Research roundup: Talking to patients about end-of-life care

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Annals Of Family Medicine: Projecting US Primary Care Physician Workforce Needs: 2010-2022 – With estimates of 30 million people in the US expected to gain health insurance under the federal health law, questions have been raised of whether there will be enough primary care physicians. Using Medical Expenditure Panel Survey data, researchers projected "that the total number of office visits to primary care physicians for the United States will increase from a base of 462 million in 2008 to 565 million in 2025. … By 2025, the United States would require nearly 260,687 practicing primary care physicians, an increase of 51,880 from the current workforce." They conclude that the "population growth will be the greatest driver" of that increase, accounting for about 33,000 of the new physicians (Petterson et al., Nov-Dec/2012).

Journal Of Clinical Oncology: Association Between End-Of-Life Discussion Characteristics And Care Received Near Death: A Prospective Cohort Study – According to the study, national guidelines recommend that conversations about end of life (EOL) care take place soon after patients are diagnosed with an incurable cancer. It is unclear, however, if such conversations lead to less aggressive care near death. "We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death," the authors write. After studying more than 1,200 patients with stage IV lung or colorectal cancer, the authors found that patients who had earlier discussions about EOL care were less likely to receive aggressive care before death. They conclude that earlier discussions with patients "have the potential to change the way EOL care is delivered for patients with advance cancer and help to assure that care is consistent with patients' preferences" (Mack et al., 11/13).

GAO: High-Expenditure Part B Drugs – The Medicare program and its beneficiaries spent about $19.5 billion on Part B drugs in 2010, according to this new report by the Government Accountability Office (GAO). Part B drugs are commonly administered by physicians or other health care providers under a physician's supervision. "The 55 highest-expenditure Part B drugs accounted for 85 percent of all Part B drug spending in 2010," the report states. In addition, "Spending on Medicare beneficiaries accounted for the majority of estimated total U.S. spending for 35 of the 55 highest-expenditure part B drugs in 2010. For 17 of the 35, Medicare spending accounted for more than two-thirds of total U.S. spending, defined as spending by the insured population in the United States" (10/12).

American Journal Of Public Health: Using The HIV Surveillance System To Monitor The National HIV/AIDS Strategy – Using surveillance data from HIV-positive adults and adolescents of 13 U.S. jurisdictions, researchers aimed to assess how successfully patients were linked to care after an HIV diagnosis and the proportion of HIV-infected patients who had suppressed virus levels. "In this analysis, we found that about 20% of people did not enter care within 3 months of diagnosis and about 30% of people living in HIV were not virally suppressed," the authors write. "We also observed disparities across race/ethnicity, age, sex, and risk groups among people who are linked to clinical care and virally suppressed." They conclude: "The findings highlight disparities in access to and success of care" (Gray et al., 11/15).

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

Medscape: Antibiotic Rx Highest In Southern States
Clinicians in 7 southern states lead the nation in prescribing antibiotics on an outpatient, per capita basis, and at roughly double the rate found in Pacific Coast states, where such rates are the lowest, according to the Center for Disease Dynamics, Economics & Policy (CDDEP). The think tank released these findings today as part of "Get Smart: Know When Antibiotics Work," a week-long publicity campaign organized by the Centers for Disease Control and Prevention (CDC). Now in its fifth year, Get Smart week aims at curbing the inappropriate use of antibiotics that leads to bacterial resistance and infections that defy treatment (Lowes, 11/13).

Medscape: Breast Cancer Deaths Higher In Black Women
In the United States, more black women than white women die from breast cancer, even though the incidence of breast cancer is slightly lower in black women. This racial disparity was highlighted in a press briefing held today by the Centers for Disease Control and Prevention (CDC), and is detailed in a report published online November 14 in the Morbidity and Mortality Weekly Report (Chustecka, 11/14). 

Medpage Today: Cost Control Key To Hospitals' Bundled Pay
Wide variation exists between hospitals in their average spending on post-acute care, researchers said, and providers that work best to coordinate that care stand to benefit the most under Medicare's bundled-payment models. The variation between the highest- and lowest-cost hospitals can exceed 100%, Robert Mechanic and Christopher Tompkins, PhD, of Brandeis University found. Hospitals spending more than the average spent almost 40% more than those below the average for various episodes (Pittman, 11/15).

Medpage Today: Physician Suicide Linked To Work Stress
Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed. Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found (Phend, 11/14).