Annals of Internal Medicine tip sheet for July 15, 2014, issue

July 15th, 2014
1. Pill appearance affects how patients take their medications*

*Sound bites and b-roll footage available. See bottom of page for feed dates, times, and coordinates

Heart patients significantly more likely to stop taking medication after pill changes appearance

When it comes to taking generic heart medications, appearance matters, according to a study published in Annals of Internal Medicine ( Physicians often prescribe generic medications for the treatment of cardiovascular disease because generics are inexpensive for patients and payors and are available in nearly every class of relevant medication – antihypertensive, lipid-lowering, anticoagulant, antiplatelet, and antiarrhythmic agents. While generic drugs are therapeutically interchangeable, pill appearance may vary among manufacturers, or between generic and brand-name versions of a drug. Whether these appearance changes affect patient adherence to medications is an issue because taking medications as prescribed is essential for good outcomes.

Researchers studied more than 11,000 patients who had a heart attack and were placed on generic prescriptions to determine if inconsistent appearance of prescribed generic medication among patients with cardiovascular disease is associated with nonpersistent use of these medications. Researchers found that for heart patients who had stopped taking their medication there were 30 percent greater odds that they had a change in pill color or shape preceding the discontinuation. Cosmetic changes in generic heart medications are common. About a third of patients had a change in pill shape or color during the study. The authors suggest that doctors who prescribe generic cardiovascular drugs proactively warn patients about the potential for appearance changes and explain that even if the pill looks different, the medication is the same.

Note: The URL will go live at 5:00 p.m. on Monday, July 14 and can be included in news stories. For an embargoed PDF, please contact Angela Collom. To speak with the lead author, please contact Jessica Maki at 617-525-6373 or

2. Having strong social ties protects men from suicide death

Social integration, such as being married, attending religious services, and having a large network of friends protects men against suicide, according to a study being published in Annals of Internal Medicine ( Suicide is one of the top 10 leading causes of death among men in the United States. Prevention efforts usually emphasize the study of psychiatric, psychological, or biological determinants. However, research has shown that a substantial proportion of suicidal behaviors occur in the absence of a formally diagnosed mental disorder, suggesting that a deeper understanding of factors driving suicide is needed. Researchers used data from the Health Professionals Follow-up Study, an ongoing prospective cohort study of 34,901 men aged 40 to 75, to estimate the association between social integration and suicide mortality over 24 years of follow-up. Social integration was measured with a seven-item index that included marital status, social network size, frequency of contact, religious participation, and participation in other social groups. Marriage, frequent attendance at religious services, and having a large social network seemed especially protective.

Note: The URL will go live at 5:00 p.m. on Monday, July 14 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author, please contact Sue McGreevy at 617-724-2764 or

3. Nurses may effectively manage outpatient care of chronic diseases

Nurse-led protocols are effective for managing outpatient care of chronic illnesses, according to an article being published in Annals of Internal Medicine ( Chronic diseases cause a substantial burden to the U.S. health care system and account for about 75 percent of every health care dollar spent. There are well-established clinical practice guidelines for the outpatient management of chronic illnesses, but access to quality and appropriate care can be an issue, especially considering the nation's shortage of primary care physicians. Some groups have suggested that quality care be delivered through a team-based approach, which the American College of Physicians calls the "patient-centered medical home" ( One new model of the medical home may involve nurse-managed protocols for routine outpatient care of chronic diseases. Researchers conducted a systematic review of published evidence to determine whether nurse-managed protocols are effective for outpatient management of adults with diabetes, hypertension, and hyperlipidemia, common chronic illnesses that require ongoing outpatient management. They found that a patient-centered medical home model using nurse-managed protocols helps to improve health outcomes for patients with moderately severe diabetes, hypertension, and hyperlipidemia, and that RNs can successfully titrate medications according to protocols for these conditions.

Note: The URL will go live at 5:00 p.m. on Monday, July 14 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author, please contact Michael Evans at 919-684-9356 or

Provided by American College of Physicians

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