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The Vitals - December 2015

Internal Medicine Alert - Infectious Disease Alert - Clinical Cardiology Alert
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Physicians Generally Respected, But Some Minorities Question If You Care

PHILADELPHIA – Physicians might want to work harder to convince minority group patients that they care about them but are generally admired for their honesty and ethical standards.

A new survey published in the journal Social Science Research reveals that the deepest mistrust of physicians comes from Latinos, followed by African-Americans.

"That's one of the biggest takeaways of this work," said lead author Abigail Sewell, PhD, of the University of Pennsylvania. "African-Americans and Latinos are more likely to think this.”

She suggests that Latinos might have an even deeper mistrust because it is more likely that one or both parents are from somewhere else.

"It reflects the relationship between immigrants and the healthcare system," Sewell said. "Most people who are immigrants or have some immigrant connection feel more disenfranchised from the healthcare system.”

The survey cohort consisted of 2,800 people 18 and older in the contiguous United States who were not institutionalized. Interviewers went door to door asking for volunteers, and about 70% of people agreed to the hour-and-a-half interview.

"What we have are perceptual data: what patients feel when they go to a doctor. Minorities in general don't have a lot of faith that they're receiving the best care they could," Sewell said. "Number two, and I think more important, the fact that they think their doctors don't care means they feel their doctors aren't taking into consideration their personal lives."

On the other hand, physicians ranked third among all professions in Gallup’s 2015 Honesty and Ethics of Professions Ratings. Nurses were at the top of the list, followed by pharmacists.

Medical doctors’ honesty and ethical standards were rated high or very high by 67% of respondents, with only 5% rating them low or very low.

“Members of Congress, lobbyists and telemarketers have shown no improvement at the bottom of the list, while nurses, pharmacists, medical doctors and high school teachers remain untarnished at the top,” according to the Gallup analysis.

The Gallup poll is based on telephone interviews conducted Dec. 2-6, 2015, with a random sample of 824 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.


Performing Repeat PSA Test Can Avoid Many Unnecessary Biopsies

OTTAWA, CANADA – For decades, prostate-specific antigen (PSA) tests were routinely performed to help screen for prostate cancer.

Now, confusion and conflicting guidelines have left physicians unsure of when a PSA is appropriate and, if one is performed, how to follow-up without ordering an unnecessary biopsy.

A new Canadian study, published in Mayo Clinic Proceedings, offers some possible solutions. Researchers from The Ottawa Hospital and the University of Ottawa report that simply repeating abnormal PSA tests dramatically reduces unnecessary procedures.

It is the first to examine how promptly repeating PSA testing in a broad range of men being screened for prostate cancer can improve results and treatment.

"A high PSA level is associated with a greater risk of prostate cancer, and PSA screening can help detect cancer at an earlier, more treatable stage," explained co-author Rodney Breau, MD. "However, PSA levels can also fluctuate because of infections, physical activity and laboratory error. Because of this variation, we implemented a protocol to always repeat an abnormal test before referring a patient for a biopsy. We had a hunch that this would reduce unnecessary biopsies and our study shows that our suspicion was correct."

For the study, the research team reviewed the medical records of 1,268 men who had an abnormal PSA test results and were evaluated at the Ottawa Regional Cancer Assessment Centre between 2008 and 2013.

In a fourth of cases, the second PSA test came back normal. In fact, according to the results, only 28% percent of men with conflicting test results underwent a biopsy compared to 62% of men who had two abnormal test results, representing a 55% reduction in biopsies.

The follow-up tests also increased accuracy, with diagnosis of cancer in only 3% of men with conflicting test results who had a biopsy, compared to 19% percent of men who had two abnormal tests.

"It is clear to me that any man with an abnormal PSA test should have this test repeated before a decision to biopsy," Breau said. "Some doctors and patients may be worried about missing a significant cancer diagnosis if they forgo a biopsy after conflicting test results, but our study shows this is very unlikely. It is also important to remember that the PSA test is just one factor we evaluate when deciding to do a biopsy, and these decisions are always made together with the patient, and can be revisited if risk factors change."


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Vast Majority of PCPs Take Medicare, Despite Demise of Bonus

WASHINGTON, DC – The demise of the 10% bonus paid to primary care physicians who accept Medicare patients has raised concerns about how that will affect availability of care.

The incentive program, part of the Affordable Care Act, began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. According to a 2014 report by the Medicare Payment Advisory Commission (MedPAC), about $664 million in bonuses was distributed in 2012 to 170,000 primary care practitioners, for an average of slightly less than $4,000 per provider.

“Policymakers, researchers, and the media have periodically raised questions about the ease or difficulty that Medicare patients experience when trying to find physicians who will see them,” according to a recent Data Note from the Kaiser Family Foundation. “Previous studies show that the vast majority of physicians accept Medicare, but the proportion taking new Medicare patients is smaller, particularly among primary care physicians compared with specialists.”

This Data Note presents findings on reported acceptance of Medicare patients among non-pediatric primary care physicians, based on data from the Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers.

Results indicate that 93% of non-pediatric primary care physicians accept Medicare, similar to the 94% who accept private insurance. A high percentage, 72%, say that they are accepting new Medicare patients, although that falls short of the 80% who report they are willing to accept new privately insured patients.

On the other hand, just 67% say they accept Medicaid.

The Data Note points out that primary care physicians who indicate that they are not taking new Medicare patients could have “closed practices,” which were reported by 19% of respondents, and are taking no new patients, regardless of payment type.

A demographic analysis revealed differences in rates of acceptance of new Medicare patients, however, according to Kaiser. While 83% of primary care physicians who self-identify as Asian accept new Medicare patients, similar to the 86% among physicians who self-identify as either Black, Hispanic, or of another or multiple races, only 66% of White primary care physicians report doing so.

In terms of age, about two-thirds (67%) of primary care physicians age 55 or older say they accept new Medicare patients compared with about three-quarters (76%) of those younger than 55.

“Younger doctors may be more likely to be building their patient caseloads and, therefore, may be more willing to take new patients,” according to the Data Note. “Alternatively, older physicians may have fuller practices and have less capacity to accept new patients.”

The Kaiser report also points out that about one-third of non-pediatric primary care physicians (32%) report that at least half their patients have Medicare, with older, male doctors having the highest share of Medicare patients.


Helicopter Parents Routinely Interfere in Doctor-Teen Patient Relationship

ANN ARBOR, MI – Do you find it difficult to have a one-on-one conversation with your teenage patients because of the helicopter parents hovering nearby?

If so, you are far from alone.

A new national poll suggests that just 34% percent of parents let their teen discuss health concerns privately with a doctor without them in the room. The percentage who reported that their teens can complete their health history form independently is even lower, at less than 10. Most don’t even consult with the child when filling out the form.

The C.S. Mott Children's Hospital National Poll on Children's Health at the University of Michigan includes a nationally-representative group of parents of teens ages 13-18.

"The majority of parents are managing teens' health care visits, and their teens may be missing out on valuable opportunities to learn how to take ownership of their own health," explained Sarah J. Clark, MPH, associate director of the C.S. Mott Children's Hospital National Poll on Children's Health.

"Having teens take the lead in responsibilities like filling out their own paperwork, describing their health problems, and asking questions during adolescence helps them gain experience and confidence in managing their health,” Clark said. “Speaking with the doctor privately is important, not only to give teens a chance to disclose confidential information, but also to provide the opportunity for them to be an active participant in their own health care, without a parent taking over."

While nearly 40% of parents responding to the survey say that they alone ask questions about health issues, only 15% say their teen would independently share physical or emotional problems with the doctor.

"Parents' top reason for handling different aspects of the healthcare visit is that their teen would not be comfortable talking about these subjects – which may stem from the fact that they aren't getting much practice," Clark notes.

The survey group urges parents to help their child become more independent at health visits by writing down any health problems or questions they have and then taking the lead in talking to the physician. The surveyors also say that teens should check in at the registration themselves and fill out forms as much as possible.


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