Physician Shortage in Community Health Centers Threatens Patients' Access to Care

Community health centers (CHCs) across the United States are experiencing a shortage of primary care professionals, including physicians, nurse practitioners, physician assistants, nurses, and certified nurse midwives. CHCs need to hire more than 3,200 additional health care professionals to meet patient demand, according to a report by the National Association of Community Health Centers (NACHC), the Robert Graham Center, and George Washington University. The report, “ACCESS Transformed: Building a Primary Care Workforce for the 21st Century,” outlines the widening gap between patients who have sufficient access to health care and those who do not. The report names health care access as the most pressing challenge to the health care system, as fewer medical school graduates choose to practice primary care medicine in underserved areas, especially low-income communities. The NACHC hopes to expand the capacity of the country's 6,600 CHCs, which currently serve about 18 million patients. To accomplish this, the NACHC has launched a campaign to increase funding from federal and state governments. The funds would be used to strengthen and expand primary care workforce development programs that provide students with education and training experience. If CHCs are expanded to reach 30 million patients, the report estimates that between $22.6 and $40.4 billion could be saved on health care expenses each year. For more information, visit https://www.aafp.org/news-now/professional-issues/20080820-chc-report.html or the NACHC Web site at http://www.nachc.com/client/documents/ACCESS%20Transformed%20full%20report.pdf.

Revisions to Physician Payments Sunshine Act Establish Uniform Rules for All States

The Physician Payments Sunshine Act has been revised to establish national regulations regarding gifts to physicians from manufacturers of drugs, biologic products, and medical devices. Companies would be required to disclose the names and office addresses of physicians who receive gifts valued at more than $25, including travel, honoraria, payments, and other rewards. The rules would not apply to drug samples or funding for clinical trials. Companies would also be required to record the information in a national database that would be accessible to patients. Any company that fails to report its gifts would be subject to fines ranging from $10,000 to $100,000. The most notable revision to the legislation is that it would override any existing state sunshine laws. The revised bill has received endorsements from companies such as Eli Lilly, Merck, Astra Zeneca, and Johnson & Johnson. For more information, visit https://www.aafp.org/news-now/government-medicine/20080820-sunshine2.html.

Immunization Registries Track Patient Data, Provide Access to Vaccine Guidelines

The United States has seen a sharp decline in preventable diseases during the past 50 years thanks to steady increases in immunization rates. However, there is still room for improvement. New vaccines, vaccine combinations, complex administration schedules, incomplete patient records, and a lack of continuity of care make it difficult for physicians to follow vaccination guidelines. The American Immunization Registry Association (AIRA) works with immunization information systems across the country to make it easier for physicians to have the information they need at their fingertips. AIRA Executive Director Cindy Sutliff says many registries are now Web-based, which allows physicians to report and access patient data over the Internet. Some registries are capable of producing reports that calculate physicians' immunization coverage rates to show them where they can improve. Physicians can also use immunization registries to access the latest guidelines from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Some physicians remain critical of the registries because of the dual data entry problem they create. Currently, physicians or staff need to enter patient immunization data twice, once into their electronic health record (EHR) system and once into the registry. Until seamless data flow between systems is available, many physicians are waiting to participate in a registry. For more information, visit https://www.aafp.org/news-now/2006-annual-clinical-focus/20080820immun-reg.html.

State Legislation Aims to Entice Physicians to Rural Areas with Financial Incentives

Massachusetts has passed legislation to improve residents' access to care, especially in rural areas. S.B. 2863, which was signed into law on August 10, 2008, creates financial incentives for physicians and nurses who agree to practice primary care in medically underserved areas. The law establishes a loan forgiveness program, an affordable housing pilot program, and tuition incentives for graduates of the University of Massachusetts Medical School who agree to practice primary care in the state for four years. The law also addresses the inadequate supply of physicians available to meet the state's growing demand for primary care. In April 2006, the Massachusetts Health Care Reform Plan made health insurance mandatory for all residents, adding more than 300,000 patients to the health care system. State legislators hope the incentives in the new law will ensure that patients have access to care when they need it. Other provisions in S.B. 2863 involve establishing a medical home demonstration project and adopting interoperable EHRs in hospitals by 2015. For more information, visit https://www.aafp.org/news-now/government-medicine/20080813masslegislation.html.

Small Disease Prevention Strategies Could Create Big Savings, Improve Patient Health

Interventions designed to increase physical activity, improve eating habits, and encourage smoking cessation could save the United States more than $16 billion per year within the next five years. “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,” a study by Trust for America's Health (TFAH), found that investing only $10 per person per year in community-based interventions would lead to significant savings for Medicare, Medicaid, and private payers. The $16 billion does not include gains from improvements in worker productivity, reduced absences at work and school, and enhanced quality of life. The report, which is based on research from the Urban Institute and the New York Academy of Medicine, studied prevention efforts that are known to reduce disease rates or improve health choices. The report cited prevention strategies such as enhancing access to affordable nutritious foods, increasing the numbers of community parks and sidewalks, and increasing taxes on tobacco products. When implemented on a community-wide scale, the strategies could reduce rates of type 2 diabetes, high blood pressure, heart and kidney disease, and stroke. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080820-tfah-prev.html or the TFAH report at http://healthyamericans.org/reports/prevention08/Prevention08.pdf.

Studies Evaluate Testing Process Errors Occurring in Family Medicine Practices

Two recent studies in Quality and Safety in Health Care found that testing process errors are common in primary care practices. Eight practices in the American Academy of Family Physicians' (AAFP) National Research Network reported 966 testing process errors during 32 weeks in 2004. About 13 percent of the errors involved test ordering, and about 18 percent involved test implementation. Other errors were related to getting test results to the ordering physician (25 percent) and reporting results to the patient (7 percent). Almost one half of the errors led to increased inefficiency and inconvenience, whereas 13 percent led to adverse clinical outcomes for the patient or pain and suffering. The studies found that test implementation errors were almost double for minority patients compared with non-Hispanic white patients. The studies also reported that the presence of an EHR system in the practice did not affect the type of errors reported. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080820-nrn-studies.html.

Ask and Act Tobacco Cessation Program Releases Podcasts on Helping Patients Quit

The AAFP's Ask and Act tobacco cessation program has introduced an “Ask the Expert” podcast series. Each of the five podcasts covers a different topic to help physicians talk with patients about tobacco use and encourage them to quit. The podcasts run approximately seven to 13 minutes and include the following topics: “New Public Health Service Clinical Practice Guidelines,” “Pharmacotherapy for Tobacco Dependence,” Tobacco Cessation Quitlines,” “How to Provide Tobacco Cessation Treatment to Patients with Mental Illness,” and “Payment for Tobacco Cessation Treatment.” The podcasts are free and available for downloading from the AAFP Web site at https://www.aafp.org/online/en/home/clinical/publichealth/tobacco/cme/podcasts.html. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080813ask-act-pod.html.

FDA Issues Warning Concerning the Risk of Tendinitis with Use of Fluoroquinolones

The U.S. Food and Drug Administration (FDA) has issued an alert regarding a risk of tendinitis and tendon rupture in patients using systemic fluoroquinolones. The FDA will require manufacturers to place warnings on product labels, and to create a medication guide for patients that addresses these and other potential side effects. Fluoroquinolones are commonly prescribed by family physicians for indications such as urinary tract infections and chronic obstructive pulmonary disease exacerbations. Physicians should advise patients to discontinue fluoroquinolone use if pain or inflammation develops in a tendon area. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080820fluoroquin-warn.html or the FDA Web site at http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm.

— AFP and AAFP NEWS NOW staff