Annals of Internal Medicine tip sheet for Dec. 20, 2011

December 19, 2011

1. Surveys Show Doctors and Patients at Odds Over Sharing Medical Information

Once reserved for paper charts, doctors' notes are evolving into the electronic medical record. While electronic medical records hold the potential for greater transparency, improved efficiency, and decreased costs, some worry that sharing doctors' notes electronically could lead to greater patient confusion and more work for the physician. Two articles being published in the December 20 issue of Annals of Internal Medicine use survey data to shed light on both sides of the issue.

In the first article, 173 primary care physicians (PCPs) and 37,856 patients completed a survey before joining a voluntary program that provided electronic links to doctor's notes. The purpose of the survey was to ascertain PCP and patient attitudes toward the potential benefits or harms of the program. The researchers found that PCPs and patients had contrasting opinions on electronic records. The PCPs that chose to participate in the program did so because they thought electronic records would improve patient safety and satisfaction, and could lead to patients being better informed and taking better care of themselves. The PCPs who declined to participate did so because they anticipated increased demands on their time during and between visits. Moreover, many feared that open notes could frighten or confuse patients, especially if the PCPs wrote candidly about sensitive health issues. In contrast, patients had ample enthusiasm for and little concern about the consequences of open notes.

In the second study, researchers conducted a web-based survey of 18,471 patient users of My HealtheVet, the electronic personal health record (PHR) of the Veterans Administration (VA), to explore preferences about sharing electronic health information. The researchers found that four out of five veterans surveyed were interested in sharing access to their PHR with someone outside their health system (a spouse or partner, child, other family member, or a non-VA health care provider). The researchers suggest that future research focus on whether shared access to PHR could reduce the burden of long-distance caregiving and improve communication among multiple care providers. The challenge is providing a system that maintains patient security and privacy at the same time.

2. USPSTF Reviews Evidence on Vitamin D and Calcium Supplementation for Fracture Protection and Cancer Prevention

Evidence Review will Inform Draft Recommendation to be Posted for Public Comment at

Studies have suggested that vitamin D supplementation may reduce cancer and fracture risks. Researchers reviewed 19 trials and 28 observational studies to determine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults. The researchers found that combined vitamin D and calcium supplementation reduces fracture risk in older persons, but vitamin D alone was not effective. There is less evidence to support vitamin D supplementation for cancer prevention. Limited data suggest that high dosages of vitamin D can reduce the risk for total cancer, but more research is needed to draw a firm conclusion. Concern remains about the proper dosing of vitamin D, as too much vitamin D can increase the risk for renal and urinary tract stones. These findings will form the basis of an upcoming recommendation statement on vitamin D supplementation from the U.S. Preventive Services Task Force (USPSTF). When finalized, the USPSTF recommendation will be published in Annals of Internal Medicine.

3. Still No Evidence to Support Vitamin D Supplementation for Prevention of Cardiovascular Disease

Vitamin D deficiency has become increasingly common. While the dangers of vitamin D deficiency are well-documented, there is no universal guideline to define vitamin D insufficiency. Risk factors for vitamin D deficiency include low exposure to ultraviolet light, being elderly or female, low socioeconomic status, and lacking dietary sources. Vitamin D deficiency has been linked to hypertension, myocardial infarction, and stroke, as well as other cardiovascular-related diseases, such as diabetes, congestive heart failure, peripheral vascular disease, atherosclerosis, and endothelial dysfunction. Researchers continue to study the benefits of supplementation. They reviewed published research from 1985 through 2011 to evaluate the effect of vitamin D supplementation on cardiovascular outcomes. Few randomized controlled trials have evaluated the effect of vitamin D replacement on cardiovascular outcomes, and the results have been inconclusive or contradictory. The researchers suggest that more randomized, controlled trials be designed to specifically evaluate the role of vitamin D supplementation in reducing cardiovascular disease.

American College of Physicians

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