Wednesday, February 02, 2005

Two underwhelming articles from this week and Kudos to the Cleveland Clinic

Carratala et al from Barcelona writing in The Feb. 1, 2005 issue of the Annals of Internal Medicine offer rather weak data suporting the predictive value of the PSI (Pneumonia Severity Index). Patients in PSI categories II and III were randomized to outpatient treatment with oral levofloxacin or in patient treatment with I.V. levofloxacin. The results were about the same in terms of complications, etc but the outpatients were more satisfied with their care. It seemed fairly obvious prior to this article that if patients are not too sick with community acquired pneumonia outpatient oral antibiotic therapy is adequate and patients would generally rather not go to the hospital.
Even more obvious and expected were the results of an article by Smith et al in the February 2, 2005 issue of JAMA.A survey was done on 32 private clinics in Colorado. Questionanaires were completed and the data showed that in 13.6 % of visits there was missing clinical information, eg lab reports, xray reports etc.Further the data showed that some finite amount of time was spent in searching for the records and that in the opinion of the responding physicians this might result in patient delays or additional services.So it seems that sometimes items are missing from charts and time will be spent trying to find them. Could not any physician who has ever worked any where have predicted these findings ?
To end on a more positive note,Cleveland Clinic's EMR performed impressively in notifying patients about the Vioxx issue. In less than 24 hours 11,699 letters were sent to patients regarding the rofecoxib recall. Details of their activites are found in an article by Jain et al in the Feb. 1, 2005 Annals of Internal Medicine.


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