Drugs, tests underutilized by doctors, survey shows
Efficiencies mean more meds, checkups
Are cardiologists prescribing less or more than guidelines advise? Are they withholding care because of cost restraints imposed by managed care, or are they just withholding care? Are they ordering sufficient diagnostic tests, or are they being forced to pinch pennies? If you think you know the answer to those questions, you may be surprised by the results of a survey by United HealthCare Corp. in Minneapolis.
Doctors in general, not just cardiologists, routinely fail to prescribe essential drugs and diagnostic tests, reports the survey. The survey is still being administered, but so far, of 1,600 cardiologists tracked in Colorado, North Carolina, Ohio, and Texas, many failed to prescribe widely recommended drugs such as beta blockers for heart attack survivors even though the American College of Cardiology in Bethesda, MD, recommends their use for weeks, months, or years. Only 37% of recent heart attack patients treated by Ohio cardiologists received the drugs within 60 days of their attack. Angiotensin converting enzyme (ACE) inhibitors are recommended for congestive heart failure patients, yet internal medicine specialists prescribed the drugs only 50% to 63% of the time in North Carolina, Ohio, and Texas. In Colorado the number was 70%.
Though the American Heart Association in Dallas recommends using anticoagulants such as warfarin to prevent stroke in patients with atrial fibrillation, patients take them at a rate between 12% and 25% in three of the states. Ohio cardiologists' outcomes were a little better: They prescribe anticoagulants for 50% of their patients.
The motive of United is not necessarily better medicine, says Lee N. Newcomer, MD, the company's medical director, but "I can buy a lot of beta blockers by avoiding the cost of treating a second heart attack."
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