Surgeon General Releases Goals and USPSTF Updates Recommendations on Obesity
The U.S. Preventive Services Task Force (USPSTF) recently updated its screening recommendations for obesity in children and adolescents. The American Academy of Family Physicians (AAFP) has adopted the USPSTF recommendations after a review by the AAFP Commission on Health of the Public and Science. The USPSTF defines overweight as an age- and gender-specific body mass index (BMI) between the 85th and 94th percentiles, and obesity as a BMI at or above the 95th percentile. In its new recommendations, the USPSTF says there is moderate certainty that there is a moderate net benefit for obesity screening in children six years and older and for moderate- to high-intensity interventions, defined as those that involve more than 25 hours of physician contact with a child or the child's family during a six-month period. Family physicians and the patient-centered medical home can play important roles in combating the nation's obesity epidemic, said U.S. Surgeon General and family physician Regina Benjamin, MD, MBA, during a January 28, 2010, press event. The event coincided with the release of The Surgeon General's Vision for a Healthy and Fit Nation 2010 report, which highlights the growing number of overweight and obese Americans; outlines the causes and health consequences of obesity; and offers steps that consumers, parents, schools, communities, and physicians can take to curb obesity. According to Benjamin, two thirds of adults and one third of children are overweight or obese in the United States. In her report, Benjamin said physicians should make it a priority to teach patients about the importance of achieving and maintaining a healthy body weight, becoming physically active, eating healthy foods, and managing stress, and that physicians should provide resources and referrals to help patients make healthy choices. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20100202uspstf-obesity.html and https://www.aafp.org/news-now/health-of-the-public/20100205obesity-conf.html.
MedPAC to Ask Congress for 1 Percent Rate Increase in 2011 Medicare Physician Payment
The Medicare Payment Advisory Commission (MedPAC) is set to ask Congress to approve a 1 percent increase in the Medicare physician payment rate for 2011 and to provide a budget-neutral payment increase next year for physicians whose practices are focused on primary care services. Med-PAC members approved the recommendations during a meeting on January 14, 2010. The two recommendations will be included in MedPAC's annual March 2010 report to Congress. According to MedPAC, Medicare fees are, on average, 20 percent lower than those paid by private plans, a gap that has remained steady during the past decade; physician payment updates increased by less than 20 percent between 1997 and 2008; and the Medicare economic index increased by a little more than 30 percent during that time. For more information, visit https://www.aafp.org/news-now/government-medicine/20100127medpac-recs.html.
Obama Reiterates Need for Health Care Reform, Budget Invests in Primary Care
During his first State of the Union address on January 27, 2010, President Obama said he would continue to work for passage of a health care reform bill. Obama's speech primarily focused on the economy, but he said reform of the nation's health care system is inextricably linked to the nation's economic well-being, and he reiterated many of the points about health care reform long championed by the AAFP. The Obama administration's fiscal year 2011 budget was released on February 1, 2010, just days after the State of the Union address. The proposed budget would provide funding increases for a number of primary care–related programs, enabling the U.S. health care system to take steps toward offering a high-quality, efficient, and accessible health care system, according to AAFP President Lori Heim, MD, Vass, N.C. It also would include $27 million in increased funding for the National Health Service Corps in fiscal year 2011, provide about $2.4 billion for community health centers during the next fiscal year, and maintain level funding for health professions training programs. For more information, visit https://www.aafp.org/news-now/government-medicine/20100128state-of-union.html and https://www.aafp.org/news-now/government-medicine/20100203fy2011-budget.html.
Obama Administration Issues Interim Final Rules for Mental Health Parity Act
The Obama administration has issued interim final rules for implementing The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The rules were published in the February 2, 2010, issue of the Federal Register. The U.S. Department of Health and Human Services (HHS) are accepting public comment on the rules until May 3, 2010. HHS, the Department of the Treasury, and the Department of Labor jointly issued the interim final rules, which are expected to take effect on April 5, 2010. According to comments submitted last May to the Labor Department by the National Council for Community Behavioral Healthcare, the new law will allow for mental health and addiction services parity for about 113 million Americans. The AAFP notes that improving mental health care treatment requires enhancing the ability of the primary care physician to treat and be appropriately paid for providing that care, which the new law achieves. For more information, visit https://www.aafp.org/news-now/government-medicine/20100203mental-act-rules.html and the Federal Register Web site at http://www.access.gpo.gov/su_docs/fedreg/a100202c.html.
Survey of Program Directors Shows Concern About More Limits on Resident Duty Hours
Most of the family medicine residency program directors who participated in a recent survey do not think proposals from the Institute of Medicine (IOM) to further restrict resident duty hours will improve patient safety and resident education. According to the study published in the December 2009 issue of the Journal of Graduate Medical Education, the program directors think the proposals, if implemented, would have detrimental effects in both of those areas. The survey comes in the wake of a December 2008 IOM report that recommended residents' work hours be kept at a maximum of 80 hours per week, averaged during a four-week period, as set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003. But the IOM made several other recommendations in its report, including recommending that residents' duty shifts not exceed 16 hours of continuous work and that the maximum shift length of 30 hours be broken up by an uninterrupted five-hour sleep period between 10 p.m. and 8 a.m. The AAFP and four other primary care organizations subsequently said in a letter to the ACGME that such additional restrictions would lead to more frequent patient hand-offs, raising the risk of medical errors and compromising continuity of care. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20100203afmrd-survey.html and the Journal of Graduate Medical Education Web site at http://www.jgme.org/doi/full/10.4300/JGME-D-09-00003.1.
MedWatch: FDA Announces Possible Safety Risks of Sibutramine, Didanosine
The U.S. Food and Drug Administration (FDA) is informing physicians and patients about the increased risk of heart attack and stroke in patients with a history of cardiovascular disease who use the prescription weight-loss drug sibutramine (Meridia). The product's label already includes warnings about its use in patients with cardiovascular disease. However, the FDA said on January 21, 2010, that manufacturer Abbott Laboratories agreed to add a history of cardiovascular disease as a new contraindication to sibutramine's label following the agency's review of additional data from an ongoing safety review launched in November 2009. According to FDA officials, physicians should regularly monitor the blood pressure and heart rate of patients using sibutramine. If sustained increases in blood pressure or heart rate are observed, use should be discontinued. Additionally, the FDA announced on January 29, 2010, that noncirrhotic portal hypertension has been reported in some patients with human immunodeficiency virus (HIV) who were taking didanosine (Videx, Videx EC), marketed by Bristol-Myers Squibb. The product labels have been revised to warn of the risk and signs and symptoms of noncirrhotic portal hypertension. The FDA evaluation concluded that the clinical benefits of didanosine continue to outweigh potential safety risks in certain patients with HIV. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20100125meridia-contra.html and http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199489.htm.
Nipro Medical Corp. Recalls Millions of Insulin Syringes and Huber Needles
Insulin syringes and Huber infusion needles distributed by Nipro Medical Corp. have been recalled in two separate actions involving millions of units. On January 21, 2010, the company voluntarily recalled all GlucoPro insulin syringes with product codes and lot numbers that expire before November 2011 because the needles may detach. The recall does not include GlucoPro syringes used with the company's Amigo Insulin Pump. Nipro Medical Corp. said no injuries associated with the defect have been reported to date. In an unrelated action on January 26, 2010, the FDA announced a Class I recall of more than 2 million Huber needles manufactured by Nipro Corp. for Exelint International Corp. The recall involves Exel/Exelint Huber needles, Exel/Exelint Huber Infusion Sets, and Exel/Exelint SecureTouch+ Safety Huber Infusion Sets manufactured from January 2007 to August 2009. Units subject to recall have lot numbers that begin with “07,” “08,” or “09.” For more information, visit https://www.aafp.org/news-now/clinical-care-research/20100127nipro-recalls.html.
— AFP and AAFP NEWS NOW staff