2022 Winter Issue

Inside the Academy | Engage with Us | Program Spotlight | Recent Happenings | Upcoming Events

Inside the Academy

“Nearly every family physician is likely to care for patients exposed to or ill with the flu or COVID, and we know that older adults are among those that face higher rates of severe complications and death from these diseases,” Julie Wood, M.D., M.P.H., the Academy’s senior vice president for Research, Science and Health of the Public, says.

“Family physicians are well positioned to provide care for older adults in many different settings. Our goal is primary prevention with vaccines and other preventive measures, but it is also important for the patient or their caregiver to be aware of testing and treatment options, ideally before they become ill. The new guidance documents the AAFP has developed facilitate family physicians getting those action plans in place for their practices and patients,” Dr. Wood says.

The new resources come as healthcare professionals across the United States brace for a potentially severe flu season. Surveillance reports from Australia, where the flu season typically runs from April to October, indicate that the country experienced its worst season since before the COVID-19 pandemic. The rate of influenza cases was about three times higher than average, and the number of cases peaked about two months earlier than usual.

Data from the Centers for Disease Control (CDC); meanwhile, show that for the week ending October 8, the latest date for which information is available, clinical laboratories reported 1,766 cases of influenza to the agency—a 39% increase from the previous week.

While anyone can become sick from the flu, older adults are considerably more likely to experience severe influenza-associated illness, hospitalization, and death compared with younger, healthier people. Children younger than five years, pregnant people, and those with weakened immune systems or chronic medical conditions, such as asthma or diabetes, are also at increased risk.

Clinical Guidance and Patient Tools

The clinical guidance sheet is divided into three sections.

Vaccinating Your Patients encourages family physicians to strongly recommend all eligible recommended vaccinations during routine or preventive office visits. It includes detailed recommendations for COVID-19 and influenza vaccination, advice on the coadministration of the vaccines, and links to the AAFP’s Seasonal Influenza Prevention & Control webpage and the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States.

Diagnosing and Testing Your Patients explains the importance of testing to distinguish between influenza and COVID-19; gives a rundown of symptoms that may occur in both diseases; discusses the use of telemedicine for patients who have acute respiratory illness and those at high risk; addresses infection prevention and control measures, and collection of respiratory specimens for testing; and reminds members that people can be infected with SARS-CoV-2 and influenza virus concurrently, and that testing for both viruses is needed to exclude one or the other.

Treating Your Patients features links to National Institutes of Health (NIH) treatment guidelines for influenza and COVID-19, a clinician summary on antiviral medications from the CDC, and the agency’s interim clinical considerations for COVID-19 treatment in outpatients.

The guidance sheet notes that empiric antiviral treatment should begin immediately, without waiting for lab confirmation of influenza, for patients who are hospitalized; have severe, complicated, or progressive illness; or are at high risk for complications.

For patients with suspected influenza who are not at high risk, the CDC recommends that clinicians use their professional judgment about starting outpatient, early empiric antiviral treatment, if it can be done within 48 hours of illness onset.

The medical history form and patient action plan complement the guidance sheet and are both designed for use with older patients. Patients can complete the medical form to list their most recent influenza and COVID-19 vaccinations, test results, symptoms, complications, and treatments all in one central location, while the action plan helps patients and their family members make decisions and prepare for unexpected illnesses that may result from COVID-19 and/or influenza.

More Member Resources

The new clinician and patient materials reflect an ongoing AAFP campaign to provide members with concise, up-to-date information on vaccines and immunizations.

In August, the CDC’s Advisory Committee on Immunization Practices revamped its influenza vaccine recommendations for the 2022–2023 flu season by issuing “preferential” recommendations for three vaccines in older adults—Fluad Quadrivalent, Flublok Quadrivalent, and Fluzone High-Dose Quadrivalent—without a preferential recommendation for one vaccine over another. If none of these vaccines is available, then any other age-appropriate influenza vaccine should be used. The AAFP endorsed the modified recommendations following review and approval by the AAFP’s Commission on Health of the Public and Science and updated its seasonal Influenza Prevention & Control webpage to reflect these changes.

Other resources the AAFP rolled out for members in time for flu season include:

• How to Approach Conversations With Parents About Routine Pediatric Vaccinations and Building Confidence When Talking to Parents About Children’s Vaccines
• Four tools to help physicians address vaccine hesitancy: a vaccine safety fact sheet, counseling guide, patient education infographic, and a series of email templates
• A fact sheet and clinical guidance sheet on influenza vaccination
• CME activities on increasing adult immunization rates and improving vaccine confidence
• Patient-related materials on familydoctor.org
• A two-part supplement on quality improvement and communication, the first of which appeared in the May/June edition of FPM

Make sure to visit for the latest information on influenza and COVID-19.

“Our hope is that the ASBI [Alcohol Screening and Brief Intervention] resources will empower family physicians to routinely screen their patients for alcohol misuse by providing easy-to-use resources and reducing barriers to ASBI implementation,” John Merrill-Steskal, M.D., a family physician at Kittitas Valley Healthcare in Ellensburg, Wash., who served as a technical expert on the project, says.

The first resource produced for members, Incorporating Alcohol Screening and Brief Intervention Into Practice, appeared as a supplement in the November/December 2020 issue of FPM, and offered guidance on selecting screening tests, establishing practice workflows, and coding and billing.

Throughout the course of the project, the AAFP made substantial additions to its Alcohol Misuse webpage, including a series of micro-learnings to help family physicians incorporate ASBI into their practices and a link to a CDC training program designed to help clinicians prevent fetal alcohol spectrum disorders.

Now that the ASBI project is complete, its findings have been added to the Alcohol Misuse webpage, as have additional tools for members. The latest resources include a second supplement published in the July/August 2022 issue of FPM, a summary of project outcomes and a presentation of results.

“The resources provided will enable family physicians to incorporate and implement screening and provide brief intervention in their clinical practice,” Hemalatha Senthilkumar, M.D., an associate director of the family medicine inpatient service at MetroHealth Medical Center in Cleveland, Ohio, an assistant professor at Case Western Reserve University School of Medicine and a co-author of the 2022 FPM supplement, says. “In practices already doing this, the resources will enhance screening rates.”

Details on New Resources

The new FPM supplement describes the effects of ASBI and the Office Champions model on patient care. According to the supplement authors, the project showed the value of using validated tools, such as the Single-Item Alcohol Screening Questionnaire and the Alcohol Use Disorders Identification Test-Consumption to assist clinicians in discussing alcohol use with patients and helping them make healthier lifestyle choices. The project also showed that screening could be performed by any clinician after receiving proper training.

The outcomes summary compiles data from more than 2,700 patient charts at three intervals. Analysis indicates that from baseline to endpoint, there were overall increases in the number of patients screened for risky alcohol use, the number who screened positive, and the number provided with a brief intervention.

The presentation uses more than two dozen charts and infographics to provide detailed project results taken at baseline and two additional intervals. The presentation includes information on patient and practice characteristics, the types of screening tools used, the types of interventions provided, and other data.

Family Physician Experts Discuss Benefits of New Tools

Senthilkumar told AAFP News that the new resources will educate and raise awareness among family physicians on alcohol misuse while encouraging them to implement screenings in their practices.

“Screening for excessive alcohol use is inconsistent and prone to bias,” Senthilkumar says. “By the time a patient is diagnosed with alcohol use disorder, damage has already been done to the patient, affecting both physical and psychological health and, also, socioeconomically. Patients are often not identified with issues related to alcohol use until late. Systematic screening will help identify patients who need intervention early so they can be offered appropriate help.”

Merrill-Steskal cited the 2020 intervention manual as an excellent resource to help family physicians add alcohol screening to their practices, noting the manual’s concise outline of the ASBI process and workflow considerations.

“I encourage family physicians to consider how best to implement ASBI in their clinical workflows,” Merrill-Steskal says. “Reducing risky alcohol use is a highly rewarding and important intervention to improve the health of patients. In addition, performing a brief intervention is a creative, valuable clinical skill that enriches a family physician’s practice while strengthening the physician-patient relationship.”

Senthilkumar added that the AAFP may work with the American Board of Family Medicine to explore incorporating ASBI screening into residency education, and that continued funding could be used to help promote existing resources. Merrill-Steskal, meanwhile, said that while other resources may appear in the future, the tools currently available are “robust “in their ability to help family physicians implement ASBI into their practices.

Additional CME and performance improvement activities are expected to be developed and made available to members in 2023.

Engage with Us

Program Spotlight

With funding from corporate partner, Janssen, the AAFP was able to bring this educational series to our members and other physicians on an expediated timeline and amplify the sessions to be offered in new formats and settings. In spring 2022, this series launched and immediately became a powerful educational tool for our members, physicians, and care teams tackling vaccine hesitancy and building confidence with their patients. In a matter of months, the series garnered over 3,000 learners in a variety of different formats and received rave reviews from members including the following comments:

"My entire clinical and policy job for the last almost two years has been COVID nearly all day every day and I think that this presentation was the most informative hour I have spent this year on COVID education!”

“This was a really great and multi-layered review of both the systemic barriers that limit patients from receiving and understanding our best intended clinical information as well as to really understand the forces that develop the misinformation that really limits our professional impact and causes a true negative health impact in the community. Excellent job!"

Thank you Janssen for your support of this valuable and crucial education for our members and beyond.

Recent Happenings

Upcoming Events

Corporate Roundtable, March 6-8, 2023
Savannah, GA
Supporter level and above partners, mark your calendars for the 2023 Corporate Roundtable in Savannah, GA. Watch your email in the coming months for more information about this event and how you’ll be able to engage with AAFP leaders and join discussions about the key issues related to family medicine and your industry.