AMA, AAFP Act to Protect Patients’ Access to Prescriptions

The American Medical Association (AMA) has adopted a policy that supports state laws allowing physicians to dispense medications that are unavailable from pharmacists who conscientiously object to filling a legally written prescription. The AMA position was supported by the American Academy of Family Physicians (AAFP), which recently adopted its own policy on the issue. The AAFP policy affirms pharmacists’ rights to conscientious objection and calls for governmental policies that protect patients’ rights to legally prescribed and medically indicated treatments. AAFP President Mary Frank, M.D., of Mill Valley, Calif., had testified in favor of the resolution, which calls on the AMA to support legislation that would require pharmacists who object to filling a legal prescription to refer patients to other pharmacies. An amendment to the resolution also calls on the AMA to support state legislation that would allow physicians to dispense medications when no willing pharmacist is available within a 30-mile radius. In recent months, 14 states have begun considering bills that would protect pharmacists who refused to fill prescriptions based on conscientious objections. Four states have bills that would require pharmacists to fill all legally written prescriptions.

AHRQ Releases Updated Guide to Clinical Preventive Services

The Agency for Healthcare Research and Quality (AHRQ) has published an updated version of evidence-based clinical guidelines from the U.S. Preventive Services Task Force (USPSTF). The Guide to Clinical Preventive Services 2005 includes the USPSTF’s recommendations on prevention and early detection of cancer; heart and vascular diseases; infectious diseases; injury and violence; mental health conditions and substance abuse; metabolic, nutritional, and endocrinologic conditions; musculoskeletal conditions; and obstetric and gynecologic conditions. Free single copies of the new guide are available online at http://www.ahrq.gov/clinic/pocketgd.htm or by calling the AHRQ Publications Clearinghouse at 1-800-358-9295.

HHS Awards $80.5 Million in Grants to Reduce Infant Mortality Rates

The U.S. Department of Health and Human Services (HHS) has awarded 77 grants totalling more than $80.5 million to improve health care for pregnant women and reduce higher-than-average infant mortality rates in targeted communities as part of the Healthy Start program. The preliminary national infant mortality rate in 2003 was 6.9 per 1,000 live births; mortality rates that year were 14.1 for blacks, 5.9 for Hispanics, and 5.8 for whites. In 2002, the infant mortality rate was 8.6 per 1,000 births for American Natives and 4.8 for Asians or Pacific Islanders. The Healthy Start grants will help fund accessible, culturally competent, and in some communities, mobile clinics that provide prenatal care and make referrals for depression or substance abuse screenings.

Residents Say Duty-Hour Limit Improves Patient Care, Reduces Errors

Family medicine residents say the 80-hours-per-week limit on duty hours improves patient care, reduces medical errors, and allows for better concentration during educational sessions, according to the results of a survey presented at a recent workshop for directors of family medicine residency programs in South Carolina. Dennis Jensen, M.D., a third-year resident at the AnMed Health Family Medicine Residency Program in Anderson, S.C., surveyed 85 family medicine chief residents during the 2004–2005 academic year. More than three fourths of the residents said the 80-hours-per-week duty limit improved patient care, and 55 percent said the limit resulted in fewer medical errors. Moreover, 82 percent said the rules improved their ability to concentrate during rounds, conferences, and seminars; 46 percent said they used the extra time to pursue additional educational opportunities. From July 2003 to May 2004, the Accreditation Council for Graduate Medical Education found that 16.9 percent of family medicine residency programs had received duty-hour violation complaints. Jensen’s survey found that although residency programs enforce the duty-hour limit, some infractions do occur. In 92 percent of those cases, residents—either on their own or in consultation with others—decided to exceed the limits. The survey found that at some point in the previous four-week reporting period, 13 percent of residents reported exceeding the 80-hours limit, 25 percent reported a rest period shorter than 10 hours, and 26 percent reported working beyond the 30-hours-per-shift limit.

CMS Offers New Option for Physicians Who Administer Drugs

Physicians who administer drugs in their offices to Medicare beneficiaries will be eligible to participate in a new competitive acquisition program beginning January 1, 2006. Under an interim final rule from the Centers for Medicare and Medicaid Services (CMS), these physicians will be able to obtain many physician-administered drugs from vendors selected by Medicare through competitive contracting. The new program will apply to physician-injectable drugs covered under Medicare’s Supplemental Medical Insurance (or Part B) program. It will not apply to drugs included in the new Prescription Drug Benefit under Medicare Part D, which also goes into effect January 1, 2006; nor will it apply to drugs that are self-administered by the patient through a device, such as a nebulizer; or to certain other drugs, such as intravenous immunoglobulin, immunosuppressive drugs, and hemophilia blood clotting factor. Of approximately 440 drugs that are billed to a physician service and paid under Part B, 181 will be included in the competitive acquisition program, accounting for 85 percent of all Medicare spending on physician-injectable drugs. Physicians choosing to participate in the program will no longer have to buy the drugs, collect copayments, or bill Medicare for the drugs. The interim final rule was to be published in the July 6 Federal Register. Comments will be accepted until September 6, 2005. Additional information is available online at http://www.cms.hhs.gov/media/press/release.asp?Counter=1492.

Medical and Public Health Groups Sue EPA Over Mercury Exposure

Four leading medical, nursing, and public health groups, representing more than 300,000 health professionals, have filed a challenge to the U.S. Environmental Protection Agency’s power plant mercury rule. The plaintiffs include Physicians for Social Responsibility, the American Academy of Pediatrics, the American Nurses Association, and the American Public Health Association. The medical and health groups, represented by John Suttles and Marily Nixon of the Southern Environmental Law Center, are filing a motion for intervention into the mercury litigation initiated by environmental organizations and 13 state attorneys general. The groups are filing the new lawsuit in response to the mercury rule’s clear threat to public health. Physicians, nurses, and other health professionals will ask the federal courts to overturn the weak mercury rule to protect Americans’ health. Additional information is available online at http://www.mercuryaction.org.

Surveys Find that Patients Rely on Physicians for Fitness Information

Almost 60 percent of family physicians discuss healthy lifestyle topics with most of their patients, according to survey results from the AAFP’s Americans in Motion fitness initiative. In addition, more than one half of patients consider their primary care physician a good source of information on physical fitness, nutrition, and emotional well-being. Nearly one out of five physicians surveyed said they discuss lifestyle choices with all of their patients, and two out of five said they discuss such topics with most of their patients. Survey respondents cited lack of time as the predominant reason they do not talk with patients about such topics as physical fitness, nutrition, and emotional well-being.