Screening practices of Israeli doctors' and their patients.

OBJECTIVE: Doctors' health matters because healthy physicians are more productive and because physicians' health practices affects their patient counseling habits, but there are few objective data on this topic. METHODS: An examination of differences in screening quality health indicators between physicians (n=429) and 1621 age, gender, and socioeconomically matched patient controls from our district Health Maintenance Organization in Israel during the first half of 2008. RESULTS: Doctors and matched patients had similar rates for low-density lipoprotein measurement (85%/84%=NS), colorectal cancer screening (23%/27%=NS), influenza vaccine among the chronically ill (23%/24%=NS), and mammography (for women, 55%/57%=NS). Doctors with hypertension had blood pressures clinically recorded considerably less frequently than matched patients do (56%/77%, p<0.001), and their smoking habits were recorded less often, but their recorded tobacco habits were significantly better. Physician-patient contrasts were also minimal (again except for clinician-recorded blood pressure and smoking) among the chronically ill. CONCLUSIONS: These are the first objective data of which we know that test (and confirm) prior self-reported data that physicians' screening experiences are similar to patients'. Improving physicians' personal screening could also improve patient screening: physicians' self-reported primary prevention habits are considerably better than patients' and have been shown repeatedly to strongly and consistently positively influence patient counseling practices, and hence the health of the public.

Adherence with statins over 8 years in a usual care setting.

OBJECTIVE: To describe adherence with statin treatment in a usual practice setting and to investigate potential determinants of better adherence. STUDY DESIGN: Retrospective cohort study using administrative claims data. METHODS: Study patients were 47,680 individuals enrolled in the Central District of Clalit Health Services HMO in Israel who filled at least 1 prescription for statins between January 1, 1999, and December 31, 2006. Data were retrieved on patients' sex, year of birth and immigration, socioeconomic status, and whether they had diabetes mellitus, hypertension, and other cardiovascular diseases. RESULTS: Mean age at the beginning of treatment was 61.3 +/- 11.8 years; 53.3% of the study patients were women. The proportion with at least 1 chronic disease before starting statins was 40.1%; and 38.9%, 21.8%, and 9.6% of the patients were continuously adherent after 1, 3, and 6 years, respectively. Risk of discontinuation was highest among new immigrants (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.14, 1.27). Adherence was higher in patients having a chronic disease before starting statins (HR = 0.88; 95% CI = 0.84, 0.94) or after starting statins (HR = 0.90; 95% CI = 0.86, 0.95). Patients age <50 or >79 years had lower adherence rates. Low socioeconomic state did not affect adherence. CONCLUSIONS: Adherence with statin therapy was poor, though adherence rates were better in patients with accompanying chronic diseases. Of particular concern was the low level of adherence in new immigrants. Intervention programs are needed and should target all patient groups.