Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Women's Preventive Services Initiative recommends screening for anxiety in women and adolescent girls 13 years or older
Review: https://www.acpjournals.org/doi/10.7326/M20-0579
Guideline: https://www.acpjournals.org/doi/10.7326/M20-0580
Editorial: https://www.acpjournals.org/doi/10.7326/M20-3116
URL goes live when the embargo lifts
The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, recommends screening for anxiety in women and adolescent girls 13 years or older, including pregnant and postpartum women. Screening involves completing a brief clinician- or self-administered questionnaire that describes symptoms of anxiety. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. Given the high prevalence of anxiety disorders, lack of recognition in clinical practice, and multiple problems associated with untreated anxiety, clinicians should consider screening women who have not been recently screened. The recommendation was adopted by the Health Resources and Services Administration and will be incorporated into the summary of covered benefits for preventive services without cost-sharing as required by the Patient Protection and Affordable Care Act. Both the guidelines and a systematic review of the evidence are published in Annals of Internal Medicine.
Lifetime prevalence of anxiety disorders in women is approximately 40 percent, twice that in men. Despite the high prevalence and burden of anxiety disorders and the availability of methods for screening, diagnosis, and treatment, only an estimated 20 percent of affected men and women seek care. The goal of clinical recommendations for screening is to increase detection and achieve earlier diagnosis of specific types of anxiety and co-occurring conditions; initiate appropriate treatment; and improve health, function, and well-being for women and girls.
To develop the recommendations, researchers reviewed studies that enrolled adolescent girls and adult women not currently diagnosed with anxiety disorders, including those who were pregnant or postpartum, and compared clinical outcomes and harms between women who were and were not screened; diagnostic accuracy studies of screening instruments; and systematic reviews of randomized trials of behavioral and pharmacologic treatments. No studies examined the overall effectiveness and harms of screening for anxiety. But the researchers found strong evidence that screening instruments for anxiety are moderately to highly accurate and that behavioral therapies and antianxiety medications effectively improve anxiety symptoms.
The authors of an accompanying editorial from Yale University School of Medicine suggest that these recommendations are a great start, but issues need to be addressed to ensure that these recommendations can be implemented in clinical practice. In addition, they suggest that it is worth considering why anxiety is so prevalent and what can be done from a public health perspective to prevent it.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author of the review, Heidi D. Nelson, MD, MPH, please contact Tracy Brawley at brawley@ohsu.edu. To request an interview with someone from the WPSI, please contact Kate Connors kconnors@acog.org.
2. Filling an opioid prescription in postpartum period strongly associated with overdose and other serious opioid-related events
Abstract: https://www.acpjournals.org/doi/10.7326/M19-3805
URL goes live when the embargo lifts
Filling an opioid prescription in postpartum period is strongly associated with overdose and other serious opioid-related events (SOREs). The risks increase with number of prescriptions filled and do not seem to differ substantially by route of delivery. Findings from a cohort study are published in Annals of Internal Medicine.
Researchers from Vanderbilt University Medical Center studied 161,318 (209,215 births) women aged 15 to 44 years enrolled in Tennessee Medicaid (TennCare) who were discharged after childbirth between January 2007 and August 2014 to assess risk for SOREs associated with postpartum opioid prescribing after childbirth, including both vaginal and cesarean births. They found that routine prescribing after vaginal birth was common in Tennessee, with 59 percent of vaginal births and 91 percent of cesarean births filling one or more opioid prescription in the postpartum period. A second postpartum opioid prescription was filled by about 11 percent of vaginal births and 24 percent of cesarean births. SOREs were identified in 4,582 women and included persistent opioid use (69 percent); substance use disorder (19 percent); buprenorphine or methadone prescriptions (10 percent); overdose (2 percent); and opioid-related death (0.2 percent). The data showed that covariate-adjusted SORE rate increased with increasing number of postpartum opioid prescriptions.
Current clinical guidelines do not provide specific recommendations for opioid prescribing after childbirth. According to the researchers, these finding suggest that design and implementation of rational opioid prescribing guidelines would be an opportunity to reduce this risk.
Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Sarah Osmundson, MD, MS, can be reached through Kelli Koch at kelli.koch@vumc.org or directly at sarah.osmundson@vumc.org. -------------------------------------------------
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Journal
Annals of Internal Medicine