Reports from the Field-Disease management
Study finds pneumonia safely treated at home
Most outpatients treated for community-acquired pneumonia (CAP) do well even though their symptoms may persist for several weeks. Many seriously ill patients hospitalized with CAP suffer from complications, take longer to return to usual activities, and sometimes die, according to a recent study from University of Pittsburgh researchers.
Researchers conducted a multicenter, prospective, observational study to describe processes of care for CAP and assess medical outcomes for 944 outpatients and 1,343 inpatients. Findings include:
• Fewer than 1% of outpatients with CAP died, compared with 8% of inpatients.
• Only 8% of outpatients suffered from complications, compared with 70% of inpatients.
• Only 7.5% of outpatients were later hospitalized.
• Nearly 90% of outpatients had returned to usual activities or work by the 30-day follow-up, compared with 82% of inpatients.
Researchers also found support for improving the processes of care for CAP. For instance, only 71% of inpatients had blood cultures to identify the specific pathogen causing the pneumonia before initiation of antibiotic therapy even though recent studies have shown improved 30-day survival in patients who have blood cultures performed within 24 hours of hospital admission.
[See: Fine MJ, Stone RA, Singer DE, et al. Processes and outcomes of care for patients with community-acquired pneumonia. Arch Int Med 1999; 159:970-980.]
Sinus woes cost billions to treat each year
Bad situation gets worse
Two recent studies found that congestion associated with common allergies leads to development or worsening of asthma, sinusitis, middle-ear infections, and nasal polyps, which created an annual price tag of $5.9 billion in direct medical costs in 1996.
Researchers convened an expert panel to estimate the outpatient and inpatient visits with a primary or secondary diagnosis of allergic rhinitis of allergic rhino-conjunctivitis and sinusitis.
The findings
Some findings of the two studies include:
• Outpatient services accounted for 63% of total costs.
• Medications accounted for 25% of total costs.
• Inpatient services accounted for 12% of total costs.
• Children 12 years old and younger accounted for 38% of total costs.
• A primary diagnosis of acute or chronic sinusitis accounted for 59% of total expenditures.
• About 12% of costs for asthma and 12% of costs for otitis media and eustachian tube disorders were attributed to diagnosis and treatment of comorbid sinusitis.
[See: Ray NF, Baraniuk JN, Thamer M, et al. Direct expenditures for the treatment of allergic rhino conjunctivitis in 1996, including contributions of related airway illnesses. J Aller Clinical Immuno. 1999; 103:401-407. Also see: Ray NF, Baraniuk JN, Thamer M, et al. Healthcare expenditures for sinusitis in 1996: Contributions of asthma, rhinitis, and other airway disorders. J Aller and Clinical Immuno. 1996; 103:408-414.]
Cryosurgery offers option for prostate cancer
Complications often follow
A technology assessment report created by the Agency for Health Care Policy and Research (AHCPR) in Silver Spring, MD, calls for more research on the long-term outcomes of cryosurgery in men who undergo the procedure because radiation therapy is not effective in treating their prostate cancer.
The Health Care Financing Administration in Baltimore commissioned the report, which concluded that in the short term, cryosurgery results in negative prostate biopsies following surgery and low or undetectable serum prostate specific antigen levels in some patients. The report also notes that outcomes of cryosurgery improve with better instrumentation, better surgical technique, and greater experience on the part of the urologists performing the procedure.
However, the report also found that while the procedure itself is well-tolerated, postoperative complications are significant. Major complications of cryosurgery include incontinence, impotence, and obstructive urinary symptoms.
Cryosurgery is increasingly used as a second-line therapy in men who are not helped by radiation treatments. Cryosurgery is better tolerated than traditional prostate cancer surgery, or prostatectomy, it can be offered to men who would not normally be candidates for the surgery because of advanced age or the presence of co-morbidities.
[Free copies of the assessment, "Cryosurgery for Recurrent Prostate Cancer Following Radia tion Therapy. Health Technology Assessment No. 13" (AHCPR publication No. 99-0004) are available from AHCPR. Call or write: AHCPR Publications Clearinghouse, Attn: No. 99-0004, P.O. Box 8547, Silver Spring, MD 20907. Tele phone: (800) 358-9295.]
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