2015: Year in Review

War on Opioids, Other Public Health News Dominate Headlines

January 05, 2016 03:30 pm News Staff

Family physicians and the AAFP played key roles in the top medical stories of 2015, including in the unified effort to combat the nation's opioid abuse crisis.

About 200 people fill the gymnasium at the East End Family Resource Center in Charleston, W.Va., to hear President Obama discuss the nation's opioid crisis. AAFP President Wanda Filer, M.D., M.B.A., attended the Oct. 21 event, during which Obama announced his administration will partner with dozens of health care professional organizations -- including the Academy -- to bolster clinicians' ability to prevent and manage opioid abuse.

In April, AAFP News covered HHS Secretary Sylvia Burwell's announcement of a multifaceted initiative(aspe.hhs.gov) targeting prescription opioid- and heroin-related overdose, death and dependence in the United States. That announcement included word that the administration was including a request for $133 million in new funding in the president's fiscal year 2016 budget proposal to address this critical issue.

In July, the Academy joined the AMA Task Force to Reduce Opioid Abuse, a group of 27 physician organizations seeking to identify best practices to combat opioid abuse and implement those practices in physician offices across the country. The group released a resource in October encouraging family physicians and other health care professionals to consider coprescribing naloxone to patients, their family members or close friends when a patient is considered at risk for overdose.

The Substance Abuse and Mental Health Services Administration announced in late July it would award 11 annual grants of about $1 million each for three years as part of its Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug and Opioid Addiction program. And in September, the CDC launched its Prescription Drug Overdose: Prevention for States program, investing $20 million in 16 states to provide them resources and expertise to help prevent overdose deaths related to prescription opioids.

The following month, the AAFP joined in the most expansive effort to date to fight opioid abuse, led by President Obama and a number of public- and private-sector partners.

In support of the initiative, the Academy pledged, in the next two years, to increase

  • family physician education in appropriate opioid prescribing practices,
  • the number of family physicians who complete training in how to provide medication-assisted treatment for opioid addiction, and
  • overall awareness about opioid abuse and pain management.

Vaccines and Immunizations

In July, California became the center of attention for both pro- and antivaccination stakeholders around the country when Gov. Jerry Brown signed into law S.B. 277, which requires vaccination of all children in school or daycare, except for exemptions a physician determines are medically necessary.

The AAFP followed suit in October when it adopted a new policy that reaffirmed the Academy's longstanding support for immunization of infants, children, adolescents and adults as defined by recommendations from the CDC's Advisory Committee on Immunization Practices (ACIP) and approved by the AAFP. The policy explicitly stated the Academy's stance that it does not support immunization exemption policies that permit vaccine refusal for any reason other than a documented allergy or medical contraindication.

[Female health care worker giving young boy shot in arm]

This year, the ACIP issued a number of new recommendations, including the following:

AAFP News coverage for the year also featured the release of an August CDC Morbidity and Mortality Weekly Report (MMWR) that recapped the ACIP's recommendations for seasonal influenza vaccine, and a recounting of the ACIP's Oct. 21 meeting, during which it voted to reconfigure its recommended pediatric immunizations schedule.

Clinical Preventive Service Recommendations

Clinical recommendations the U.S. Preventive Services Task Force (USPSTF) released in 2015 covered a wide range of health issues, from Americans' expanding waistlines to cancer prevention.

In October, the USPSTF released its final recommendation statement on screening adults for hypertension. After reviewing the evidence, the USPSTF found that screening patients ages 18 and older for high blood pressure has a profound and positive impact on important health outcomes -- a grade A recommendation.(www.uspreventiveservicestaskforce.org)

Then in November, the task force released its final recommendation statement that calls for adults ages 40-70 who are at increased risk for type 2 diabetes (i.e., those who are overweight or obese) to be screened to detect abnormal blood glucose levels or diabetes -- a B recommendation.

The USPSTF also issued a final recommendation to screen for and encourage smoking cessation in adults, including pregnant women. Specifically, the task force recommended that physicians ask all adults about tobacco use and advise and assist those who smoke to quit using appropriate cessation aids.

Notably, in a draft recommendation statement released in April, task force members reaffirmed their 2009 recommendation to use mammography to screen women ages 50-74 for breast cancer every two years -- a B recommendation. But for women 40-49, the task force continues to recommend an individualized decision to screen in which the patient and physician together weigh the benefits and harms of screening every two years -- a C recommendation.

On a related note, the American Cancer Society published an updated breast cancer screening guideline in October that recommends women at average risk start annual screening with mammography at age 45 and transition to screening every two years at age 55.

The task force also issued draft recommendations on the following health issues:

  • a call to screen nonpregnant adults and adolescents who are at increased risk for syphilis for the disease;
  • a recommendation calling for people at increased risk for cardiovascular disease (CVD) -- that is, those with dyslipidemia, diabetes or hypertension and those who smoke -- to use statins to prevent CVD events;
  • a reaffirmation that screening for colorectal cancer in adults ages 50-75 reduces mortality from the disease;
  • a statement supporting prophylactic low-dose aspirin therapy for patients ages 50-59 who have an increased risk of heart attack and stroke;
  • a recommendation to screen adolescents ages 12 to 18 for major depressive disorder when adequate systems are in place for diagnosis, treatment and monitoring;
  • a statement that recommends screening all adults for depression in the primary care setting; and
  • a statement recommending against screening asymptomatic individuals for chronic obstructive pulmonary disease.

In several other instances, the USPSTF found insufficient evidence to weigh the benefits and harms of various interventions and, therefore, could make no recommendation for or against their use.

AAFP Resources

The AAFP tackled other key health issues throughout the year and offered members resources to assist them in providing patient care.

Maternal health was a major focus in January when the AAFP released an evidence-based, peer-reviewed guideline for family physicians that discussed planning for labor after cesarean and vaginal birth after cesarean and laid out short- and long-term health outcomes associated with the procedures.

Also in January, the Academy announced its first tobacco control mini-grant recipients. The 10 customizable grants of $4,000 each funded innovative tobacco-control efforts at the state and local levels.

The AAFP's Multi-State Office Champions Behavioral Health Tobacco Cessation project was created to reach tobacco-dependent patients with other behavioral and mental health comorbidities. The Office Champions Tobacco Cessation Behavioral Health Fact Sheet that came out of the project was converted into an online tool.

Then in November, the Academy launched its online Tobacco and Nicotine Toolkit, complete with tips for integrating tobacco cessation efforts into practices, coding and payment information, patient education materials, and various related guides.

That same month, the AAFP updated its Tar Wars resources for presenters, including revised PowerPoint slides, a handout for kids to take home to share with their parents, and a Tar Wars in the Doctor's Office word search game intended to educate students and their families about the harmful effects of tobacco use.

Other new Academy resources introduced in 2015 include

  • a breastfeeding resource and toolkit that offers office- and community-based tools, advocacy resources, evidence-based knowledge and educational material that family physicians can share with their patients;
  • a comprehensive resource to inform and remind family physicians about the importance of recommending that pregnant women receive tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine during every pregnancy -- ideally, between 27 and 36 weeks' gestation;
  • a paper detailing how family physicians can help address poverty with their patients and in their communities; and
  • an AAFP National Research Network-developed guide to aid physicians in identifying and testing for hepatitis C virus.

AAFP Advocacy

The AAFP was a vocal advocate in the longstanding fight to keep some tobacco products from gaining exemption to the FDA's proposed rule to oversee currently unregulated products such as electronic cigarettes (e-cigarettes), some or all cigars, pipe tobacco, nicotine gels, waterpipe (hookah) tobacco and dissolvables. That work paid off, when a provision that would have legislated those exemptions was stripped from the omnibus spending bill Congress passed before its December adjournment.

The Academy also saw success when it joined with other health care and public health agencies in pressing the FDA to call for tobacco companies to stop deceptive advertising of their products, including using terms such as "natural" and "additive-free" to describe them.

In February, the AAFP and seven other health professional organizations joined the American Bar Association in a call for policies to reduce firearm-related injuries and deaths in the United States and to protect physicians' free speech rights to discuss gun ownership with patients.

And in November, the AAFP joined a campaign led by the CDC and the Immunization Action Coalition that encouraged physicians to "strongly recommend and administer the second (booster) dose of meningococcal ACWY vaccine at age 16."

Government Actions

A number of regulatory actions proved to be of particular interest to family physicians and their patients in 2015, including

  • a CMS announcement to cover certain Medicare beneficiaries for lung cancer screening with low-dose CT scans;
  • HHS Secretary Sylvia Burwell's introduction of the Million Hearts CVD Risk Reduction Model, which uses a data-driven predictive modeling approach to generate personalized CVD risk scores and modification plans for Medicare beneficiaries;
  • CMS' decision to cover HPV testing once every five years -- in conjunction with a Pap smear test -- as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries ages 30-65; and
  • the August release of a CDC Vital Signs report that projected an increase in drug-resistant infections and illness caused by Clostridium difficile in U.S. health care facilities absent an immediate coordinated effort to improve infection control and antibiotic prescribing practices.

Public Health Roundup

"Sitting is the new smoking" was a buzz phrase in January when an Annals of Internal Medicine study found that prolonged sitting is independently associated with negative health outcomes and mortality. The health effects of prolonged sitting were most pronounced in people who seldom or never exercised.

Residents at the Drexel University Family Medicine Residency Program in Philadelphia lead fitness activities in the "Move It With Mommy and Me" program at the Eliza Shirley House, a facility for homeless women and children.

AAFP News coverage addressing the obesity epidemic and related health issues included a July story on the Family Medicine Residency Childhood Obesity Initiative that shared successes in addressing childhood obesity by promoting fitness to at-risk patients and their families.

A study published in September in JAMA: the Journal of the American Medical Association found that in 2012, more than half of American adults had either diabetes or prediabetes. Also of interest was the fact that more than one-third of those who met the study's criteria for diabetes were unaware they had the disease.

There were fewer disease outbreaks in 2015 than the year before, but the United States still saw pockets of measles, Middle East respiratory syndrome coronavirus and cryptosporidiosis.

Finally, in November, the CDC released an MMWR report that found about 25 percent of sexually active gay and bisexual adult men, 18.5 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults are at significant risk for HIV infection and should be counseled about pre-exposure prophylaxis to prevent infection.