Annals of Internal Medicine tip sheet for July 19, 2005

July 18, 2005

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information.

1. Many Still Take Vitamin E, Even Though It May Be Ineffective or Harmful

A large national survey shows that 12 percent of U.S. adults (24 million people) consumed high doses (400 IU per day or more) of vitamin E supplements in 1999-2000 (Brief Communications, p. 116).

Researchers refer to several recent clinical trials that show that high doses of vitamin E are associated with increased risk for premature death.

Editorial writers point to other recent studies that show that high doses of vitamin E do not prevent or lower risk for heart disease, cancer, Alzheimer disease, or amyotrophic lateral sclerosis (ALS) (Editorial, p. 143). Based on this research, they say that, at this time, "people should avoid this vitamin at high dosages."

2. Test Results Pending After Hospital Discharge Often Languish

A study of hospitalist services at two hospitals found that about 41 percent of 2,644 discharged patients had pending laboratory and radiologic test results and that 191 (nine percent) of these results indicated urgent clinical action, such as starting or changing antibiotic therapy (Improving Patient Care, p. 121).

Of 105 hospital physicians who responded to a survey about the actionable results, 65 were unaware of the results and 31 were unaware that the tests had been ordered.

Researchers say that despite the small numbers in the study, results suggest a need for a highly reliable system of ensuring follow-up of hospital test results.

3. Medicare Would Save Money and Improve Care by Paying Full Cost of ACE Inhibitors for People with Diabetes

Medicare would save money and improve health outcomes by providing full coverage of ACE inhibitors for people with diabetes, a new cost effectiveness study finds (Article, p. 89).

Angiotensin-converting enzyme (ACE) inhibitors slow progression of kidney disease and reduce heart disease and deaths in patients with diabetes, yet the drugs are underused by elderly patients with diabetes. Some studies have found that elderly people with diabetes cut use of essential drugs as their out-of-pocket drug costs rise. Currently Medicare does not pay for medications.

Researchers used a computer model to compare three scenarios: current practice (no Medicare coverage of medications), coverage under the new Medicare drug benefit to be implemented in 2006 (shared costs), and full coverage of ACE inhibitors for patients with diabetes.

They found that even if full coverage increased ACE inhibitor use only 7.2 percent, full coverage would save Medicare money and improve outcomes for diabetic patients.

Researchers conclude, "In an era of growing concerns over Medicare's future financial viability, rare opportunities to improve quality while also saving money should not be treated lightly."

American College of Physicians

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