AAFP News Now: AFP Edition
Policy and Health Issues in the News
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Am Fam Physician. 2010 Apr 15;81(8):939-940.
Health Care Reform Bill Only a Starting Point for Physicians, Says AAFP President
Physicians need to be closely involved as the recently enacted health care reform legislation begins to take effect, according to American Academy of Family Physicians (AAFP) President Lori Heim, MD, of Vass, N.C. “It is the implementation of (health care reform) that we have to be intimately involved with,” Heim said to more than 300 physicians, nurses, and other health care professionals during a March 22, 2010, Capitol Hill rally sponsored by Doctors of America. “We are the ones who know how this system should work. We are the ones who have all of the stories about the patients. We know the programs that need to be modified.” Heim said that passage of the health care reform bill would end some of the worst discriminatory practices on the part of the insurance industry. Democratic House members passed H.R. 3590, the Patient Protection and Affordable Care Act, on March 21, 2010, and President Obama signed it into law on March 23, 2010. House Democrats also passed a reconciliation bill, H.R. 4872, that makes modifications to the larger health care reform legislation, which the Senate then forced back to the House a few days later after finding violations in two provisions. For more information, visit http://www.aafp.org/news-now/government-medicine/20100324heim-hcr-rally.html.
FDA Recommends Temporary Stop to Use of Rotarix Rotavirus Vaccine
The U.S. Food and Drug Administration (FDA) is recommending that physicians temporarily suspend use of GlaxoSmithKline's Rotarix rotavirus vaccine because DNA from porcine circovirus 1 (PCV1) has been detected in the vaccine. It is unclear how PCV1 got into the vaccine. FDA commissioner Margaret Hamburg, MD, said during a March 22, 2010, conference call that PCV1 is not known to cause disease in animals or humans. She said the Rotarix rotavirus vaccine, which was approved in 2008, has an excellent safety record, and the recommendation to suspend its use was made out of an abundance of caution. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20100323rotarix.html.
NRMP Results Show Highest Ever Fill Rate for Family Medicine Resident Matching
After a downturn in 2009, more U.S. medical students chose family medicine as their specialty this year, resulting in a fill rate of 91.4 percent, the highest percentage for family medicine ever. According to the results of the 2010 National Resident Matching Program (NRMP), 2,404 family medicine positions were filled out of 2,630 positions offered. In addition, 75 more family medicine positions were offered in 2010 than in 2009, an increase of 2.9 percent. Health care reform efforts have heightened awareness of the need for patient-centered primary care services that increase quality and outcomes, said AAFP President Lori Heim, MD. The AAFP will continue its commitment to a health care system that is balanced and equitable so the number of students who choose to specialize in family medicine and primary care will continue to climb in the future, she said. For more information, visit http://www.aafp.org/news-now/resident-student-focus/20100318matchresults.html.
Family Medicine Groups Support New Recommendations on GME Funding
According to a comment letter submitted to the Medicare Payment Advisory Commission (MedPAC) by the AAFP and other family physician organizations, MedPAC should adopt recommendations to reflect the changing nature and focus of graduate medical education (GME) as it relates to primary care. The groups have asked MedPAC to adopt recommendations to change financial incentives that currently encourage teaching hospitals to confine their residents' learning experiences to hospitals. Under current law, hospitals cannot count residents as part of their residency load when they are sent out of the hospital to train in a nonhospital setting, which is where most family physician training takes place. The organizations also are calling on MedPAC to recommend a five-year pilot program to evaluate modernized funding models for primary care training. For more information, visit http://www.aafp.org/news-now/resident-student-focus/20100323gmerecommendations.html.
AAFP Adopts Immunization for Universal Flu, Supports New Use of Prevnar 13 Vaccine
The AAFP adopted a provisional recommendation by the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) to expand the recommendation for annual influenza vaccination to include all persons six months and older in whom the vaccine is not contraindicated. The AAFP also adopted ACIP's recommendation that children six weeks to five years of age receive the recently approved 13-valent pneumococcal conjugate vaccine (Prevnar 13) in place of the 7-valent Prevnar product. Both provisional recommendations were made during ACIP's February 2010 meeting in Atlanta, Ga. The finalized pneumococcal recommendation was published March 12, 2010, in Morbidity and Mortality Weekly Report. For more information, visit http://www.aafp.org/news-now/inside-aafp/20100316aafpflureqs.html, and http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm.
MedWatch FDA Warns of Risks Associated with Clopidogrel, Simvastatin
The FDA has added a boxed warning to the label for the anti-blood clotting medication clopidogrel (Plavix). The warning highlights the reduced effectiveness of the drug in certain patients who do not effectively metabolize the drug, and recommends that physicians consider use of other antiplatelet medications or alternative dosing strategies for clopidogrel in such patients. The FDA said patients should not stop taking clopidogrel unless advised to do so by their physicians, but should talk to their physicians if they have concerns. According to a March 19, 2010, FDA safety alert, there is an increased risk of muscle injury in patients taking the highest approved dose (i.e., 80 mg) of simvastatin (Zocor) compared with patients taking lower doses of the drug or other statins. The risk increases when simvastatin is used with certain other drugs. The FDA recently approved a labeling revision for simvastatin based on interim results from an ongoing clinical trial—patients of Chi-nese descent should not receive simvastatin 80 mg with cholesterol-modifying doses of niacin-containing products. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20100317clopidogrelwarning.html, and http://www.aafp.org/news-now/health-of-the-public/20100324simvastatinalert.html.
NIH Issues Recommendations for Vaginal Birth After Cesarean Delivery
A National Institutes of Health (NIH) consensus panel has issued recommendations for vaginal birth after cesarean delivery that contain elements similar to those in recommendations made by the AAFP five years ago. The panel said in its draft statement that trial of labor is a reasonable option for many women with a previous low transverse uterine incision. Patient preference should be considered and shared decision making should be made when trial of labor and elective, repeat cesarean delivery are medically equivalent options. The NIH panel's recommendations were based, in part, on a new evidence report from the Agency for Healthcare Research and Quality. The report is an update to a 2003 evidence report that was originally requested by the AAFP and the American College of Obstetricians and Gynecologists. The AAFP plans to review its current policy and its shared decision-making tool in light of the new evidence report, said Bellinda Schoof, MHA, the AAFP's scientific affairs manager. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20100316nihvbacreqs.html, and http://consensus.nih.gov/2010/images/vbac/vbac_statement.pdf.
CDC Issues Recommendations to Help Evaluate and Treat Haitian Orphans
The CDC has released interim medical screening recommendations for U.S. physicians evaluating orphans who were evacuated from Haiti. Under normal circumstances, internationally adopted children are required to have a medical examination in their country of origin. However, following the January 12, 2010, earthquake in Haiti, the Department of Homeland Security announced that Haitian orphans entering the United States will be allowed to bypass overseas medical screening. The CDC said medical screening, including medical history and physical examination, should be performed as soon as possible after a child arrives in the United States. Additionally, the CDC recommends that children from Haiti have routine vaccinations and a comprehensive examination after they arrive at their final destination to evaluate for other medical and developmental issues. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20100319haitiorphans.html.
Resources Help Physicians Communicate with Parents About Immunizations
The CDC, in collaboration with the AAFP and the American Academy of Pediatrics, has developed new, free materials to help physicians talk to parents about vaccinating their children. The CDC has launched Provider Resources for Vaccine Conversations with Parents on its Web site. Physicians can sign up for e-mail updates as new resources are added to the Web page. The resources are intended to help physicians stay up-to-date on vaccine safety topics; strengthen communication and trust between physicians and parents; and share with parents up-to-date, easy-to-use information about vaccines and vaccine-preventable diseases. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20100311immunizationresources.html, and http://www.cdc.gov/vaccines/spec-grps/hcp/conv-materials.htm#talkpvi.
— AFP and AAFP NEWS NOW staff
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