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Am Fam Physician. 2005 Apr 15;71(8):1469-1470.

Demand for Subspecialists May Jeopardize Public Health

Increasing the number of primary care physicians in the United States would provide better health outcomes than letting market demand determine the number of subspecialists, according to two recent articles in Health Affairs. A study by Barbara Starfield, M.D., M.P.H., of Johns Hopkins University School of Public Health, Baltimore, and colleagues confirms the results of previous studies at state and other levels that found lower mortality rates in areas with more primary care physicians. The authors note that increasing the number of specialists likely will lead to greater disparities in health status and outcomes between the United States and other industrialized countries. Robert Phillips Jr., M.D., M.S.P.H., director of the Robert Graham Center in Washington, and colleagues agree that there is no benefit to adding more specialists to the physician workforce. In fact, they say, current efforts to satisfy demand for subspecialists actually may jeopardize public health. The article by Starfield, et al., is available online at http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.97/DC1. The article by Phillips, et al., is available at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.111v1.

CDC Survey Reveals Limited Use of Electronic Health Records Systems

Less than one third of hospital emergency and outpatient departments in the United States use electronic medical records, and even fewer physicians' offices do, according to a report from the Centers for Disease Control and Prevention (CDC). Although three quarters of physicians' offices use electronic billing systems, only 17 percent reported that they use electronic medical records to support patient care. In hospitals, 31 percent of emergency departments and 29 percent of outpatient departments reported using electronic records in a CDC survey conducted between 2001 and 2003. The survey measured the use of systems to improve the accuracy and safety of prescription drug use. About 8 percent of physicians use a computerized physician order entry system (CPOE) instead of prescription pads. These systems compare orders with standard dosages and check for potential allergies and drug interactions. The study found that physicians younger than age 50 are twice as likely as older physicians to use CPOEs. The full CDC report, “Use of Computerized Clinical Support Systems in Medical Settings: United States, 2001–03,” is available online at http://www.cdc.gov/nchs.

SAMHSA Offers $12.4 Million in Grants for Child Trauma Initiative

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced that nearly $12.4 million is available for 27 grants under the National Child Traumatic Stress Initiative. Nineteen grants totaling about $7.6 million will be awarded for community treatment and service centers to promote the local use of best practices for children who have experienced traumatic events. The average award is expected to be $400,000 per year, for up to four years. Eight grants totaling about $4.8 million will be awarded to provide national expertise on specific types of traumatic events, population groups, and service systems and to support specialized adaptation of effective treatment and service approaches for communities. The average award is expected to be up to $600,000 per year, for up to four years. More information is available online at http://www.samhsa.gov.

Preventive Diabetes Care Could Save $2.5 Billion per Year

Nearly two thirds of the annual costs for treating severe diabetes complications could be averted with appropriate primary care, according to the Agency for Healthcare Research and Quality (AHRQ). In 2001, approximately $3.8 billion was spent on inpatient hospital costs for diabetic complications such as heart disease, stroke, kidney failure, blindness, and nerve and circulatory problems. An AHRQ analysis concludes that nearly $2.5 billion could have been saved with appropriate preventive care. Approximately 30 percent of patients with diabetes are hospitalized multiple times in the same year for similar problems, and health care costs for diabetic patients with multiple hospital stays are three times higher than those for patients who are hospitalized only once. Blacks and other minorities are more likely than non-Hispanic whites to have multiple hospitalizations and higher hospital costs, as are patients enrolled in public insurance programs and those living in low-income communities. More information is available online at http://www.ahrq.gov/data/hcup/highlight1/high1.htm.

2-1-1 Program Provides Free Health and Social Services Information

A bill before a U.S. Senate committee would provide resources and funding for a telephone service that connects callers with free information about community-based health and social service programs. The 2-1-1 service, which is already active in 31 states, Washington, D.C., and Puerto Rico, connects callers with local food banks, shelters, crisis intervention hotlines, counseling services, drug and alcohol intervention programs, and maternal and children's health programs, as well as medical information, health insurance information, and other services. Launched in Atlanta in 1997, the 2-1-1 program is funded through local United Way agencies. The Senate bill would provide federal grants for states to implement the service. Additional information about the 2-1-1 service is available online at http://www.211.org; the Senate bill is available at http://thomas.loc.gov/cgi-bin/query/z?c109:S.211:.

Admissions for Treatment of Marijuana Abuse Increasing in the United States

Admission rates for treatment of marijuana abuse increased by more than 160 percent in the United States between 1992 and 2002, according to data from the SAMSHA. In 1992, the national admission rate for treatment of marijuana abuse was 45 per 100,000 persons aged 12 years and older. In 2002, the rate was 118 admissions per 100,000. Admission rates for treatment increased in at least 41 states, and in 18 states the rate more than doubled. The full report, “Trends in Marijuana Treatment Admission, by State: 1992–2002,” is available online at http://www.oas.samhsa.gov/2k5/MJstateTrends/MJstateTrends.htm.

Physician Counseling for Tobacco Cessation to Be Covered Under Medicare

Physicians who counsel patients about cessation of smoking and other tobacco use may be reimbursed under a recent decision from the Centers for Medicare and Medicaid Services (CMS). Coverage applies to patients with illnesses caused or complicated by tobacco use, as well as patients taking medications that may be less effective with tobacco use, such as insulin, antihypertensive agents, anticoagulants, and antidepressants. Physicians will be reimbursed for up to eight counseling sessions annually per beneficiary. The CMS decision memo is available online at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=130.

AAFP Offers Preparation Courses for ABFM Examinations

Family physicians taking the American Board of Family Medicine (ABFM) examinations can prepare for certification or recertification at the American Academy of Family Physicians' (AAFP's) Family Medicine Board Review courses. The six-and-one-half day programs will be offered in Seattle from April 17 to 23; Kansas City, Mo., from May 15 to 21; and Greensboro, N.C., from June 5 to 11. Lectures will be offered in internal medicine, geriatrics, surgery, pediatrics, women's health, and obstetrics. Breakout sessions will include electrocardiogram interpretation; nutrition; common ear, nose, and throat problems; and management of chronic pain. Online registration is available at http://www.aafp.org/x3298.xml.


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