Patients with online access to personal health records unexpectedly increased their use of most clinical services, according to a JAMA study. Previous studies found the opposite effect.
The retrospective cohort study involved some 44,000 users of Kaiser Permanente Colorado‘s MyHealthManager who were matched to members who did not establish accounts. Matching was based on members’ history of office visits.
Compared with nonusers, users had an increased rate of office visits in the year following activation of their MyHealthManager account, a difference of 0.7 per member per year. Similarly, telephone encounters, after-hours clinic visits, emergency department visits, and hospitalizations all rose significantly. Among patients with coronary artery disease, use of services did not increase.
Editorialists call the findings “sobering for patient portal enthusiasts.” They speculate that the reason for the discrepancy between this and earlier studies may have to do with regional differences in healthcare delivery.
Beta-blockers might not lower the risk for major cardiovascular events in patients with — or at risk for — stable coronary artery disease (CAD), according to a JAMA study.
Investigators compared outcomes with and without beta-blocker therapy in about 22,000 participants in the REACH (Reduction of Atherothrombosis for Continued Health) registry who had prior myocardial infarction, CAD without MI, or CAD risk factors only. Patients were followed for roughly 44 months.
In both cohorts with CAD, risk for the primary outcome — a composite of cardiovascular death, MI, or stroke — did not differ significantly between beta-blocker recipients and nonrecipients. In the risk-factor-only group, the primary outcome occurred more often among beta-blocker recipients (14% vs. 12% among nonrecipients).
The authors note that their findings support recent changes in secondary prevention guidelines, giving class I status only to the short-term use of beta-blockers after MI.
Children with higher levels of urinary bisphenol A (BPA) — a chemical found in many food and beverage containers — are more likely to be obese, according to a JAMA study.
Researchers studied some 2800 children and adolescents aged 6 through 19 years who participated in an NHANES survey between 2003 and 2008. All participants provided urine samples for BPA measurement, had their BMIs measured, and answered lifestyle questionnaires.
After adjustment for confounders including caloric intake and television watching, children with higher BPA concentrations were twice as likely to be obese as those with the lowest concentrations (roughly 20% vs. 10%). The BPA–obesity link was significant only among white children.
The researchers cite studies showing that BPA interferes with “multiple metabolic mechanisms.” Nonetheless, they acknowledge that their cross-sectional analysis “cannot rule out the possibility that obese children ingest food with higher BPA content or have greater adipose stores of BPA.”