The Ethics Observer » Research

NYTimes: When Heart Devices Fail, Who Should Be Blamed?

Site Staff — Thu, 22 Apr 2010 03:09:24 +0000

From The New York Times:

When Heart Devices Fail, Who Should Be Blamed?

Doctors in a landmark medical device case ask who should be held responsible when a company sells flawed products.

The Future of Primary Medical Care

Site Staff — Wed, 23 Sep 2009 14:32:38 +0000

In this issue, Linzer and colleagues found that family practitioners and general internists report high levels of unhappiness about time pressures and practice pace, little sense of control over work conditions, and deficient organizational culture. Primary care as an indispensable set of functions will persist in one form or another; the challenge is to organize it as part of an integrated system that serves the needs of both patients and physicians, enhances quality, and keeps costs within reasonable limits.

Read full text at Annals (subscription required)

Dementia Care in Different Ethnic Groups

Site Staff — Tue, 12 Dec 2006 06:50:53 +0000

A recent study (RCT) in Annals of Internal Medicine looks into the effects of multi component intervention on quality of life and clinical depression in caregivers and on rats of institutional placement of care recipients in 3 diverse racial groups. The groups studied were Hispanic or Latino, White or Caucasian and Black or African-American caregivers and their care recipients. What the study found out was that Hispanic caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (p< 0.001). Black or AA spouse caregivers also improved significantly more. Prevalence of depression was lower among caregivers in the intervention group. On thing of not is the lack of institutionalization rate at 6 months. From this the authors of the study concluded that "a structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. The study has certain limitations. For one, as the authors point out that the follow up was only 6 months. This is not enough for a chronic illness like dementia. Second, not all the ethnic groups were included limiting the generalizability of the study. However, the study opens a door for further studies like this on a more long term basis. Summary for patients can be found here.

Disparities in the Utilization of Complex Surgery

Site Staff — Wed, 25 Oct 2006 09:21:30 +0000

A new study finds disparities in the Utilization of High-Volume Hospitals for Complex Surgery. This is not surprising at all given the fact that complex surgeries cost more and hospitals and doctors do what ever they can to divert the “self-pays” or lower paying patients to other facilities, defer these procedures or make it more difficult for these patients to have this sort of surgeries done.

The study findings were as follows:

A total of 719 608 patients received 1 of the 10 operations. Overall, nonwhites, Medicaid patients, and uninsured patients were less likely to receive care at high-volume hospitals and more likely to receive care at low-volume hospitals when controlling for other patient-level characteristics. Blacks were significantly (P<.05) less likely than whites to receive care at high-volume hospitals for 6 of the 10 operations (relative risk [RR] range, 0.40-0.72), while Asians and Hispanics were significantly less likely to receive care at high-volume hospitals for 5 (RR range, 0.60-0.91) and 9 (RR range, 0.46-0.88), respectively. Medicaid patients were significantly less likely than Medicare patients to receive care at high-volume hospitals for 7 of the operations (RR range, 0.22-0.66), while uninsured patients were less likely to be treated at high-volume hospitals for 9 (RR range, 0.20-0.81).

The authors conclude that:

There are substantial disparities in the characteristics of patients receiving care at high-volume hospitals. The interest in selective referral to high-volume hospitals should include explicit efforts to identify the patient and system factors required to reduce current inequities regarding their use.

You can view the article at the JAMA site.