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Medical Guidelines Need Regular Check-Ups?

An recent analysis found guidelines for treating illnesses ranging from cancer to ear infections to be largely outdated. Researchers have suggested that they be reviewed at least every 3 years. Of outlines distributed by a government agency for 17 ailments, 13 were out of date according to the study. Seven of the reviewed guidelines, established within the last decade, needed a major overhaul.


An example included the guidelines for treating prostatic hypertrophy which recommended a balloon dilating procedure now rarely used as well as the drug finasteride, which has since been shown to be less effective than alpha blockers.


The outdated guidelines were removed from the Web sites soon after the study was completed.




New Guidelines on Antibiotic Use

According to a series of four guidelines issued by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) antibiotics are not needed for most respiratory infections. These guidelines cover appropriate antibiotic use in nonspecitic upper respiratory tract infections, bronchitis, pharyngitis, and sinusitis. The best treatments for most healthy adults with these conditions, which usually resolve independently within 2 weeks, are over-the-counter remedies for symptom relief such as nasal sprays, decongestants, cough drops, and gargles.


The guidelines were developed as a result of concern about the growth of antibiotic-resistant disease and were created in conjunction with the CDC, the American Academy of Family Physicians, and the Infectious Diseases Society of America. The guidelines can be obtained online at; a patient brochure entitled "Antibiotics: Do you really need them?" can be downloaded or ordered at


Finding Medicare Numbers of Other Providers

If you learn from HIQH that a patient is currently under a home health plan of care by another agency, their screen will provide the episode information (start/end date), an intermediary number (the Regional Home Health Intermediary [RHHI] that processed the RAP/claim), and the provider number of the primary agency that opened the episode, among other information.


You then can contact the appropriate RHHI who will provide you with the agency's name and address. Below are the RHHI numbers, names, and phone numbers.


RHHI-00180: Associated Hospital Services of Maine (877) 498-1351.


RHHI-00380: Palmetto Government Benefits Admin (GBA) (877) 272-5786.


RHHI-00450: United Government Services (877) 309-4290.


RHHI-00454: United Government Services (California) (866) 539-5594.


RHHI-00011: Cahaba Government Benefits Administration (GBA) (877) 299-4500.


New Patients and Warfarin

More than one-half of the patients who have atrial fibrillation and are discharged from the hospital on warfarin are also taking one or more prescription drug that may further increase their bleeding risk. Reported at the annual meeting of the American College of Cardiology, this study indicates that family and healthcare providers caring for newly discharged patients should carefully review their medication regime.


There is a lag time between instituting warfarin and seeing a patient's international normalized ratio (INR) climb; the full effects of a typical warfarin drug interaction are delayed and may not be felt until 1 or 2 weeks after hospital discharge.


Drugs that could increase bleeding risk through other mechanisms were mainly aspirin, other NSAID's, and various antiplatelet drugs.


Internal Medicine News, June 1, 2001.


No Changes in Smoking

The smoking rate among American adults has hardly budged over the past several years, holding steady at roughly 1 in 4. The government is aiming for 12% by 2010 and admits the numbers are lagging far behind that goal set last year. Smoking dropped steadily during the 1980s, but it flattened out in the 1990s even amid heavy anti-tobacco advertising, higher cigarette prices, and restrictions on smoking in public places.


The national figures that have been released also show sizable gaps along financial and educational lines. Approximately 33% of individuals below the poverty line smoke, versus 23% of those at or above the poverty line. Only 13% of individuals with an undergraduate degree smoke cigarettes, versus nearly 40% of those who only completed some high school. Percentage of smokers by race was 24.3% Whites and Blacks, and 18.1% Hispanics.


Associated Press, October 14, 2001.


Seniors Online?

According to a recent survey conducted by the Pew Internet and American Life Project, 69% of wired seniors go online daily. The survey also found that 93% of online seniors use e-mail and 53% use the Internet to search for health and medical information. Meanwhile, a recent study by the Centers for Disease Control and Prevention found that the rate of office visits for Americans 65 years of age and older has increased by over 20%, with physicians spending an average of 20 minutes with patients.


The results of these two studies suggest seniors might benefit from online patient/physicians contact because they are: 1. visiting physicians more frequently, 2. spending less time with their physicians due to managed care restrictions, 3. being prescribed more medication in general, and 4. seeing more specialists. Because many seniors are online it would be convenient for them to use the Internet instead of the phone to communicate with their physicians. For more information contact the National Physicians DataSource at (860) 409-7000.


Caring for Caregivers

Who cares for the caregivers? A recent issue of Psychology Today cites a study at the State University of New York, Buffalo, that included 60 hypertensive men and women who were caring for seriously ill spouses. As part of the study, one-half of the caregivers adopted a dog. For 6 months, both groups wore ambulatory blood pressure monitors while interacting with their spouses and new pets. The caregivers with dogs had significantly reduced blood pressure and heart rate levels versus those who had no pets.


American Family Physician, 63 (6), 1020.