PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Higher levels of primary care physicians in area associated with favorable outcomes for patients

2011-05-25
(Press-News.org) Medicare beneficiaries residing in areas with higher levels of primary care physicians per population have modestly lower death rates and fewer preventable hospitalizations, according to a study in the May 25 issue of JAMA.

"Strengthening the role of primary care is a key element in most proposals to improve the outcomes and efficiency of health care delivery in the United States. With the aging population and the waning interest in primary care by U.S. medical school graduates, some have projected a large shortage of general internists and family physicians to care for a growing number of elderly patients," according to background information in the article. "Despite a widespread interest in increasing the numbers of primary care physicians to improve care and to moderate costs, the relationship of the primary care physician workforce to patient-level outcomes remains poorly understood."

Chiang-Hua Chang, Ph.D., of Dartmouth Medical School, Hanover, N.H., and colleagues conducted a study to examine whether high levels of primary care physician workforce are associated with lower mortality, fewer ambulatory care sensitive condition (ACSC) hospitalizations, and lower spending in Medicare beneficiaries. ACSC hospitalizations are regarded as largely preventable admissions when adequate and timely ambulatory (outpatient) care is provided. The study consisted of an analysis of the outcomes of a 20 percent sample of fee-for-service Medicare beneficiaries age 65 years or older (n = 5,132,936) in 2007, and used 2 measures of adult primary care physicians (general internists and family physicians) across Primary Care Service Areas (n = 6,542): American Medical Association (AMA) Masterfile nonfederal, office-based physicians per total population; and full-time equivalents (FTEs), a workforce measure that is an estimate of the ambulatory clinical FTEs of primary care physicians, derived from Medicare office- and clinic-based claims of primary care physicians.

The researchers found marked variation in the primary care physician workforce across areas, but low correlation was observed between the 2 primary care workforce measures. After adjusting for certain patient and area variables, only small differences were observed in mortality and Medicare program spending across quintiles (one of five groups) of primary care physicians per population. However, beneficiaries residing in areas with the highest quintile of primary care physicians per population had 6 percent lower rates of ACSC hospitalizations, with adjusted rates of 74.90 vs. 79.61 per 1,000 beneficiaries, respectively, for highest vs. lowest quintile of primary care workforce.

Stronger associations were observed in models that used primary care physician FTEs as the measure of primary care workforce. "For example, not only did beneficiaries residing in the highest quintile of primary care FTEs have 5 percent lower mortality, but also 9 percent fewer ACSC hospitalizations and 1 percent higher total Medicare program spending. The adjusted rates of the highest compared with lowest quintile were 5.19 vs. 5.49 deaths per 100 beneficiaries, 72.53 vs. 79.48 ACSC hospitalizations per 1,000 beneficiaries, and $8,857 vs. $8,769 total Medicare spending per beneficiary, respectively. There were significant trends in the association of primary care FTEs with mortality, ACSC hospitalizations, and acute care facility Medicare spending," the authors write.

"Our findings suggest that a higher local workforce of primary care physicians has a generally positive benefit for Medicare populations, but that this association may not simply be the result of having more physicians trained in primary care in an area. Instead, associations were much stronger with a measure of primary care activity that was linked to a central concept of primary care—ambulatory care delivered in an office or clinic setting by physicians trained in primary care. The FTEs measure also more accurately reflected physician retirement or part-time effort."

"The benefits of primary care workforce appear quite sensitive to the accurate discrimination of those physicians trained in primary care with those practicing ambulatory primary care. Recognizing this difference is important not just to improve primary care clinician measurement, but also as an indication of the drift of physicians trained as primary care physicians to nonprimary care careers. Increasing the training capacity of family medicine and internal medicine may have disappointing patient benefits if the resulting physicians are primary care in name only," the researchers conclude.

###

(JAMA. 2011;305[20]2096-2105. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact Chiang-Hua Chang, Ph.D., call Deborah Kimbell at 603-650-6694 or email deborah.kimbell@dartmouth.edu.

END



ELSE PRESS RELEASES FROM THIS DATE:

New-onset atrial fibrillation in initially healthy women may increase risk of premature death

2011-05-25
In a follow-up of participants from the Women's Health Study, seemingly healthy middle-aged women with new-onset atrial fibrillation had an associated increased risk of cardiovascular, noncardiovascular, and all-cause death, with some of the risk potentially explained by nonfatal cardiovascular events, according to a study in the May 25 issue of JAMA. "Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is markedly increasing over time. Substantial evidence exists that the risk of stroke, congestive heart failure (CHF), and cognitive dysfunction ...

Certain biomarkers appear to increase risk of death for elderly patients with heart failure symptoms

2011-05-25
Elderly patients with symptoms of heart failure and increased concentrations in the blood of the biomarker copeptin, or a combination of elevated concentrations of copeptin and the biomarker NT-proBNP, had an associated increased risk of all-cause death, according to a study in the May 25 issue of JAMA. "A central part in evaluation of elderly patients with symptoms of heart failure is to identify simple tools that can aid the clinician in identifying high-risk and low-risk patients. Combining a biomarker produced locally in the myocardium [the muscle tissue of the heart] ...

Rethinking extinction risk?

2011-05-25
For more than 40 years, the International Union for Conservation of Nature (IUCN) has published the Red List of Threatened Species describing the conservation status of various species of animals. They are now also including plants in their lists and the picture they present is dramatic. According to recent estimates, around 20 per cent of flowering plants are currently at risk of extinction – though the exact number is unknown since such a small proportion of plant species has even been measured. Now, however, research conducted in South Africa and the U.K. by an international ...

The healing power of hydrogen peroxide

2011-05-25
New information has come to light explaining how injured skin cells and touch-sensing nerve fibers coordinate their regeneration during wound healing. UCLA researchers Sandra Rieger and Alvaro Sagasti found that a chemical signal released by wounded skin cells promotes the regeneration of sensory fibers, thus helping to ensure that touch sensation is restored to healing skin. They discovered that the reactive oxygen species hydrogen peroxide, which is found at high concentrations at wounds, is a key component of this signal. The study, published on May 24th in the online, ...

Grape Escapes - 6 of the Best Vineyard Cycle Routes

Grape Escapes - 6 of the Best Vineyard Cycle Routes
2011-05-25
Once there, exploring by bike means that you'll often stumble upon the lesser-known vineyards too (we'll point you in the right direction!), and you'll find that owners will welcome you as long-lost friends rather than fleeting tourists! Don't forget too that, if you have your car in the region with you, we offer a complimentary wine service where we'll collect any purchases and deliver them to your final hotel for you. So, if you enjoy wine, and fancy the idea of trying out old favourites, as well as making some new discoveries, here are 6 cycling holidays we think ...

Expanded VLA flexing new scientific muscle

2011-05-25
A new and uniquely powerful tool for cutting-edge science is emerging on the crisp, high desert of western New Mexico. Outwardly, it looks much the same as the famed Very Large Array (VLA), a radio telescope that has spent more than three decades on the frontiers of astronomical research. The 27 white, 230-ton dish antennas still peer skyward, the 72 miles of railroad track still wait to transport the antennas across the arid plains, the familiar buildings remain, and crews still fan out across the desert to service the antennas. Functionally, however, everything has ...

Research suggests that lipofilling may be safe during conservation treatment for breast cancer

2011-05-25
A new study has gone some way to answering the question about whether or not a technique called lipofilling is safe for women who are having their breasts reconstructed after surgery for breast cancer. Lipofilling involves taking some fat from another area of a woman's body, such as her abdomen, and using it to fill in small defects or asymmetry that may occur during breast reconstruction. However, until now, there has been a lack of evidence as to whether or not the technique could trigger a recurrence of the original breast cancer, and so plastic surgeons have not ...

Atrial fibrillation associated with increased risk of death and cardiovascular events in women

2011-05-25
Boston, MA – Researchers at Brigham and Women's Hospital (BWH) have found that among women who are mostly healthy, those diagnosed with atrial fibrillation have an increased risk of death when compared to women without atrial fibrillation. These findings are published in the May 25, 2011 issue of the Journal of the American Medical Association. "We knew that atrial fibrillation was associated with an increase risk of death in most cases, but in this study we found that even in a population of women who were mostly healthy and did not have established cardiovascular ...

Wales faces deepest NHS cuts of all UK countries

2011-05-25
In Wales, the NHS is set for a real budget cut of nearly 11% over four years, while England escapes the deepest cuts across the four nations, according to John Appleby, Chief Economist at the King's Fund on bmj.com today. In much of the discussion and debate about health care spending and reform, the "N" in NHS seems often to stand for England, writes Appleby. Yet around 10 million people in the UK do not live in England or use its health care services. Given the political arguments about whether the NHS budget has received a real increase in funding over the next ...

Increasing daily calcium will not reduce the risk of fractures in later life

2011-05-25
While moderate amounts of calcium (around 700 mg a day) are vital for maintaining healthy bones, there is no need to start increasing calcium intake in order to reduce the risk of fractures or osteoporosis in later life, finds a paper published on bmj.com today. As people age, their bones lose calcium and they are more at risk of fractures and osteoporosis - this is especially the case for women. As well as causing individual suffering, fractures are a huge drain on health services. With ageing populations, this burden will increase in the coming years and therefore ...

LAST 30 PRESS RELEASES:

Engineers uncover why tiny particles form clusters in turbulent air

GLP-1RA drugs dramatically reduce death and cardiovascular risk in psoriasis patients

Psoriasis linked to increased risk of vision-threatening eye disease, study finds

Reprogramming obesity: New drug from Italian biotech aims to treat the underlying causes of obesity

Type 2 diabetes may accelerate development of multiple chronic diseases, particularly in the early stages, UK Biobank study suggests

Resistance training may improve nerve health, slow aging process, study shows

Common and inexpensive medicine halves the risk of recurrence in patients with colorectal cancer

SwRI-built instruments to monitor, provide advanced warning of space weather events

Breakthrough advances sodium-based battery design

New targeted radiation therapy shows near-complete response in rare sarcoma patients

Does physical frailty contribute to dementia?

Soccer headers and brain health: Study finds changes within folds of the brain

Decoding plants’ language of light

UNC Greensboro study finds ticks carrying Lyme disease moving into western NC

New implant restores blood pressure balance after spinal cord injury

New York City's medical specialist advantage may be an illusion, new NYU Tandon research shows

Could a local anesthetic that doesn’t impair motor function be within reach?

1 in 8 Italian cetacean strandings show evidence of fishery interactions, with bottlenose and striped dolphins most commonly affected, according to analysis across four decades of data and more than 5

In the wild, chimpanzees likely ingest the equivalent of several alcoholic drinks every day

Warming of 2°C intensifies Arctic carbon sink but weakens Alpine sink, study finds

Bronze and Iron Age cultures in the Middle East were committed to wine production

Indian adolescents are mostly starting their periods at an earlier age than 25 years ago

Temporary medical centers in Gaza known as "Medical Points" (MPs) treat an average of 117 people daily with only about 7 staff per MP

Rates of alcohol-induced deaths among the general population nearly doubled from 1999 to 2024

PLOS One study: In adolescent lab animals exposed to cocaine, High-Intensity Interval Training boosts aversion to the drug

Scientists identify four ways our bodies respond to COVID-19 vaccines

Stronger together: A new fusion protein boosts cancer immunotherapy

Hidden brain waves as triggers for post-seizure wandering

Music training can help the brain focus

Researcher develop the first hydride ion prototype battery

[Press-News.org] Higher levels of primary care physicians in area associated with favorable outcomes for patients