UPDATED: I misread the results of the alcohol study, and an eagle-eyed reader pointed that out. It’s worse than I thought. It’s fixed now.
This has been a ridiculous week of travel for me. I haven’t been able to blog like I’d like, so I’m giving you my thoughts in a Friday news dump. First up, “Results From the National Epidemiologic Survey on Alcohol and Related Conditions III“:
Importance National epidemiologic information from recently collected data on the new DSM-5classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed.
Objective To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 AUD diagnoses overall and according to severity level (mild, moderate, or severe).
Design, Setting, and Participants We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36 309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014.
Main Outcomes and Measures Twelve-month and lifetime prevalences of AUD.
Bottom line: 14% of adults met the criteria for an alcohol use disorder in the last year. About 29% met the criteria at some point in their life. The good news is that more than half of these people had sought treatment. The bad news is that fewer than 20% of people with a lifetime history of alcohol abuse disorders got treatment, and so many of them needed to. Remember, we’re talking about more than 30 million Americans in just the last year who have an alcohol use disorder. But, you know, nothing to see here – pot is the danger, right?
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Next up, the NEJM, with “A NICE Delivery — The Cross-Atlantic Divide over Treatment Intensity in Childbirth”:
After completing an evidence-based review, the United Kingdom’s National Institute for Health and Care Excellence (NICE) concluded that healthy women with straightforward pregnancies are safer giving birth at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician. Across the pond, eyebrows went up. The New York Times editorial board (and others) wondered, “Are midwives safer than doctors?” How can homes be safer than hospitals? And what implications will the British guidelines have for the United States?
Currently, 9 out of 10 babies born in the United Kingdom are delivered in physician-led hospital maternity units (in the United States, the rate is closer to 99 out of 100). NICE does not dictate a clinician type or birth setting and makes it clear that women should have freedom to make choices consistent with their needs and preferences. Yet Britain’s National Health Service believes that when the new guidelines are implemented, these preferences may change. Thousands more British women per year are expected to avoid hospitals willingly — at least in part out of concern for their own safety and with the expectation that their babies will be no worse off.
There are caveats, of course, and this applies strictly to low-risk pregnancies. But it challenged my sensibilities. Worth a read. Go.
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And finally, from JAMA Internal Medicine, a study comparing whether direct to consumer telemedicine compares favorably to traditional visits in terms of quality. “Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Telemedicine Visits“:
In both unadjusted and adjusted analyses, the fraction of ARI visits at which an antibiotic was prescribed was similar for Teladoc and physician offices (Table 2). The adjusted antibiotic prescribing rate for all ARI visits was 58% for Teladoc vs 55% at physician offices (P = .07). This pattern varied by specific diagnosis, with Teladoc more likely to prescribe antibiotics for pharyngitis and bronchitis and less likely for upper respiratory infection and nasopharyngitis.
So the good news is that there was no significant difference in the rates of antibiotic prescriptions. The bad news is that this is because both are bad in terms of inappropriate antibiotic use. Additionally, the teledocs were more likely to use broad-spectrum antibiotics, likely because they were being more conservative. But that has implications for resistance. Something to watch.
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I’ll be in town all next week, so back to usual blogging!
