By Anne Harding

NEW YORK (Reuters Health) - Efforts to improve health care quality can help reduce some -- but not all -- of the inequalities in medical care provided to black patients compared with whites, a new study shows.

Four years after launching a program to improve the quality of diabetes care, a large Boston-based physician group found that racial disparities in cholesterol screening were reduced, but blacks remained less likely than whites to be taking statins to get their LDL ("bad") cholesterol down, or to have their blood sugar under long-term control.

"While improving quality in general does result in reduction of disparities, what we found was that the more important measures of quality, which were the outcomes ... those things tended to have more persistent disparities," Dr. Thomas D. Sequist of Harvard Medical School in Boston, the study's lead author, told Reuters Health.

Sequist and his colleagues looked at 7,088 patients with diabetes -- 28 percent of whom were black -- who received care at Harvard Vanguard Medical Associates, to investigate the effect of quality improvement efforts on ethnic disparities in care. The initiative included patient outreach and electronic reminders sent to physicians.

As they report in the Archives of Internal Medicine, the team found that from 1997 to 2001, the percentage of patients who had their LDL cholesterol checked every year rose from 39 percent to 64 percent, while the disparity between blacks and whites fell from 14 percent to 4 percent.

During that same time period, the percentage of diabetic patients with their LDL cholesterol under effective control rose from 15 percent to 43 percent, with the racial disparity falling from 9 percent to 6 percent.

While the percent of patients taking cholesterol-lowering statins rose from 20 percent to 37 percent, there was no change in the disparity between blacks and whites taking the drugs, the researchers found.

Many factors could be at work here, Sequist noted. Physicians may be less likely to prescribe the drugs to black patients, or black patients could be less likely to fill the prescriptions, for example.

The percentage of patients with their blood sugar under long-term control remained at 31 percent throughout the study period. Racial disparities did not budge for this measurement; 24 percent of black patients had their blood sugar under long-term control, compared to 34 percent of whites.

Sequist and his colleagues point out that blood glucose control is a much more complex issue than lowering cholesterol, given that it may require changes in diet, exercise, and multiple medications.

It likely will be necessary for physicians to develop focused efforts to effectively address differences in care between blacks and whites in their own practices, Sequist told Reuters Health.

"A lot of health care disparities or the underlying reasons driving health care disparities do occur in a physician's office," he said.

SOURCE: Archives of Internal Medicine, March 27, 2006.

Related MedlinePlus Pages:

• African-American Health - http://www.nlm.nih.gov/medlineplus//africanamericanhealth.html
• Cholesterol - http://www.nlm.nih.gov/medlineplus//cholesterol.html
• Diabetes - http://www.nlm.nih.gov/medlineplus//diabetes.html

MONDAY, April 10 (HealthDay News) -- There's a bit of good news in the latest AARP report that prescription drug prices continue to outpace the rate of inflation.

The rate of increase for a sample of 193 brand-name drugs was 6 percent in 2005, higher than the 3.4 percent inflation rate that year, but "that was a little more reasonable than in previous years," said John Rother, policy director at AARP.

And the average price of the 75 generic drugs monitored by AARP actually dropped, if only by 0.8 percent, in 2005, the report said.

"One bottom line for consumers is that the value of generic drugs is going up, so they can save even more money by switching to generics," Rother said.

That decrease in generics was due entirely to a drop in the price of 100 milligram tablets of the generic version of the antibiotic ciprofloxacin, down more than 38 percent in 2005. There were price increases for six generic drugs, while the prices of the other 68 covered in the report did not change, according to the report.

By contrast, the price increases for the 187 brand-name drugs used by older people for chronic conditions, such as high blood pressure, arthritis pain and cardiovascular disease, meant that the average annual cost per prescription was $47.43 higher in 2005, slightly better than the $51.82 increase in 2004, the report said.

Over the six years that AARP has been issuing its Rx Watchdog review, the average annual cost of therapy with brand-name products used to treat chronic conditions increased $297. But, typical older Americans regularly take four drugs, so their annual cost of therapy rose almost $1,200 from 1999 through 2005, the report said.

Looking at the 24 most widely used brand-name drugs, AARP found the highest price increase, 11.1 percent, was for Toprol XL 50-milligram tablets, a beta blocker marketed by AstraZeneca. The lowest increase among these best sellers, 2.9 percent, was for Plavix 75-milligram tablets, a clot-preventing drug marketed by Bristol-Meyers Squibb.

A prediction of higher prices to come was made by Sharon Treat, executive director of the National Legislative Association on Prescription Drug Prices. She said her pessimism was based on the terms of the new Medicare prescription drug program, which took effect at the start of this year.

The program, Medicare Plan D, requires participants to enroll with one of many private insurance companies, the terms of whose offers differ widely. "And the incentives are completely wrong," Treat said. "It makes no sense to have multiple programs, and there is no provision for negotiating prices with the companies. Anyone who looked at the law as it was being passed knew that it was wrong, and now what we predicted is happening."

Rother's appraisal was more cautious. The new Medicare program went into effect after the period covered by the latest AARP report, he noted, adding, "I don't want to speculate on what might happen. I don't think we can say yet."

Pharmaceutical companies "made a lot of pledges" about holding prices down, Rother said. If that does not happen, "it would invite more legislation by Congress," he said.

But the trend over the last six years has been for drug price increases to be higher than the general rate of inflation, Rother said, noting the average price increase of 40 percent, compared to inflation at 17 percent.

AARP releases its Rx Watchdog report periodically, tracking changes in drug pricing for its 35 million members aged 50 and older. The group bases its figures on changes in manufacturers' list prices for wholesalers.

Related MedlinePlus Pages:

• Medicines - http://www.nlm.nih.gov/medlineplus//medicines.html
• Seniors' Health Issues - http://www.nlm.nih.gov/medlineplus//seniorshealthissues.html