Patients starting antipsychotic drugs face increased risks

Antipsychotic drugs are often prescribed to treat agitation and other symptoms of dementia, but a new study suggests they may have harmful consequences.

Among patients living in a community (non-nursing home) setting, those taking one of the drugs were more than three times as likely to suffer a "serious event" within 30 days of starting treatment, according to a new study in Archives of Internal Medicine.

The authors defined a serious event as one leading to an acute-care hospital admission or death, ranging from hip fractures to strokes. Among the 6,894 community-dwelling patients who were on a newer class of antipsychotics - such as olanzapine, sold as Zyprexa - 960 experienced such an event in the first month. A similar effect was found for older antipsychotics, such as haloperidol.

The link was less pronounced among nursing-home patients but still significant: A serious event was about twice as likely for those on the medications as for those who were not.

The researchers, who studied data from more than 40,000 dementia patients in Canada, urged caution with such drugs - even when prescribed for a short term.

- Tom Avril

Study: Nursing homes should give more osteoporosis drugs

Patients admitted to nursing homes after breaking a bone are not usually put on medications to treat poor bone density, or osteoporosis, a new study concludes.

The study, led by Harvard Medical School researchers, looked at pharmaceutical claims data and Medicare data from 1995 to 2004 to analyze osteoporosis drug usage among patients admitted to a nursing home following a hip, wrist or shoulder fracture.

Of the 4,430 fracture patients, only 11.5 percent were prescribed an osteoporosis drug. Usage increased from less than 2 percent in 1995, when the bone-building drug Fosamax was approved, to 19 percent in 2001, but then remained static.

The researchers concluded in the May 26 Archives of Internal Medicine that "more appropriate use of drug treatment of high-risk patients is needed in nursing homes."

- Marie McCullough

Doctors need guidelines to treat diabetics' hypertension

Despite published recommendations for treating high blood pressure, physicians are often uncertain what to do for diabetics with hypertension, even though the condition increases their already-high risks.

A new study of 1,169 diabetics seen at Veterans Administration health clinics found that when diabetics have a high blood pressure reading in their doctor's office, half the time nothing is done.

The rest of the time, changes are made to medications or the patient is directed to return in a few weeks for a recheck.

Why doesn't a worrisome blood pressure reading get response all the time? Through questionnaires, the University of Michigan researchers found that doctors may be unsure the reading is accurate, or persuaded by the patient that home readings are fine. Or, the doctor may be busy addressing the patient's more urgent health problems.

Doctors need better guidance for monitoring blood pressure in diabetics, concluded the study, published in the May issue of the Annals of Internal Medicine.

- M.M.

You can get help managing your health treatment

Your back is killing you. You suspect you have a herniated disc and want to see a doctor. But what type of caregiver do you see?

A neurosurgeon may recommend removing the offending portion of the disc. An orthopedic surgeon may want to fuse your spine. A physiatrist may want to inject a steroid around the nerve to reduce inflammation. Your family doctor may send you to a physical therapist or a chiropractor.

If you're like most Americans, you have a hard time sorting out what to do, according to a survey by the Agency for Healthcare Research and Quality.

Just 12 percent of the nation's 228 million adults have the skills to manage their own health care proficiently, the survey found. Nearly 22 percent of those surveyed had just a basic understanding of medical treatments and 14 percent could only accomplish the most rudimentary tasks, such as understanding a short set of treatment instructions.

AHRQ, a federal agency, offers such help at

» READ MORE: www.ahrq.gov/consumer

.

- John Sullivan