Family Medicine Update

Leukotriene inhibitors in the treatment of allergy and asthma.

Am Fam Physician. 2007 Jan 1;75(1):65-70

Authors: Scow DT, Luttermoser GK, Dickerson KS

Leukotriene inhibitors are the first new class of medications for the treatment of persistent asthma that have been approved by the U.S. Food and Drug Administration in more than two decades. They also have been approved for the treatment of allergic rhinitis. Prescriptions of leukotriene inhibitors have outpaced the evidence supporting their use, perhaps because of perceived ease of use compared with other asthma medications. In the treatment of persistent asthma, randomized controlled trials have shown leukotriene inhibitors to be more effective than placebo but less effective than inhaled corticosteroids. The use of leukotriene inhibitors has not consistently shown an inhaled-steroid-sparing effect, a reduction in need for systemic steroid treatment, or a cost savings. For exercise-induced asthma, leukotriene inhibitors are as effective as long-acting beta2-agonist bronchodilators and are superior to placebo; they have not been compared with short-acting bronchodilators. Leukotriene inhibitors are as effective as antihistamines but are less effective than intranasal steroids for the treatment of allergic rhinitis. The use of leukotriene inhibitors in treating atopic dermatitis, aspirin-intolerant asthma, and chronic idiopathic urticaria appears promising but has not been studied thoroughly. Leukotriene inhibitors have minimal side effects and are well tolerated in most populations.

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Correlates of quality of life in primary care patients with hypertension.

Int J Psychiatry Med. 2006;36(4):483-97

Authors: Ayalon L, Gross R, Tabenkin H, Porath A, Heymann A, Porter B

BACKGROUND: Hypertension has been associated with lower levels of quality of life (QoL). However, the specific correlates of lower QoL in this patient population have remained largely unclear. METHODS: A cross-sectional design of 1,125 primary care patients with hypertension. We evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of hypertension treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and perceived QoL in the hypothetical absence of hypertension. RESULTS: Worse financial status, poorer blood pressure control, worse subjective health, mental distress, lack of hypertension diet, and irregular hypertension care were all associated with worse QoL. Worse financial status, poorer blood pressure control, higher body mass index, mental distress, and following a hypertension diet were associated with better QoL in the hypothetical absence of hypertension. CONCLUSIONS: In addition to taking into consideration well known determinants of QoL, such as financial status, health status, and mental health, physicians need to be aware of the potential tradeoff between following medical recommendations that advocate for a strict diet and the impact these have on patients’ QoL. Physicians also need to be aware of the effect of imparting information regarding imbalanced blood pressure on perceived QoL.

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Cross-sectional comparison of electronic and paper medical records on medication counseling in primary care clinics: a Southern Primary-Care Urban Research Network (SPUR-Net) study.

J Am Board Fam Med. 2007 Mar-Apr;20(2):164-73

Authors: Kuo GM, Mullen PD, McQueen A, Swank PR, Rogers JC

INTRODUCTION: This study compared the frequency of oral counseling and written information by primary care physicians at paper medical record (PMR) clinics and electronic medical record (EMR) clinics, and assessed relationships between medication counseling and medication outcomes (knowledge, questions, reported adherence and side effects, and medication fill). METHODS: A cross-sectional study with two convenience samples of English-speaking adult patients receiving > or =1 prescription at the primary care index visit was conducted in two PMR clinics, with 184 (48% response) patients seen by one of 22 physicians, and in two EMR clinics, with 249 (37% response) patients seen by one of 25 physicians. Data were from medical record reviews of the index visit and 2-week post-visit telephone interviews. RESULTS: Three mutually exclusive counseling categories were evaluated. Patients received 1,095 prescriptions, 61% with oral counseling for indications, 21% with oral counseling for indications and side effects, and 12% with written information plus oral (“multi-mode”) counseling. General linear mixed models found 1) less multi-mode counseling in PMR clinics (2%) than EMR clinics (20%); 2) PMR and EMR clinics were similar in oral counseling for indications and side effects; and 3) PMR clinics provided more oral counseling only for indications (69%) than EMR (53%) clinics. The impact of receiving oral or written counseling on patients’ reports of having questions about their medications was inconclusive. Not receiving oral counseling for indications was associated with more questions, but not receiving written information was associated with fewer questions. Filling a prescription was lower when no oral counseling for indications and side effects was reported, but the absence of written information was associated with more prescriptions fills. CONCLUSIONS: Physicians’ use of EMR to print medication information did not seem to compromise their oral counseling for medication indications and side effects. This feature of the EMR was underutilized by physicians; however, future studies addressing patient recall and evaluating the quality and content of medication counseling are needed.

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