Research Briefs: June 2009

• Privately Insured Patients Have Better Gastric Bypass Outcomes

Digestive Disease Week Abstract M1588; presented June 1, 2009; Chicago, IL.

Insurance status may affect long-term outcomes for patients undergoing Roux-en-Y gastric bypass surgery, a California medical center study shows. Demographic, preoperative, and one-year postoperative data was collected on 750 patients who were divided into private insurance, Medicare, and MediCal study groups. Although all groups had significant weight loss, patients with private insurance lost more weight and had better resolution of comorbidities. At 12 months postoperatively, patients with private insurance had the lowest BMI, lowest complication rate, and the largest improvement in c-reactive protein levels. Medicare patients saw the greatest improvement in hemoglobin A1C levels. Significant preoperative demographic differences existed in the Medicare group, which was older and had a higher percentage of whites, higher BMI, and higher prevalence of depression and hypertension. The MediCal group had the highest percentage of women. Researchers concluded that the type of insurance correlates with demographics and outcomes of patients undergoing gastric bypass surgery.

• Geographic Analyses May Explain Racial Differences in Cancer Survival

Cancer. 115:2212-2221. [May 15, 2009]

Large-city studies have previously shown that whites experience significantly higher survival rates for prostate and breast cancer compared with blacks in large geographic areas; but in smaller geographic areas, such as community-defined neighborhoods, disparities virtually disappear. Researchers used data compiled on 124,218 breast cancer cases and 120,615 prostate cancer cases from the Michigan Cancer Surveillance Program to analyze cancer survival rates in various southern Michigan geographic locations. As geographic scales decrease, populations become more homogenous in terms of income, access to care, and other factors that may influence cancer survival.

• Costs of Interactions With Health Plans $21-$31 Billion per Year

Health Affairs. 28:w533-w543. [May 14, 2009]

A national survey conducted by Medical Group Management Assn. showed that physicians spend 43 minutes per day—an equivalent of three hours a week and nearly three weeks per year—interacting with health plans. Total staff time converted to $21 billion to $31 billion annually, or more than $68,000 per practice per year, on average. Primary care physicians spent significantly more time than medical or surgical specialists; nursing and clerical staff spent much larger amounts of time than that. Interactions included authorizations, formulary, claims/billing, credentialing, contracting, and quality data. Practices spend the most time on dealing with formularies. Forty-one percent of respondents said that they believed that costs had increased a lot over the past two years; 36.4% said that they had increased somewhat. Researchers say that these data are an indicator of the need to streamline healthcare administration for physicians.

• New Tool for Predicting Alzheimer’s in Older People

Neurology. doi:10.1212/WNL.0b013e3181a81636. [May 13, 2009]

A new tool for predicting whether a person 65 years old or older is at risk for developing dementia has been developed by researchers at the San Francisco VA Medical Center. The tool could identify people with no signs of dementia but who are at high risk, allowing treatment to begin as soon as possible.

Researchers tracked 3,375 participants with no signs of dementia (mean age, 76 years) for six years. By study end, 14% of participants had developed dementia. Variables significantly predictive of dementia were used to develop a 15-point test and those who score 8 or more points have a high risk of developing dementia within 6 years. Fifty-six percent of people in the study with high scores developed dementia. Some items are well-known risk factors: older age, low scores on cognitive tests, and the presence of a gene linked to Alzheimer’s. However, surprising factors such as slow physical functioning, a history of coronary bypass surgery, low weight, and nonconsumption of alcohol also were predictive.

• Women More Likely to Have Problems Affording Healthcare

The Commonwealth Fund 2007 Biennial Health Insurance Survey.http://www.commonwealthfund.org/Content/Surveys/2007/2007-Commonwealth-Fund-Biennial-Health-Insurance-Survey.aspx/. [May 11, 2009]

A 2007 Commonwealth Fund health insurance survey shows that women are more likely than men to have problems getting or affording healthcare. Seven out of 10 American working-age women are uninsured, underinsured, or have medical debt or access problems. Overall, 52% of women have problems affording healthcare compared with 39% of men. Forty-five percent of women have problems paying medical bills compared with 36% of men. Healthcare costs affect women more than men because, on average, they have lower incomes, have higher out-of-pocket costs, and need to access healthcare systems more often. Women are also less likely to have employer-provided insurance, sometimes because they work part time.

• Acupuncture Is Effective at Relieving Lower Back Pain

Arch Intern Med. 169:858-866. [May 11, 2009]

Needle acupuncture and simulated acupuncture are equally effective for low back pain, according to results of The SPINE (Stimulating Points to Investigate Needling Efficacy) trial. Patients received standard medical (usual) care, one of two needle acupuncture techniques, or simulated acupuncture. Dysfunction scores at eight weeks improved significantly more for patients in the acupuncture groups than for those in the usual-care-only group; benefits lasted for a year. Results showed that simulated acupuncture was as beneficial as needle acupuncture, which raises questions about how acupuncture works, said researchers.

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