EHC Program Inside Track Newsletter

Issue 7, September 2012
EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program.

In this issue:

EHC Program Expands Library of Treatment Comparisons for Mental Health Conditions

A diverse menu of new publications from AHRQ’s Effective Health Care (EHC) Program is now available to help health care professionals work with their patients to compare treatment options for mental health disorders.
The publications, detailed below, summarize the evidence on:

  • Off-label use of antipsychotics to treat conditions such as dementia, generalized anxiety disorder, and obsessive-compulsive disorder
  • The use of second-generation antidepressants to treat adults
  • Behavioral counseling interventions for reducing alcohol misuse
  • Interventions for treating depression and co-occurring medical conditions

Consumer and Clinician summaries on Medicines for Treating Mental Health Conditions are available from the EHC Program.The new products, ranging from research reviews to continuing education activities, expand AHRQ’s growing library of mental health resources.

Nearly 1 in 4 Americans has a mental illness and nearly 1 in 2 U.S. adults will develop at least one mental illness during their lifetime, according to Federal estimates. Given the prevalence of these disorders, it is important that clinicians and patients have access to reliable information about the effectiveness and risks of treatment options.

The newest additions to AHRQ’s library of mental health products include:

Antipsychotic Medications: Off-Label Use

Summary materials for patients and clinicians outline key findings and clinical implications for various off-label uses of antipsychotics for disorders such as dementia, generalized anxiety disorder, and obsessive-compulsive disorder. Resources include–

Medicines for Treating Mental Health Conditions consumer summary.

Depression: Second-Generation Antidepressant Medications

Medicines for Treating Depression consumer summary.New resources summarize the effectiveness and adverse effects of 13 second-generation antidepressants used to treat adults with depression. The materials are based on a review which found that overall there are no substantial differences in effectiveness among these drugs, but that there are some differences in onset of action and adverse effects, which may affect treatment choices. Resources include –

Alcohol Misuse: Screening, Counseling, Referral

A new research review concludes that behavioral counseling interventions improve certain outcomes for adults with risky/hazardous drinking habits. This new report compares clinical studies assessing the effectiveness of screening and behavioral counseling for alcohol misuse in adolescents and adults in primary care settings. The best evidence of effectiveness is for 10-15 minute sessions on behavior improvement focusing on how patients use or misuse alcohol. Although behavioral counseling interventions improve unhealthy drinking behaviors, such as heavy episodic drinking and high weekly consumption of alcohol for most long-term health outcomes, such as liver damage or death, available evidence is largely insufficient to draw conclusions. Read the full research review here: Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse. Companion summary resources for patients and clinicians will be available soon.

Depression: Collaborative Care for Depression and Other Chronic Conditions

Collaborative care interventions involving close coordination between mental health and primary care providers may improve outcomes for depression symptoms, remission, depression-free days, and quality of life in primary care patients experiencing both depression and other chronic medical conditions, according to this new research review. However, there is little evidence available on the effect of collaborative care treatment on medical outcomes for arthritis, cancer, diabetes, heart disease, and HIV. Read the full research review here: Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting. Companion summary resources for patients and clinicians will be available soon.

 More New Effective Health Care Program Resources

New Evidence-Based Treatment Comparisons for Patients and Clinicians
These treatment comparison summaries are available to help patients and clinicians learn about treatment options and compare their risks, benefits, and effectiveness. (To order free print copies, call 1-800-358-9295 and use reference code C-05.)

Spanish-Language Patient ResourcesThree new Spanish-language consumer summaries are now available on low bone density, chronic pelvic pain, and urinary incontinence.

New Research Reviews Comparing Treatment Options
Each of these reviews compares available evidence from numerous research studies. Companion summary resources for patients and clinicians will be available for each of these reviews in the future.

Autism: Interventions for Adolescents and Young Adults
Despite the number of teens and young adults affected by autism spectrum disorders, there is insufficient evidence available for caregivers to choose the best therapies. This new review focused on the comparative effectiveness of behavioral, educational, vocational, adaptive life skills, and medical interventions, but found that most studies had low strength of evidence, addressed different interventions and outcomes, and lacked replication, making it challenging to draw comparisons across therapies. Read the full research review here: Interventions for Adolescents and Young Adults with Autism Spectrum Disorders.

Cancer: Serum Free Light Chain Analysis for the Diagnosis of Plasma Cell Dyscrasias
Although the SFLC procedure has been in use for a decade for PCD diagnosis, how best to incorporate it into practice remains unclear. The review determined that evidence was mostly insufficient as to what extent adding SFLC to current tests improves diagnosis, prognosis, monitoring of therapy, and treatment decisions. Read the full research review here: Serum-Free Light Chain Analysis for the Diagnosis, Management, and Prognosis of Plasma Cell Dyscrasias.

Diabetes: Insulin Delivery and Glucose Monitoring
According to this new research review, sensor-augmented insulin pumps are superior to multiple daily insulin injections with self-monitoring blood glucose using fingersticks for lowering high blood sugar in patients with Type 1 diabetes. Sensor-augmented insulin pumps combine insulin pumps with real-time, continuous glucose-blood sugar monitoring. The review found an improved quality of life for type 1 diabetic patients who are using continuous insulin infusion rather than multiple daily injections of insulin and called for more research to assess the impact of these technologies on long-term clinical outcomes and on different patient populations. Read the full research review here: Methods of Insulin Delivery and Glucose Monitoring: Comparative Effectiveness.

Heart Disease: Treatment for Women
Although cardiovascular disease is the leading cause of death for women in the United States, most studies do not focus on the effectiveness of treatments in women specifically, and existing research may not adequately reflect the benefits and risks that women experience. According to this new research review of numerous clinical studies, current evidence is too limited to draw firm conclusions about the comparative benefits or harms of different treatment strategies for women with coronary artery disease. However, some evidence suggests that women may respond differently to certain treatment strategies than men. Read the full research review here: Treatment Strategies for Women With Coronary Artery Disease.

Inguinal Hernia: Surgical Treatments
For painful abdominal hernias in adults, this new research review finds that the risk of a recurrent hernia after open surgery was lower than the risk of recurrence after laparoscopic surgery. However, the review did show that for pediatric hernias laparoscopy is generally more effective than surgery for reducing recurrence. The study did not highlight many negative side effects for open surgery versus laparoscopy, but did note that the recovery time for open surgery was generally longer. The study also noted that quality of life after the diagnosis of an inguinal hernia was higher after one year for individuals who chose surgical intervention (either open surgery or laparoscopy) rather than watchful waiting. Read the full research review here: Surgical Options for Inguinal Hernia.

Kidney Stones: Prevention Methods
Several treatments decrease the risk of recurrent calcium kidney stones, according to a new research review. These treatments include increased fluid intake, reduced soft drink consumption, thiazide diuretics (which lower urinary calcium excretion, and prevent calcium containing kidney stones), citrate pharmacotherapy (which prevents kidney stone formation), and allopurinol (used to treat excess uric acid in blood plasma). Evidence was mixed on whether dietary intervention effectively reduces the risk of recurrent stones. Read the full research review here: Recurrent Nephrolithiasis in Adults: A Comparative Effectiveness Review of Preventive Medical Strategies.

Pregnancy: Nitrous Oxide for Managing Labor Pain
This new research review evaluates the use of inhaled nitrous oxide or “laughing gas” to manage maternal pain during labor. Although nitrous oxide is commonly used in many countries for labor pain, only five centers in the United States are known to provide it as an option. However, it is an important area of study because nitrous oxide offers several potential benefits, including being inexpensive, noninvasive, and able to be self-administered as needed at any point during labor. The research review found that nitrous oxide was less effective at controlling pain than epidural analgesia, but it noted that the quality of available studies was generally poor and additional research is needed to assess effectiveness for pain control, women’s satisfaction, type of birth, harms, and health system factors related to the use of nitrous oxide in labor. Read the full research review here: Nitrous Oxide for the Management of Labor Pain.

Respiratory Failure: Noninvasive Positive Pressure Ventilation
Noninvasive positive pressure ventilation (NPPV) is increasingly recognized as an alternative to conventional mechanical ventilation for treating some cases of acute respiratory failure. This new research review finds that it may offer several benefits with minimal side effects for patients suffering from acute respiratory failure due chronic obstructive pulmonary disease (COPD) or congestive heart failure, as well as those who are post-operative or post-transplant. Read the full research review here: Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure.

Page last reviewed September 2012
Internet Citation: EHC Program Inside Track Newsletter. Content last reviewed September 2012. Agency for Healthcare Research and Quality, Rockville, MD.