What This Study Found When parents lack health insurance, their insured children are more likely to go without necessary medical and preventive services. Among 43,509 US children 2 to 17 years old, insured children with uninsured parents had higher odds of an insurance coverage gap, no usual source of care, unmet health care needs, and not receiving at least one preventive counseling service compared with insured children with insured parents.
Implications
- Based on the study findings, if the current trend continues, the majority of US children will soon live in families with discordant and disrupted patterns of family health insurance.
- The authors call for policy makers to look beyond child-only insurance models. They describe an urgent need to replace the current patchwork of public insurance and private insurance with a new comprehensive model that provides a basic level of stable coverage to all families and everyone in the family.
Depression and Increased Mortality in Diabetes: Unexpected Causes of Death
Elizabeth H. B Lin , and colleagues
Background Previous research has found that people with diabetes are more likely than others to experience depression, and that people with both diabetes and depression have higher rates of death than diabetes patients with no depression. This study examined whether depression in diabetes patients was associated mainly with death from cardiovascular disease (the focus of most research on depression and mortality since the two were first linked), or whether it was also associated with increased risks of death from other common medical causes.
What This Study Found Patients with both diabetes and depression face substantially higher risks of death beyond cardiovascular-related death.
Implications
- Obesity, smoking, and physical inactivity are more common among patients with diabetes and depression compared with diabetes patients without depression, and may help explain the association of depression with a wide range of causes of death. Other factors contributing to higher death rates could include not taking medicines as prescribed and physiologic changes.
- Future research on patients with diabetes and depression should aim to improve health behavior, medication adherence, and control of other medical conditions, in addition to ensuring optimal depression care.
Yield of Opportunistic Targeted Screening for Type 2 Diabetes in Primary Care: The Diabscreen Study
Erwin P. Klein Woolthuis , and colleagues
Background The American Diabetes Association recommends that high-risk adults be tested for diabetes. This study assessed the results of opportunistic targeted screening for type 2 diabetes in the primary care setting.
What This Study Found The yield of an opportunistic targeted screening program was fair: in 1year, undiagnosed type 2 diabetes was identified in 101 high-risk patients (2.7%). The yield of screening in low-risk patients was only 0.4% Of the American Diabetes Association risk factors, obesity was the strongest predictor of undiagnosed type 2 diabetes.
Implications
- Opportunistic screening for type 2 diabetes in primary care could target middle-aged and older adults with obesity.
- These findings confirm a low yield in screening low-risk individuals for diabetes.
Availability of Antibiotics for Purchase Without a Prescription on the Internet
Arch G. Mainous III , and colleagues
Background Overuse of antibiotics has contributed to the spread of antibiotics resistance, an important clinical and public health issue. Most initiatives to address this problem focus on prescribing by clinicians. The purpose of this study was to examine the availability of antibiotics without a prescription on the Internet. The authors conducted a simple search with the keywords �purchase antibiotics without a prescription� and �online� on the Google and Yahoo search engines.
What This Study Found Antibiotics are freely available for purchase on the Internet without a prescription. Researchers found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36 percent sold antibiotics without a prescription and 64 percent provided an online prescription. Nearly all shipped to the United States with an average delivery time of 8 days. Vendors who sold antibiotics without a prescription were more likely to sell in quantities greater than a single course and more likely to take more than 7 days for the antibiotics to reach the customer than were vendors who required a medical interview, suggesting that these transactions would likely be used by individuals storing the drugs for future self-diagnosis and treatment.
Implications
- There is potentially a large pool of antibiotics in the US that is not affected by efforts to change doctors' prescribing habits. The ready availability of these antibiotics may be contributing to antibiotic resistance.
- The authors call for public health officials to expand their efforts to control antibiotic resistance to include education directed to patients and the community, as well as increased regulation and enforcement of existing regulations.
Beth Barnet , and colleagues
Background Almost one-quarter of adolescent mothers give birth to another child within 2 years of having a baby. Repeat births in adolescents have been shown to increase risks of poorer medical, educational, economic, and developmental outcomes. This study evaluates the effectiveness of a program that combines computerized information, individual counseling by community members, and home visits. Some participants received additional services, such as parenting training. The goal of the program was to prevent rapid repeat births in low-income African-American adolescent mothers.
What This Study Found The program was effective in reducing subsequent birth within 24 months in teen mothers. The group that received additional services, including parenting training, had a 44% reduction in repeat births. Mothers in this group who reported continuous insurance coverage had the greatest reduction in the risk of repeat births.
Implications
- Receipt of at least two computer-assisted motivational intervention sessions reduces the risk of rapid subsequent birth to low-income, African American adolescent mothers.
- The approach used in this study can be effective in reducing repeat births, but its impact may be affected by participants' insurance coverage.
Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice
Anita Feleus , and colleagues
Background Complaints about the arm, neck, and shoulder are common in Western societies, but there is wide variation in the management of these complaints. This study evaluated associations between diagnosis and characteristics of the patient, complaint, and general practitioner and 6 common management decisions in patients with nontraumatic arm, neck, and shoulder complaints.
What This Study Found In treating arm, neck, and should conditions, a long duration of complaints and many limitations in functioning were most frequently associated with the choice of a management option. This study of 682 patients seen in 21 Dutch general practices also identified several physician characteristics that appear to play a role in determining the course of treatment.
Implications
- The lack of solid evidence in favor of the treatment options explored in this study may explain variability in management of these conditions and may leave more room for personal preferences of both the patient and doctor.
Diagnostic Accuracy of Spanish Language Depression-Screening Instruments
Daniel S. Reuland , and colleagues
Background Because of differences in language and culture, research based mainly on studies in English-speaking populations may not be applicable to non-English-speaking populations. This study systematically reviewed past research summarizing the evidence on diagnostic accuracy of depression-screening instruments for Spanish-speaking populations in primary care settings.
What This Study Found The study found fair evidence to support the use of 5 commonly used instruments to accurately screen for depression in Spanish-speaking patients.
Implications
- There is limited evidence that directly guides primary care-based depression-screening for Spanish speakers, a large and rapidly-growing segment of the US population.
- The study found important gaps in knowledge. In particular, no evidence was found to directly support the accuracy of ultrashort screening instruments in Spanish. This is an important topic for future research.
Steve M. Blevins
Background A primary care doctor reminds us that when it comes to clinical practice, patients are doctors� greatest teachers. The author reflects on how a longtime patient�s experience with a degenerative disease offered him solace, inspiration, and a glimpse into his own future.