Research roundup: Who do patients seek for primary care?; Treating kids with antipsychotics

Each week KHN reporter Ankita Rao compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Visits For Primary Care Services To Primary Care And Specialty Physicians, 1999 and 2007 -- In order to find out what kind of doctor patients were visiting for primary care service, researchers analyzed the frequency in which patients visited generalists and specialists in 1999 and 2007 by using a nationally representative sample of outpatient visits. They wrote in a research letter in the journal that "we found that fewer than two-thirds took place with primary care physicians in 1999, a proportion which remained essentially unchanged as of 2007. These findings inform our understanding of the current role primary care physicians are playing within the US health care system and raise concerns about the potential inefficiencies between primary care physician supply" (Kale, Federman and Ross, 8/20).

Archives of General Psychiatry: National Trends In The Office-Based Treatment Of Children, Adolescents, And Adults With Antipsychotics -- Researchers compared trends in the antipsychotic treatment of children, adolescents and adults between 1993 and 2009 as the numbers of people using antipsychotic drugs has increased. They found the increase "has been especially concentrated among children and adolescents, particularly among youths diagnosed with mood disorders and those treated by nonpsychiatrist physicians. A substantial majority of child antipsychotic visits are for young people diagnosed with disruptive behavior disorders. In light of known safety concerns and uncertainty over long-term risks and benefits, these trends may signal a need to reevaluate clinical practice patterns and strengthen efforts to educate physicians, especially primary care physicians, concerning the known safety and efficacy of antipsychotic medications." The safety concerns of the medication include possible weight gain and diabetes (Olfson, et al, August/2012).

Related KHN Coverage: Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns (Boodman, 3/12).

The New England Journal Of Medicine: Racial and Ethnic Health Disparities Among Fifth-Graders In Three Cities -- Although health-related racial and ethnic disparities have been studied in teenagers, researchers for this study looked at more than 5,000 fifth graders in Birmingham, Ala., Houston and Los Angeles County. In their interviews they "examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. ... We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children." although they note that when adjusting for for socioeconomic status and the child's school those differences are substantially reduced. They write, "Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health" and add, "The fact that disparities are prevalent among preadolescents and, in many cases, mirror disparities found in older age groups suggests that intervention efforts may need to begin early" (Schuster, et al, 8/23).  

Kaiser Family Foundation: Overview Of Health Coverage For Individuals With Limited English Proficiency -- There are about 21.1 million nonelderly individuals with Limited English Proficiency in the U.S. The group, which is mostly comprised of Spanish speakers, is significantly more likely to be uninsured than English speakers and face multiple barriers to getting health care. "The ACA coverage expansions will provide new coverage options for many individuals with LEP. However, to increase coverage and care for individuals with LEP, it will be important to provide adequate language assistance and address other barriers they face to enrolling in coverage and accessing needed care," the authors write (8/17).

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

Governing: GAO: States Spending More On Medicaid Supplemental Payments
States reported a combined $32 billion in supplemental payments to Medicaid providers in 2010, a substantial increase from 2006, according to a report released Monday by the Government Accountabilty Office (GAO), but incomplete reporting by states means the exact amount isn't known. Medicaid supplemental payments ... are divided into two categories. Disproportionate share hospital (DSH) payments are intended to offset uncompensated care costs for hospitals that serve more low-income and Medicaid patients, and non-DSH payments go to other health-care providers based on criteria set by state officials, but aren't required by federal law. Non-DSH payments increased by $8 billion from 2006 to 2010, GAO found, to a total of $14.4 billion. Most of those payments went to inpatient hospital services. The office noted that non-DSH payments as a share of a state's Medicaid spending varied significantly, from less than 1 percent to 17 percent (Scott, 8/21).

Medscape: Drug-Dispensing Physicians Charge More Than Pharmacies
Physicians who dispense pain medications and other commonly used drugs to workers' compensation (WC) patients charge up to 3 times more than pharmacies in some states, according to a recent study from the not-for-profit Workers Compensation Research Institute (WCRI). That kind of mark-up could explain why physician dispensing for WC patients has grown at a rapid clip in recent years, and why some states now limit how much clinicians can charge. However, a desire for profit may not be the only reason why physicians charge more than pharmacies. Another factor may be wholesale prices that physicians pay to obtain the drugs that they sell. (Lowes, 8/21).

MedPage Today: When Elmo Likes Apples, Kids Want Them Too
Apples became substantially more popular at lunch time among grade school children when the fruits carried pictures of the Sesame Street puppet Elmo, researchers said. When the apples sported an Elmo sticker, the number of children, ages 8 to 11, taking apples with their lunches increased by about 65% compared with stickerless apples, reported Brian Wansink, PhD, of Cornell University in Ithaca, N.Y., and colleagues (Gever, 8/20).

MedPage Today: PSA Gets Partial Credit for Survival Benefit
Overall survival in metastatic prostate cancer improved significantly after the introduction of prostate-specific antigen (PSA) screening, particularly among black men, a retrospective comparison of three larger clinical trials showed. The mortality hazard decreased by 22% among men treated after PSA screening became widespread, versus those treated in trials conducted during the pre-PSA era. Median overall survival increased by about 50% in the later trial, and the traditional survival disparity between black and nonblack men disappeared (Bankhead, 8/23).