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NEW YORK (Reuters Health) - Older patients with the inflammatory skin disorder rosacea appear significantly more likely to be diagnosed with dementia, according to Danish researchers.

As Dr. Alexander Egeberg told Reuters Health by email, "We found an increased risk of dementia, in particular Alzheimer's disease (AD), in patients with rosacea. The risk was only increased in patients older than 60 years, however."

"Emerging data," he added, "suggest a link between rosacea and neurological disorders. Yet, it is important for patients to remember that the absolute risk is still low."

In an April 28 online paper in Annals of Neurology, Dr. Egeberg, of the University of Copenhagen, and colleagues note that in rosacea there's upregulation of various inflammatory mediators, for example, cytokines, antimicrobial peptides (AMPs), chemokines, and matrix metalloproteinases (MMPs). Similar processes appear to be at work in certain neurodegenerative disorders.

To examine the possible relationship, the team studied data from 1997 to 2012 on almost 5.6 million Danes. Of these, 82,439 had rosacea at baseline. Over a maximum follow-up of 16 years, 99,040 developed dementia, of whom 29,193 were diagnosed with AD.

After adjustment, patients with rosacea were at significantly increased risk of dementia (hazard ratio 1.07) and of AD (HR 1.25). Women were at greater risk of AD (HR 1.28) than men (HR 1.16).

However, stratification by age at study entry showed that the risk of AD was significantly increased only in those enrolled at the age of 60 or more (HR 1.20). When analyses were limited to patients with a hospital dermatologist diagnosis of rosacea, the HR for dementia was 1.42 and for AD it was 1.92.

The current sum of evidence, conclude the investigators,"suggests that certain forms of dementia, in particular AD, have prominent inflammatory components, and MMPs and AMPs may provide mechanistic links for the observed association between rosacea and dementia."

"Increased focus on symptoms of cognitive dysfunction in patients with rosacea may be warranted," they say.

The authors reported no funding or disclosures.

NEW YORK (Reuters Health) - Older patients with the inflammatory skin disorder rosacea appear significantly more likely to be diagnosed with dementia, according to Danish researchers.

As Dr. Alexander Egeberg told Reuters Health by email, "We found an increased risk of dementia, in particular Alzheimer's disease (AD), in patients with rosacea. The risk was only increased in patients older than 60 years, however."

"Emerging data," he added, "suggest a link between rosacea and neurological disorders. Yet, it is important for patients to remember that the absolute risk is still low."

In an April 28 online paper in Annals of Neurology, Dr. Egeberg, of the University of Copenhagen, and colleagues note that in rosacea there's upregulation of various inflammatory mediators, for example, cytokines, antimicrobial peptides (AMPs), chemokines, and matrix metalloproteinases (MMPs). Similar processes appear to be at work in certain neurodegenerative disorders.

To examine the possible relationship, the team studied data from 1997 to 2012 on almost 5.6 million Danes. Of these, 82,439 had rosacea at baseline. Over a maximum follow-up of 16 years, 99,040 developed dementia, of whom 29,193 were diagnosed with AD.

After adjustment, patients with rosacea were at significantly increased risk of dementia (hazard ratio 1.07) and of AD (HR 1.25). Women were at greater risk of AD (HR 1.28) than men (HR 1.16).

However, stratification by age at study entry showed that the risk of AD was significantly increased only in those enrolled at the age of 60 or more (HR 1.20). When analyses were limited to patients with a hospital dermatologist diagnosis of rosacea, the HR for dementia was 1.42 and for AD it was 1.92.

The current sum of evidence, conclude the investigators,"suggests that certain forms of dementia, in particular AD, have prominent inflammatory components, and MMPs and AMPs may provide mechanistic links for the observed association between rosacea and dementia."

"Increased focus on symptoms of cognitive dysfunction in patients with rosacea may be warranted," they say.

The authors reported no funding or disclosures.

NEW YORK (Reuters Health) - Older patients with the inflammatory skin disorder rosacea appear significantly more likely to be diagnosed with dementia, according to Danish researchers.

As Dr. Alexander Egeberg told Reuters Health by email, "We found an increased risk of dementia, in particular Alzheimer's disease (AD), in patients with rosacea. The risk was only increased in patients older than 60 years, however."

"Emerging data," he added, "suggest a link between rosacea and neurological disorders. Yet, it is important for patients to remember that the absolute risk is still low."

In an April 28 online paper in Annals of Neurology, Dr. Egeberg, of the University of Copenhagen, and colleagues note that in rosacea there's upregulation of various inflammatory mediators, for example, cytokines, antimicrobial peptides (AMPs), chemokines, and matrix metalloproteinases (MMPs). Similar processes appear to be at work in certain neurodegenerative disorders.

To examine the possible relationship, the team studied data from 1997 to 2012 on almost 5.6 million Danes. Of these, 82,439 had rosacea at baseline. Over a maximum follow-up of 16 years, 99,040 developed dementia, of whom 29,193 were diagnosed with AD.

After adjustment, patients with rosacea were at significantly increased risk of dementia (hazard ratio 1.07) and of AD (HR 1.25). Women were at greater risk of AD (HR 1.28) than men (HR 1.16).

However, stratification by age at study entry showed that the risk of AD was significantly increased only in those enrolled at the age of 60 or more (HR 1.20). When analyses were limited to patients with a hospital dermatologist diagnosis of rosacea, the HR for dementia was 1.42 and for AD it was 1.92.

The current sum of evidence, conclude the investigators,"suggests that certain forms of dementia, in particular AD, have prominent inflammatory components, and MMPs and AMPs may provide mechanistic links for the observed association between rosacea and dementia."

"Increased focus on symptoms of cognitive dysfunction in patients with rosacea may be warranted," they say.

The authors reported no funding or disclosures.

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."

LONDON - Researchers voiced concern on Nov. 25 about poor quality studies on the popular ADHD treatment methylphenidate, saying evidence of some benefits, but also of sleep problems and appetite loss, suggests the drug should be prescribed with caution.

Methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) has been used to treat attention deficit hyperactivity disorder (ADHD) for more than 50 years.

The Cochrane Review researchers, who conducted a full assessment of studies on the benefits and harms of methylphenidate, said evidence on its use in children was poor.

"Our expectations of this treatment are probably greater than they should be," said Morris Zwi, a London-based consultant child and adolescent psychiatrist, who worked on the review.

"Whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence. What we still need are large, well-conducted trials to clarify the risks versus the benefits."

Cochrane Reviews are conducted by international panels of independent researchers and considered as studies of the best available science on a topic.

Jonathan Green, a professor of child and adolescent psychiatry at Britain's Manchester University who was asked to comment on the Cochrane Review, said it would be "wrong to draw the conclusion... that methylphenidate is ineffective.

"In fact, clinical level evidence strongly supports the effectiveness of methylphenidate for many children with ADHD."

The Cochrane Review included data from 185 randomized controlled trials involving more than 12,000 children or adolescents. The studies were conducted mainly in the United States, Canada and Europe, and each one compared methylphenidate with either a placebo or no intervention.

In their review, the Cochrane researchers found that methylphenidate led to modest improvements in ADHD symptoms, general behavior, and quality of life, but that side-effects included a higher risk of sleep problems and loss of appetite.

The researchers added, however, that their confidence in the evidence was low since many of the trials were not conducted with sufficient rigor and results reporting was not complete.

"Clinicians prescribing methylphenidate must take account of the poor quality of the evidence, monitor treatment carefully, and weigh up the benefits and adverse effects," they said.

The analysis was published online Nov. 25 in the Cochrane Library.

LONDON - Researchers voiced concern on Nov. 25 about poor quality studies on the popular ADHD treatment methylphenidate, saying evidence of some benefits, but also of sleep problems and appetite loss, suggests the drug should be prescribed with caution.

Methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) has been used to treat attention deficit hyperactivity disorder (ADHD) for more than 50 years.

The Cochrane Review researchers, who conducted a full assessment of studies on the benefits and harms of methylphenidate, said evidence on its use in children was poor.

"Our expectations of this treatment are probably greater than they should be," said Morris Zwi, a London-based consultant child and adolescent psychiatrist, who worked on the review.

"Whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence. What we still need are large, well-conducted trials to clarify the risks versus the benefits."

Cochrane Reviews are conducted by international panels of independent researchers and considered as studies of the best available science on a topic.

Jonathan Green, a professor of child and adolescent psychiatry at Britain's Manchester University who was asked to comment on the Cochrane Review, said it would be "wrong to draw the conclusion... that methylphenidate is ineffective.

"In fact, clinical level evidence strongly supports the effectiveness of methylphenidate for many children with ADHD."

The Cochrane Review included data from 185 randomized controlled trials involving more than 12,000 children or adolescents. The studies were conducted mainly in the United States, Canada and Europe, and each one compared methylphenidate with either a placebo or no intervention.

In their review, the Cochrane researchers found that methylphenidate led to modest improvements in ADHD symptoms, general behavior, and quality of life, but that side-effects included a higher risk of sleep problems and loss of appetite.

The researchers added, however, that their confidence in the evidence was low since many of the trials were not conducted with sufficient rigor and results reporting was not complete.

"Clinicians prescribing methylphenidate must take account of the poor quality of the evidence, monitor treatment carefully, and weigh up the benefits and adverse effects," they said.

The analysis was published online Nov. 25 in the Cochrane Library.

LONDON - Researchers voiced concern on Nov. 25 about poor quality studies on the popular ADHD treatment methylphenidate, saying evidence of some benefits, but also of sleep problems and appetite loss, suggests the drug should be prescribed with caution.

Methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) has been used to treat attention deficit hyperactivity disorder (ADHD) for more than 50 years.

The Cochrane Review researchers, who conducted a full assessment of studies on the benefits and harms of methylphenidate, said evidence on its use in children was poor.

"Our expectations of this treatment are probably greater than they should be," said Morris Zwi, a London-based consultant child and adolescent psychiatrist, who worked on the review.

"Whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence. What we still need are large, well-conducted trials to clarify the risks versus the benefits."

Cochrane Reviews are conducted by international panels of independent researchers and considered as studies of the best available science on a topic.

Jonathan Green, a professor of child and adolescent psychiatry at Britain's Manchester University who was asked to comment on the Cochrane Review, said it would be "wrong to draw the conclusion... that methylphenidate is ineffective.

"In fact, clinical level evidence strongly supports the effectiveness of methylphenidate for many children with ADHD."

The Cochrane Review included data from 185 randomized controlled trials involving more than 12,000 children or adolescents. The studies were conducted mainly in the United States, Canada and Europe, and each one compared methylphenidate with either a placebo or no intervention.

In their review, the Cochrane researchers found that methylphenidate led to modest improvements in ADHD symptoms, general behavior, and quality of life, but that side-effects included a higher risk of sleep problems and loss of appetite.

The researchers added, however, that their confidence in the evidence was low since many of the trials were not conducted with sufficient rigor and results reporting was not complete.

"Clinicians prescribing methylphenidate must take account of the poor quality of the evidence, monitor treatment carefully, and weigh up the benefits and adverse effects," they said.

The analysis was published online Nov. 25 in the Cochrane Library.

NEW YORK - Outpatient care may cost more when hospitals own the medical practices or employ the physicians, a U.S. study suggests.

Hospital employment of doctors and ownership of physician practices has grown over the past decade as health care providers seek to curb expenses with economies of scale and deliver better-coordinated treatment to patients.

Research reported in an article online October 19 in JAMA Internal Medicine examined how the rise of tighter financial integration between doctors and hospitals affected costs for people enrolled in private health insurance plans from 2008 to 2012.

In communities with the sharpest increase in financial integration between doctors and hospitals over the study period, average annual outpatient costs for each person with private health insurance increased by $75, while the amount of outpatient services they used was little changed.

"We document an increase in spending driven by prices, without any change in utilization," lead author Hannah Neprash, a health policy researcher at Harvard University in Boston, said by email.

"Some price increases may be acceptable - particularly if they are accompanied with improved quality of care," Neprash added. This study, however, didn't look at changes in quality associated with physician-hospital integration, she said.

Using Medicare claims data for 240 metropolitan areas nationwide, the researchers identified physicians who were either directly employed by hospitals or who worked for practices owned by hospitals.

Overall, the proportion of physicians with close financial ties to hospitals rose from 18% in 2008 to 21.3% in 2012.

Next, the researchers analyzed spending and prices for nearly 7.4 million non-elderly adults in these regions with two common types of private health insurance coverage: preferred-provider organizations (PPO) or point-of-service (POS) plans. These types of insurance may tie patients' out-of-pocket fees to the prices doctors charge.

The cost increase seen with greater financial integration of doctors and hospitals was confined to outpatient spending, bringing the average outpatient cost per enrollee in the PPO and POS plans in 2012 to about $2,400.

The average cost of $872 for inpatient treatments, however, was unaffected by financial ties between doctors and hospitals, the study found.

One shortcoming of the study is that the researchers didn't assess quality of care, the authors acknowledge. Better quality outpatient care might justify higher prices, they note.

Newer payment arrangements, however, are starting to hold providers more accountable for both inpatient and outpatient spending and for outcomes, senior study author Dr. J. Michael McWilliams of Harvard Medical School and Brigham and Women's Hospital in Boston, said by email.

Over time, this means "physician-hospital integration could conceivably offer some distinct efficiencies in terms of higher quality of care at a lower cost," Dr. McWilliams said.

Still, price hikes for people with private insurance - often provided to U.S. workers by their employers - are probably going to lead to higher out-of-pocket costs for patients, noted Dr. James Reschovsky and Dr. Eugene Rich of Mathematica Policy Research in Washington, D.C., in an accompanying editorial.

"The higher prices in hospital outpatient departments are passed on to employers in the form of higher premiums, and ultimately to workers in the form of less generous health benefits, higher premium cost sharing, or lower wages," Dr. Reschovsky said by email. "Certainly patients with co-insurance would pay more out-of-pocket when the price of service is higher."

The Robert Wood Johnson Foundation supported this research. One coauthor reported being formerly employed by Truven Health Analytics.

NEW YORK - Outpatient care may cost more when hospitals own the medical practices or employ the physicians, a U.S. study suggests.

Hospital employment of doctors and ownership of physician practices has grown over the past decade as health care providers seek to curb expenses with economies of scale and deliver better-coordinated treatment to patients.

Research reported in an article online October 19 in JAMA Internal Medicine examined how the rise of tighter financial integration between doctors and hospitals affected costs for people enrolled in private health insurance plans from 2008 to 2012.

In communities with the sharpest increase in financial integration between doctors and hospitals over the study period, average annual outpatient costs for each person with private health insurance increased by $75, while the amount of outpatient services they used was little changed.

"We document an increase in spending driven by prices, without any change in utilization," lead author Hannah Neprash, a health policy researcher at Harvard University in Boston, said by email.

"Some price increases may be acceptable - particularly if they are accompanied with improved quality of care," Neprash added. This study, however, didn't look at changes in quality associated with physician-hospital integration, she said.

Using Medicare claims data for 240 metropolitan areas nationwide, the researchers identified physicians who were either directly employed by hospitals or who worked for practices owned by hospitals.

Overall, the proportion of physicians with close financial ties to hospitals rose from 18% in 2008 to 21.3% in 2012.

Next, the researchers analyzed spending and prices for nearly 7.4 million non-elderly adults in these regions with two common types of private health insurance coverage: preferred-provider organizations (PPO) or point-of-service (POS) plans. These types of insurance may tie patients' out-of-pocket fees to the prices doctors charge.

The cost increase seen with greater financial integration of doctors and hospitals was confined to outpatient spending, bringing the average outpatient cost per enrollee in the PPO and POS plans in 2012 to about $2,400.

The average cost of $872 for inpatient treatments, however, was unaffected by financial ties between doctors and hospitals, the study found.

One shortcoming of the study is that the researchers didn't assess quality of care, the authors acknowledge. Better quality outpatient care might justify higher prices, they note.

Newer payment arrangements, however, are starting to hold providers more accountable for both inpatient and outpatient spending and for outcomes, senior study author Dr. J. Michael McWilliams of Harvard Medical School and Brigham and Women's Hospital in Boston, said by email.

Over time, this means "physician-hospital integration could conceivably offer some distinct efficiencies in terms of higher quality of care at a lower cost," Dr. McWilliams said.

Still, price hikes for people with private insurance - often provided to U.S. workers by their employers - are probably going to lead to higher out-of-pocket costs for patients, noted Dr. James Reschovsky and Dr. Eugene Rich of Mathematica Policy Research in Washington, D.C., in an accompanying editorial.

"The higher prices in hospital outpatient departments are passed on to employers in the form of higher premiums, and ultimately to workers in the form of less generous health benefits, higher premium cost sharing, or lower wages," Dr. Reschovsky said by email. "Certainly patients with co-insurance would pay more out-of-pocket when the price of service is higher."

The Robert Wood Johnson Foundation supported this research. One coauthor reported being formerly employed by Truven Health Analytics.

NEW YORK - Outpatient care may cost more when hospitals own the medical practices or employ the physicians, a U.S. study suggests.

Hospital employment of doctors and ownership of physician practices has grown over the past decade as health care providers seek to curb expenses with economies of scale and deliver better-coordinated treatment to patients.

Research reported in an article online October 19 in JAMA Internal Medicine examined how the rise of tighter financial integration between doctors and hospitals affected costs for people enrolled in private health insurance plans from 2008 to 2012.

In communities with the sharpest increase in financial integration between doctors and hospitals over the study period, average annual outpatient costs for each person with private health insurance increased by $75, while the amount of outpatient services they used was little changed.

"We document an increase in spending driven by prices, without any change in utilization," lead author Hannah Neprash, a health policy researcher at Harvard University in Boston, said by email.

"Some price increases may be acceptable - particularly if they are accompanied with improved quality of care," Neprash added. This study, however, didn't look at changes in quality associated with physician-hospital integration, she said.

Using Medicare claims data for 240 metropolitan areas nationwide, the researchers identified physicians who were either directly employed by hospitals or who worked for practices owned by hospitals.

Overall, the proportion of physicians with close financial ties to hospitals rose from 18% in 2008 to 21.3% in 2012.

Next, the researchers analyzed spending and prices for nearly 7.4 million non-elderly adults in these regions with two common types of private health insurance coverage: preferred-provider organizations (PPO) or point-of-service (POS) plans. These types of insurance may tie patients' out-of-pocket fees to the prices doctors charge.

The cost increase seen with greater financial integration of doctors and hospitals was confined to outpatient spending, bringing the average outpatient cost per enrollee in the PPO and POS plans in 2012 to about $2,400.

The average cost of $872 for inpatient treatments, however, was unaffected by financial ties between doctors and hospitals, the study found.

One shortcoming of the study is that the researchers didn't assess quality of care, the authors acknowledge. Better quality outpatient care might justify higher prices, they note.

Newer payment arrangements, however, are starting to hold providers more accountable for both inpatient and outpatient spending and for outcomes, senior study author Dr. J. Michael McWilliams of Harvard Medical School and Brigham and Women's Hospital in Boston, said by email.

Over time, this means "physician-hospital integration could conceivably offer some distinct efficiencies in terms of higher quality of care at a lower cost," Dr. McWilliams said.

Still, price hikes for people with private insurance - often provided to U.S. workers by their employers - are probably going to lead to higher out-of-pocket costs for patients, noted Dr. James Reschovsky and Dr. Eugene Rich of Mathematica Policy Research in Washington, D.C., in an accompanying editorial.

"The higher prices in hospital outpatient departments are passed on to employers in the form of higher premiums, and ultimately to workers in the form of less generous health benefits, higher premium cost sharing, or lower wages," Dr. Reschovsky said by email. "Certainly patients with co-insurance would pay more out-of-pocket when the price of service is higher."

The Robert Wood Johnson Foundation supported this research. One coauthor reported being formerly employed by Truven Health Analytics.

NEW YORK  - People with long-term exposure to loud noise at work or in leisure activities may be at increased risk of heart disease, a U.S. study finds.

Researchers found the strongest link in working-age people with high-frequency hearing loss, which is typically the result of chronic noise exposure.

"Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease," Dr. Wen Qi Gan of the University of Kentucky College of Public Health in Lexington, said by email.

Past research has already linked noise exposure, especially in workplaces, to coronary heart disease, hypertension, and other illnesses, Dr. Gan and his colleagues noted online September 15 in Occupational and Environmental Medicine. But many of these studies lacked individual information about actual noise exposure, relying instead on average decibel levels in the person's environment.

High-frequency hearing loss, the researchers wrote, is a better indicator of exposure to loud noise over time. To investigate the connection with heart disease, the researchers looked at data on 5223 individuals, ages 20 to 69, who participated in national health surveys between 1999 and 2004.

Overall, people with bilateral high-frequency hearing loss were about twice as likely to have coronary heart disease compared to those with normal high-frequency hearing. Among those age 50 and under, who were also most likely to be exposed to loud noise at work, the heart disease risk was increased four-fold.

There was no link to heart disease among people with one-sided hearing loss or loss of lower-frequency hearing, the study team noted, further supporting the idea that noise exposure is the culprit.

The study only looked at people at one time point, however, and cannot prove that noise or hearing loss are direct causes of heart disease. The researchers also acknowledged that they relied on study participants' own recollections about their work and leisure-time noise exposure.

Nonetheless, Dr. Gan said, accumulating evidence suggests that exposure to loud noise can increase the risk of coronary heart disease.

NEW YORK  - People with long-term exposure to loud noise at work or in leisure activities may be at increased risk of heart disease, a U.S. study finds.

Researchers found the strongest link in working-age people with high-frequency hearing loss, which is typically the result of chronic noise exposure.

"Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease," Dr. Wen Qi Gan of the University of Kentucky College of Public Health in Lexington, said by email.

Past research has already linked noise exposure, especially in workplaces, to coronary heart disease, hypertension, and other illnesses, Dr. Gan and his colleagues noted online September 15 in Occupational and Environmental Medicine. But many of these studies lacked individual information about actual noise exposure, relying instead on average decibel levels in the person's environment.

High-frequency hearing loss, the researchers wrote, is a better indicator of exposure to loud noise over time. To investigate the connection with heart disease, the researchers looked at data on 5223 individuals, ages 20 to 69, who participated in national health surveys between 1999 and 2004.

Overall, people with bilateral high-frequency hearing loss were about twice as likely to have coronary heart disease compared to those with normal high-frequency hearing. Among those age 50 and under, who were also most likely to be exposed to loud noise at work, the heart disease risk was increased four-fold.

There was no link to heart disease among people with one-sided hearing loss or loss of lower-frequency hearing, the study team noted, further supporting the idea that noise exposure is the culprit.

The study only looked at people at one time point, however, and cannot prove that noise or hearing loss are direct causes of heart disease. The researchers also acknowledged that they relied on study participants' own recollections about their work and leisure-time noise exposure.

Nonetheless, Dr. Gan said, accumulating evidence suggests that exposure to loud noise can increase the risk of coronary heart disease.

NEW YORK  - People with long-term exposure to loud noise at work or in leisure activities may be at increased risk of heart disease, a U.S. study finds.

Researchers found the strongest link in working-age people with high-frequency hearing loss, which is typically the result of chronic noise exposure.

"Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease," Dr. Wen Qi Gan of the University of Kentucky College of Public Health in Lexington, said by email.

Past research has already linked noise exposure, especially in workplaces, to coronary heart disease, hypertension, and other illnesses, Dr. Gan and his colleagues noted online September 15 in Occupational and Environmental Medicine. But many of these studies lacked individual information about actual noise exposure, relying instead on average decibel levels in the person's environment.

High-frequency hearing loss, the researchers wrote, is a better indicator of exposure to loud noise over time. To investigate the connection with heart disease, the researchers looked at data on 5223 individuals, ages 20 to 69, who participated in national health surveys between 1999 and 2004.

Overall, people with bilateral high-frequency hearing loss were about twice as likely to have coronary heart disease compared to those with normal high-frequency hearing. Among those age 50 and under, who were also most likely to be exposed to loud noise at work, the heart disease risk was increased four-fold.

There was no link to heart disease among people with one-sided hearing loss or loss of lower-frequency hearing, the study team noted, further supporting the idea that noise exposure is the culprit.

The study only looked at people at one time point, however, and cannot prove that noise or hearing loss are direct causes of heart disease. The researchers also acknowledged that they relied on study participants' own recollections about their work and leisure-time noise exposure.

Nonetheless, Dr. Gan said, accumulating evidence suggests that exposure to loud noise can increase the risk of coronary heart disease.

Florescent lotion and black light revealed that health care workers often contaminate their skin and clothing while removing their protective gear, researchers say.

"It was surprising for the participants in the study to see that they frequently contaminated themselves during [personal protective equipment] removal," said senior author Dr. Curtis J. Donskey of the Cleveland Veterans Affairs Medical Center.

"Most of the participants appeared to be unaware of the high risk for contamination and many reported receiving minimal or no training in putting on and taking off [personal protective equipment]," he said by email.

The researchers recruited doctors, nurses and ancillary personnel such as phlebotomists and physical therapists at four Cleveland-area hospitals to participate in the simulations. More than half of the 435 simulations were performed by nurses.

As reported online October 12 in JAMA Internal Medicine, the participants put on protective gowns and gloves in their usual manner and then had a small amount of fluorescent lotion placed in the palm of their hands, which they then rubbed between their hands for 15 seconds to simulate dirtied gloves, then smeared the gloves over the chest and abdomen area of the gown. Then the gloves were exchanged for clean ones.

After they removed their gloves and gowns in their usual manners, researchers used a black light to check for lotion contamination of the hands, forearms, neck, face, hair or clothing.

Skin or clothing contamination happened 46% of the time, more frequently during glove removal.

Researchers also noted whether participants had used proper protective equipment technique, e.g., wearing gloves extended over the wrists of the gown, gown removed first by pulling away from the neck and body, and gloves removed second. Contamination happened 70% of the time when proper technique was not followed, compared to 30% of the time when it was followed.

"When dealing with pathogens that are potentially fatal, the goal has to be zero contamination," Dr. Donskey said. "In routine care settings, we would like personnel to be well trained and confident that they can minimize contamination, but would not insist on zero contamination."

It is important for personnel to perform hand hygiene after removing gloves and gowns, he said.

The researchers also conducted these tests with a group of personnel who had attended special infection control sessions, with a 10-minute video presentation and 20 minutes of demonstrations and practice in using and removing protective gear.

Before the training sessions, these individuals contaminated themselves 60% of the time, compared to roughly 19% after the sessions. The improvements were still seen at re-tests done one and three months later.

"This suggests that training using fluorescent lotion can be useful to identify minor deficiencies in technique that lead to contamination," Donskey said.

Recent experience with the Ebola virus in the U.S. showed that self-contamination during removal of protective equipment does occur, but this study exposes a more widespread issue that may be happening during routine patient care, said Dr. Michelle Doll of Virginia Commonwealth University in Richmond who coauthored a commentary on the new study.

"Use of gowns and gloves for contact precautions on a busy inpatient unit is costly on multiple levels," Doll said by email. "In situations when we do decide to use these tools for infection prevention, we need to optimize techniques to achieve the best efficacy possible. Otherwise it is wasteful of healthcare worker efforts and hospital resources."

The sight of fluorescent dye on one's face and hands would be a powerful and lasting lesson, she said.

"Being able to see where contamination occurs allows personnel to make adjustments in their technique," Dr. Donskey said. "Because training alone did not result in zero contamination, there is a need for other approaches such as improving [equipment] design or disinfection of [equipment] prior to removal."

Florescent lotion and black light revealed that health care workers often contaminate their skin and clothing while removing their protective gear, researchers say.

"It was surprising for the participants in the study to see that they frequently contaminated themselves during [personal protective equipment] removal," said senior author Dr. Curtis J. Donskey of the Cleveland Veterans Affairs Medical Center.

"Most of the participants appeared to be unaware of the high risk for contamination and many reported receiving minimal or no training in putting on and taking off [personal protective equipment]," he said by email.

The researchers recruited doctors, nurses and ancillary personnel such as phlebotomists and physical therapists at four Cleveland-area hospitals to participate in the simulations. More than half of the 435 simulations were performed by nurses.

As reported online October 12 in JAMA Internal Medicine, the participants put on protective gowns and gloves in their usual manner and then had a small amount of fluorescent lotion placed in the palm of their hands, which they then rubbed between their hands for 15 seconds to simulate dirtied gloves, then smeared the gloves over the chest and abdomen area of the gown. Then the gloves were exchanged for clean ones.

After they removed their gloves and gowns in their usual manners, researchers used a black light to check for lotion contamination of the hands, forearms, neck, face, hair or clothing.

Skin or clothing contamination happened 46% of the time, more frequently during glove removal.

Researchers also noted whether participants had used proper protective equipment technique, e.g., wearing gloves extended over the wrists of the gown, gown removed first by pulling away from the neck and body, and gloves removed second. Contamination happened 70% of the time when proper technique was not followed, compared to 30% of the time when it was followed.

"When dealing with pathogens that are potentially fatal, the goal has to be zero contamination," Dr. Donskey said. "In routine care settings, we would like personnel to be well trained and confident that they can minimize contamination, but would not insist on zero contamination."

It is important for personnel to perform hand hygiene after removing gloves and gowns, he said.

The researchers also conducted these tests with a group of personnel who had attended special infection control sessions, with a 10-minute video presentation and 20 minutes of demonstrations and practice in using and removing protective gear.

Before the training sessions, these individuals contaminated themselves 60% of the time, compared to roughly 19% after the sessions. The improvements were still seen at re-tests done one and three months later.

"This suggests that training using fluorescent lotion can be useful to identify minor deficiencies in technique that lead to contamination," Donskey said.

Recent experience with the Ebola virus in the U.S. showed that self-contamination during removal of protective equipment does occur, but this study exposes a more widespread issue that may be happening during routine patient care, said Dr. Michelle Doll of Virginia Commonwealth University in Richmond who coauthored a commentary on the new study.

"Use of gowns and gloves for contact precautions on a busy inpatient unit is costly on multiple levels," Doll said by email. "In situations when we do decide to use these tools for infection prevention, we need to optimize techniques to achieve the best efficacy possible. Otherwise it is wasteful of healthcare worker efforts and hospital resources."

The sight of fluorescent dye on one's face and hands would be a powerful and lasting lesson, she said.

"Being able to see where contamination occurs allows personnel to make adjustments in their technique," Dr. Donskey said. "Because training alone did not result in zero contamination, there is a need for other approaches such as improving [equipment] design or disinfection of [equipment] prior to removal."

Florescent lotion and black light revealed that health care workers often contaminate their skin and clothing while removing their protective gear, researchers say.

"It was surprising for the participants in the study to see that they frequently contaminated themselves during [personal protective equipment] removal," said senior author Dr. Curtis J. Donskey of the Cleveland Veterans Affairs Medical Center.

"Most of the participants appeared to be unaware of the high risk for contamination and many reported receiving minimal or no training in putting on and taking off [personal protective equipment]," he said by email.

The researchers recruited doctors, nurses and ancillary personnel such as phlebotomists and physical therapists at four Cleveland-area hospitals to participate in the simulations. More than half of the 435 simulations were performed by nurses.

As reported online October 12 in JAMA Internal Medicine, the participants put on protective gowns and gloves in their usual manner and then had a small amount of fluorescent lotion placed in the palm of their hands, which they then rubbed between their hands for 15 seconds to simulate dirtied gloves, then smeared the gloves over the chest and abdomen area of the gown. Then the gloves were exchanged for clean ones.

After they removed their gloves and gowns in their usual manners, researchers used a black light to check for lotion contamination of the hands, forearms, neck, face, hair or clothing.

Skin or clothing contamination happened 46% of the time, more frequently during glove removal.

Researchers also noted whether participants had used proper protective equipment technique, e.g., wearing gloves extended over the wrists of the gown, gown removed first by pulling away from the neck and body, and gloves removed second. Contamination happened 70% of the time when proper technique was not followed, compared to 30% of the time when it was followed.

"When dealing with pathogens that are potentially fatal, the goal has to be zero contamination," Dr. Donskey said. "In routine care settings, we would like personnel to be well trained and confident that they can minimize contamination, but would not insist on zero contamination."

It is important for personnel to perform hand hygiene after removing gloves and gowns, he said.

The researchers also conducted these tests with a group of personnel who had attended special infection control sessions, with a 10-minute video presentation and 20 minutes of demonstrations and practice in using and removing protective gear.

Before the training sessions, these individuals contaminated themselves 60% of the time, compared to roughly 19% after the sessions. The improvements were still seen at re-tests done one and three months later.

"This suggests that training using fluorescent lotion can be useful to identify minor deficiencies in technique that lead to contamination," Donskey said.

Recent experience with the Ebola virus in the U.S. showed that self-contamination during removal of protective equipment does occur, but this study exposes a more widespread issue that may be happening during routine patient care, said Dr. Michelle Doll of Virginia Commonwealth University in Richmond who coauthored a commentary on the new study.

"Use of gowns and gloves for contact precautions on a busy inpatient unit is costly on multiple levels," Doll said by email. "In situations when we do decide to use these tools for infection prevention, we need to optimize techniques to achieve the best efficacy possible. Otherwise it is wasteful of healthcare worker efforts and hospital resources."

The sight of fluorescent dye on one's face and hands would be a powerful and lasting lesson, she said.

"Being able to see where contamination occurs allows personnel to make adjustments in their technique," Dr. Donskey said. "Because training alone did not result in zero contamination, there is a need for other approaches such as improving [equipment] design or disinfection of [equipment] prior to removal."

NEW YORK  - A novel warfarin composite measure (WCM) that combines percent time in therapeutic range (TTR) and international normalized ratio (INR) variability might be useful in comparing anticoagulation clinic performance rankings, researchers report.

TTR reflects the intensity of anticoagulation, whereas INR variability reflects its stability. Both are important measures of anticoagulation quality, and previous studies have suggested their combination provides added value.

Dr. Zayd Razouki from Durham VA Medical Center in North Carolina and colleagues developed the WCM, which combines standardized TTR and standardized log INR variability, and examined its feasibility for profiling anticoagulation clinics in the Veterans Health Administration.

WCM's hazard ratios for fatal bleeding and ischemic stroke were greater with very poor control or poor control, compared with those with TTR or INR variability, the researchers report in Circulation Cardiovascular Quality and Outcomes, online September 29.

In contrast, WCM's hazard ratios for major bleeding were larger than those with INR variability but not significantly different from those with TTR.

As for patient level outcomes, WCM was no better than TTR or INR variability.

At the anticoagulation clinic level, WCM reconciled moderately well the discordance in rankings that occurred when using TTR or INR variability separately.

"We would recommend the use of WCM as a performance measure for clinic profiling, as it seems to identify different clinics as outliers," the researchers conclude. "Both on an empirical and a theoretical basis, WCM captures more completely relevant dimensions of anticoagulation control than its component measures."

Dr. Gabriel Vanerio from CASMU Arrhythmia Service in Montevideo, Uruguay, recently demonstrated the usefulness of INR variability for assessing anticoagulation quality. While admitting that the WCM is "very well constructed," he said by email, "I do not believe that this new measurement will be clinically useful."

Instead, Dr. Vanerio suggested that physicians should take home "the importance of anticoagulation quality control" as the main message of this report.

Dr. Razouki did not respond to a request for comments.

NEW YORK  - A novel warfarin composite measure (WCM) that combines percent time in therapeutic range (TTR) and international normalized ratio (INR) variability might be useful in comparing anticoagulation clinic performance rankings, researchers report.

TTR reflects the intensity of anticoagulation, whereas INR variability reflects its stability. Both are important measures of anticoagulation quality, and previous studies have suggested their combination provides added value.

Dr. Zayd Razouki from Durham VA Medical Center in North Carolina and colleagues developed the WCM, which combines standardized TTR and standardized log INR variability, and examined its feasibility for profiling anticoagulation clinics in the Veterans Health Administration.

WCM's hazard ratios for fatal bleeding and ischemic stroke were greater with very poor control or poor control, compared with those with TTR or INR variability, the researchers report in Circulation Cardiovascular Quality and Outcomes, online September 29.

In contrast, WCM's hazard ratios for major bleeding were larger than those with INR variability but not significantly different from those with TTR.

As for patient level outcomes, WCM was no better than TTR or INR variability.

At the anticoagulation clinic level, WCM reconciled moderately well the discordance in rankings that occurred when using TTR or INR variability separately.

"We would recommend the use of WCM as a performance measure for clinic profiling, as it seems to identify different clinics as outliers," the researchers conclude. "Both on an empirical and a theoretical basis, WCM captures more completely relevant dimensions of anticoagulation control than its component measures."

Dr. Gabriel Vanerio from CASMU Arrhythmia Service in Montevideo, Uruguay, recently demonstrated the usefulness of INR variability for assessing anticoagulation quality. While admitting that the WCM is "very well constructed," he said by email, "I do not believe that this new measurement will be clinically useful."

Instead, Dr. Vanerio suggested that physicians should take home "the importance of anticoagulation quality control" as the main message of this report.

Dr. Razouki did not respond to a request for comments.

NEW YORK  - A novel warfarin composite measure (WCM) that combines percent time in therapeutic range (TTR) and international normalized ratio (INR) variability might be useful in comparing anticoagulation clinic performance rankings, researchers report.

TTR reflects the intensity of anticoagulation, whereas INR variability reflects its stability. Both are important measures of anticoagulation quality, and previous studies have suggested their combination provides added value.

Dr. Zayd Razouki from Durham VA Medical Center in North Carolina and colleagues developed the WCM, which combines standardized TTR and standardized log INR variability, and examined its feasibility for profiling anticoagulation clinics in the Veterans Health Administration.

WCM's hazard ratios for fatal bleeding and ischemic stroke were greater with very poor control or poor control, compared with those with TTR or INR variability, the researchers report in Circulation Cardiovascular Quality and Outcomes, online September 29.

In contrast, WCM's hazard ratios for major bleeding were larger than those with INR variability but not significantly different from those with TTR.

As for patient level outcomes, WCM was no better than TTR or INR variability.

At the anticoagulation clinic level, WCM reconciled moderately well the discordance in rankings that occurred when using TTR or INR variability separately.

"We would recommend the use of WCM as a performance measure for clinic profiling, as it seems to identify different clinics as outliers," the researchers conclude. "Both on an empirical and a theoretical basis, WCM captures more completely relevant dimensions of anticoagulation control than its component measures."

Dr. Gabriel Vanerio from CASMU Arrhythmia Service in Montevideo, Uruguay, recently demonstrated the usefulness of INR variability for assessing anticoagulation quality. While admitting that the WCM is "very well constructed," he said by email, "I do not believe that this new measurement will be clinically useful."

Instead, Dr. Vanerio suggested that physicians should take home "the importance of anticoagulation quality control" as the main message of this report.

Dr. Razouki did not respond to a request for comments.

NEW YORK - Diabetes patients in the Kaiser Health System spent more days with their prescribed statins on hand if they used Kaiser's online refill tool, a study shows.

The researchers looked specifically at racial and ethnic minorities and found that while these groups had poorer medication adherence than white patients before using the online refills, using the online refills conferred the same benefit for every group.

"Many other systems are implementing online portals other than Kaiser," said lead author Dr. Courtney Lyles in a phone interview. "The key message that our study puts forward is that providing tools to help with medication adherence is critical."

Lyles, an affiliate investigator at the Kaiser Permanente Division of Research and assistant professor at the University of California, San Francisco, and her colleagues studied patients in the type 2 diabetes registry in Kaiser Permanente Northern California between 2006 and 2012.

All had access to online patient tools that allow for viewing medical history and visit summaries, viewing laboratory results, scheduling appointments, sending and receiving secure email messages with providers, and requesting prescription refills.

Patients could request a prescription refill online and receive the medication by mail or pick it up in person at the pharmacy.

The researchers compared diabetes patients with statin prescriptions who used the online refill tool to those who did not, and compared individual patients before and after they started using the online refills.

According to pharmacy data, at baseline, whites on average spent about 12% of the time without having the medicine on hand, compared to about 16% of the time for blacks and Latinos, and about 13% of the time for Asians and Filipinos.

But when patients switched from other refill habits to exclusively online refills, they reduced their time without statins by more than 3%, the researchers reported in an article online September 2 in the Journal of the American Medical Informatics Association.

Racial and ethnic minority patients are less likely to use online portals, even after adjusting for Internet access or use of Internet in everyday life, Lyles said.

"There is a concern that if particular populations are less likely to use these portals, then perhaps the benefits will be differential," she said. "But we found that racial minorities are less likely to use it overall, but have the same benefit in adherence."

Online portals do appear to make prescription refills more convenient, and people using the portals reduced the number of days without medication by 10 or 15 days per year, according to Dr. Jessica S. Ancker, a health care policy researcher at Weill Cornell Medical College in New York City, who was not part of the new study.

Healthcare organizations started offering online portals as a "leap of faith," assuming they would improve patient experiences, but without any concrete proof, she said.

"A new wave of research measures whether it's improving things," she said.

The Agency for Healthcare Research and Quality funded this research.

NEW YORK - Diabetes patients in the Kaiser Health System spent more days with their prescribed statins on hand if they used Kaiser's online refill tool, a study shows.

The researchers looked specifically at racial and ethnic minorities and found that while these groups had poorer medication adherence than white patients before using the online refills, using the online refills conferred the same benefit for every group.

"Many other systems are implementing online portals other than Kaiser," said lead author Dr. Courtney Lyles in a phone interview. "The key message that our study puts forward is that providing tools to help with medication adherence is critical."

Lyles, an affiliate investigator at the Kaiser Permanente Division of Research and assistant professor at the University of California, San Francisco, and her colleagues studied patients in the type 2 diabetes registry in Kaiser Permanente Northern California between 2006 and 2012.

All had access to online patient tools that allow for viewing medical history and visit summaries, viewing laboratory results, scheduling appointments, sending and receiving secure email messages with providers, and requesting prescription refills.

Patients could request a prescription refill online and receive the medication by mail or pick it up in person at the pharmacy.

The researchers compared diabetes patients with statin prescriptions who used the online refill tool to those who did not, and compared individual patients before and after they started using the online refills.

According to pharmacy data, at baseline, whites on average spent about 12% of the time without having the medicine on hand, compared to about 16% of the time for blacks and Latinos, and about 13% of the time for Asians and Filipinos.

But when patients switched from other refill habits to exclusively online refills, they reduced their time without statins by more than 3%, the researchers reported in an article online September 2 in the Journal of the American Medical Informatics Association.

Racial and ethnic minority patients are less likely to use online portals, even after adjusting for Internet access or use of Internet in everyday life, Lyles said.

"There is a concern that if particular populations are less likely to use these portals, then perhaps the benefits will be differential," she said. "But we found that racial minorities are less likely to use it overall, but have the same benefit in adherence."

Online portals do appear to make prescription refills more convenient, and people using the portals reduced the number of days without medication by 10 or 15 days per year, according to Dr. Jessica S. Ancker, a health care policy researcher at Weill Cornell Medical College in New York City, who was not part of the new study.

Healthcare organizations started offering online portals as a "leap of faith," assuming they would improve patient experiences, but without any concrete proof, she said.

"A new wave of research measures whether it's improving things," she said.

The Agency for Healthcare Research and Quality funded this research.

NEW YORK - Diabetes patients in the Kaiser Health System spent more days with their prescribed statins on hand if they used Kaiser's online refill tool, a study shows.

The researchers looked specifically at racial and ethnic minorities and found that while these groups had poorer medication adherence than white patients before using the online refills, using the online refills conferred the same benefit for every group.

"Many other systems are implementing online portals other than Kaiser," said lead author Dr. Courtney Lyles in a phone interview. "The key message that our study puts forward is that providing tools to help with medication adherence is critical."

Lyles, an affiliate investigator at the Kaiser Permanente Division of Research and assistant professor at the University of California, San Francisco, and her colleagues studied patients in the type 2 diabetes registry in Kaiser Permanente Northern California between 2006 and 2012.

All had access to online patient tools that allow for viewing medical history and visit summaries, viewing laboratory results, scheduling appointments, sending and receiving secure email messages with providers, and requesting prescription refills.

Patients could request a prescription refill online and receive the medication by mail or pick it up in person at the pharmacy.

The researchers compared diabetes patients with statin prescriptions who used the online refill tool to those who did not, and compared individual patients before and after they started using the online refills.

According to pharmacy data, at baseline, whites on average spent about 12% of the time without having the medicine on hand, compared to about 16% of the time for blacks and Latinos, and about 13% of the time for Asians and Filipinos.

But when patients switched from other refill habits to exclusively online refills, they reduced their time without statins by more than 3%, the researchers reported in an article online September 2 in the Journal of the American Medical Informatics Association.

Racial and ethnic minority patients are less likely to use online portals, even after adjusting for Internet access or use of Internet in everyday life, Lyles said.

"There is a concern that if particular populations are less likely to use these portals, then perhaps the benefits will be differential," she said. "But we found that racial minorities are less likely to use it overall, but have the same benefit in adherence."

Online portals do appear to make prescription refills more convenient, and people using the portals reduced the number of days without medication by 10 or 15 days per year, according to Dr. Jessica S. Ancker, a health care policy researcher at Weill Cornell Medical College in New York City, who was not part of the new study.

Healthcare organizations started offering online portals as a "leap of faith," assuming they would improve patient experiences, but without any concrete proof, she said.

"A new wave of research measures whether it's improving things," she said.

The Agency for Healthcare Research and Quality funded this research.