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With the cold and flu season upon us, the November/December issue of Annals of Family Medicine features several studies that cover the following topics: * Impact of the 2004 influenza vaccine shortage on continuity of care * Improving influenza vaccination of high-risk children * Proper use of antibiotics to treat upper respiratory infections, sinusitis and sore throat INFLUENZA VACCINE The flu vaccine shortage of 2004 appears to have had a negative impact on continuity of care according to an analysis of Medicare data in West Virginia. Medicare claims for flu vaccinations in West Virginia dropped by more than 50 percent from more than 92,000 in 2003 to approximately 44,000 in 2004. The shortage severely affected the ability of physicians to provide influenza vaccination to their patients and therefore some patients received vaccines from sources other than their regular doctors, most often from a mass immunizer, or did not receive vaccine at all. The percentage of Medicare recipients who received flu vaccine from the same clinician as the year before fell from 54 percent in 2002-2003 to 3 percent in 2003-2004. The authors suggest that the disruption of continuity of care is concerning because continuity of care in the ambulatory care setting has important benefits including improved health and reduced health care costs. A second study looks at ways to help inner-city health centers raise vaccination rates among high-risk children and finds that when a menu of tailored interventions (such as flu vaccines on a walk-in basis or reminder e-mails for clinicians) is implemented in inner-city health centers, the result is a modest rise in flu vaccination rates for children aged 2 to 17 years. Influenza vaccination rates improved modestly from baseline (10.4 percent) to 13.1 percent during the first year of the intervention implementation and to 18.7 percent during the second year. A variety of strategies were used based on the health centers' specific needs and their office and patient cultures. Impact of the 2004 Influenza Vaccine Shortage Impact on Repeat Immunization Rates By Charles P. Schade, M.D., M.P.H., et al Improving Influenza Vaccination Rates of High-Risk Inner-City Children Over 2 Intervention Years By Richard K. Zimmerman, M.D., et al USE OF ANTIBIOTICS TO TREAT UPPER RESPIRATORY INFECTIONS Millions of people suffer from sinusitis, making it a common ailment of the cold and flu season. The best policy for patients who might have sinusitis and do not have signs of complications or severe infection is to wait for natural recovery, rather than utilize antibiotics finds this study. A secondary analysis of 300 patients who participated in a randomized controlled trial finds that signs and symptoms of sinusitis and abnormal sinus x-rays do not help physicians predict the course of the illness or whether the patient will benefit from antibiotics. Although antibiotics are not generally effective in treating this condition, they are effective in treating a bacterial type of sinusitis that affects a minority of patients. Another study about the use of antibiotics finds that patients with sore throat, who hope for antibiotics, may in fact be more concerned about receiving pain relief. In this study of 298 sore throat patients, the three most common reasons for consulting their physician were to find out the cause of the symptoms, pain relief and information about the course of the illness. Additionally, a patients' desire for pain relief was a strong predictor for their hope of receiving an antibiotic. The authors suggest that physicians should address patients' expectations and needs for managing pain when treating sore throat, rather than prescribing antibiotics. In an accompanying editorial, the author, a family physician researcher of respiratory infections and antibiotic use, reflects upon the two studies above and how their findings might reframe his approach to management of acute respiratory infections. He states that he will focus more on symptom relief than on explanations of the differences between viruses and bacteria for all patients with common acute respiratory infections. Predicting Prognosis and Effect of Antibiotic Treatment in Acute Rhinosinusitis By An De Sutter, M.D., Ph.D., et al Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief" By Mieke L. van Driel, M.D., M.Sc., et al A New Look at an Old Problem: Inappropriate Antibiotics for Acute Respiratory Infections By John Hickner, M.D., M.Sc. ### November/December 2006 Annals Of Family Medicine Tip Sheet Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Annals is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the North American Primary Care Research Group. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials.
Article Source: http://www.new.citynewslive.com
Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org/. Contact: Kristin Robinson American Academy of Family Physicians
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