High Quality
Open the downloaded document, and select print from the file menu (PDF reader required).
Medical Home SetTo Move Forward
BY KERRI WACHTER
Senior Writer
W
ASHINGTON
— Medicalhome advocates hope a new setofmetrics will help primary carephysicians move closer to imple-menting this model ofcare.The metrics assess how patientcentered an office-based practiceis and how well the practice’scare delivery system works.Scores on the tool correlate withenhanced clinical performanceand lead to voluntary designationas a patient-centered medicalhome, according to Dr. Greg Pawlson, executive vice presidentofthe National Committee for Quality Assurance (NCQA).Having a set ofmetrics is “avery important step on the wayto ...a series oflarge-scale pilotdemonstration projects,”Dr.Pawlson said at a pressbriefing tounveil the tool. “Most impor-tantly, it provides a road map for where a practice needs to gofrom where it is now to where itneeds to be as a patient-centeredmedical home,” he said.The American College of Physicians, the American Acade-my ofFamily Physicians, the American Academy ofPediatrics,and the American Osteopathic Association worked with NCQAon the development ofPhysicianPractice Connections. These four primary care groups have en-dorsed the tool as a way for prac-tices to qualify as medical homesin pilot demonstration projectsslated to begin as early as 2008.“I think ofmedical home as
the
standard ofcare for primarycare. That’s the type ofcare thatwe all want to provide,” said Dr.Vera F. Tait, associate executivedirector ofthe American Acade-my ofPediatrics.Not everyone is clear on whatexactly a medical home is, not-ed Dr. James King, president of the American Academy ofFam-ily Physicians. “A lot ofpeople[are] starting to use the phrase
BY ROBERT FINN
San Francisco Bureau
S
AN
F
RANCISCO
— Acutekidney injury may not be as rarea consequence oforal sodiumphosphate bowel purgatives aspreviously thought, researcherssaid at the annual meeting ofthe American Society ofNephrology.In a retrospective study of nearly 10,000 patients, those giv-en oral sodium phosphate purga-tives prior to colonoscopy had2.35 times the chance ofdevel-oping acute kidney injury as didthose given polyethylene glycolpurgatives. This result was ob-tained after adjustment for manypotential confounders, and was based on a definition ofacutekidney injury as a 50% increase inserum creatinine, said Col. Frank P. Hearst, MC, USA, and his col-leagues at the Walter Reed ArmyMedical Center, Washington.The study involved 6,432 pa-tients who received oral sodiumphosphate and 3,367 who re-ceived polyethylene glycol as out-patients prior to colonoscopy. Allpatients were at least 50 yearsold, and all had serum creatininemeasurements within 365 days before and after the procedure
Need for laser therapy was cut by 37%.
Fenofibrate CurbedRetinopathy inDiabetic Patients
Oral Purgatives LinkedWith Acute Kidney Injury
BY MITCHEL L.ZOLER
Philadelphia Bureau
O
RLANDO
— Treatment withfenofibrate led to a substantialdrop in the need for laser treat-ments for retinopathy in a con-trolled trial ofnearly 10,000 pa-tients with type 2 diabetes.Physicians should “consider us-ing fenofibrate on all patientswith diabetes, even patients al-ready on a statin and at their tar-get lipid levels, to further reducetheir risk and microvascular com-plications,” Dr. Anthony C. Keechsaid at an industry-sponsoredpress briefing during the annualscientific sessions ofthe Ameri-can Heart Association.“Having a new tool to dealwith [diabetic retinopathy] is veryexciting. It’s exciting to use it totreat patients, and it opens awhole new area ofresearch,”commented Dr. Virgil Brown,professor ofinternal medicine atEmory University, Atlanta.The benefits offenofibrate for microvascular disease ofdiabetesappeared to extend beyond its sig-nificant effect on retinopathy. Pa-tients treated with fenofibrate alsohad less progression ofalbumin-uria, and fewer amputations, Dr.Keech and his associates reported.“The results were very clear-cut. It’s very hard to make a co-herent argument not to usefenofibrate” in patients with dia- betes, said Dr. Keech, professor of
S
H E R I
M
A T T E S
/ E
L S E V I E R
G
L O B A L
M
E D I C A L
N
E W S
Improved reimbursement is “a very urgent issue,” said Dr. DavidC. Dale, president of the American College of Physicians.
Early Signs ofParkinson’s
Preclinical brain changes canbe seen on SPECT images.
PAGE 13
Family History
Genetics column looks at new applications for family health history.
PAGE 28
Toe Tips
Clinical pearls for thediagnosis and treatment of onychomycosis.
PAGE 26
See
Medical Home
page 5
INSIDE
E
FFECTIVE
P
HYSICIAN
: N
EW
A
STHMA
G
UIDELINES
,
PAGE
19
www.eclinicalpsychiatrynews.com
V
OL
. 40, N
O
. 23
The Leading Independent Newspaper for the Internist—Since 1968
See
Fenofibrate
page 20See
Purgatives
page 6
www.internalmedicinenews.com
NewsInternal Medicine
D
ECEMBER
1, 2007
Pediatric: infectious diseasePediatric: generalFamily practice (without OB)Pediatric: hospitalistInternal medicine: generalInternal medicine: pediatric
Average Workweeks in Selected Primary CareSpecialties Were Similar in 2006
Note: Mean hours that clinician is involved in direct patient care.Source: Medical Group Management Association
38.7 hours37.0 hours36.6 hours36.6 hours35.7 hours33.1 hours
(n = 76)(n = 3,368)(n = 62)(n = 4,634)(n = 2,390)(n = 14)
VITAL SIGNS
E
L S E V I E R
G
L O B A L
M
E D I C A L
N
E W S
Add a Comment