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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:1260.
The Effect of Explicit Financial Incentives on Physician Behavior
In this review of the literature, Armour et al
examine the influence of managed care financial incentives on physicians'
use of resources. There is a limited amount of data on the subject, and evidence
regarding the effect of explicit financial incentives and bonus payments to
physicians is mixed.
(SEE ARTICLE)
Sex Differences in Risk Factors for HIV Seroconversion Among Injection
Drug Users
A 10-Year Perspective
In this 10-year study of 1874 injection drug users, Strathdee and colleagues found that risk factors for human immunodeficiency
virus (HIV) infection were different for men and women. Among men, sharing
needles, daily injection, shooting-gallery attendance, and homosexuality were
the most prominent risk factors. Among women, incidence was higher in those
with sexually transmitted diseases. These results show that HIV interventions
for injection drug users should be sex-specific.
(SEE ARTICLE)
Comorbidity and Glycemic Control in Patients With Type 2 Diabetes
The impact of comorbidity on glycemic control is assessed in this article
on 654 patients with type 2 diabetes mellitus. El-Kebbi
et al used the Chronic Disease Score (CDS) index to rate comorbidity
and found that patients with higher CDS scores were older and had lower hemoglobin
A1c (HbA1c) levels.
They found higher HbA1c levels
in patients receiving drug therapy, patients with lower C-peptide levels,
and younger patients.
(SEE ARTICLE)
Deep Vein Thrombosis and Its Prevention in Critically Ill Adults
This review by Attia et al summarizes data
from published studies on the rate of deep vein thrombosis (DVT) and the efficacy
of thromboprophylaxis among general medical-surgical, trauma, neurosurgical,
and spinal cord injury patients. Low-dose, unfractionated subcutaneous heparin
appears to provide adequate DVT prophylaxis in medical and surgical patients
in the intensive care unit, but may be less efficacious than subcutaneous
low–molecular weight heparin in those who have sustained major trauma
with skeletal injury. Mechanical prophylaxis, such as graduated compression
stockings or pneumatic compression devices, has not been well investigated
in either of these populations, but offers some benefit among neurosurgical
patients. Studies of patients with spinal cord injury are too disparate to
arrive at any meaningful conclusions. Decisions about prophylaxis against
DVT must balance the absolute risk of venous thromboembolism against that
of hemorrhage; thus, the efficacy data established in one population do not
necessarily translate into a net benefit among other individuals.
(SEE ARTICLE)
Clinician Attributions for Symptoms and Treatment of Gulf War–Related
Health Concerns
To assess clinician beliefs about the etiology, clinical course, and
treatment of patients with illness attributed to service in the Gulf War, Richardson and colleagues surveyed providers from the general
internal medicine and mental health clinics of 3 Veterans Affairs medical
centers. Internal medicine providers were more likely to attribute health
problems of Gulf War veterans to psychological causes and to recommend psychological
treatment than mental health care providers. Mental health care providers
were more likely to attribute the symptoms of these veterans to physical causes
and to recommend biomedical treatment. The authors conclude that divergent
provider beliefs may contribute to the multiple referrals experienced by Gulf
War patients and others with medically unexplained symptoms.
(SEE ARTICLE)
Health Care Use of Individuals With Diabetes in an Employer-Based Insurance
Population
Using a sample of claims from a commercial insurer, Laditka et al studied health care use and costs for individuals with
diabetes. The diabetic population was 1.6% of the total population, but had
9.4% of costs. The greatest use of healthcare resources and cost was associated
with individuals with type 1 diabetes mellitus. The hospitalization rate for
this group was 8 times higher for both acute myocardial infarction and coronary
artery bypass, nearly 9 times higher for cardiac catheterization, and more
than 22 times higher for heart failure. For physician services, those with
type 1 diabetes used over 27 times more relative value units than the general
population for endocrinologists and nephrologists. These results reflect the
great human toll of diabetes and highlight the importance of aggressive diabetes
management, especially for those with type 1 diabetes.
(SEE ARTICLE)
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