Tuesday, July 10, 2007

EHRs, I can has antidepressants?

The news has been making the rounds. Electronic health records don't aid patient care. Not all of the Presidential candidates are going to be happy to hear this.

But enough about the candidates. I was originally going to rant about the MSM and the paucity of information they always give out on important topics in science and medicine. Fortunately, before I could go too far off into the deep end, I thought to look for the press release. Silly me, I should have remembered that press releases are usually full of fluff. So, just this once, I'll give the corporate-owned media bobos a get-out-jail-free card.

Still, it would be nice if somebody who [1] understands this stuff, [2] has access to the literature, and [3] can write would report on it. I've found the abstract of the journal article, but if I paid $15 each time I wanted to read an article, I'd never be able to feed kittens. And look, down at the bottom of the press release, you see that this research was funded by the U.S. Agency for Healthcare Research and Quality. I'm thinking that .gov in the URL means that my tax dollars paid for this research. I don't think I should have to pay extra to read the results.

So, anyway, just looking at the abstract---
Results Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01).

Statins aren't properly prescribed for patients with high cholesterol if their doctors use EHRs. I'm too lazy to go look for it, but hasn't there been some question about when it's best to use or not use statins for high cholesterol?

Apparently urinalysis is over-utilized in routine physicals if your doctor hasn't got EHRs. I can't get excited about this, urinalysis is cheap, and if you accidentally find a few cases of diabetes or kidney failure or whatever a bit earlier than you would have otherwise, how is this bad? It's not like they measured the over- or under-utilization of MRIs.

If you're taking antidepressants, you'll be safer if your doctor uses EHRs, but probably any good pharmacy would note that drug interaction problem too.

Only tangentially related... on the topic of antidepressants and their new-found popularity, I just thought I'd mention some of the reasons [that I know about] that antidepressants are prescribed. They're given to people to help them quit smoking. They're given to cancer patients. They're used in conjunction with pain relievers in pain management. Just in case you were curious.


Keifus said...

Interestingly enough, urinalysis is one of the old, by which I mean oldest sorts of diagnostic tools (scroll to about the middle of the page). (What the hell is it with the ancients and the boils though? How hard is it do diagnose a friggin boil?)

You make a pretty good point about tax-funded research and accessiblity. It's especially pertinent on research that affects public policy (and health). On one hand, I'm not sure it's worth fucking around with teh system of peer review and publication, but dissemination could be done better.

(Rapidly expiring copyrights on the text?)

txdcz: tax dollarz

Steve Bates said...

A bit of doggerel from early 2001:

   Anti-, Anti-, Oh, You Know!

WHAT Dem's in the Senate? Not one of them's making
In any small part of this godawful mess a dent...
Excuse me a moment; I've got to be taking
My new medication... an antidepresident!

- SB the YDD

(I'll try to be serious and on-topic next time.)

hipparchia said...

it's my blog and i like threadjacks way more than on-topic-ness, especially if they include gems like antidepresident.

hipparchia said...


i'm not arguing against peer review [though it could use a bit of sprucing up] and the publication process [been there, done that, wouldn't want to tackle that one myself].

dissemination should be free.

thanks for that link. fascinating stuff.

Archaeopteryx said...

Somewhat off-topic. Saw Sicko the other day--it was typical Moore--funny, manipulative, angry and angering. I think you should see it, since you're not mad enough about health care.

hipparchia said...

funny man make joke.

gcmlgzxg: guzzling gizzard mcnuggets

Anonymous said...

Statins can interfere with other drugs and whether or not to prescribe statins can be a trade off, i.e. which is the more serious condition, which determines which drug has to be accommodated.

As I mentioned in my post, the KMart pharmacy program works well catching these problems, but you have to use the same pharmacy/chain for all your medications for the system to be effective.

There is a major problem with hospital pharmacies as they don't apparently check much of anything and they make substitutions.

hipparchia said...

walgreens pharmacy is excellent. plus you can call them up and say i'm taking xyz prescription and now i need to know if i can also take abc over-the-counter drug too [aspirin, cough syrup, whatever] and they'll tell you.

also, they don't condone that crap about letting their employees opt out of dispensing birth control pills or emergency contraception, at least not where i live.

Steve Bates said...

For all the reasons you enumerate, I use Walgreen's exclusively. In a business where there aren't a lot of points on which to gain competitive advantage, Walgreen's offers a few actual advantages.

I've phoned Walgreen's more than once in the middle of the night to obtain info about potential conflicts between prescription meds and over-the-counter stuff my docs may not even know I use. Now that is potentially life-saving advice, and I value it.

(Stella uses Walgreen's as well, for the last reason you mention. FTR, I, too, boycott pharmacies that allow their pharmacists to opt out of filling any legitimate prescription for any medication... it's not their decision to make. But you already knew that about me, I'm sure.)

[eicwuqma - one of the nine billion names of god?]

hipparchia said...

one of the nine million names of god! oh, excellent!

{i sorta thought that last point might be true of you :-))

i like to support indie businesses as much as possible, but when my favorite independent pharmacist retired, i had to go pharmacy shopping. i made it a point to ask that question of each of the ones i checked out. frankly, i was amazed to find anyone in this part of the country with such an enlightened policy.

not to mention that it angers me that giving women their full rights is still an extremely enlightened idea. it ought to be so routine that nobody even thinks of it.