Making It to Sustainability: Evaluating Billing Strategies for Collaborative Care.

The collaborative care model (CoCM) is an effective strategy to manage common mental disorders in primary care. Despite the growing adoption of newer CoCM billing codes to support these programs, few studies have investigated the use of these codes. This column evaluated the implementation of CoCM billing codes by comparing clinics using different billing strategies and assessed the impact of CoCM code implementation on revenue and on clinical and process-of-care outcomes. Qualitative data were obtained to understand provider perspectives. The results indicate that CoCM billing code implementation is operationally feasible, does not adversely affect the delivery of patient care or revenue, and is acceptable to providers.

Drivers of Well-Being and Burnout in Anesthesiology Residents.

Background: With more than 50% of anesthesiology residents reporting burnout, many residency programs have begun creating wellness programs to address burnout and promote well-being. However, to date, many wellness initiatives have focused on individual strategies rather than systems approaches to improve the learning environment. Individual-focused interventions in the absence of systematic efforts can lead to resentment, resistance, and worsening burnout and precipitate a loss of trust in leadership and the organization. Here, we describe a process to engage anesthesiology residents, who are key stakeholders, by exploring their perspectives on burnout and well-being to better inform systematic interventions to improve the clinical work and learning environments. Methods: We conducted semistructured interviews with second- and third-year clinical anesthesia residents at the University of California, San Francisco, using the areas of worklife model as sensitizing concepts. We conducted a thematic analysis on transcribed interviews grounded in constructivist orientation. Results: We identified the following 3 major categories of themes based on interviews with 10 residents: (1) definition of well-being, (2) challenges to well-being, and (3) strategies for coping with challenges and burnout. Challenges described by anesthesiology residents align with the areas of the worklife model, with the coronavirus disease 2019 pandemic precipitating additional threats in the domains of workload and community. Conclusions: Anesthesiology residents' definition of well-being includes both individual (resilience) and systemic (meaning in work, job autonomy, and control) factors, reaffirming that positive work and learning environments are critical to professional well-being.

Efficacy, Safety, and Tolerability of Centanafadine Sustained-Release Tablets in Adults With Attention-Deficit/Hyperactivity Disorder: Results of 2 Phase 3, Randomized, Double-blind, Multicenter, Placebo-Controlled Trials.

PURPOSE/BACKGROUND: Centanafadine is an inhibitor of norepinephrine, dopamine, and serotonin reuptake transporters under investigation for the treatment of attention-deficit/hyperactivity disorder (ADHD). METHODS/PROCEDURES: Two phase 3 randomized, double-blind, placebo-controlled, parallel-group studies of 200 mg/d or 400 mg/d centanafadine sustained-release tablets versus placebo included adults (18-55 years of age) with a diagnosis of ADHD. The primary and key secondary efficacy endpoints were the change from baseline at day 42 in the Adult ADHD Investigator Symptom Rating Scale (AISRS) total score and the Clinical Global Impression-Severity of Illness Scale, respectively. FINDINGS/RESULTS: Subjects randomized in study 1 (centanafadine 200 mg/d, n = 149; centanafadine 400 mg/d, n = 149; placebo, n = 148) and study 2 (centanafadine 200 mg/d, n = 145; centanafadine 400 mg/d, n = 143; placebo, n = 142) had moderate to severe ADHD (mean AISRS total score, 38.7 [SD, 6.8] across both studies). At day 42, statistically significant least-squares mean differences in AISRS total score were observed in favor of centanafadine versus placebo in study 1 (200 mg/d: -3.16, P = 0.019; 400 mg/d: -2.74, P = 0.039) and study 2 (200 mg/d: -4.01, P = 0.002; 400 mg/d: -4.47, P = 0.001). Effect sizes versus placebo were -0.28 for 200 mg/d and -0.24 for 400 mg/d in study 1 and -0.37 for 200 mg/d and -0.40 for 400 mg/d in study 2. The overall rate of treatment-emergent adverse events (TEAEs) was low, but there was a small increase in TEAE occurrence with increasing dose. Incidences of serious TEAEs and abuse potential-related AEs were low. IMPLICATIONS/CONCLUSIONS: These are the first large-scale studies to demonstrate the efficacy and safety profiles of 200 mg/d and 400 mg/d centanafadine in adults with ADHD.

Clinician's commentary to accompany "measurement-based care in integrated health care: A randomized clinical trial".

Comments on the article by B. L. Duncan et al (see record 2021-76744-003). As a physician and a Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, the author asks several questions related to this randomized clinical trial. How do the research questions and findings in this paper resonate with your experience as a clinician? What Is one thing you might do differently in your practice after reading this paper? What factors might facilitate or hinder the uptake/implementation of this research in practice? What is one unanswered question that you would like to see pursued as a follow-up to this research? (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development and Implementation of an Integrated Care Fellowship.

BACKGROUND: Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. OBJECTIVE: Describe a formal clinical fellowship devoted to professional development for the integrated care psychiatrist role. METHODS: The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics. RESULTS: We successfully recruited 3 classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All 5 graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n = 5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n = 581) and the mean quality of the talk was 5.35 (n = 582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows). CONCLUSIONS: The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing consultation-liaison psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.

Psychiatry's Expanded Integration into Primary Care.

Integrated behavioral care, and in particular, the collaborative care model, has been working to improve access and treatment for people with mental health disorders. Integrated care allows for adaptable, scalable, and sustainable practice that addresses the mental health needs of the public. During the pandemic several challenges emerged to delivering integrated care. This disruption happened at a systems level, team-based care level, scope of care level, and patient access level. This article looks through the lens of those various levels to identify and some of the lessons learned to help build a more resilient and flexible integrated care program.

Augmenting systems-level implementation of patient-reported outcomes for depression care through the use of structured analysis and design technique.

Background: Health systems increasingly need to implement complex practice changes such as the routine capture of patient-reported outcome (PRO) measures. Yet, health systems have met challenges when trying to bring practice change to scale across systems at large. While implementation science can guide the evaluation of implementation determinants, teams first need tools to systematically understand and compare workflow activities across practice sites. Structured analysis and design technique (SADT), a system engineering method of workflow modeling, may offer an opportunity to enhance the scalability of implementation evaluation for complex practice change like PROs. Method: We utilized SADT to identify the core workflow activities needed to implement PROs across diverse settings and goals for use, establishing a generalizable PRO workflow diagram. We then used the PRO workflow diagram to guide implementation monitoring and evaluation for a 1-year pilot implementation of the electronic Patient Health Questionnaire-9 (ePHQ). The pilot occurred across multiple clinical settings and for two clinical use cases: depression screening and depression management. Results: SADT identified five activities central to the use of PROs in clinical care: deploying PRO measures, collecting PRO data, tracking PRO completion, reviewing PRO results, and documenting PRO data for future use. During the 1-year pilot, 8,596 patients received the ePHQ for depression screening via the patient portal, of which 1,719 (21%) submitted the ePHQ; 367 patients received the ePHQ for depression management, of which 174 (47%) submitted the ePHQ. We present three case examples of how the SADT PRO workflow diagram augmented implementation monitoring, tailoring, and evaluation activities. Conclusions: Use of a generalizable PRO workflow diagram aided the ability to systematically assess barriers and facilitators to fidelity and identify needed adaptations. The use of SADT offers an opportunity to align systems science and implementation science approaches, augmenting the capacity for health systems to advance system-level implementation. Plain Language Summary: Health systems increasingly need to implement complex practice changes such as the routine capture of patient-reported outcome (PRO) measures. Yet these system-level changes can be challenging to manage given the variability in practice sites and implementation context across the system at large. We utilized a systems engineering method-structured analysis and design technique-to develop a generalizable diagram of PRO workflow that captures five common workflow activities: deploying PRO measures, collecting PRO data, tracking PRO completion, reviewing PRO results, and documenting PRO data for future use. Next, we used the PRO workflow diagram to guide our implementation of PROs for depression care in multiple clinics. Our experience showed that use of a standard workflow diagram supported our implementation evaluation activities in a systematic way. The use of structured analysis and design technique may enhance future implementation efforts in complex health settings.

C-L Case Conference: Chronic Psychosis Managed in Collaborative Care.

We present the case of a 60-year-old woman who presented to primary care with chronic mixed depressive and hypomanic symptoms consistent with schizoaffective disorder. Patients with serious mental illness such as psychotic disorders are ideally referred for treatment in specialty psychiatric settings; however, many patients with serious mental illness receive their care in primary care settings due to patient preference or unavailability of psychiatric services. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. The Collaborative Care Model (CoCM) can support primary care providers in managing patients with serious mental illness. Key teaching topics include the application of the CoCM to patients with psychotic disorders, clinician- and systems-level facilitators and barriers to CoCM implementation, and quality improvement within the CoCM. Specifically, the differential diagnosis when a patient is not improving should include systems-level considerations.

Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare.

OBJECTIVE: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians. METHODS: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. RESULTS: Overall, 10,294 CoCM and general BHI services were delivered in 2017, totaling $626,292 in payments, and 81,433 CoCM and general BHI services were delivered in 2018, totaling $7,442,985 in payments. Medicare denied 5% of services in 2017 and 32% in 2018. Most CoCM and general BHI services were delivered by primary care physicians in office-based settings. CONCLUSIONS: This study of codes designed to promote BHI revealed an eightfold increase in CoCM and general BHI use between 2017 and 2018. However, denied services represent a barrier, and use among eligible beneficiaries remains low.

Two randomized, double-blind, placebo-controlled trials and one open-label, long-term trial of brexpiprazole for the acute treatment of bipolar mania.

BACKGROUND: Brexpiprazole is a dopamine/serotonin receptor partial agonist (D2, 5-HT1A) and antagonist (5-HT2A) approved for treatment of schizophrenia and major depressive disorder (adjunct to antidepressants). AIMS: This study aimed to investigate brexpiprazole as monotherapy in acute mania (bipolar I disorder) in two short-term (ST) studies (study 080 and study 081) and one open-label (OL) extension (study 083). METHODS: ST studies were three-week randomized, double-blind, flexible dose (2-4 mg/day), placebo-controlled studies. The primary endpoint was mean change in Young Mania Rating Scale (YMRS) total score from baseline to day 21. The OL study was a 26-week flexible dose (2-4 mg/day) study for patients completing the ST studies. RESULTS: A total of 164 and 158 (study 080) and 170 and 162 (study 081) inpatients with DSM-5 mania with/without mixed features were randomized to placebo or brexpiprazole, respectively. The primary analyses did not show a statistically significant difference between brexpiprazole and placebo: study 080: least squares mean difference (95% confidence limits): 0.14 (-1.74, 2.03), p = 0.8797; study 081: -1.62 (-3.56, 0.32), p = 0.1011. OL study patients (n = 381) demonstrated a gradual improvement in YMRS total score. Akathisia was the only adverse event, with an incidence of ⩾5% with brexpiprazole and more than placebo in the ST studies, or ⩾5% in the OL study. Brexpiprazole was more efficacious in patients with impaired or no insight (predominantly EU patients) than in patients with excellent insight (predominantly US patients). CONCLUSIONS: Further studies are necessary to address the potential efficacy of brexpiprazole in acute mania, which should ensure that the study sample is severe enough (especially with regard to insight), and that the dose/titration schedule is not too modest.

Transforming Population-Based Depression Care: a Quality Improvement Initiative Using Remote, Centralized Care Management.

INTRODUCTION: With the growing prevalence of value-based contracts, health systems are incentivized to consider population approaches to service delivery, particularly for chronic conditions like depression. To this end, UW Medicine implemented the Depression-Population Approach to Health (PATH) program in primary care (PC) as part of a system-wide Center for Medicare and Medicaid Innovation (CMMI) quality improvement (QI) initiative. AIM: To examine the feasibility of a pilot PATH program and its impact on clinical and process-of-care outcomes. SETTING: A large, diverse, geographically disparate academic health system in Western Washington State including 28 PC clinics across five networks. PROGRAM DESCRIPTION: The PATH program was a population-level, centralized, measurement-based care intervention that utilized a clinician to provide remote monitoring of treatment progress via chart review and facilitate patient engagement when appropriate. The primary goals of the program were to improve care engagement and increase follow-up PHQ-9 assessments for patients with depression and elevated initial PHQ-9 scores. PROGRAM EVALUATION: We employed a prospective, observational study design, including commercially insured adult patients with new depression diagnoses and elevated initial PHQ-9 scores. The pilot intervention group, consisting of accountable care network (ACN) self-enrollees (N = 262), was compared with a similar commercially insured cohort (N = 2527) using difference-in-differences analyses adjusted for patient comorbidities, initial PHQ-9 score, and time trends. The PATH program was associated with three times the odds of PHQ-9 follow-up (OR 3.28, 95% CI 1.79-5.99), twice the odds of a follow-up PC clinic visit (OR 1.74, 95% CI 0.99-3.08), and twice the odds of treatment response, defined as reduction in PHQ-9 score by ≥ 50% (OR 2.02, 95% CI 0.97-4.21). DISCUSSION: Our results demonstrate that a centralized, remote care management initiative is both feasible and effective for large academic health systems aiming to improve depression outcome ascertainment, treatment engagement, and clinical care.

Sustaining the Collaborative Care Model (CoCM): Billing Newly Available CoCM CPT Codes in an Academic Primary Care System.

Novel Current Procedural Terminology (CPT) codes specific to the collaborative care model (CoCM) offer advantages over traditional billing options, but their uptake may require considerable billing and clinical workflow adjustments. This column presents a case study addressing the challenges of using these codes within the University of Washington Neighborhood Clinics (UWNC), an academically affiliated primary care clinic system in western Washington State. The UWNC experience thus far demonstrates that CoCM CPT codes can successfully be used in a large academic primary care system to help move this evidence-based service model toward financial sustainability.

Anesthetic management of pediatric patients with Niemann-Pick disease type C for intrathecal 2-hydroxypropyl-ß-cyclodextrin injection.

BACKGROUND: Niemann-Pick disease type C is an autosomal-recessive, lysosomal storage disorder with variable age of onset and a heterogeneous clinical presentation that includes neurological, psychiatric, and visceral findings. Serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin are being evaluated as a treatment modality for Niemann-Pick disease type C with a subset of patients requiring anesthesia for this procedure. AIMS: The aim of this study was to evaluate the safety of anesthesia provided for patients undergoing intrathecal injection of 2-hydroxypropyl-beta-cyclodextrin. METHODS: A retrospective review of pediatric patients who received serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin with anesthesia at two tertiary care centers was conducted from December 2015 through April 2019. Data were extracted for analysis included preoperative comorbidities, demographics, vital signs, intraoperative anesthesia course, airway management technique, venous access, postoperative course, and perioperative complications. In total, 19 patients were identified and a total of 394 anesthetic encounters were included in this study. RESULTS: All 394 2-hydroxypropyl-beta-cyclodextrin administration procedures were successfully performed, and there were no changes made in the anesthetic plan during the anesthesia encounters. Three hundred forty-nine anesthetics were performed utilizing inhalation induction and mask maintenance, and 45 anesthetics were performed with placement of a supraglottic airway device due to patient body habitus and provider preference. The incidence of a major adverse event (aspirations, arterial desaturation) was 5/394 (1.3%, 95% CI 0.05%-3.1%). Minor adverse events (emesis, delirium, hypotension, seizure, and airway obstruction) were observed in 19/394 encounters (4.8%, 95% CI 3.0%-7.5%). CONCLUSIONS: Our findings suggest that general anesthesia induced via inhalation induction and maintained with volatile anesthetic via mask or supraglottic airway is a safe and effective option for pediatric patients with Niemann-Pick disease type C undergoing serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin, supporting this technique as a viable option for anesthetic care in these patients.

Pre-Outplacement Perceptions of Dental Students Regarding Rural Oral Health Practice and Associated Factors.

Rural outplacement programs have been offered by Australian universities to encourage dental students to consider rural careers. The dental curricula should be designed to provide graduates with a good understanding of oral health issues that rural oral health care workers face. Pre-outplacement perceptions of dental students on rural practice are considered imperative to review and update the outplacement programs; however, they have not been investigated in detail. An online, anonymous, voluntary survey was conducted among the first-year dental students. The responses were solicited on the level of awareness and understanding of rural oral health, intention to practice in rural locations and factors informing the appeal of rural dental practice. The mean of a seven-point Likert scale revealed that most students had some level of perceived knowledge and awareness of rural communities and oral health. Students with rural affiliation were more likely to have the intent to practise rurally after graduation (p = 0.001). For short-term rural practice, students overall expressed positive intention. Greater job opportunities were the main motivating factor, while the distance from family and friends was the main deterring factor for practising rurally. Rural affiliation influences the intent to practise rurally on graduation. The pre-outplacement perceptions, in this study, are comparable with post-outplacement observations reported in the literature.

Dog erythrocyte antigens 1.1, 1.2, 3, 4, 7, and Dal blood typing and cross-matching by gel column technique.

BACKGROUND: Testing for canine blood types other than dog erythrocyte antigen 1.1 (DEA 1.1) is controversial and complicated by reagent availability and methodology. OBJECTIVES: The objectives of this study were to use available gel column technology to develop an extended blood-typing method using polyclonal reagents for DEA 1.1, 1.2, 3, 4, 7, and Dal and to assess the use of gel columns for cross-matching. METHODS: Dogs (43-75) were typed for DEA 1.1, 1.2, 3, 4, 7, and Dal. METHODS included tube agglutination (Tube) using polyclonal reagents, a commercially available DEA 1.1 gel column test kit (Standard-Gel) using monoclonal reagent, and multiple gel columns (Extended-Gel) using polyclonal reagents. Blood from 10 recipient and 15 donor dogs was typed as described above and cross-matched using the gel column technique. RESULTS: Of 43 dogs typed for DEA 1.1, 23, 25, and 20 dogs were positive using Standard-Gel, Extended-Gel, and Tube, respectively. Typing for DEA 1.2 was not achievable with Extended-Gel. For 75 dogs typed for DEA 3, 4, and 7, concordance of Extended-Gel with Tube was 94.7%, 100%, and 84%, respectively. Dal, determined only by Extended-Gel, was positive for all dogs. Post-transfusion major cross-matches were incompatible in 10 of 14 pairings, but none were associated with demonstrable blood type incompatibilities. CONCLUSIONS: Gel column methodology can be adapted for use with polyclonal reagents for detecting DEA 1.1, 3, 4, 7, and Dal. Agglutination reactions are similar between Extended-Gel and Tube, but are more easily interpreted with Extended-Gel. When using gel columns for cross-matching, incompatible blood cross-matches can be detected following sensitization by transfusion, although in this study incompatibilities associated with any tested DEA or Dal antigens were not found.

Efficacy and safety of biphasic insulin aspart 70/30 versus exenatide in subjects with type 2 diabetes failing to achieve glycemic control with metformin and a sulfonylurea.

OBJECTIVE: To compare safety and efficacy of biphasic insulin aspart 70/30 (BIAsp 30) with exenatide in subjects with type 2 diabetes mellitus (T2DM) not achieving glycemic targets with metformin and sulfonylurea in a randomized, open-label, 24-week trial. RESEARCH DESIGN AND METHODS: Subjects (N = 372, T2DM > 6 months, age > or = 18 and < or = 80 years, HbA1c > or = 8%, insulin naive not achieving glycaemic targets, receiving metformin and sulfonylurea) were randomized 1: 1: 1 to receive either BIAsp 30 QD (12 U before supper); BIAsp 30 BID (12 U divided equally between pre-breakfast and pre-supper); or exenatide (5 microg BID for 4 weeks and 10 microg BID thereafter). Efficacy (HbA1c, fasting plasma glucose [FPG]) and safety (adverse events and hypoglycemic episodes) were assessed. RESULTS: Glycemic control achieved with both BIAsp 30 BID and BIAsp 30 QD was superior to that with exenatide (BIAsp 30 BID-exenatide: HbA1c difference -0.91% [95% CI: -1.23 to -0.59%] and BIAsp 30 QD-exenatide: difference: -0.67% [95% CI: -0.99 to -0.34%]). At the end of the study, more subjects achieved HbA1c < 7% and < or = 6.5% in the BIAsp 30 BID group than in the exenatide group (HbA1c < 7%: 37% vs. 20%, p = 0.0060; HbA1c < or = 6.5%: 25% vs. 8%, p = 0.0004, respectively). Combined hypoglycemic episodes (major, minor, symptoms only) were reported by 56%, 61%, and 29% of the subjects in the BIAsp 30 QD, BIAsp 30 BID, and exenatide groups, respectively. Weight gain was observed in the BIAsp 30 group (BIAsp 30 QD: 2.85 kg, BIAsp 30 BID: 4.08 kg) and weight loss was observed in the exenatide group (-1.96 kg). Nausea or vomiting was responsible for discontinuation of seven subjects in the exenatide group and one subject in the BIAsp 30 BID group. CONCLUSIONS: Significantly more T2DM patients (poorly controlled with combination metformin/sulfonylurea) achieved glycemic goals when treated with BIAsp 30 than with exenatide. The high baseline HbA1c values (approximately 10.2%) and the long duration of diabetes (approximately 9 years) suggests that some subjects may have been in an advanced stage of their diabetes and may not have had sufficient beta-cell function for a GLP-1 mimetic to be effective. The insulin-treated groups had more minor hypoglycemic events and weight gain but less gastrointestinal side-effects. In summary, BIAsp 30 was more efficacious in helping patients with high baseline HbA1c achieve glycemic goals. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00097877.

Rehabilitation implications of non-traumatic subarachnoid haemorrhage.

OBJECTIVE: Subarachnoid haemorrhage (SAH) remains an important cause of stroke in the rehabilitation population, whose incidence has not been changed by pre-morbid medical treatment. The understanding of the pathophysiological changes that occur after SAH has been more clearly defined, therefore the treatment and outcomes of these patients have undergone drastic changes over the past few years. The purpose of this review is to update and familiarize the rehabilitation professional on the state of the art treatment and common complications associated with this disease and how this may affect the rehabilitation programme. Also, the current literature on the outcomes of these patients will be reviewed to help advise the rehabilitation professional on potential predictors. DATA SOURCES: Literature review. STUDY SELECTION: Articles of relevance to the current management of SAH. DATA EXTRACTION: Information that was deemed significant in the understanding of the pathophysiology, treatment and results of outcomes in patients with SAH. DATA SYNTHESIS: Subarachnoid haemorrhage (SAH) is the one sub-type of stroke whose incidence has not declined. Due to advances in medical care, mortality rate is on the decline. Outcomes data was analysed to look for common predictors for this patient population. CONCLUSIONS: While the incidence of SAH has not declined, improving medical treatment has reduced mortality. The rehabilitation professional should be familiar with the latest advances, potential complications and likely outcomes in order to plan the most appropriate therapy course for these patients.

Reporting number needed to treat and absolute risk reduction in randomized controlled trials.

CONTEXT: Ongoing efforts to improve the quality of reporting for randomized controlled trials (RCTs) include the Consolidated Standards of Reporting Trials (CONSORT) statement. We examined the frequency of explicit reporting of the number needed to treat (NNT) and the absolute risk reduction (ARR) in RCTs. METHODS: Five frequently cited journals were investigated: Annals of Internal Medicine, BMJ, JAMA, The Lancet, and the New England Journal of Medicine. For each journal, 4 years were evaluated: 1989, 1992, 1995, and 1998. All issues of each journal for each year were reviewed manually. Eligible articles were those in which an RCT was conducted on the use of a medication showing a significant treatment effect. Elements abstracted from each eligible article were the condition investigated, event being treated or prevented, intervention, study results, and reporting methods (relative risk reduction, NNT, and ARR). RESULTS: Of 359 eligible articles, NNT was reported in 8 articles. Six of the 8 studies were from 1998. Absolute risk reduction was reported in 18 articles, 10 of which were from 1998. CONCLUSIONS: Despite CONSORT recommendations, few authors expressed their findings in terms of NNT or ARR. Consideration should be given to including these values in reports of RCTs.