AAFP Delivers Useful Clinical Resources for 2018

January 03, 2018 11:53 am News Staff

The AAFP offered a wide range of clinical recommendations and resources throughout 2017 -- including practice guidelines, immunization guidance and preventive services recommendations -- that members can use in 2018 and beyond.

[exam room with exam table, bp monitor, instruments]

Most recently, the AAFP decided in December to not endorse an American Heart Association/American College of Cardiology (AHA/ACC) hypertension guideline released in November that called for high blood pressure to be treated with lifestyle changes and with medication as needed beginning at 130/80 mm Hg rather than the previous commonly accepted threshold of 140/90 mm Hg.

The Academy wasn't involved in the development of the AHA/ACC guideline(hyper.ahajournals.org) and continues to endorse the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults(jamanetwork.com) developed by panel members appointed to the Eighth Joint National Committee.

On a related note, the AAFP and the American College of Physicians (ACP) published their own clinical practice guideline last year that focused on hypertension in adults older than 60.(annals.org) Issued in January, that guideline's chief recommendation was that physicians initiate treatment in patients 60 and older who have persistent systolic blood pressure (SBP) at or above 150 mm Hg to achieve a target SBP of less than 150 mm Hg to reduce the risk of mortality, stroke and cardiac events.

AAFP Launches The EveryONE Project

In September, the AAFP's Center for Diversity and Health Equity (CDHE) unveiled The EveryONE Project during the 2017 Family Medicine Experience in San Antonio.

AAFP's EveryONE Project aims to advance health equity by promoting evidence-based strategies that support community and policy changes, creating tools to help family physicians and their teams advocate for health equity, and collaborating with others who share these values.

Stay tuned to AAFP News for more details on The EveryONE Project's toolkit, which is scheduled to launch in early January.

Also of interest, a study published in the March/April issue of Annals of Family Medicine(www.annfammed.org) found that automated office blood pressure monitoring for 30 minutes in the clinic may dramatically reduce the potential for white-coat hypertension and related overtreatment of patients.

Other Practice Guidelines Span CVD, Gout, Hep B

In addition to the recommendations mentioned above, the AAFP issued an updated clinical practice guideline on the pharmacologic management of atrial fibrillation that outlined five key treatment recommendations and provided the rationale for each. Approved in June by the Academy's Board of Directors, the new practice guideline replaced a 2003 guideline developed by the AAFP and the ACP that the Academy reaffirmed in 2008.

The AAFP also gave a nod to the ACP's guideline on managing acute, recurrent gout,(annals.org) which the Academy endorsed.  

In addition, the ACP joined the CDC in publishing a joint clinical guideline(annals.org) on hepatitis B virus (HBV) screening, which explained that chronic HBV infection rates can be reduced by screening at-risk adults, increasing HBV vaccination rates and linking patients with the infection to care. The recommendations in that guideline are generally consistent with the AAFP's own recommendations on HBV immunization and screening.  

Keeping Members Up-to-Date on Immunizations

Immunizations are an essential tool to help keep patients healthy, and the AAFP is committed to helping its members stay on top of current guidance.

The CDC's Advisory Committee on Immunization Practices (ACIP) -- which includes AAFP representatives -- leads these updates, and during its first meeting of 2017, the group voted to approve a recommendation for single-dose revaccination of unprotected infants born to hepatitis B surface antigen-positive mothers.

During its June meeting, the ACIP decided for the second year in a row to recommend against use of live attenuated influenza vaccine for the 2017-2018 flu season because of the vaccine's reduced efficacy.

The CDC released its yearly flu vaccination recommendations(www.cdc.gov) in a Morbidity and Mortality Weekly Report (MMWR) published in August, which the AAFP adopted.  

And during the ACIP's last meeting of 2017, the group voted to recommend preferential use of a new herpes zoster subunit (HZ/su; Shingrix) vaccine over the currently available herpes zoster live (Zostavax) vaccine for adults 50 and older.

Finally, the AAFP offered an updated webcast on the benefits of influenza vaccine in adults 65 and older, including information on how to properly code and bill for this service.

Preventive Services Recommendations Cover the Waterfront

The AAFP also issued numerous clinical preventive services recommendations to aid family physicians in caring for their patients, many -- but not all -- of which aligned with recommendations from the USPSTF.

For example, the AAFP did not agree with the USPSTF's stance in March that current evidence was insufficient to assess the balance of benefits and harms of performing screening pelvic exams in asymptomatic women who are not pregnant.(www.uspreventiveservicestaskforce.org) Instead, the Academy recommended against screening pelvic exams in asymptomatic women.  

However, the AAFP did agree with the USPSTF in recommending that pregnant women be screened for pre-eclampsia throughout pregnancy using blood pressure measurements.

The two groups also agreed that asymptomatic adults should not be screened for thyroid cancer.

In July, the U.S. Preventive Services Task Force (USPSTF) published a final recommendation statement that said physicians who care for adults at low or average risk for cardiovascular disease (CVD) should consider offering or referring them to behavioral counseling to promote a healthy diet and regular physical activity to prevent CVD. The AAFP agreed in its own recommendation on the topic.

And in a pair of recommendations that focused on children, the USPSTF and the AAFP recommended that children and adolescents ages 6-18 be screened for obesity and that those who are diagnosed with obesity be offered or referred to comprehensive, intensive behavioral interventions to promote improved weight status.

The groups also agreed that vision screening should be performed at least once on all children ages 3-5 years. Both the task force and the AAFP found, however, that there wasn't enough evidence to support vision screening to detect amblyopia or its risk factors in children younger than 3.

Highlighting AAFP Resources

The Academy created a number of other resources that members and their patients can use in 2018, including an alcohol use practice manual(466 KB PDF) focused on screening and brief intervention that represents a collaboration with Baylor College of Medicine in Houston.

The AAFP released an online mapping tool that permits members to review vaccine coverage and exemptions by state, allowing them to better advocate for immunizations in their communities.

Also in 2017, the AAFP Foundation launched its Highlight on VACCINATIONS 4 TEENS,(www.aafpfoundation.org) which is intended to help family physicians educate teens and their families about the importance of getting the vaccines recommended for their age group.

Finally, the Academy continued to address the national opioid crisis in 2017, sending a letter(3 page PDF) to the President's Commission on Combating Drug Addiction and the Opioid Crisis(www.whitehouse.gov) that offered the Academy's perspective on recommendations in the commission's draft interim report(www.whitehouse.gov) and highlighted the AAFP's work to combat the U.S. opioid misuse epidemic.