Study shows good doctor-patient relationships facilitate discussions about health care costs

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Article Date: 26 Jul 2013 - 0:00 PDT Current ratings for:
Study shows good doctor-patient relationships facilitate discussions about health care costs

Strong relationships with physicians, particularly those that are long standing, are likely to increase patients' openness to talk about health care costs when decisions are being made about their treatment options.

According to a new study[1] by Marion Danis from the National Institutes of Health Clinical Center[2] in the US, and colleagues, rushed visits with insufficient time to talk about important issues can undermine efforts to bring sensitive topics like costs into the doctor-patient relationship and can be counterproductive. The work appears online in the Journal of General Internal Medicine[3], published by Springer.

Physicians are increasingly expected to take costs into account when they offer treatment recommendations and make decisions for patients. Several communication strategies have been considered to help doctors broach the topic of insurer and out-of-pocket costs with patients. These include:

Using empathy so doctors and patients are working as a team to address the issue of cost Each party doing their part to address costs so the decision-making is fair Emphasizing that the less expensive option is good enough and debunking the notion that the newest, most expensive treatment is the better choice Educating patients of the impact of rising health care costs on their premiums.

Danis and team convened 22 focus groups of 211 insured patients to explore attitudes towards discussing and considering insurer and out-of-pocket costs in the doctor-patient encounter. They also examined whether proposed communications strategies would make the patient more receptive to discussing cost.

In the focus groups, patients were led though a series of scenarios. For example, patients were asked to imagine they had experienced the worst headache of their life for three months, for which their doctor recommended an imaging study e.g. MRI or CT scan. The doctor explained that the difference between the two tests was marginal; the MRI however was twice as expensive as the CT. For all scenarios, participants discussed whether and how they would want their physicians to broach the topic of costs with them, and which treatment option they would ultimately choose. The researchers also observed participants' reactions to the four communications strategies.

Patients were more willing to talk to doctors about personal, out-of-pocket costs than insurer costs. Older and sicker participants were more willing to talk to their doctor about costs than younger and healthier participants.

Overall, patients did not endorse recommended communications strategies for discussing costs in the clinical encounter. In contrast, patients stated that trust in their doctor would make them more willing to discuss costs. Barriers to having those discussions included rushed, impersonal visits and clinicians who were insufficiently informed about costs.

The authors conclude: "Our findings suggest that trust is a valuable ingredient for honest conversations about how to make cost-effective treatment decisions. Given that patients are more receptive to discussing out-of-pocket costs, stronger efforts to educate the public about the importance, for their own sake, of controlling insurer costs is a possible strategy for enabling discussions about these costs."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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1. Danis M et al (2013). Exploring Public Attitudes Towards Approaches to Discussing Costs in the Clinical Encounter. Journal of General Internal Medicine; DOI 10.1007/s11606-013-2543-9

2. The study findings and their interpretation reflect the views of the authors and do not necessarily reflect the policies of the National Institutes of Health or the US Department of Health and Human Services.

3.The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine.

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Fewer female soccer injuries on artificial turf: study

By Kathleen Raven

NEW YORK | Fri Sep 6, 2013 2:48pm EDT

NEW YORK (Reuters Health) - Female soccer players suffered fewer severe injuries while competing on an artificial surface called FieldTurf than when playing on natural grass fields, in a new study.

Researchers found women's college teams had an average of 7.7 injuries - both minor and serious - for every 10 matches played on FieldTurf, compared to 9.5 injuries per 10 matches on grass. Most competitive collegiate soccer seasons consist of 20 to 25 matches.

The findings suggest "FieldTurf is a practical alternative to natural grass," study author Michael Meyers of Idaho State University in Pocatello told Reuters Health.

Early versions of synthetic turf that appeared in the late 1960s and 1970s were sometimes little more than a layer of thick, carpet-like material laid over concrete, he said. In today's U.S. artificial surface market, more than 30 companies compete with proprietary mixes of what the industry calls "infill systems," which can include rubber, silica sand and polyethylene fibers.

Montreal-based FieldTurf, which funded 40 percent of the current study, relies on a blend of silica sand and cryogenically ground rubber for its fields.

Estimates vary, but artificial field turf surfaces can last up to 10 years, with initial installment costs ranging from $800,000 to $1 million and annual maintenance fees of about $2,500.

"As the impact of the game increases, as the adverse weather worsens, FieldTurf provides a more consistent surface," than grass fields, said Meyers, who does not own any stock in the company.

The new study, published in The American Journal of Sports Medicine, is based on injury data from nearly 800 matches reported by athletic trainers at 13 universities classified as National Collegiate Athletic Association (NCAA) Division IA. Women's soccer programs that spent nearly equal competition time on FieldTurf and natural grass were included.

There were 693 injuries recorded during the five-year study period, including 130 substantial or severe injuries.

Substantial injuries requiring one to three weeks off were twice as common on natural grass as turf, Meyers found.

In his analysis, he considered the athlete's weight, shoe cleat design, weather conditions, position played at the time of injury, the age of the field itself and the surface temperature.

The current study is "remarkably comprehensive," said Glen Livesay, a biomedical engineer at Rose-Hulman Institute of Technology in Terre Haute, Indiana.

Livesay, who was not involved in the current study, has investigated FieldTurf in his own research. He told Reuters Health similar experiments completed in lab environments tend to use simple, repetitive motions done at a slower pace compared to real-life games.

The study's findings run counter to another report that found a higher rate of anterior cruciate ligament (ACL) injuries on FieldTurf compared to grass surfaces for National Football League players (see Reuters Health story of September 14, 2012 here: reut.rs/1dN8J1Z).

A separate 2012 study of data from the NCAA's Injury Surveillance System on football games arrived at a similar conclusion regarding ACL injuries.

Meyers' findings do point in the same direction, however, as a 2007 British study that found no differences in injury rates among male and female soccer players on artificial turf versus grass surfaces.

Researchers agreed it's difficult to make comparisons between different sports, genders, playing levels and surface types.

Livesay said the current study could have been improved by looking at practice fields used by soccer teams to determine possible correlations between changing field types from practice to competition and injury incidence.

The current study is "another important piece in the puzzle, but it's not the whole answer," Dr. Samuel Taylor, an orthopedic fellow at the Hospital for Special Surgery in New York, who did not participate in the new research, told Reuters Health.

"It's difficult to make generalizable comparisons because so many factors go into the interaction between the type of turf and different injury types," he said.

SOURCE: bit.ly/1dN3H5n The American Journal of Sports Medicine, online August 13, 2013.

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Study reassures on safety of inhaled lung treatment

LONDON | Sun Sep 8, 2013 6:51am EDT

LONDON (Reuters) - A major study on the safety of a mist inhaler used to treat chronic lung disease has found it does not increase the risk of patients dying early, in contrast to an earlier analysis published two years ago.

The reassuring result with a formulation of Boehringer Ingelheim's Spiriva delivered through its new Respimat device is good news for the German drugmaker and potentially for others developing rival products containing so-called LAMA drugs.

Data from the 17,135-patient study, comparing the safety and efficacy of Spiriva Respimat against a formulation of the drug given via the older HandiHaler device, were unveiled at the European Respiratory Society congress in Barcelona on Sunday.

Competitors in the field include GlaxoSmithKline, whose experimental product Anoro combining a LAMA drug with a different kind of treatment called a LABA will be assessed by a U.S. Food and Drug Administration advisory panel on September 10.

The encouraging safety message on Spiriva Respimat may lower the regulatory hurdle for such new LAMA-containing products, industry analysts believe.

Several drugmakers are betting that LABA/LAMA inhalers will become the first choice for chronic obstructive pulmonary disease (COPD), which causes debilitating breathlessness and affects more than 200 million people worldwide.

Other companies working on long-acting beta-2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) combinations include Novartis, which has an alliance with Vectura; AstraZeneca, following its recent acquisition of Pearl Therapeutics; and a partnership of Almirall and Forest Laboratories.

Boehringer itself also has a LABA/LAMA drug in development.

Current market-leading drugs for COPD include Spiriva and GSK's Advair.

Spiriva has been on the market since 2002 but concerns about its safety were aroused in 2011 when a study based on a pooled analysis of previous trials suggested patients taking it via the Respimat device increased their risk of dying by 52 percent compared to those on placebo.

Boehringer and its marketing partner Pfizer disputed the findings at the time.

The new three-year clinical trial found Respimat was just as safe as the older HandiHaler inhaler and that COPD patients enjoyed a median 756 days without a sustained worsening of symptoms against 719 days among those using the HandiHaler. The new trial did not include a placebo group.

Boehringer hopes the new company-sponsored trial - one of the biggest to date in COPD - will draw a line under the safety question and reinforce the benefits of all Spiriva formulations. Global sales of Spiriva last year were $4.6 billion.

The outcome is also important for Boehringer's future ambitions in developing new medicines, including its LABA/LAMA product, since these also rely on the Respimat device.

The new study, which was sponsored by Boehringer, was published simultaneously in the New England Journal of Medicine.

(Editing by Anthony Barker)

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Mallinckrodt's extended-release pain drug meets main goal of study

By Vrinda Manocha

Fri Sep 6, 2013 2:37am EDT

n">(Reuters) - Specialty pharmaceutical company Mallinckrodt Plc said its experimental painkiller significantly reduced the intensity of pain in patients who had undergone a surgical removal of bunions.

The drug, MNK-795, showed statistically significant improvement in pain scores over 48 hours, compared to a placebo in a late-stage trial.

During the study, subjects took two tablets of MNK-795 every 12 hours. The drug is also designed to resist abuse.

The drug is a combination of two older pain drugs acetaminophen and oxycodone. The combination, already available as generics in the market, is highly addictive and often abused by snorting or by injecting into the muscles or veins.

Endo Pharmaceuticals' Percocet and Johnson & Johnson unit Janssen Pharmaceuticals' Tylox are branded versions of the drug.

BMO Capital Markets analyst David Maris said MNK-795 sales could peak at $200 million by 2017.

Dublin-based Mallinckrodt, spun off from Covidien Plc in July, said common side effects associated with the drug included nausea, dizziness and headaches.

Shares of the company were up about 2 percent at $45.97 in afternoon trading on the Nasdaq.

(This story corrects in the third paragraph the frequency of dosage to say two MNK-795 tablets taken every 12 hours, not once a day. Also removes BMO Capital Markets analyst quote in the fourth paragraph)

(Reporting By Vrinda Manocha in Bangalore; Editing by Don Sebastian)

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Warming helps crop pests spread north, south: study

By Environment Correspondent Alister Doyle

OSLO | Sun Sep 1, 2013 1:03pm EDT

OSLO (Reuters) - Crop-damaging pests are moving towards the poles at a rate of more than 25 km (16 miles) a decade, aided by global warming and human transport, posing a potential threat to world food security, a study showed on Sunday.

The spread of beetles, moths, bacteria, worms, funghi and other pests in a warming world may be quicker than for many types of wild animals and plants, perhaps because people are accidentally moving them with harvests, it said.

Scientists based in Britain studied more than 600 types of pests around the world and found that their ranges shifted on average towards the poles by 26.6 kms per decade since the 1960s, occupying vast new areas.

"We believe the spread is driven to a large degree by global warming," lead author Daniel Bebber of Exeter University told Reuters of the findings in the journal Nature Climate Change. They wrote it was the first study to estimate how pests are moving because of a changing climate.

The spread of pests is "a growing threat to global food security", the study said. Between 10 and 16 percent of crop production is lost to pests, with similar losses after harvest, they wrote.

The rate of spread, away from the equator and towards the north and south poles, is slightly faster than 17.6 kms found in a study in 2011 for wild animals and plants that was in turn quicker than 6.1 kms for wildlife estimated in a 2003 study.

The rate, however, is virtually identical to a theoretical prediction in 2011 that rising temperatures would allow a poleward shift of wildlife of 27.3 kms a decade, the experts wrote. Many crops are growing nearer the poles due to warming.

ROADS, CITIES

Researchers say crop pests are moving into new areas at a quicker rate than their predators, meaning they can do more damage to crops.

Wild species may find it harder to move because their habitats are getting fragmented by deforestation, farms, roads or cities. "Pest species are constantly being shifted around the world by trade...We are giving them a helping hand," Bebber said.

"I'm not surprised," by the faster rate than for wild animals and plants, said Gary Yohe, a professor at Wesleyan University in the United States who was co-author of the 2003 study that put the average pole wards shift at 6.1 kms.

A tiny pest is more likely than the average animal or plant to be carried inadvertently be taken on an train, truck or airplane to a new area, he noted. And he said the 2003 study was conservative.

Another possibility is that the rate of movement by wildlife "has really speeded up" in recent decades, said Michael Singer, a professor who works at both Plymouth University in England and the University of Texas.

And some insects pests may be getting more mobile since they are often forced to move by humans. "They have to be mobile because humans are constantly ploughing or otherwise modifying their habitats," Singer said.

Sunday's study said that there were many problems in determining how far climate was driving the pests' movements.

"New crop varieties and agricultural technologies have extended the agricultural margin northward in the United States and deforestation has increased production in the tropics, thus providing new opportunities for pest invasions at high and low latitudes," it said.

The scientists urged governments to think more about where to plant crops and monitor trade more closely to limit losses.

For the study, click here: here

(Editing by Keiron Henderson)

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