Family physicians flocked to Florida this week to partake in a signature event -- the AAFP's annual Congress of Delegates. During the 2016 Congress, in session here from Sept. 19-21, the Reference Committee on Advocacy -- one of five committees seated to hear discussion of resolutions in particular topic areas -- took up a diverse docket of issues.
Georgia AFP President Mitzi Rubin, M.D., of Atlanta, receives hearty applause from her colleagues when she introduces a resolution that would remove assessment of a patient's pain as a vital sign.
Members wrote, discussed and voted on topics that greatly affect family physicians and their patients.
For instance, during the Sept. 19 hearing, the reference committee heard testimony on a resolution put forth by the Georgia and Massachusetts chapters that drew applause at its introduction. The resolution centered on eliminating the subjective measure of a patient's pain as the "fifth vital sign."
Matthew Burke, M.D., of Arlington, Va., a new physician constituency delegate, spoke in favor of the resolution. "Pain is not an objective measurement of human physiology," he said. "While we should all strive to control pain, this is an inappropriate distraction."
Alternate delegate Douglas Martin, M.D., of Sioux City, Iowa, noted his work in the area of occupational medicine and his experience with workers compensation claims. A patient will say his pain level is a nine out of 10, said Martin, even though the patient is able to carry on a normal conversation. "Function makes a lot more sense than pain" as a measure of illness or disability, he said.
- The AAFP's Reference Committee on Advocacy focused on a variety of patient care issues during the 2016 Congress of Delegates.
- Family physicians discussed and voted on issues ranging from using a patient's assessment of pain as a valid vital sign to ensuring comprehensive health care for incarcerated women.
- In addition to those resolutions adopted by the Congress, delegates also voted to refer several items to the AAFP Board of Directors for further discussion.
District of Columbia delegate Kandie Tate, M.D., of Laurel, Md., expressed her concerns with total elimination of the pain score, however. "I'm worried we're moving the pendulum so far that we're not treating pain adequately. What would you replace it with, and how would you address pain?" she asked.
Connecticut alternate delegate Robert Carr, M.D., of Southbury, said the pain measures "sound good and feel good" but are not evidence-based and have unintended outcomes.
The Congress agreed and adopted a substitute resolution asking the AAFP to work to eliminate the classification of pain as a determinant of quality patient care.
Comprehensive Health Services, Incarcerated Women
The reference committee also heard passionate testimony on a topic many Americans likely have never considered -- increasing access to comprehensive health care, including reproductive health, for incarcerated women.
Heather Paladine, M.D., of New York, N.Y., testified in support of the resolution and noted that women face serious threats to their health while incarcerated and upon their release. "Physicians who take care of inmates should follow national standards for reproductive health care while these women are incarcerated," she said.
Nebraska delegate David Hoelting, M.D., of Pender, serves on the AAFP's Commission on Health of the Public and Science http://www.aafp.org/about/governance/committees/2016-members.mem.html and said his group is working on a position paper on incarceration. "Specifically, we're going to be addressing this issue of women's health," he said.
Alternate delegate Matthew Peters, of Boise, Idaho, representing the student member constituency, offered his group's input. "This resolution would support a significantly vulnerable population of women who are predominantly minorities from underserved backgrounds with high rates of HIV, unwanted pregnancy and subsequent infection."
He noted that although some incarceration facilities provide excellent reproductive care, "others provide little to none."
Illinois delegate Kathleen Miller, M.D., of Decatur, testified that she has provided health care for incarcerated women for several years. She pointed out that similar resources are lacking in state prisons and jails all across the country. "Most women serve many, many months in local jails before they ever get to prison," she said. "There is a need at all levels of incarceration."
The delegates voted to adopt a resolution that directs the AAFP to advocate for the provision of comprehensive and appropriate health care services -- including, but not limited to, reproductive health -- for women in federal detention facilities.
Drug Monitoring Program
A resolution introduced by four state chapters -- Missouri, Arkansas, Kansas and Tennessee -- asked for the creation of a national prescription drug database with mandated interoperability.
Missouri delegate David Schneider, M.D., of St. Louis, stated in the Sept. 19 reference committee hearing that his state (the only one in the nation) does not have a prescription drug monitoring program (PDMP). "In many parts of the state, we would have to check three to four other drug databases to be sure our patient hasn't gone to three or four other states."
Maryland delegate Adebowale Prest, M.D., of Hebron, noted that she recently learned from a patient that the patient successfully opted out of the Maryland PDMP because of options provided under the Health Insurance Portability and Accountability Act. The patient admitted to doctor-shopping for narcotics.
Marc Price, D.O., an alternate delegate from Mechanicville, N.Y., is first in line to offer his support of a resolution on transgender use of public facilities. The issue sparked much discussion and a variety of viewpoints.
"I was unaware that opting out was an option for patients," said Prest.
Louisiana alternate delegate Bryan Picou, M.D., of Natchitoches, told the reference committee that his state had a good program but lamented the lack of interoperability. "We don't have access to states next to ours, and we often get calls from another state saying they've got a patient who's walked in with a Louisiana prescription."
Pennsylvania delegate Madalyn Schaefgen, M.D., of Allentown, reiterated that patients can opt out -- as can pharmacies. And mail-order pharmacies located outside the state are popular with patients and are not required to participate in the drug database.
Washington alternate delegate Gregg VandeKieft, M.D., M.A., of Olympia, noted that it's not unusual for law enforcement to utilize database information for prosecutorial purposes.
Although the reference committee recommended a substitute resolution, the delegates overturned that recommendation during the Congress and adopted the resolution with the original language intact.
Life-sustaining, Life-saving Medications
The reference committee also accepted a late resolution co-sponsored by 12 state chapters that addressed the issue of patient access to widely used life-sustaining or life-saving medications in which a pharmaceutical company maintains a monopoly.
Resolution author Robert Eidus, M.D., M.B.A., of Cranford, N.J., referred to it as the "EpiPen resolution" because it was framed around the dramatic price increase for that product that has recently dominated news headlines.
"Rebates are a political maneuver and insufficient," said Eidus. They will not address the next debacle that occurs when a drug company benefits by having a monopoly, he added.
After much discussion in the Congress, delegates adopted an amended resolution that added verbiage directing the AAFP to call on the FDA and the U.S. Congress to "establish mechanisms to prioritize and fast-track competitive drug options for widely used life-saving or life-sustaining drugs that may be subject to monopoly power."
In addition, delegates adopted resolutions or substitute resolutions that asked the AAFP to
- encourage, without age restriction, access to OTC oral contraceptive pills;
- advocate for emergency contraception as a covered benefit under all Medicaid programs and for all women of reproductive age;
- support legislation allowing Medicare to negotiate drug prices;
- advocate for the classification of specialized medical foods for the treatment of inborn errors of metabolism as an essential health benefit under the Patient Protection and Affordable Care Act; and
- support transgender people's use of public facilities that match their identity.
Delegates also voted to refer a number of items to the Board of Directors for further discussion. Among those items were resolutions that discussed
- raising the minimum wage;
- advocating for Medicare prescription drug cost-saving;
- studying a national publicly financed, privately-delivered health care system;
- advocating for a single-payer health care system; and
- ensuring physician protections under a single-payer system.
The last three items were combined into one measure that directed the AAFP to study the issues involved and submit a report of that work to the 2017 Congress of Delegates.
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