In the News for the Week of 5-10-05
- FDA approves first adolescent pertussis vaccine
The business of medicine
- Many hospitals pay specialists for on-call services
Clinical news in the headlines
- ACP Journal Club: Implantable cardioverter defibrillators reduce all-cause mortality in non-ischemic cardiomyopathy
- Health care for Medicare patients still posts big gaps
- Arkansas clinic wins national leadership/commitment award
- Drug alliance is one-stop shop for patients in need
- IT conference this month to focus on community implementation
- College airs its concerns on CMS' Part B outpatient drug plan
- ACP seeks nominations for awards and Masterships by July 1
The FDA last week approved the first combination pertussis vaccine designed to boost immunity in adolescent patients.
The vaccine, which also protects against tetanus and diphtheria, will be marketed as Boostrix by GlaxoSmithKline, according to a May 3 FDA news release. While the disease is usually less severe in adolescents than in infants, the release noted, older patients can transmit the disease to babies, in whom it can be fatal.
The move by the FDA is in response to a recent increase in cases of pertussis among infants who have not been immunized as well as among adolescents and adults. The new vaccine—which contains tetanus toxoid, reduced diphtheria toxoid and acellular pertussis—should be given in a single dose to adolescents ages 10 to18.
According to the May 4 Philadelphia Inquirer, the vaccine will be available this summer. Another company expects its pertussis booster shot—which will be for adults as well as for adolescents—to be approved later this year.
Side effects of the booster shot include pain, redness and swelling, and sometimes headaches, fever and fatigue, according to the FDA release. During testing, pain at the injection site was more frequent among those who received the new vaccine than among those who received the current tetanus-diphtheria booster vaccine.
The FDA press release is online.
The Philadelphia Inquirer is online.
The business of medicine
More than half of the hospital executives polled in a recent survey said they were having trouble finding specialists to work on-call in emergency departments, and almost half said they paid specialists for that service.
Sixty-four percent of the 814 physician executives polled in the American College of Physician Executive's 2005 on-call survey said they were having trouble getting specialists to take emergency room call, while only 29% said they had no trouble, according to survey results. Almost 47% said that the hospitals they were affiliated with were paying specialists to take emergency call.
Among survey respondents who said they were not paying specialists for call duty, 46% said they had considered the idea. Some physician executives commented that paying specialists is inevitable to ensure adequate emergency coverage, while others said they are moving toward employing physicians instead of paying for on-call service.
Complete survey results are online.
Clinical news in the headlines
Implantable cardioverter defibrillators (ICDs) were more effective than standard therapy in preventing fatal arrhythmias in patients with non-ischemic cardiomyopathy, according to a recent meta-analysis.
Researchers found a relative 31% survival benefit of ICDs over standard therapy after reviewing seven trials with a combined total of more than 2,000 patients with non-ischemic cardiomyopathy. The review is abstracted in the May-June ACP Journal Club.
The review is important because most previous studies of ICDs have focused on patients with ischemic heart failure and because individual trials have not been definitive, said the Journal Club reviewer. However, the review leaves some questions unanswered.
For example, it does not consider the potential costs involved with increased ICD use. Additional work should focus on how sudden death occurs in non-ischemic vs. ischemic cardiomyopathies, the reviewer said, as well as on developing tests to help physicians identify patients who would derive the most benefit from an ICD to prevent an arrhythmic death.
ACP Journal Club is online.
An analysis released last week of health care for Medicare beneficiaries found that while some improvements have been made in preventive services and chronic care, significant problems in health care quality for seniors continue to exist.
Researchers used 60 charts and analyses, compiled after reviewing recently published studies and reports, to quantify changes in the delivery of health care for Medicare beneficiaries. The authors noted improvement in preventive services, such as mammography, and in outpatient care for chronic diseases. And the authors found that a higher proportion of generalists compared to specialists was associated with higher quality of care and lower costs.
They also found that fewer elderly patients are dying in hospitals after being treated for stroke and pneumonia, and that more patients are getting care from a constant source. Results were included in the "Quality of Health Care for Medicare Beneficiaries: A Chartbook" released by The Commonwealth Fund, a private foundation that supports independent health care research.
But researchers also found that gaps remain in treating depression, controlling high blood pressure and screening for colorectal cancer. They also found that variations and disparities in quality exist based on age; coverage type; race, ethnicity and income; and geography. The chartbook is the third in a Commonwealth Fund series on problems in health care quality.
More information, including a link to order a free download of the chartbook, is online.
The Northeast Arkansas (NEA) Clinic earlier this year received this year's national medical group preeminence award from the American Medical Group Association. The clinic, which is based in Jonesboro, Ark.,was founded by Ray H. Hall Jr., FACP, ACP's Governor for the Arkansas Chapter.
The award recognizes leadership, innovation, quality improvement and local public health contributions. The clinic's management was recognized for delivering a quality, integrated health care system to its community by acquiring a 110-bed acute care hospital, forming a managed care organization to handle all insurers, adding electronic medical record capabilities to its sites and expanding urgent care services.
Through its charitable foundation, the clinic also established a medicine assistance program that serves 6,000 patients with more than $500,000 worth of prescription drugs per month. The AMGA is a trade organization representing large multispecialty groups and integrated health care systems.
An AMGA press release is online.
A new program that matches needy patients with drug assistance programs has helped more than 100,000 patients in its first month of operation.
The nonprofit Partnership for Prescription Assistance (PPA) is a one-stop resource giving patients access to more than 275 public and private patient assistance programs, according to a recent PPA press release. The initiative was launched last month by pharmaceutical companies in partnership with more than 50 groups representing doctors, nurses, pharmacists, patient advocates and civic organizations.
Patients from all 50 states have called the PPA's toll-free number (888-4PPA-NOW) or visited its Web site, the release said. Most of the assistance programs are not new, the release noted, but many seniors and low-income patients either didn't know about the programs or found it too difficult to apply to multiple programs.
More information on the Partnership for Prescription Assistance is online.
A two-day conference being held later this month will provide practical guidance on implementing electronic health information technology in communities.
The second annual "Connecting Communities for Better Health Learning Forum and Exhibition" will focus on the technical, legal, financial and organizational challenges of implementing information technology in communities. The conference will be held May 25-26 in Washington. Meeting sponsors include the eHealth Initiative Foundation—of which ACP is a strategic partner—and the American Health Quality Association.
This year's conference will feature breakout sessions according to region and state, so attendees can get locale-specific implementation guidance; and an interactive format to allow attendees to work with technical experts and national leaders.
More information is available online.
The National Cancer Institute is seeking comments from patients on a new brochure on recurrent cancer.
The agency is asking patients who have been diagnosed with recurrent cancer in the last year to review the booklet and participate in a 30-minute phone call to share their reactions. Participation requires a total time commitment of one to two hours, and all participants will be paid for their time.
Health care professionals or those employed in a health care setting are not eligible. Patients who want to participate should call toll free 888-249-0029. Qualified patients will then be contacted to schedule a call.
A link to the NCI booklet, "When Cancer Recurs: Meeting the Challenge," is online.
A California nonprofit has created a new advance directive form designed specifically for low-literacy Americans.
The document is being distributed free online by the nonprofit Institute for Healthcare Advancement (IHA). The directive has a simple fill-in-the-blank format with illustrations and easy-to-read bullet points. According to a recent IHA news release, the directive allows low-literacy patients to make their health care wishes known, to choose an agent to make medical decisions for them and to provide the necessary signatures to make the document legally binding,
Geared to the 90 million American adults who read below a fifth-grade level, the directive was developed jointly by the University of California at San Francisco, San Francisco General Hospital and the San Francisco Department of Public Health.
Instructions for downloading the document or for ordering copies in bulk are on the IHA Web site.
The IHA news release is online.
More information on health literacy is available online from the ACP Foundation.
A recent College letter sent to the Centers for Medicare and Medicaid Services (CMS) outlined ACP's concerns with the agency's proposed rule on the competitive acquisition of Medicare Part B outpatient drugs. The proposed rule is an alternative to the current practice of physicians buying and billing for drugs under the average sales price system.
According to the April 25 letter to CMS Administrator Mark McClellan, FACP, ACP has the following concerns and recommendations:
The rule's proposed 14-day requirement for submitting drug administration claims—down from the current one-year window—would place an "excessive burden" on many practices. The College is instead proposing a deadline of 30 business days.
The rule currently does not provide for any separate or additional payment to cover physicians' clerical and inventory resources associated with participating in the competitive acquisition program. The College letter pointed out that the new program will force practices to spend more time and resources providing more information on prescription forms and returning drugs not administered. The College recommends that the CMS conduct a study before implementing its final rule to assess actual resource costs.
The CMS wants participating doctors to acquire all drugs listed in a category from a chosen vendor. The College believes this requirement will prevent many physicians from participating in the program because it will prohibit their ability to choose which drugs to acquire. ACP wants this requirement removed.
The proposed rule does not provide enough protection for patients regarding payment collections, the letter said. While there is a grievance process related to billing, the letter pointed out that the process doesn't cover several common situations. The College is asking for more comprehensive patient protections in the final rule.
ACP recommends that the agency release an interim rule instead of a final one, to allow for public comment and further modifications to the program.
The letter is available online.
The ACP Awards Committee needs your help to identify deserving individuals for the College's awards and Masterships.
Each year, the College bestows 17 awards and a number of Masterships during Convocation at Annual Session. These awards recognize the accomplishments of distinguished individuals in a wide variety of areas, including the practice of medicine, teaching, research, and public and volunteer service.
Individuals may not self-nominate. For all awards and Masterships, each nominee must have a minimum of five detailed letters of nomination and support and a current CV before being considered by the Awards Committee. The College must receive all materials by July 1.
The "Awards and Mastership Booklet" contains criteria for College awards and Masterships, and specific instructions for writing nominating and supporting letters.
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Copyright 2005 by the American College of Physicians.
A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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