In This Issue of Archives of Internal Medicine FREE

Depression is a prevalent condition in patients undergoing coronary artery bypass graft surgery (CABG) and is often associated with a less favorable health status. However, an alternative predictive direction may also hold: a bad health status might lead to an increase in depressive symptomatology. Kendel et al assessed data from 883 consecutive subjects (19.8% women) undergoing CABG to test longitudinal, cross-lagged associations between depressive symptoms and physical functioning following surgery. The cross-lagged analysis showed that an increase in depressive symptoms predicted a decrease in physical functioning, but not vice versa. Given these associations, more attention should be paid to diagnosis and treatment of depression in patients undergoing CABG.

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Primary care for conditions such as falls and urinary incontinence is inadequate. To improve care, we augmented the Assessing Care of Vulnerable Elders practice redesign intervention in collaboration with the American College of Physicians. Five diverse primary care practices, each with intervention and control clinics, implemented the low-tech intervention including efficient collection of data, medical record prompts, patient education materials, and physician decision support. Intervention patients compared with controls received more recommended care for falls (60% vs 38%) and incontinence (47% vs 28%). Practice redesign can improve the care that community-based primary care physicians provide for older patients with falls and incontinence.

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Serum potassium levels affect insulin secretion by pancreatic β cells, and hypokalemia associated with diuretic use has been associated with dysglycemia. Chatterjee et al hypothesized that adults with lower serum potassium levels and lower dietary potassium intake are at higher risk for incident diabetes, independent of diuretic use. The authors analyzed data from the Atherosclerosis Risk in Communities (ARIC) Study cohort and found a significant inverse association between serum potassium and risk of incident diabetes, which was robust in a variety of sensitivity analyses. There was an inverse association between dietary potassium intake and risk of incident diabetes only in unadjusted models. Serum potassium is an independent predictor of incident diabetes in this cohort. Further study is needed to determine if modification of serum potassium level could reduce the subsequent risk of diabetes.

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Over 15 million endoscopic procedures are carried out annually in the United States, yet comprehensive safety and complication data are limited. In this study by Leffler et al, a novel automated adverse event tracking system was used to prospectively evaluate the incidence and cost of outpatient endoscopy-related hospital visits. They found that approximately 1% of all patients having outpatient endoscopies are seen in the hospital for a related adverse event within 14 days of the procedure, with significant attributable cost. These findings underscore the importance of developing adverse event tracking within electronic medical record systems to better assess the risks and costs of medical procedures.

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Earlier studies have shown large variations in physician pay across specialties. Most of these studies measured annual income. However, hours worked per week and number of weeks worked per year vary by specialty and must also be accounted for to get a fuller sense of between-specialty differences in compensation. This study measures differentials in wages (remuneration per hour) across 4 broad specialty categories and 41 narrower specialties. Data were drawn from a large nationally representative sample of physicians. Within the broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. Within the 41 specialties, wages were lowest for internal medicine/pediatrics (combined), internal medicine, family medicine, and other pediatric subspecialties. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at reducing wage disparities between primary care physicians and all others.

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