AAFP Congress Grapples With Retail Health, Rural Care, Pharma, Tobacco Issues

Retail health clinics, rural health care, pharmaceutical company support and smoking cessation were big items on the Congress of Delegates' agenda on Oct. 2 and Oct. 3.

Contentious debate was the order of the day as delegates considered two resolutions regarding retail health clinics. Those who testified about the issue in reference committee pointed out that some physicians are involved with retail clinics, while others are finding ways to compete with the clinics. The clinics are still evolving in many respects, and the laws governing them vary from state to state, all of which complicate setting policy. Delegates also decried the lack of physician supervision in many of these establishments, while others were concerned about being forced to work with the clinics.

Some suggested it was "disingenuous" for physicians to say they are keepers of the medical home but then not want to receive information about their patients from the retail clinics.

AAFP Past President Michael Fleming, M.D., of Shreveport, La., who serves on the quality assurance board for MinuteClinic, said that physician practices should accept clinical information transferred from retail clinics if they truly are going to be medical homes.

"If we say we are in favor of patient-centered care, there are times when retail health clinics that abide by (AAFP's "Desired Attributes of Retail Health Clinics") may meet patient needs for minor problems," Fleming said.

Others expressed concern that companies could abuse the AAFP's desired attributes by using the attributes to imply that the AAFP endorses their business model.

In the end, delegates approved a substitute resolution amending the introduction to the AAFP's "Desired Attributes of Retail Health Clinics" to read, "AAFP does not endorse retail health clinics and believes that such health care delivery could interfere with the medical home."

The Congress of Delegates initially approved a resolution to refer to the Board of Directors a proposal to re-establish a committee on rural health. But in an unusual move, delegates reconsidered and eventually approved a substitute resolution that calls for establishing a working group on rural health. The working group will include at least one member from each AAFP commission who has a rural background.

Delegates disagreed about a resolution to provide a more detailed accounting of pharmaceutical company contributions to the Academy. Some delegates called for an "itemized report" of such contributions, while others said the action would be too costly to implement and would alienate pharmaceutical companies. Delegates finally adopted a substitute resolution that calls on the AAFP to "develop a more detailed, single-source, logical and consistent accounting of income from the pharmaceutical industry and provide this information at the 2008 Congress of Delegates."

New Hampshire AFP members submitted a resolution calling on the Academy to withdraw support from the Family Smoking Prevention and Control Act, which, if passed, would give the FDA authority to regulate tobacco products.

"We can do better than this," said James Fieseher, M.D., of Portsmouth, N.H., an alternate delegate.

He warned the delegates that the pending legislation could result in an FDA endorsement of cigarettes. And he compared the legislation to the Bush administration's No Child Left Behind initiative, saying that the Family Smoking Prevention and Control Act is the tobacco industry's version of "no cigarette left behind."

Other delegates described the tobacco bill as a "good first step" in regulating and curbing tobacco use.

In the final analysis, delegates called on the AAFP to support legislation that gives the FDA "authority to use all means available to help people stop smoking and to prevent children and adults from starting." The measure says the FDA must have authority to reduce the nicotine in tobacco products to zero, ban use of menthol and clove as additives in tobacco products, increase the size of required warning labels, and ban nonceremonial or nonreligious consumption of tobacco products.