Delegates Praise Rhode Island's Influenza Vaccine Model, Oppose DTC Health Screening

Tiny Rhode Island played a big role at the 2008 AAFP Congress of Delegates here, when the testimony of one of that constituent chapter's delegates gave his colleagues an inside look at a state-based system that's working to ensure adults get needed immunizations and physicians avoid the hassles that can snarl the vaccine acquisition and administration process.

In testimony before the Reference Committee on Health of the Public and Science about a seasonal influenza vaccine resolution, family physicians drove home the point that the U.S. system of vaccine acquisition, distribution and payment -- despite gains made in recent years -- remains cumbersome and, in some cases, wholly inequitable. A number testified that the so-called big-box purchasers, such as pharmacy retailers, grocery chains and even department stores, continue to beat them to the punch when it comes to getting enough influenza vaccine to immunize their high-risk patients at the start of the flu season.

Specifically, the resolution the reference committee considered asked the Academy to "advocate for legislative or regulatory action to make the federal government the purchaser and distributor of flu vaccine." All those who testified agreed that some sort of further action could help perpetuate the momentum already generated by the Academy, the AMA, the CDC and other groups that have collaborated with vaccine manufacturers and distributors to improve vaccine-related processes. However, the burden of testimony was that placing such a complex and time-sensitive task in the hands of the federal government would be ill-advised.

Massachusetts delegate Hugh Taylor, M.D., of Hamilton, was one of many family physicians who testified against the resolution. In his testimony, Taylor recalled previous discussions among members of the AAFP's Influenza Vaccine Task Force on this very issue. Taylor served on the task force in 2005-06.

"We considered recommending this route," Taylor told the reference committee, "and steered away from it because we didn't think, in the end, that it was really feasible."

That's when Rhode Island delegate John Bossian II, D.O., of Wakefield, spoke up.

Describing what he called a "major improvement in the delivery of health care," Bossian outlined his state's Immunize for Life adult immunization program, which is administered by the Rhode Island Department of Health. The program, which was spearheaded by physicians, state health officials and other stakeholders, launched two years ago with an initial focus on providing annual influenza vaccine for the state's residents.

"I don't order flu vaccine anymore," Bossian testified, "I just check a box on a form and send it to the state health department."

The health department orders the needed doses at a considerable discount, he added, and then coordinates delivery of all vaccine ordered throughout the state, so physicians' offices receive their vaccine at the same time the retail outlets do.

"With the money that's saved, the state is also able to turn around and use those funds to supply the vaccine for people who have low or no insurance," Bossian said in an interview with AAFP News Now.

"This is good for the medical home," Bossian told committee members. "It means my patients -- especially my older patients -- can come in for whatever services they need, and I can give them the vaccine right then. It's a win-win."

The delegates agreed, adopting a substitute resolution that directs the Academy to "disseminate to the state chapters the Rhode Island legislation on state purchasing of flu vaccine as potential model legislation."

Delegates also took a clear stand against the proliferation of direct-to-consumer marketing of unnecessary -- and potentially harmful -- health screening exams.

Although some family physicians who testified in opposition to this increasingly prevalent practice acknowledged that many of the organizations that sponsor screening clinics do so with the best of intentions, they agreed that the risks incurred by patients undergoing these often expensive procedures outweigh the potential benefits.

"My own church held one," Missouri alternate delegate Debra McCaul, M.D., of Rolla, testified at the hearing, adding that she later registered her concerns about the event with its organizers.

Dale Moquist, M.D., of Sugarland, Texas, chair of the AAFP delegation to the AMA, put it succinctly in his testimony: "This is a patient safety issue."

On Sept. 16, the delegates gave a collective thumbs-up to a resolution that calls for the AAFP to