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florida80 · 07-10-2019

July/August 2019 Annals of Family Medicine tip sheet

American Academy of Family Physicians

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Diabetes Patients Experiencing Empathy From Primary Care Practitioners Have Lower Risk of Mortality

A United Kingdom study designed to examine the association between primary care practitioner empathy and incidence of cardiovascular disease and all-cause mortality among type 2 diabetes patients found that those patients experiencing greater empathy in the year following their diagnosis saw beneficial long-term clinical outcomes. Using the consultation and relational empathy (CARE) questionnaire, which measures patients' experience of care with a focus on empathy, a numerical score for 628 participants from 49 general practices in East Anglia, UK, was computed 12 months after diagnosis. Those patients reporting better experiences of empathy had a lower risk (40-50%) of all-cause mortality over the subsequent 10 years compared with those reporting low practitioner empathy. While medicine moves increasingly towards precision, target-driven health care and technology-based assessment models, these findings suggest that interpersonal, empathic care may be an important determinant in the risk of mortality.

Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study
Hajira Dambha-Miller, MRCGP, PhD et al
University of Cambridge, United Kingdom
http://www.annfammed.org/content/17/4/311

Metformin Could Lower Risk of Dementia in African Americans With Type 2 Diabetes

A large observational cohort study examining male veterans aged over 50 years with type 2 diabetes found that metformin use was associated with a significantly lower risk of dementia in African American patients. The study included data from 73,500 patients who received care through the Veteran's Health Administration from 2000-2015 and were diabetes- and dementia-free at baseline and who subsequently developed type 2 diabetes and began treatment with either metformin or sulfonylurea. Cox proportional hazards models, using propensity scores and inverse probability treatment to balance confounding factors, were computed to measure the association of both drugs and incident dementia across race and age groups. For African American patients aged 50-64 years, the hazard ratio for developing dementia was 0.60 (CI, 0.45-0.81), and for African American patients aged 65-74 years, the hazard ratio was 0.71 (CI, 0.53-0.94). The study showed modest to no association between metformin and lower risk for dementia in white patients 65-74 and no association in other age groups. The present results may point to a novel approach for reducing dementia risk in African Americans with type 2 diabetes mellitus.

Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients
Jeffrey F. Scherrer, PhD, et al
Saint Louis University, St. Louis, Missouri
http://www.annfammed.org/content/17/4/352

Redesign of Opioid Medication Management Shows Impact in Rural Clinics

In rural practice, a system redesign resulted in declines in the proportion of patients on high dose opioids and the number of patients receiving opioids. The "Six Building Blocks," a team-based redesign of opioid medication management within smaller practice settings addressing policy changes, patient agreements, patient tracking, in-clinic support, and success metrics, was implemented in 20 clinic locations across eastern Washington and central Idaho. Among patients aged 21 years and over, there was a 2.2% decline in patients receiving high dose opioids over a period of 15 months, compared to a 1.3% decline in the control group. Similarly, a 14% decline was observed in the total number of patients receiving opioids in the intervention clinics compared to a 4.8% control group decline. The results indicate that efforts to redesign care by primary care teams, guided by the Six Building Blocks framework, can improve opioid prescribing practices and possibly reduce dependency.

Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing
Michael L. Parchman, MD, MPH, et al
Kaiser Permanente Washington Health Research Institute, Seattle
http://www.annfammed.org/content/17/4/319

07-10-2019	#1170
florida80 R11 Tuyệt Thế Thiên Hạ Join Date: Aug 2007 Posts: 113,793 Thanks: 7,446 Thanked 47,185 Times in 13,138 Posts Mentioned: 1 Post(s) Tagged: 0 Thread(s) Quoted: 511 Post(s) Rep Power: 162	July/August 2019 Annals of Family Medicine tip sheet American Academy of Family Physicians     Share  Print  E-Mail Diabetes Patients Experiencing Empathy From Primary Care Practitioners Have Lower Risk of Mortality A United Kingdom study designed to examine the association between primary care practitioner empathy and incidence of cardiovascular disease and all-cause mortality among type 2 diabetes patients found that those patients experiencing greater empathy in the year following their diagnosis saw beneficial long-term clinical outcomes. Using the consultation and relational empathy (CARE) questionnaire, which measures patients' experience of care with a focus on empathy, a numerical score for 628 participants from 49 general practices in East Anglia, UK, was computed 12 months after diagnosis. Those patients reporting better experiences of empathy had a lower risk (40-50%) of all-cause mortality over the subsequent 10 years compared with those reporting low practitioner empathy. While medicine moves increasingly towards precision, target-driven health care and technology-based assessment models, these findings suggest that interpersonal, empathic care may be an important determinant in the risk of mortality. Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study Hajira Dambha-Miller, MRCGP, PhD et al University of Cambridge, United Kingdom http://www.annfammed.org/content/17/4/311 Metformin Could Lower Risk of Dementia in African Americans With Type 2 Diabetes A large observational cohort study examining male veterans aged over 50 years with type 2 diabetes found that metformin use was associated with a significantly lower risk of dementia in African American patients. The study included data from 73,500 patients who received care through the Veteran's Health Administration from 2000-2015 and were diabetes- and dementia-free at baseline and who subsequently developed type 2 diabetes and began treatment with either metformin or sulfonylurea. Cox proportional hazards models, using propensity scores and inverse probability treatment to balance confounding factors, were computed to measure the association of both drugs and incident dementia across race and age groups. For African American patients aged 50-64 years, the hazard ratio for developing dementia was 0.60 (CI, 0.45-0.81), and for African American patients aged 65-74 years, the hazard ratio was 0.71 (CI, 0.53-0.94). The study showed modest to no association between metformin and lower risk for dementia in white patients 65-74 and no association in other age groups. The present results may point to a novel approach for reducing dementia risk in African Americans with type 2 diabetes mellitus. Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients Jeffrey F. Scherrer, PhD, et al Saint Louis University, St. Louis, Missouri http://www.annfammed.org/content/17/4/352 Redesign of Opioid Medication Management Shows Impact in Rural Clinics In rural practice, a system redesign resulted in declines in the proportion of patients on high dose opioids and the number of patients receiving opioids. The "Six Building Blocks," a team-based redesign of opioid medication management within smaller practice settings addressing policy changes, patient agreements, patient tracking, in-clinic support, and success metrics, was implemented in 20 clinic locations across eastern Washington and central Idaho. Among patients aged 21 years and over, there was a 2.2% decline in patients receiving high dose opioids over a period of 15 months, compared to a 1.3% decline in the control group. Similarly, a 14% decline was observed in the total number of patients receiving opioids in the intervention clinics compared to a 4.8% control group decline. The results indicate that efforts to redesign care by primary care teams, guided by the Six Building Blocks framework, can improve opioid prescribing practices and possibly reduce dependency. Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing Michael L. Parchman, MD, MPH, et al Kaiser Permanente Washington Health Research Institute, Seattle http://www.annfammed.org/content/17/4/319