Research Roundup: Even Parents With A Pediatrician Often Choose Retail Clinics

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: States With The Least Restrictive Regulations Experienced The Largest Increase In Patients Seen By Nurse Practitioners – Although primary care is considered a key focus of health reform, the number of medical students choosing that practice has declined from 60 percent in 1998 to less than 30 percent today. One proposal to help meet the need for more primary care is to expand the practicing privileges of nurse practitioners. Using Medicare data, researchers in this study aimed to assess the impact of state regulation on the use of advanced practice nurses. "The number of Medicare patients receiving care from nurse practitioners rose fifteenfold between 1998 and 2010," the authors write. They found that state laws, particularly those giving or prohibiting power to prescribe medication, contribute strongly to increasing the number of nurse practitioners and the number of patients they treat. "Modifying state regulations of [nurse practitioners'] practice is one path to expanding access to primary care," the authors conclude (Kuo et al., 7/2013).

JAMA Pediatrics: Parents' Experiences With Pediatric Care At Retail Clinics –Retail clinics, set inside stores such as Walgreens and CVS, offer convenient but limited primary care services to adults and children. But while the number of such clinics in the country is expected to grow beyond 6,000 by 2013, little is known about their use for pediatric care. In this study, researchers  surveyed nearly 1,500 parents in waiting rooms of 19 pediatric offices in the Midwest. They found that more than 23 percent of parents—who had established contacts with a pediatric practice—had used retail clinics for their children's care, many of them multiple times. Most of the visits to the retail clinics, the parents reported, occurred when their pediatricians' offices were open. "Many parents first considered going to the pediatrician for care but were unable to or believed they would be unable to get a convenient, timely appointment for an office visit; or thought the illness was not severe enough to warrant an office visit or bother their [primary care provider] after hours," the authors write. Pediatricians, the authors conclude, need to directly address parents' need for convenient access to care, should set up communications with retail clinics to insure patients' quality of care and cut down duplication of services and make clear to patients that if they seek care at a retail clinic, they should let the pediatricians know so that care can be coordinated (Garbutt et al., 7/22).

JAMA: Characteristics Associated With Differences In Survival Among Black And White Women With Breast Cancer – In this study, researchers examined the extent of the disparity between white and black breast cancer patients by analyzing differences in treatments between 1991 and 2005. Their study included 107,273 Medicare beneficiaries who were newly diagnosed with breast cancer. While only 7,375 patients in their study population were black, the large number of white patients allowed the researchers to sequentially match and then compare patients of both races. "Racial differences in breast cancer survival did not substantially change among women diagnosed between 1991 and 2005," the authors write. They found the breast cancer survival rate among black women to be three years shorter compared to white women. Black women, they add, had more advanced cancers when they first sought treatment. "These differences in survival appear primary related to presentation characteristics at diagnosis rather than treatment differences," the authors conclude (Silber et al., 7/24).

The Kaiser Family Foundation: Health Coverage For Blacks In The United States Today And Under The Affordable Care Act – The federal health law has important implications for the black Americans, who make up more than a tenth of the total population. The law aims to reduce the number of uninsured individuals by expanding state Medicaid programs, which provide health coverage to people with low incomes, and by opening state-based online health marketplaces that will offer insurance plans and help people with lower incomes get subsidies to help pay for that coverage. According to the authors of this report, "Many uninsured Blacks could benefit from these new pathways to coverage, which would help increase their access to care and promote greater equity in health care." The report provides national and state-by-state data on the economic situation of African-Americans and their health coverage.  "Given that most uninsured Blacks are in low-income families, the majority would be in the income range to qualify for the ACA coverage expansions, particularly the Medicaid expansion. As such, state decisions to implement the ACA Medicaid expansion have particularly important implications for Blacks," the authors write. "If a state does not implement the expansion, poor uninsured adults will not gain a new coverage option and will likely remain uninsured. Currently, Blacks are at the highest risk of continuing to face coverage gaps due to state expansion decisions. Even with the coverage expansions, targeted outreach and enrollment assistance will be important for ensuring eligible individuals enroll in coverage" (Duckett and Artiga, 7/24).

Here is a selection of news coverage of other recent research:

NBC News: Obamacare Won’t Slash Workers' Hours, Report Finds
Opponents of Obamacare say it will kill jobs, and they specifically say provisions forcing employers to offer health insurance to workers will encourage smaller businesses to cut jobs and cut hours. But a new report finds that, if anything, fewer people are working part-time this year than the year before. The report, from the left-leaning Center for Economic and Policy Research, says data show companies have not been cutting hours in anticipation of the law. It contradicts business owners who say they’ve already started cutting back (Fox, 7/24). 

Medscape: Missed Diagnoses Trigger Primary Care Malpractice Claims
Most malpractice claims against primary care physicians are a result of missed diagnoses, especially of cancer and myocardial infarction in adults and meningitis in children, and medication errors, according to an analysis of data from 34 published studies of malpractice claims. Emma Wallace, MB Bch, BAO, a clinical research fellow in the Health Research Board Centre for Primary Care Research at the Royal College of Surgeons in Ireland Medical School in Dublin, and colleagues report their findings in an article published online July 18 in BMJ Open (Brown, 7/18).

Reuters: U.S. HPV Vaccination Rates Far From Goal, Officials Say
Only slightly more than half of U.S. girls aged 13 to 17 had been vaccinated against a virus that can cause cervical and other cancers last year, and a top U.S. health official said on Thursday that more must be done to bring the rate up to the long-term goal of 80 percent. The vaccination rate to protect against human papillomavirus (HPV) was 53.8 percent last year for teen-age girls, just marginally higher than the 53 percent rate a year earlier, the Centers for Disease Control and Prevention reported on Thursday (Abutaleb, 7/25).

Medscape: Operating Room Errors: Equipment-Related Failures Common
Equipment-related errors make up approximately one fifth of all errors that occur in the operating room, according to the findings of a systematic review. Ruwan A. Weerakkody, PhD, from Imperial College London in the United Kingdom, and colleagues published their findings online July 25 in BMJ Quality and Safety. In the study, the researchers searched various electronic databases to identify quantitative studies that assessed operating room errors and adverse events (Barber Jr., 7/25).