H1N1 Vaccine Production Lags Behind Goal, ACIP Revises Priority Recommendations

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) has lowered its estimate of the number of novel influenza A (H1N1) vaccine doses it expects to be ready by mid-October 2009. Because manufacturing issues have slowed production of the new vaccine, only 45 million doses are expected be available instead of the 120 million doses previously anticipated. However, according to the U.S. Department of Health and Human Services (HHS), an additional 20 million doses per week should be available after the original October date. In response to the initial limited supply of H1N1 vaccine, ACIP has revised its recommendations of which groups should receive the vaccine before others. These groups include pregnant women; persons who live with or care for children younger than six months; health care and emergency services personnel who have direct patient contact; children six months to four years of age; and children five to 18 years of age who have chronic medical conditions. When the vaccine becomes more widely available, ACIP recommends that all health care and emergency services personnel receive the vaccine, as well as all persons four to 24 years of age, and persons 25 to 64 years of age who have chronic medical conditions. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090819h1n1-update.html.

Medical Groups Press Health Insurers for Coverage of Tobacco Cessation Therapy

Several medical subspecialty organizations, including the American Academy of Family Physicians (AAFP), are pressing health insurance companies to include tobacco cessation counseling and associated pharmacotherapy in their standard benefit plan packages. The organizations also expect the insurance companies to pay physicians fairly for providing those services. In a July 21, 2009, letter sent to dozens of health plans, the organizations argued that commercial insurance plans have yet to follow Medicare, which has paid for smoking cessation counseling since 2005. According to the letter, primary care physicians are in a unique position to help patients with their tobacco addictions because nearly six out of 10 office visits in the United States are made to primary care physicians. To underscore their point, the organizations offered several facts about tobacco use, such as tobacco is the leading preventable cause of death in America; tobacco use and nicotine addiction cost the country $193 billion each year in health-related costs and lost productivity; and quit rates increase when patients have insurance coverage for smoking cessation treatment. For more information, visit https://www.aafp.org/news-now/practice-management/20090729tobacco-ltr.html.

CMS Medical Home Demonstration Project Still Awaits Final Approval

The Centers for Medicare and Medicaid Services (CMS) has yet to receive final approval to conduct a medical home demonstration project within the Medicare program. Because of the delay, the project likely will not be fully underway for at least another year. Congress created the three-year medical home demonstration project as part of the Tax Relief and Health Care Act of 2006. According to the provisions of the act, the project will take place in eight states, with CMS announcing the names of the states when the project receives final clearance. The project will involve up to 400 practices; 2,000 physicians; and 400,000 Medicare beneficiaries, according to CMS. Officials originally expected to launch the project in early 2010. For more information, visit https://www.aafp.org/news-now/government-medicine/20090810cms-pilot-project.html.

Stimulus Funds Help Community Health Centers Meet Growing Needs

The American Recovery and Reinvestment Act has provided an infusion of funds for U.S. community health centers (CHCs). According to an analysis from the National Association of Community Health Centers (NACHC), HHS has released $1.3 billion of the $2 billion allocated to CHCs. Of the $1.3 billion, HHS has designated $155 million to establish 126 new health centers, which will provide supporting care for an additional 750,000 persons and lead to the creation or retention of 5,500 jobs. HHS also released $338 million in grants to support care for an additional 2.1 million persons and to create or retain 6,400 jobs. Additionally, in June 2009, HHS released $851 million in capital improvement program grants to support the construction, repair, and renovation of more than 1,500 CHC sites nationwide. More than 650 centers will use the funds to purchase new equipment or health information technology systems, and nearly 400 centers will adopt and expand the use of electronic health record systems. The NACHC has launched a Web page to show how many jobs were created and how much care was expanded at CHCs as a result of the stimulus money. For more information, visit https://www.aafp.org/news-now/government-medicine/20090811chc-stimulus-funding.html or the NACHC Web site at http://www.nachc.com/health-center-stimulus-map.cfm.

TransforMED Launches Interactive Physician Networking Site for Practice Transformation

TransforMED, a subsidiary of the AAFP, has launched Delta-Exchange, a social networking site for primary care physicians. The site, which was created in the wake of TransforMED's two-year demonstration project, offers a variety of tools to help physicians progress toward practice transformation and the patient-centered medical home. For $30 per month, members of Delta-Exchange can access resources such as online discussions, interactive webinars, articles on practice-improvement topics, an expert panel of practice facilitators, and forms to streamline policies and procedures. For more information, visit https://www.aafp.org/news-now/practice-management/20090811delta-exchange.html or the Delta-Exchange Web site at http://www.transformed.com/Delta-Exchange/index.cfm.

Fraud Alert Warns Physicians About Phony Medical Board Certification Offers

Physicians are being targeted in a scam, perpetrated through the mail, involving the sale of fake medical board certifications. A family physician in Hudson, Fla., recently received an unsolicited letter offering lifetime diplomate certification through the American Board of Geriatric Medicine. The letter included an expedited application form and requested a registration fee of $500. According to Connecticut Attorney General Richard Blumenthal, at least 130 complaints have been reported, and several purported medical board names have been connected with the scheme. The solicitations generally target foreign-born or foreign-taught physicians who may be unaware of certification processes in the United States. Physicians who receive a similar solicitation should file a report with the attorney general's office in the state in which they practice. For more information, visit https://www.aafp.org/news-now/professional-issues/20090817board-cert-scam.html.

ACIP Updates Recommendations for Poliovirus Vaccinations in Children

ACIP has updated its recommendations for poliovirus vaccination to help clarify the timing of the vaccine and how to use combination vaccines. Since 1999, when ACIP recommended that all poliovirus vaccines administered in the United States be inactivated vaccines, three different combination vaccines containing inactivated poliovirus vaccine (IPV) have been licensed. To avoid confusion, ACIP has issued guidelines to clarify the appropriate administration ages and minimum intervals for the four-dose IPV series. ACIP also clarified the schedule for combination vaccines. The combination vaccine for diphtheria and tetanus toxoids and acellular pertussis (DTaP); IPV; and Haemophilus influenzae type b is not indicated for use as a booster dose. If the product is used to provide four doses at two, four, six, and 15 to 18 months of age, a dose of age-appropriate IPV should be administered at four to six years of age. This five-dose series has been approved by ACIP. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090811poliovirus-vaccinations.html.

MEDWATCH: FDA Requires Boxed Warnings on Smoking Cessation Drugs

The U.S. Food and Drug Administration (FDA) is requiring manufacturers to put a boxed warning on the prescribing information for the smoking cessation drugs Chantix, Zyban, and Zyban's generic version bupropion. Their use has been linked to serious mental health events, including changes in behavior, depression, hostility, and suicidal thoughts. The FDA advises physicians to monitor patients for unusual changes in mood or behavior, and patients should be instructed to contact their physician if they experience such changes. For more information, visit https://www.aafp.org/news-now/news-in-brief/20090702clin-upd.html or the FDA Web site at http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm169988.htm.

New Pertussis Awareness Campaign Aims to Increase Immunization Rates

The AAFP is launching an initiative to increase awareness about pertussis vaccination. During the first phase, the campaign focuses on reminding physicians to encourage patients to get vaccinated. According to the CDC, 600,000 cases of pertussis, or whooping cough, occur each year in the United States, although only 2 percent of U.S. adults received the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) from 2005 to 2007. ACIP recommends a single booster dose of Tdap for adults 19 to 64 years of age to replace the tetanus and diphtheria toxoids vaccine (Td) in patients who received their last dose of Td 10 or more years earlier and who have not previously received Tdap. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090825pertussis-campaign.html.

— AFP and AAFP NEWS NOW staff