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2012: The Year in Review
Prevention, Aiding Veterans, Opioid Abuse Take Center Stage for FPs
By Matt Brown
Changes to Immunization Recommendations
Developed in conjunction with the AAFP and other groups, several of the changes were especially pertinent to family physicians; among them was the CDC's call for routine hepatitis B immunization of unvaccinated adults with diabetes who are younger than age 60, with optional immunization recommended for adults 60 and older who have diabetes.
The schedule also called for pregnant women who have never received the Tdap vaccine to be immunized during their second or third trimester, rather than in the immediate postpartum period, and for health care personnel to receive a single dose of Tdap vaccine if they'd not received it previously. In November, the ACIP went even further, making a provisional recommendation that pregnant women receive a Tdap dose during each pregnancy, regardless of immunization history.
The ACIP also agreed in June on a provisional recommendation to expand the age recommendation for administration of the 13-valent pneumococcal conjugate vaccine (PCV13) to adults 19 and older who have certain immunocompromising conditions. To date, that recommendation has not been approved by the CDC.
In August, the Academy adopted the CDC's influenza vaccine recommendations for the 2012-13 influenza season, including a recommended two doses of influenza vaccine -- administered a minimum of four weeks apart -- for children ages 6 months through 8 years during their first season of vaccination to optimize immune response.
Recommended Clinical Preventive Services
The task force made significant changes to its cervical cancer screening guidelines in March, offering women ages 30-65 an alternative to the blanket recommendation that women ages 21-65 who have a cervix have a Pap smear every three years. The older subset now may choose to undergo a combination of Pap smear and HPV testing every five years.
The task force and the Academy waded into the fray concerning prostate-specific antigen (PSA)-based screening in May, making a final recommendation against PSA screening for prostate cancer in asymptomatic men. The task force cited evidence that indicates that "nearly 90 percent of U.S. men with PSA-detected prostate cancer are treated with surgery, radiation or androgen deprivation," with many of these men being harmed by treatment rather than helped.
The USPSTF also cited a high incidence of false-positive PSA testing results, pointing to data that indicate about 80 percent of PSA test results are false-positive when a PSA threshold between 2.5 micrograms per liter and 4.0 micrograms per liter is used.
In light of these updated recommendations, the Academy revised its patient education resources on prostate cancer and added a newly developed handout covering the pros and cons of PSA-based screening to aid doctor-patient discussions on the topic.
Fall 2012 saw the release of two female-specific preventive recommendations. The first, an updated recommendation against screening for ovarian cancer in women, came in September. It reaffirmed both the Academy's and the task force's previous positions, citing the fact that no available screening method exists that is effective in reducing deaths.
In October, the task force recommended against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, as well as the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. This stance, which mirrored an already-held AAFP position, does not apply to women considering using hormone therapy for the management of menopausal symptoms or women younger than 50 who have undergone surgical menopause.
Care for Returning Veterans and Opioid Abuse
FDA Acts to Safeguard Patients' Health
Of course, opioid addiction is not limited to veterans alone. With the overall problem of prescription drug abuse reaching epidemic levels, the Academy joined a national campaign to educate the public about the dangers of abusing both prescription and OTC drugs while simultaneously highlighting the important role family physicians and other primary care clinicians play in effective pain management, including by prescribing opioid analgesics. The move followed other AAFP efforts to balance the need for effective pain management with legitimate patient access concerns.
One such effort was the Aug. 1 release of a formal position paper on opioid abuse and pain management in which the Academy stated its opposition to mandated CME and any other barriers to family physicians' ability to prescribe these drugs. According to the paper, the creation of additional prescribing barriers for primary care physicians could limit patient access when there is a legitimate need for pain relief.
Multiple Disease Outbreaks
In regard to H3N2v, the CDC reported a fivefold increase in the number of confirmed H3N2v virus infections. First detected in people in July 2011, the infections were mostly associated with prolonged exposure to pigs at agricultural fairs. As of September, the CDC reported 307 cases of H3N2v across 11 states.
Finally, in October, the CDC issued guidance for physicians in the wake of a fungal meningitis outbreak that had caused more than 110 illnesses and 11 deaths in 10 states as of Oct. 10. By Dec. 17, those numbers had risen to 367 illnesses and 39 deaths in 19 states. The cases are associated with a potentially contaminated steroid -- methylprednisolone acetate -- manufactured by New England Compounding Center in Framingham, Mass. The company has recalled all products compounded at and distributed from its Framingham facility, and the CDC said health care professionals should cease use of any product produced by the company.
2012: Year in Review
Preventive Services, Public Health Issues Dominate 2012