Patient-Physician Communication / Depression Guideline Adherence / Resident Work Hours / Supplements for Anxiety

Septiembre 5, 2007

PHYSICIAN'S FIRST WATCH for September 5, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief

– Patient-Physician Communication Scores Predict Patient Complaints
– Adherence to Depression Practice Guidelines Could Improve Patient Outcomes
– Resident Duty Hour Regulations Show Little Effect on Patient Mortality
– Dietary and Herbal Supplements for Anxiety: A Review

Patient-Physician Communication Scores Predict Patient Complaints

Low communication scores on physician licensing exams predict patient
complaints years later, reports a new study in JAMA.

In a longitudinal study, Canadian researchers looked at some 3400 physicians
who took the Medical Council of Canada clinical skills examination from 1993
to 1996. Physicians could receive low scores on the communication portion by
exhibiting "condescending, offensive, or judgmental behaviors, or ignoring
patient responses."

Physicians who scored in the lowest quartile for communication had 4.26
patient complaints to the regulatory authority per 100 practice-years,
compared with 2.51 per 100 practice-years for clinicians scoring in the top
quartile. The communication score remained predictive of complaints after
adjustment for the written clinical decision-making section of the test.

The authors recommend changing examinations to test communication skills
more efficiently and earlier in a physician's training, and they suggest a
minimum passing standard for communication skills.

Link(s):
JAMA article (Free abstract; full text requires subscription)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hK
%2F9qMPOZ0wTKCsCsOOzJtc%3D
JAMA editorial (Subscription required)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hF
vjxd7%2F3VGEKCsCsOOzJtc%3D

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Adherence to Depression Practice Guidelines Could Improve Patient Outcomes

Outcomes in primary care patients with depression appear to improve when
physicians follow treatment guidelines, according to a study in Annals of
Internal Medicine.

The study was based on some 1100 patients in 45 practices. It found that
adherence to guidelines was high for one-third of the recommendations
measured, including diagnosing depression and monitoring patients over the
following months. However, adherence was low for nearly half of the
guideline recommendations, including adjusting treatment of patients who did
not initially respond.

Among patients with the worst prognoses, the predicted probability of
persistent depression at 2 years was 0.61 in those who received the
lowest-quality care compared with 0.51 in those who got the best care.

In an accompanying editorial, Journal Watch Cardiology Editor-in-Chief
Harlan M. Krumholz says the study "lends greater credence to the guideline
recommendations and supports their use for accountability."

Link(s):
Annals of Internal Medicine article (Free abstract; full text requires
subscription)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hL
Tr2dApo2QCKCsCsOOzJtc%3D
Annals of Internal Medicine editorial (Subscription required)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hP
S7OO%2F9rA49KCsCsOOzJtc%3D

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Resident Duty Hour Regulations Show Little Effect on Patient Mortality

Limiting resident work hours has little effect on mortality among older
hospitalized patients, according to two analyses in JAMA.

Researchers examined whether resident duty hour regulations, implemented in
2003 by the Accreditation Council for Graduate Medical Education, have
affected 30-day death rates among patients hospitalized for acute care.

In one analysis of more than 8.5 million Medicare beneficiaries, the ACGME
regulations were not associated with significant changes in mortality among
medical or surgical patients during the 2 years after the reform. In another
analysis of some 300,000 patients at Veterans Affairs hospitals, the
regulations were associated with reduced mortality among medical patients in
year 2, whereas no changes were seen for surgical patients.

The authors note that they didn't have data on actual hours worked.
Editorialists say that "adherence with duty hour restrictions is not
complete … [which] raises questions of how to interpret studies … that
do not assess adherence."

Link(s):
JAMA article on mortality in Medicare beneficiaries (Free)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hP
tB8lkJflIyKCsCsOOzJtc%3D
JAMA article on mortality at VA hospitals (Free abstract; full text requires
subscription)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hB
F%2BMWIBedUbKCsCsOOzJtc%3D
JAMA editorial (Subscription required)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hD
5AdDF8NkCoKCsCsOOzJtc%3D

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Dietary and Herbal Supplements for Anxiety: A Review

A review of the evidence on alternative remedies for anxiety disorders
appears in a recent issue of American Family Physician.

Investigators searched Medline for studies and guidelines on the
effectiveness of popular supplements (e.g., kava, St. John's wort) for the
treatment of anxiety disorders. Their review of the evidence includes:

— concise tables summarizing safety and effectiveness data on various
supplements;
— ratings of the evidence;
— a table listing supplements with no clinical evidence of benefit.

Link(s):
American Family Physician article (Free)
http://click2.nejm.org/cts/click?q=227%3B298503%3B%2FTYtelTvdzOtIY%2FGuqR9hD
rXy0hlqGNnKCsCsOOzJtc%3D