Report Finds Off-Label Use of Atypical Antipsychotic Drugs Not Supported By Evidence for Some Conditions

Electronic Newsletter, Issue 325

For patients age 40 and over with chronic obstructive pulmonary disease (COPD), hospital readmissions within 30 days of initial treatment were 30 percent higher among blacks than Hispanics or Asians and Pacific Islanders and about 9 percent higher than among whites in 2008. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #121: Readmissions for Chronic Obstructive Pulmonary Disease, 2008.]

Today's Headlines

Report finds off-label use of atypical antipsychotic drugs not supported by evidence for some conditions
AHRQ initiative encourages better two-way communication between clinicians and patients
New guides compare benefits and risks of GERD treatments
Patient-Centered Outcomes Research Institute announces $26 million pilot projects grant program
Statement by Secretary Sebelius on National Sickly Cell Disease awareness month
Report finds DMARDs effective in treating juvenile arthritis
AHRQ addresses inconsistent provider performance scores
AHRQ-funded projects focus on improving patient safety through simulation research
New interactive decision aid for men with clinically localized prostate cancer
AHRQ's Innovations Exchange focuses on smoking cessation programs
Highlights from most recent monthly newsletter
AHRQ in the professional literature

1. Report finds off-label use of atypical antipsychotic drugs not supported by evidence for some conditions

AHRQ�s Effective Health Care Program has released a new report that found there is little evidence to support the use of atypical antipsychotic drugs for some treatments other than their officially approved purposes, even though many clinicians continue to commonly prescribe these drugs for of- label uses. Atypical antipsychotic medications, which are approved by the FDA for treatment of schizophrenia, bipolar disorder and, in some cases, depression, are commonly prescribed to treat other behavioral conditions. The report, which is an update of a 2007 report, found limited evidence to support the off-label use of certain atypical antipsychotic medications. Evidence was strongest, for example, for the off-label use of risperidone, olanzapine and aripiprazole to treat symptoms of dementia; quetiapine to treat generalized anxiety disorder; and risperidone to treat obsessive-compulsive disorder. However, evidence was lacking to justify the use of these and other atypical antipsychotic drugs to treat substance abuse problems, eating disorders or insomnia. These findings and future research needs are summarized in the review, Off-Label Use of Atypical Antipsychotics: An Update. Select to read our press release and select to access the abstract on PubMed.®

2. AHRQ Initiative Encourages Better Two-Way Communication Between Clinicians and Patients

AHRQ launched an initiative to encourage clinicians and patients to engage in effective two-way communication to ensure safer care and better health outcomes. For nearly a decade, AHRQ has encouraged patients to be more involved in their health care, and this new initiative builds on previous public education campaigns AHRQ has conducted under contract with the Ad Council around the theme "Questions are the Answer." An original series of new videos features real patients and clinicians discussing the importance of asking questions and sharing information. Several patients discuss how good communication helped them avoid medication errors or get a correct diagnosis. Clinicians stress the benefits of having their patients prepare for medical appointments by bringing a prioritized list of the questions they wish to cover. Select to read our press release and select to access with the videos and other resources.

3. New Guides Compare Benefits and Risks of GERD Treatments

New plain-language publications compare the benefits and risks of treatments for gastroesophageal reflux disease (GERD), a digestive condition that affects millions of Americans and can be treated with medications or surgery. The new publications—a summary for consumers and a companion publication for clinicians—are based on the findings of an updated evidence report, Comparative Effectiveness of Management Strategies for Adults with Gastroesophageal Reflux Disease by AHRQ's Tufts Medical Center Evidence-based Practice Center. The report concluded that established drug-based therapy is effective. It also concluded that a type of surgical treatment known as laparoscopic fundoplication is at least as effective as drug-based medical treatment for some patients, but also had a higher risk of serious side effects. Select to read our press release and access the report and the consumer and clinicians publications.

4. Patient-Centered Outcomes Research Institute Announces $26 Million Pilot Projects Grant Program

The Patient-Centered Outcomes Research Institute (PCORI) announced the Pilot Projects Grant Program, the organization's first major funding opportunity. The purpose of the program is to inform PCORI's ongoing development and enhancement of national priorities for patient-centered outcomes research (PCOR), support the collection of preliminary data that can provide a platform for an evolving research agenda, and support the identification of research methodology to advance PCOR. The Institute intends to commit up to $26 million under the program—$13 million per year for two years support of approximately 40 awards. PCORI is interested in the development of research methods, patient-oriented outcomes instruments, patient-provider communication and other decision-making strategies, building collaborative research teams with stakeholders, translating research findings into clinical practice, stakeholder engagement, and research agenda setting strategies that can be used in future comparative effectiveness research. All application materials can be downloaded from the "Funding Opportunities" section of PCORI's Web site. Letters of intent for grants must be received by November 1, and applications must be received by December 1.

5. Statement by Secretary Sebelius on National Sickle Cell Disease Awareness Month

September is National Sickle Cell Disease (SCD) Awareness month. Earlier this year, HHS launched the Sickle Cell Disease Initiative, which brings together multiple HHS agencies—including the NIH, HRSA, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Food and Drug Administration, and AHRQ—to find better ways to educate the public about SCD, enhance research to find better treatments, and train more clinicians using evidence-based guidelines that promote quality, comprehensive care. HHS is increasing its attention on children with SCD transitioning to adult care and adults with SCD. As part of this effort, AHRQ is awarding an $865,365 grant, over a three-year period, to Duke University to conduct research that will help improve the quality of care provided by emergency departments (EDs) for adults with SCD. A recent study indicates that approximately 25 percent of adults with SCD visit the ED more than six times a year, and many of these patients have potentially life threatening complications. Select for more information on the Sickle Cell Disease Initiative (Plugin Software Help). Select for more information on Sickle Cell Disease. Select to read the HHS press release.

6. Report Finds DMARDs Effective in Treating Juvenile Arthritis

Medications known as disease-modifying anti-rheumatic drugs, or DMARDs, appear to be more effective than other treatment for children with arthritis, but there is not enough evidence to support one kind of DMARD over another, according to a new AHRQ report. The report compared DMARDs with conventional treatments such as ibuprofen and steroids. It found that DMARDs are more effective than other treatments for improving symptoms of juvenile idiopathic arthritis, but the evidence was unclear about their long-term effectiveness and safety. The new comparative effectiveness review was prepared by AHRQ's Duke Evidence-based Practice Center. Also available are summary publications for consumers and clinicians explaining juvenile arthritis and options for treatment. Select to access the report and the companion guides and select to read our press release.

7. AHRQ Addresses Inconsistent Provider Performance Scores

AHRQ's new white paper, Methodological Considerations in Generating Provider Performance Scales is intended to help Chartered Value Exchanges (CVEs) and other organizations involved in public reporting of health care provider performance information. The paper offers guidance on identifying the sequence of decisions involved in public reporting and the range of options for each of these decisions. The paper addresses decisions encountered when working on six key tasks: negotiating consensus on goals and value judgments of performance reporting; selecting the measures for evaluating provider performance; identifying data sources and aggregating performance data; checking data quality and completeness; computing provider-level performance scores; and creating reports. The paper also distinguishes different types of measurement error, how sources of error may enter into the construction of provider performance scores, and how to mitigate or minimize the risk of misclassifying a provider. The paper, which was developed for AHRQ by Mark W. Friedberg, M.D., and Cheryl L. Damberg, Ph.D., of RAND Corporation, is intended to support ongoing dialogue on data and measure decisions as we as a Nation contemplate the future of public reporting for consumers. Select to access the paper.

8. AHRQ-Funded Projects Focus on Improving Patient Safety Through Simulation Research

AHRQ-funded simulation research creates a safe learning environment in which researchers and practitioners can test new clinical processes and enhance their individual and team skills. AHRQ has released a new fact sheet that summarizes grant awards for simulation research projects funded in fiscal year 2011. AHRQ funded 11 multi-year demonstration grants to evaluate the use and effectiveness of various simulation approaches and the role they can play in improving the safety and quality of health care delivery. Grant research topics include simulations of cardiac surgery, pediatric resuscitation methods, steps to recognize sepsis, and techniques for teaching femoral arterial access used for coronary artery stent placement. These newly funded projects will inform providers, health educators, payers, policymakers, patients, and the public about the effective use of simulation in improving patient safety. Select for more information.

9. New Interactive Decision Aid for Men with Clinically Localized Prostate Cancer

AHRQ's Effective Health Care Program has released a new Web-based self-directed patient decision aid, "Knowing Your Options: A Decision Aid for Men with Clinically Localized Prostate Cancer." This interactive tool is designed to help men who have been recently diagnosed with clinically localized prostate cancer learn more about prostate anatomy; what it means to have clinically localized prostate cancer; treatment options, including the choice to not begin treatment immediately; and information about treatment options. Patients who complete the decision aid can save and print an information summary to share with their doctors. Experts in the International Patient Decision Aid Standards guided the development of the decision aid based on AHRQ's Effective Health Care 2008 published research report, Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer and more recently published evidence.

10. AHRQ's Innovations Exchange Focuses on Smoking Cessation Programs

The September 28 issue of AHRQ's Health Care Innovations Exchange features profiles of two programs that increased the use of smoking cessation resources and led to higher quit rates. One such profile, Culturally Appropriate, Interactive Decision Aid Yields High Quit Rates, describes a program that uses a video-based decision aid to improve knowledge and use of resources among underserved, low-literacy Latino and Hispanic smokers. The program led to high degrees of engagement by participants and to well above-average quit rates in those who expressed a desire to stop smoking. Read more innovations and tools about smoking cessation on the Innovations Exchange Web Site, which contains more than 650 searchable innovations and 1,625 searchable QualityTools.

11. Highlights from Our Most Recent Monthly Newsletter

The September issue of Research Activities is available online. Key articles include:

The challenge of prioritizing care for complex patients.
Optimizing health care and ultimately the health of Americans is getting harder as patients increasingly have more than one chronic condition: diabetes, depression, heart disease, and more. Researchers are looking at how to prioritize treatment and preventive care for these patients. For example, how do you decide which medications to prescribe when treating patients with multiple conditions when the medicines may have dangerous interactions? And, what are the harms and benefits of preventive tests that may unnecessarily burden patients with multiple chronic conditions who are already juggling numerous drugs and doctors' visits?

Select to read this article.