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News from Annals of Family Medicine: November/December 2014

Two Techniques Make Swallowing Pills Easier

With previous research showing more than half of people experience swallowing difficulties when taking tablets or capsules, researchers in Germany demonstrate that two specific swallowing techniques notably improve the ease of swallowing tablets and capsules in patients with and without swallowing difficulties. In the first, the pop-bottle method, the tablet is placed in the mouth, the lips are tightly closed around the opening of a flexible plastic beverage bottle and the tablet is swallowed in a swift suction movement to overcome the volitional phase of swallowing. In the second, the lean-forward technique, capsules are swallowed in an upright position with the head bent forward. Researchers had 181 adults swallow 16 differently shaped placebos and rate their ease of swallowing. They then swallowed the two dosage forms they rated most difficult again using the appropriate technique. They found the pop-bottle method substantially improved swallowing of tablets in 60 percent of participants and the lean-forward technique in 89 percent. The authors conclude both techniques were remarkably effective in participants with and without reported difficulties swallowing pills and should be recommended regularly.

Two Techniques to Make Swallowing Pills Easier
By Walter E. Haefeli, MD, et al
University of Heidelberg, Germany

Associated with Reduced Mortality, Morbidity and Health Care Expenses

First Study to Show Direct Link Between Continuity and Mortality

Continuity of care, defined as a sustained partnership between patient and clinician, is considered a core element of high quality primary care, but its impact on mortality and is unclear. Seeking to determine the impact of continuity of care on mortality, and health outcomes in patients with newly diagnosed cardiovascular risk factors, researchers find clear and convincing empirical evidence that continuity of care is associated with reduced mortality, morbidity and health care expenses and may thus provide added value in the management of chronic conditions. Specifically, researchers studied a 3 percent random sample (n=1,162,234) of Korean National Health Insurance enrollees, 47,433 of whom had received new diagnoses of hypertension, diabetes, hypercholesterolemia or other complications in 2003 or 2004. Evaluating the association of three standard indices of continuity of care with patients’ overall mortality, cardiovascular mortality, incident cardiovascular events and over five years, they found lower indices of continuity of care were associated with higher all-cause and cardiovascular mortality, cardiovascular events and . Specifically, the multivariable-adjusted hazard ratios for all-cause mortality, cardiovascular mortality, incident myocardial infarction and incident ischemic stroke, comparing participants with a continuity of care index below the median to those above the median were HR=1.12 (95 percent CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95) and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. The authors also found lower continuity of care was associated with increased inpatient and outpatient days and costs. The authors write that while the findings cannot be generalized to other conditions, the results suggest that continuity of care is a robust predictor of outcomes in patients for conditions with available preventive interventions. With the increasing fragmentation of health care systems and importance of cost containment, the authors assert that health care systems should be designed to support longer-term trusting relationships between patients and physicians, and health policies should encourage patients to concentrate their care with one physician.