Research roundup: Savings from electronic health records?

Each week reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Journal of General Internal Medicine: Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department? -- Researchers examined the records of 1,252 patients who visited Memphis-area emergency rooms at least twice or more because of severe headache to see if a health information exchange helped avoid duplicate tests and imaging. They concluded that this data-sharing system among providers was "associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. ... ongoing federal support for HIE is warranted, but that funding should be tied to ongoing demonstration of meaningful HIE use" (Bailey et al., 5/31).

Health Affairs: Despite 'Welcome To Medicare' Benefit, One In Eight Enrollees Delay First Use Of Part B Services For At Least Two Years -- Medicare's Part B covers non-hospital medical services, and it includes a 'Welcome to Medicare" check-up visit at no cost to the patient. This analysis of national survey data found that about one in eight people did not use Part B services in the first two years. Researchers noted that "this delay reflected patterns of use before enrollment ... Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites." They concluded that underuse of preventive care "may lead to more expensive care and a higher cost burden on Medicare in later years" (Sloan, Acquah, Lee and Sangvai, 6/5).

Annals of Internal Medicine: Effect Of The Medicare Part D Coverage Gap On Medication Use Among Patients With Hypertension and Hyperlipidemia -- Medicare Part D was introduced in 2006 to increase access to prescription medicines, but a gap in coverage known as the "doughnut hole" left seniors with 100 percent of cost between $2250 and $5100. Researchers looked at claims before and after Part D was implemented to see if the gap affected beneficiaries' use of drugs for high blood pressure and high cholesterol. They concluded: "The Part D coverage gap was associated with decreased use of medications for hypertension and hyperlipidemia in patients with no gap coverage and generic-only gap coverage. The proposed phasing out of the gap by 2020 will benefit such patients; however, use of low-value medications may also increase" (Li et al., 6/5).

Health Affairs: Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients -- Coordinated care for seniors with chronic disease and frequent hospitalizations has the potential to improve health and reduce Medicare spending. The authors picked out six key practices from demonstration projects, which include "supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations." These techniques did not reduce spending (Brown et al., 6/5).

Here is a selection of news coverage of other recent research:

Medscape Medical News:  Three Crucial Factors Link After-Hours Care To Primary Care
Primary care practices (PCPs) can better integrate after-hours care if they have adequate payer support and incorporate features such as shared electronic health records and systematic notification procedures to maintain continuity of care, according to a new analysis [published online June 1 in the Journal of General Internal Medicine]. ... The study also found that efforts to provide after-hours care often work best when adopted as part of a broader PCP strategy to improve access and continuity of patient care (Hitt, 6/6).  

MedPage Today: Therapy by Phone Good Against Depression
Receiving cognitive behavioral therapy (CBT) over the phone is just as effective in primary care patients as when counseling is done face-to-face, and phone CBT may keep patients in treatment longer (Fiore, 6/5).

Reuters: Therapy For Depression Can Work Over The Phone: Study

But while people may not drop out of therapy as much, such treatment in a traditional setting may still be slightly more helpful, according to findings published in the Journal of the American Medical Association(6/6).