LDI Issue Brief

In 2007, the pharmaceutical industry spent more than $4.9 billion on direct-to-consumer advertising (DTCA) of prescription drugs in the U.S. Controversy over DTCA has grown since the Food and Drug Administration liberalized its regulations in 1997. Proponents claim that such advertising educates consumers, promotes patient participation in clinical decisions, and improves patient adherence to medication instructions. Opponents argue that such advertising is meant to persuade, not educate, and that it promotes inappropriate use of prescription drugs, or diverts consumers from better alternatives...

As national health care reform advances, increasing attention is being paid to the adequacy of existing resources to meet health care needs. Do we have the right mix of providers and facilities? Are they located and organized efficiently? These persistent questions are especially relevant to the provision of emergency care, in which timely access can save lives. This Issue Brief describes the first national study of population access to emergency care, taking into account the locations of emergency departments (EDs), people, and transportation...

Unhealthy behaviors, such as smoking, poor diet, and sedentary lifestyles, account for as much as 40% of premature deaths in the U.S. Although behavioral interventions have the potential to improve health, behavior change is difficult, especially over the long term. Many people have difficulty changing health behaviors because it requires trade-offs between immediate consumption and delayed and often intangible health benefits. Incentives can provide people with immediate and tangible feedback that helps make it easier for them to do in the short term what is in their long-term best interest...

As part of its war on drugs, the U.S. government spent nearly $1 billion between 1998 and 2004 for the National Youth Anti-Drug Media Campaign. The campaign had three goals: educating children and teenagers (ages 9 to 18) on how to reject illegal drugs, preventing them from starting drug use, and convincing occasional users to stop. Analyzing the effects of this campaign is important not only for future funding decisions but also for more effective targeting of future efforts. This Issue Brief summarizes a Congressionally-mandated evaluation of the campaign's effects on youths' cognitions and behavior around marijuana use...

Much of the public was introduced to the implantable cardioverter-defibrillator (ICD) when Vice President Cheney, a survivor of four heart attacks, received the device in 2001. Although ICDs were initially limited to patients with previous cardiac arrests or arrhythmias, more recent studies have demonstrated that ICDs can prevent sudden cardiac death in patients who have not had a cardiac arrest, but are at greater risk for one (for example, those with congestive heart failure and reduced cardiac function)...

Recently, the Food and Drug Administration approved a new drug, varenicline, to help people quit smoking. It is the first new smoking cessation drug in nearly a decade, and joins just two other pharmacotherapy approaches [nicotine replacement therapies (NRTs) and bupropion] that have been proven effective for the treatment of tobacco dependence. However, even the most effective treatments help just one in four smokers quit long term. Smoking is the single most preventable cause of death in the U.S., killing nearly 440,000 Americans each year...

About 10-15% of all adults report that they are allergic penicillin or other antibiotics, although the accuracy and significance these reports remain unclear. In the outpatient setting, clinicians face a dilemma in prescribing for patients with a history of an allergic reaction to antibiotics. Which drugs should these patients avoid? Are these patients at increased risk for an allergic reaction to related drugs? This Issue Brief summarizes several large studies that can help guide improve the management of patients with antibiotic allergies...

One in three U.S. households contains at least one firearm. Gun owners cite two main reasons for having a gun: hunting and self-protection. A majority of handgun owners believe that they are protecting their homes and families against violent assaults. But in a country where the majority of homicides and suicides involve a gun, it is reasonable to question whether access to a gun increases or decreases the risk of violent death. This Issue Brief describes case-control studies that investigate links between gun availability and gun death, and supports earlier findings that people with guns in their homes appear to increase their risk of being shot fatally (intentionally or unintentionally) or taking their own life with a gun...

In 2000, nearly 29,000 people in the U.S. died from firearm injury.The vast majority of these people died from suicide (58%) or homicide (38%). And for every person who died, at least two others were shot and survived, often with permanent disability. The Firearm Injury Center at Penn (FICAP), founded in 1997, is a unique collaboration among health professionals, researchers and communities to address the magnitude and impact of firearm injury and violence. In this Issue Brief, FICAP presents an overview of firearm violence, and discusses public health approaches to reducing the toll of violent injury...

Injuries with used needles and other "sharps" put health care workers at risk for serious bloodborne infections, such as HIV and hepatitis B and C. To some extent, this risk can be lessened through safer techniques (such as not recapping needles) and safer devices (such as needleless and self-sheathing equipment). But these injuries occur within a context (often a hospital unit) with organizational features that may themselves contribute to an increased or decreased risk. This Issue Brief summarizes a series of studies that investigate whether workplace aspects of the hospital (such as staffing levels, and organizational structure and climate) affect the risk of needlestick injuries to nurses...

The Department of Veterans Affairs (VA) runs the largest integrated health system in the country, and provides care to nearly 4 million patients each year. It has been dogged by persistent doubts about its efficiency and quality of care, despite numerous quality improvement programs and an extensive reorganization in 1995. In fact, recent studies have found that health care in the VA compares favorably with non-VA systems, in areas such as preventive care and treatment for acute myocardial infarction. This Issue Brief summarizes a comparison in another area-inpatient rehabilitation for stroke- and highlights the difficulty and complexity of assessing quality across systems of care...

As phrases like "managed care backlash" become part of the lexicon in American health care policy circles, it is instructive to examine a managed competition experiment in a vastly different context. Britain's Conservative government instituted reforms in 1991 to transform the National Health Service (NHS) from a centrally administered service to managed competition between purchasers and providers. Five years later, it replaced those reforms to promote cooperation rather than competition. This Issue Brief summarizes what the NHS can learn from decades of American experience with purchasing care, and what the American health system can learn from the British experiment with an internal market in the 1990s...