EHC Program Inside Track Newsletter

Issue 14, May 2013
EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program.

In this issue:


AHRQ Highlights Resources Available for Mental Health

In recognition of May as Mental Health Awareness Month, AHRQ’s Effective Health Care Program (EHC) Program is highlighting resources that help clinicians work with patients to find the treatment options that are best for them.

Twenty-five percent of adults in the United States have a mental illness, and nearly half will develop at least one mental illness during their lifetime, according to the Centers for Disease Control and Prevention. Mental illness is associated with increased occurrence of chronic diseases such as cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer.

As part of ongoing efforts to highlight evidence on mental health treatment options, AHRQ recently held a special Webinar titled, “What Works for Depression? An Evidence-based Comparison of Treatment Options.” The Webinar, archived here, summarizes findings from Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review. The AHRQ-funded evidence review summarizes the benefits and harms of 13 commonly prescribed second-generation antidepressants for the treatment of depressive disorders in adults. Gerald Gartlehner, M.D., M.P.H., of the AHRQ-funded RTI-University of North Carolina Evidence-Based Practice Center, presented the evidence, which also covered the comparative benefits and harms of drugs during acute, maintenance, and continuation phases of major depressive disorder.

The recent Webinar is one of several evidence-based resources on mental health treatments offered by the EHC Program. Research summaries based on comparative effectiveness reviews provide background on mental health conditions and offer clear information for clinicians, patients, and caregivers to compare the benefits and risks of different treatments. Health care providers may also be interested in free continuing medical education/continuing education (CME/CE) courses covering evidence-based treatment comparisons for various mental health diseases and conditions.

In addition, educational slide sets on mental health topics are available for clinicians, researchers, and health professionals in training. Each slide set contains speaker notes, references, and key words to find slides on other health topics.

Finally, AHRQ recently launched two new Facebook pages (Treatment Options for English-language speakers and Toma las riendas for Spanish-language speakers) that include links to numerous plain-language research summaries so that your patients can better understand the possible benefits, risks, and side effects of treatments for mental health conditions, as well other conditions.

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More New, Free Effective Health Care Program Resources

New Evidence-Based Treatment Summaries for Patients and Clinicians

Treatment summaries help patients and clinicians learn about treatment options and compare their effectiveness, benefits, and risks. To order free print copies, call 1-800-358-9295 and use reference code C-05.

First- vs. Second-Generation Antipsychotics

New materials are available from AHRQ that compare individual first- and second-generation antipsychotic medications in adults with schizophrenia, schizophrenia-related psychoses, or bipolar disorder. These materials outline the evidence comparing the effectiveness and side effects of different types of drugs, and provide questions that patients and health care providers should consider before choosing a treatment. The new resources include—

  1. A patient summary of antipsychotic medications for adults
  2. A clinician research summary that outlines the clinical bottom line
  3. A CME/CE course for clinicians to receive free continuing education credits
  4. An educational slide set for clinicians to share the evidence with colleagues and students
  5. The full research review

New Research Reviews Comparing Treatment Options

Each of these reviews compares available evidence from numerous research studies.

Postpartum Depression Screening: Efficacy and Safety

According to a new AHRQ research review on screening for postpartum depression, screening improves some maternal outcomes compared with no screening, but the long-term effects on maternal and child outcomes are unclear. The potential effectiveness appears to be related to the availability of systems to ensure adequate followup of women with positive results. Additional research is needed to define ideal characteristics of screening tests for postpartum depression including sensitivity, specificity, timing, and frequency. These findings can be found in the full review, Efficacy of and Safety of Screening for Postpartum Depression.

Migraine in Adults: Drug Treatments

New AHRQ research found approved drug treatments for chronic and episodic migraine are mostly effective; however, treatments increase the risk of adverse effects and treatment discontinuation due to those effects. For chronic migraine, the medicine onabotulinumtoxin A reduces migraine attacks by more than 50 percent, but increases the risk of adverse effects and treatment discontinuation due to those effects. For episodic migraine, all approved drugs—such as topiramate, opiramate, divalproex, timolol, and propranolol—are effective in reducing monthly migraine frequency, but similarly increase the risk of adverse effects and treatment discontinuation. Compared with approved migraine drugs, some off-label beta blockers and angiotensin inhibiting drugs are more effective and safer for preventing adult migraine. These findings can be found in the full review, Migraine in Adults: Preventive Pharmacologic Treatments.

Children Exposed to Trauma: Interventions Addressing Maltreatment

According to a new AHRQ research review, there is an urgent need to build the evidence base on interventions addressing child maltreatment. Several interventions show promise in improving trauma symptoms or other serious emotional difficulties experienced by children exposed to sexual or physical abuse. For very young children, existing psychotherapeutic approaches focused on repairing the child-caregiver attachment relationship were applied to maltreating parents. In contrast, interventions with foster parents were psychoeducational, providing information and strategies to promote care giving that is responsive to the particular needs of children in foster care and to manage challenging behaviors. However, the review identifies major research gaps and points to the need for collaborative clinical trials supported by a multisite research network. Read the full research review here: Child Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Maltreatment.

Interventions to Improve Cardiovascular Risk Factors in People with Serious Mental Illness

A new research review from AHRQ evaluated interventions to improve cardiovascular disease (CVD) risk factors in patients with serious mental illness (SMI). Individuals with SMI have excess mortality from CVD and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in non-SMI populations, and antipsychotic-management strategies. These findings can be found in the research review, Pharmacological and Behavioral Interventions to Improve Cardiovascular Risk Factors in People With Serious Mental Illness.

Updated Review Finds Epoetin and Darbepoetin Reduce Need for Transfusions, Increase Risk of Blood Clots for Anemia in Cancer Patients

According to an updated research review by AHRQ, epoetin and darbepoetin reduce the need for blood transfusions in cancer patient with anemia who were receiving chemotherapy and/or radiotherapy treatment. These findings are consistent with a previous review on this topic in 2006. The review also finds that epoetin and darbepoetin are associated with an increased risk of thromboembolism (blood clot in the legs), and the use of these therapies increases the risk of death during and shortly following treatment. However, there is not enough available evidence to draw conclusions about the long-term effects of these treatments on survival. These findings are available in the research review, Comparative Effectiveness of Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment—Update.

Review Finds More Research Needed for Pulmonary Arterial Hypertension Screening, Management, and Treatment

According to the latest research review from AHRQ, more research is needed to determine the comparative validity, reliability, and feasibility of various screening, diagnostic, management, and treatment strategies for pulmonary arterial hypertension (PAH). If left untreated, this rare and progressive disease could lead to heart failure and premature death. The review finds that additional research is needed to determine if the combination of echocardiography and the biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) —two investigational diagnostic strategies for PAH—is sufficiently accurate to rule out the disease when testing patients with symptoms of PAH. Similarly, more research is needed to determine their effectiveness for screening asymptomatic patients who are at risk for PAH. Read the full research review here: Pulmonary Arterial Hypertension: Screening, Management, and Treatment.

New Review Compares Treatment Options for Otitis Media with Effusion

According to the latest research review from AHRQ, there is evidence that placement of tympanostomy tubes and removal of the adenoids (adenoidectomy), both alone or in combination, decrease the time with otitis media effusion (OME)—a collection of fluid in the middle ear without signs or symptoms of acute ear infection—and improve hearing in the short term. However, the review did not show differences in longer-term speech, language, or other functional outcomes. The review further finds that results were mixed concerning whether there is additional benefit from both placement of tympanostomy tubes and an adenoidectomy, and there is evidence of potential harms associated with each. Drainage from the ear is common after placement of tympanostomy tubes and can be persistent; post-surgical hemorrhage, although rare, can result from adenoidectomy. Consistent with current guidelines, newer evidence did not show that nasal or oral steroids provide any benefit. Additional studies are needed to help resolve the risk-benefit ratio of treating OME by measuring the recurrence of acute otitis media, quality-of life measures, and functional and other long-term outcomes. Also, this literature was limited largely to children without other medical problems, and more research is needed to support treatment decisions in subpopulations, including adults, children with coexisting conditions such as craniofacial abnormalities or Down syndrome, and children who have received pneumococcal vaccination, which is associated with a reduced risk of acute otitis media. Read the full research review here: Otitis Media with Effusion: Comparative Effectiveness of Treatments.

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Page last reviewed April 2013
Internet Citation: EHC Program Inside Track Newsletter. Content last reviewed April 2013. Agency for Healthcare Research and Quality, Rockville, MD.