EHC Program Inside Track Newsletter

Issue 15, June 2013

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

In this issue:

 

Evidence at Your Fingertips: New Web Page Offers Access to AHRQ’s Unbiased Treatment Information

This new Web page is part of AHRQ’s growing efforts to connect health care professionals with resources that will maximize the value of their time while supporting their ongoing efforts to find the best possible treatment for individual patients.  Image of Get the Bottom Line cover.

The research summaries from AHRQ’s Effective Health Care (EHC) Program offer the “Clinical Bottom Line” on the benefits and harms of treatments. These publications also identify the strength of evidence behind each key finding and provide brief background on each health condition.

Among the most popular research summaries for health care professionals are Core-Needle Biopsy for Breast Abnormalities; Premixed Insulin Analogues: A Comparison With Other Treatments for Type 2 Diabetes; Gestational Diabetes: Caring for Women During and After Pregnancy; Elective Induction of Labor: Safety and Harms; Treating Cholesterol With Combination Therapy; ACEIs, ARBs, or DRI for Adults With Hypertension; and Second-Generation Antidepressants for Treating Adult Depression: An Update.

In addition to research summaries for clinicians, the new Web page also includes a “For Your Patients” button that provides access to companion, plain-language research summaries for patients, as well as links to three animated videos – one for Newly Diagnosed patients, one for those Considering Other Choices, and one for those who are Caring for a Loved One. Each video encourages viewers to access AHRQ’s unbiased treatment information to become better informed before talking with their health care team about treatment options.

A Spanish-language version of Treatment Options, Toma Las Riendas: Infórmate. Compara. Prepárate., is also available for patients.

AHRQ launched a Treatment Options text messaging program designed to connect adults to clear, unbiased information about treatments for common health conditions. Weekly text messages provide information about treatment options and links to resources where subscribers can find more information, tips for working with health care providers to find the best treatment options, and new treatment information and resources from AHRQ.

Subscribers can opt to receive general messages or messages related to diabetes; heart and blood vessel conditions; men's health; mental health; muscle, bone, and joint conditions; or women's health. To sign up, your patients can text COMPARE to 22764 for messages in English or text MISALUD to 22764 for messages in Spanish.

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Help AHRQ Shape New Tools for Shared Decisionmaking

AHRQ would appreciate your participation in an online survey to measure the needs and preferences for new clinical tools to support shared health care decisionmaking. AHRQ values your ongoing interest in the EHC Program. Your participation will ensure that your voice is heard as AHRQ develops new tools to advance the use of comparative effectiveness research findings among patients, caregivers, and health care professionals. To access the survey, please click here.

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More New, Free Effective Health Care Program Resources

New Research Reviews Comparing Treatment Options

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

Pressure Ulcers: Prevention and Risk Assessment

According to the latest research, commonly used instruments to assess risk of pressure ulcers, such as the Braden, Norton, and Waterlow scales, can identify patients at increased risk for ulcers when compared with clinical judgment. Although risk assessment instruments can identify patients at higher risk for pressure ulcers, more research is needed to understand how the use of these instruments impacts pressure ulcer incidence compared with clinical judgment. Read the full research review here: Pressure Ulcer Prevention and Risk Assessment: A Comparative Effectiveness Review.

Pressure Ulcers: Effective Treatment Strategies

There is limited evidence to draw firm conclusions about the best approaches for treating pressure ulcers, a finding consistent with other recent reviews on this topic, according to new AHRQ research. It is also generally unknown whether the effectiveness of treatment strategies differs by settings and their characteristics, patient characteristics, or features of pressure ulcers. However, some evidence suggests wound improvement (reduction in ulcer size) was better on air-fluidized beds compared to other support surfaces, including standard hospital beds. Using protein-containing nutritional supplementation also resulted in wound improvement when used with other measures. Read the full research review here: Pressure Ulcer Treatment Strategies: A Comparative Effectiveness Review.

Wireless Motility Capsule: Effective Gastroparesis and Constipation Diagnosis

According to a new AHRQ research review the wireless motility capsule (WMC) has similar accuracy to current testing methods for detecting gastroparesis (delayed gastric emptying), or slow-transit constipation, and may provide increased diagnostic gain as compared with standard motility testing, such as gastric scintigraphy. WMC is a small pill that when swallowed can detect specific transit times in the stomach, small bowel, and colon. This device is a portable, one-time use, ingestible capsule that records and transmits data to a receiver as it travels through the gut. More research is needed to evaluate how the WMC should be used in combination with or instead of other testing modalities for evaluating slow-transit constipation and gastroparesis. These findings can be found in the full review, Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review.

Several Strategies Can Increase Health Care Providers Adherence to Asthma Guidelines

There is some evidence to support the use of decision support tools, feedback and audit, and clinical pharmacy support may improve the adherence of health care providers to asthma guidelines, as measured through health care process outcomes, and to improve clinical outcomes. There is a need for more evaluations of how these interventions may improve clinical outcomes for patients with asthma. Read the full research review here: Interventions to Modify Health Care Provider Adherence to Asthma Guidelines.

Local Therapies for Unresectable Primary Hepatocellular Carcinoma

A new research review from the Agency for Healthcare Research and Quality (AHRQ) finds that there is not enough evidence in the available literature to draw conclusions about effectiveness outcomes (overall survival, quality of life, disease progression, local recurrence, length of hospital stay, and days of work missed) and adverse events across most of the 13 local hepatic therapies that were studied for the treatment of unresectable primary hepatocellular carcinoma (HCC). More research is needed, especially considering the incidence of and mortality rate due to HCC, the most common type of liver cancer, are projected to increase worldwide in the next 20 years. These findings are available in the research review, Local Therapies for Unresectable Primary Hepatocellular Carcinoma.

Venous Thromboembolism: Prevention for Special Populations

According to a new AHRQ research review, there is a lack of high quality evidence on the comparative effectiveness and safety of techniques to prevent venous thromboembolism (VTE) in special populations, including those hospitalized with trauma, traumatic brain injury, burns, or liver disease; patients on antiplatelet therapy; and obese or underweight patients. Low strength evidence suggests that inferior vena cava (IVC) filter placement is associated with a lower occurrence of pulmonary embolism (PE) and fatal PE in hospitalized patients with trauma compared to no IVC filter placement. Given that clinical trials typically exclude or do not report on these populations, more high quality observational research on VTE prevention in special populations is needed that controls for confounding variables, such as provider and practice patterns and disease severity. These findings can be found in the full review, Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations; Comparative Effectiveness Review.

Peripheral Artery Disease: Treatment Options

According to a new AHRQ research review, the available evidence for treatment of patients with peripheral artery disease (PAD) is limited by the few studies that provide direct comparisons of treatment options. Research does find that with respect to antiplatelet therapy for the prevention of cardiovascular events in patients with PAD, a limited number of studies found that aspirin has no benefit over placebo in asymptomatic PAD patients. There is moderate evidence that clopidogrel monotherapy is superior to aspirin monotherapy in the reduction of cardiovascular mortality, nonfatal myocardial infarction, and composite vascular events, but low evidence that it affects nonfatal stroke in the PAD population. More studies of asymptomatic and symptomatic patients with PAD are needed to firmly conclude whether antiplatelet monotherapy or dual antiplatelet therapy is necessary in this high-risk cardiovascular population. These findings can be found in the research review, Treatment Strategies for Patients With Peripheral Artery Disease.

Bariatric Surgery and Diabetes

Bariatric surgery is a procedure performed on morbidly obese patients with a body mass index (BMI) of 40 kg/m2 or greater to lose weight and to treat and prevent weight-related comorbidities like diabetes. According to new AHRQ research published in The Journal of the American Medical Association on June 5, 2013, bariatric surgery may be effective in the short term for treating diabetes in non-morbidly obese patients with body mass index (BMI) of at least 30 but less than 35 kg/m2. At one year, surgery patients also show much greater weight loss than usually seen in studies of diet, exercise, or other behavioral interventions. Read the full research review here: Comparative Effectiveness of Bariatric Surgery and Nonsurgical Therapy in Adults with Metabolic Conditions and a Body Mass Index of 30.0 to 34.9 kg/m2.

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Current as of June 2013
Internet Citation: EHC Program Inside Track Newsletter: Issue 15, June 2013. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/insidetrack/2013/15/index.html