Making a business case for small medical practices to maintain quality while addressing racial healthcare disparities.

Various reports have documented variations in quality of care that occur among racial and ethnic populations, even after accounting for socioeconomic factors and health insurance status. Although quality improvement initiatives are often touted as the answer to healthcare disparities, researchers have questioned whether a business case exists that supports this notion. We assess various barriers and incentives for using quality improvement to address racial and ethnic healthcare disparities in small-to-medium-sized practices. We believe that although both indirect and direct cost incentives may exist, a favorable business case for small private practices cannot be made unless there are additional financial incentives. The business community can work with health plans to provide these incentives.

Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain.

BACKGROUND: The treatment of moderate to severe chronic nonmalignant pain (CNMP) is a challenge for both the patient and health care provider. Conflicting information exists regarding the appropriate use of long-acting (ie, controlled-release [CR]) opioid analgesics for CNMP, and physicians may be reluctant to prescribe them even when medically appropriate. OBJECTIVE: This study examined physicians' willingness and attitudes toward prescribing long-acting opioids to patients with moderate to severe CNMP METHODS: As part of a larger survey sent to 2750 family physicians, one question was used to assess physicians' willingness to prescribe, and 20 Likert-type questions were used to measure physicians' attitudes toward prescribing CR opioids. RESULTS: Of the 267 usable responses (10% response rate), two thirds of physicians indicated that they were "somewhat willing" to "extremely willing" to prescribe long-acting opioids to their patients with CNMP Physicians indicated an overall slightly favorable attitude (mean [SD], +2.96 [17.75] [possible range, -90 to +90]) toward prescribing long-acting opioids for CNMP Physicians who were unwilling to prescribe had an overall unfavorable attitude (mean [SD], -7.87 [17.43]) compared with willing physicians (mean [SD], +9.56 [14.81]). Approximately 80% of physicians believed that long-acting opioids would be effective in controlling pain and would improve overall quality of life in patients with CNMP. However, 78% indicated that they were "somewhat likely" to "extremely likely" to encounter regulatory scrutiny if they prescribed long-acting opioids for CNMP, and about half (51%) of the respondents believed prescribing them would lead to patient addiction. Unwilling physicians held stronger beliefs that prescribing opioids would lead to patient abuse, addiction, and regulatory scrutiny compared with willing physicians. CONCLUSIONS: About two thirds of physician respondents were willing to prescribe long-acting opioids for patients with CNMP, and physician attitudes were marginally favorable. Further study should investigate how physicians' attitudes and willingness translate into actual prescribing behavior.

Phase II study of interferon gamma in malignant carcinoid tumors (E9292): a trial of the Eastern Cooperative Oncology Group.

PURPOSE: To determine the safety and efficacy of treatment with gamma interferon (IFNgamma) in patients with metastatic carcinoid tumor. PATIENTS AND METHODS: 51 patients were enrolled on this Phase II Eastern Cooperative Oncology Group (ECOG) study. Seventy five percent of them had hormonally active tumors. Treatment consisted of IFNgamma subcutaneously at a daily dose of 0.1 mg/m(2). Patents were evaluated for toxicity weekly for the first month and monthly thereafter; response was determined radiologically every 8 weeks. RESULTS: Patients received treatment with IFNgamma for a median of 17.9 weeks (range 2-175). Toxicity was generally mild and expected: 61% experienced noninfected fever and 21% developed granulocytopenia. Three patients (6%) had a partial response; there were no complete responses. Median time to progression was 5.5 months (95% confidence interval 3.9-11.1). The 1-year progression free rate was 28% (13.4-43.4%). Median survival was 42 months, with a 1-year survival rate of 67% (53.3-80%). DISCUSSION: This Phase II study demonstrated that therapy with IFNgamma in patients with metastatic carcinoid tumor was well-tolerated, but did not produce significant antitumor effects. The overall results were somewhat comparable to those previously seen with alpha interferons as well as cytotoxic drugs.