Becker's Clinical Quality & Infection Control

Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. Study: 37% of Physicians Give in to Patients' Demands for Brand-Name Drugs By Sabrina Rodak  T hirty-seven percent of physicians sometimes or often give in to patients' demands for brandname drugs when equivalent generic drugs are available, according to a study in JAMA Internal Medicine, formerly Archives of Internal Medicine. Researchers studied physicians' prescribing decisions using data from 1,891 physicians in seven specialties who responded to a national survey. Overall, 37 percent of physicians sometimes or often gave in to patients' requests for brand-name drugs. Among physicians in practice for more than 10 years, this percent rose to 43 percent, compared with 31 percent of physicians in practice for 10 years or less. The study identified several factors associated with capitulation to patients' request for brandname drugs: • ediatricians, anesthesiologists, cardiologists and general surgeons were significantly less likely P to give in than were internal medicine physicians. • hysicians in solo or two-person practices were more likely to give in than were those working P in a hospital or medical school setting, with rates of 46 percent and 35 percent, respectively. • hirty-three percent of physicians who received free food and/or beverages in the workplace T from drug companies (industry) yielded to patients' demands for brand-name drugs compared with 39 percent who did not receive these items. • orty percent of physicians who received drug samples from companies gave in compared with F 31 percent of those who did not receive samples. • orty-percent of physicians who often met with industry representatives to stay up-to-date F gave in compared with 34 percent of physicians who did not meet with representatives. n Study: Surgery Generally More Cost-Effective Than Radiation for Prostate Cancer By Sabrina Rodak  Surgical treatment for localized prostate cancer is generally more cost-effective than radiation therapy, according to a study in the British Journal of Urology International. The researchers aimed to determine the differences in outcomes and costs for various prostate cancer treatments, including radical prostatectomy (open, laparoscopic or robot-assisted) and radiation therapy (dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy or combination). The researchers used a model to determine the probable outcomes of primary treatment for hypothetical men with low-, intermediate- and high-risk localized prostate cancer. The authors based probabilities on a literature search of 232 publications and they determined costs from the USA payor perspective. Results showed only slight differences in quality-adjusted life years across all treatment types. Surgical methods were generally more effective than RT methods, except for combined external beam and brachytherapy for high-risk disease. However, there was a wide range of costs, spanning from $19,901 for robot-assisted prostatectomy for low-risk disease to $50,276 for combined RT for high-risk disease. n 15 Surgeons Make Preventable Mistakes 4,000 Times a Year, Study Says By Rachel Fields  D espite a significant push to reduce "never events" — surgical errors such as wrong-site surgery, mistaken patient identity and retained surgical items — surgeons make such mistakes more than 4,000 times a year in the United States, according to a Johns Hopkins study published in Surgery. According to the study, which used data from the National Practitioner Data Bank, over 9,744 cases of retained surgical items, wrongsite surgery, wrong-patient surgery and wrong-procedure surgery occurred between 1990 and 2010 in the U.S. In these cases, just over 6 percent of patients lost their lives. Another 32.9 percent suffered permanent injury, and 59.2 percent suffered temporary injury, according to the report. A prior study indicated that only 12 percent of surgical adverse events result in indemnity payments — meaning only those cases would be listed in the National Practitioner Data Bank. This means that up to 4,082 mistakes could occur in the U.S. every year, with 78 percent of those cases going unreported. Hospitals are required to report events that result in a settlement or mention in the National Practitioner Data Bank. According to Martin Makary, lead author of the study and associate professor of surgery at Johns Hopkins, these types of surgical errors are entirely preventable. Hospitals and other healthcare facilities have been working for years to implement safety programs to prevent adverse events. Such programs include surgical checklists, as touted by the World Health Organization and surgeon-author Atul Gawande, MD, and "timeouts" before surgery to ensure nothing is amiss. n

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