2010 Potpourri V

As PDAs and smartphones proliferate, medical uses follow.  One possible use is the viewing of radiologic images.  Researchers examined the ability of radiologists to read scans and xrays on PDAs and smartphones (the iTouch was used, which has a screen comparable to the iPhone) compared to typical computer monitors used to read such images.   (AJR Article) (abstract only)  The ability to accurately interpret the images was at least as good, in some cases better, on the PDAs and smartphones.

The Centers for Disease Control has a sub-group called the National Center for Health Statistics which does a National Health Interview Survey on various topics.  (All these subgroups, centers, etc. may help explain why we have an out-of-control federal budget.)   A recent survey included information on use of HIT by consumers.   (CDC Survey) It found that about 74% of adults 18-64 use the internet and 61% have used it to find health information.  About 3% used an online chat room for information.  Women were more likely than men to use the internet for health needs.  About 5% communicated with a provider by email, 6% had requested a prescription refill and 3% had made an appointment using the internet.

Cigna released a report on performance of its consumer driven heath plans.  (Cigna Study) Although one always has to be careful looking at a company’s analysis of its own performance, the study seems to have a solid methodological basis.  The medical cost trend for first-year members was 14% lower than for other plans and the lower trend appears to persist.  These members use preventive care more, are more engaged in health management and are more compliant with medication use, although they are cost-sensitive purchasers.

An editorial in the American Journal of Managed Care discusses issues related to guidelines and performance measures.  (AJMC Editorial) The editorial reflects on research published in the same issue. (Note that all AJMC articles are available free on the site.)  The research suggested that rigid application of a guideline, particularly when performance on it was to be publicly reported or used as a basis for compensation, may do harm to some patients.  To be useful for measurement purposes, guidelines have to be simple and the measuring process inexpensive.  This is not always consistent with state-of-the-art  medicine or with physicians using good judgment for individual patients.

Patients are consumers and research into general consumer behavior can be very helpful in understanding health-related behaviors and in designing intervention programs.  The current issue of the Journal of Consumer Research has a lengthy study of how Weight Watchers appears to work.   (JCR Study) (Abstract only)  The study uses Weight Watchers as an example of a support group and explores the dynamics of that group.  Support groups are widespread, particularly in health care.  The underlying model is described as a spiritual and therapeutic quest for well-being and specific psychological and behavioral mechanisms are described.  Really fascinating and thought provoking reading.

The current issue of the Journal of the American Medical Association  includes an article on research into use of feeding tubes for elderly patients with dementia.  (JAMA Article) (Abstract Only)  The use of such tubes is not usually beneficial for outcomes and tends to vary widely across facilities and regions.  The research finds they are used more often in for-profit and large hospitals.  It is not clear that the use of these tubes would have been consistent with patient preference.  The study is just one more example of why it is critical for patient desires regarding care to be understood in advance and complied with.