Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
Minorities receive fewer heart procedures
--Researchers in Annals of Internal Medicine try to pinpoint why
(Review, p. 352; Article, p. 328. See release next page.)
People who use complementary and alternative medicine are not dissatisfied with conventional care
A national survey of adults who saw a medical doctor and/or used complementary and alternative medicine (CAM) in the previous year reveals the porous boundaries between CAM and traditional medicine (Academia and Clinic, p. 344). Seventy-nine percent of those surveyed felt the combination of the two types of therapy was superior to either alone; 70 percent visited a medical doctor before or at the same time as seeing a CAM provider; between 77 and 81 percent had about the same level of confidence for a CAM provider as a medical doctor, and 63 to 72 percent did not tell their doctors they used at least one type of CAM therapy. Participants felt that CAM therapy was more helpful than conventional care for headaches and back and neck conditions and that conventional care was more helpful than CAM therapy for hypertension.
Study examines role of restricted activity among older people
--Editorial: Cutting Activity May Indicate Decline or "Just Having a Bad Day" (Article, p. 313; Editorial, p. 374.)
Minorities receive fewer heart procedures --Researchers in Annals of Internal Medicine try to pinpoint why
A review of research shows that African-American patients in the United States receive fewer heart procedures than white patients, even though heart disease, the nation's leading cause of death, is more common in African-Americans. Researchers, examining more than 60 previously published studies that included data on race and heart procedures, confirmed that minorities received fewer procedures, but they did not find conclusive research to explain why (Review, p. 352). They say that initiatives such as the federal Initiative to Eliminate Racial and Ethnic Disparities in Health by the year 2010 cannot succeed unless the underlying causes of lower rates of heart disease treatments and procedures can be identified. They suggest several factors that may affect which patients get needed treatments:
- Patient's education, marital and employment status, income and medical knowledge, beliefs and attitudes
- Physician attitudes
- Severity of the patient's medical condition
- Health system factors, such as reimbursement, financing and availability of heart procedures
Most studies examined only a few of these factors. The researchers say that future studies must examine all of these variables simultaneously to understand the racial differences in cardiac care.
Racial differences in procedure rates could be due to underutilization in African-American patients or overutilization in white patients. In a second article (p. 328), researchers tried to determine if overuse or inappropriate use of two heart procedures in white patients accounted for the differences in care. They examined Medicare records of nearly 4,000 elderly men and women from 173 hospitals in five states and found that rates of inappropriate coronary artery bypass graft surgery (CABG) were the same in African-Americans and whites. Rates of inappropriate percutaneous transluminal coronary angioplasty (PTCA) were higher among white patients but did not fully explain the racial disparities. Overuse varied more widely by state than by race or sex. These researchers suggest that the hospital or region in which a patient undergoes heart procedures may be the most significant factor in determining whether a patient receives an inappropriate heart procedure.
Journal
Annals of Internal Medicine