Accountable Care Organizations Still Evolving, AAFP Adopts Recommendations

According to some lawmakers, accountable care organizations (ACOs) are important in improving health care while saving costs, but the American Academy of Family Physicians (AAFP) and other organizations are taking a critical look at the model. A new policy brief from the Urban Institute and the Robert Wood Johnson Foundation defines an ACO as a local health care organization and a related set of health care professionals who are held accountable for the cost and quality of care delivered to a defined population, with the goal of delivering coordinated and efficient care. ACOs that achieve quality and cost targets would receive a financial bonus, but they could incur penalties for failing to achieve those targets. Robert Berenson, MD, an Urban Institute fellow and coauthor of the brief, said ACOs are still evolving and will take at least five to 10 years to develop, but could be a fundamental solution to health care cost and quality problems. The AAFP Board of Directors recently adopted principles that would help make primary care and the patient-centered medical home (PCMH) part of the foundation of ACOs. The principles also include recommendations concerning health information technology systems, payment structures, nationally accepted clinical performance measures, and incentives for encouraging patient engagement in health and wellness activities. For more information, visit https://www.aafp.org/news-now/practice-management/20091215acopolicybrief.html or https://www.aafp.org/news-now/practice-management/20091216aco-principles.html.

Manufacturer Recalls Pediatric H1N1 Vaccine Lots Because of Decreased Potency

Sanofi Pasteur Inc. recalled about 800,000 doses of its novel influenza A (H1N1) vaccine in December 2009, after four lots of single-dose pediatric vaccine in 0.25-mL prefilled syringes failed stability testing. The Centers for Disease Control and Prevention (CDC) said the four lots of vaccine met specifications at the time of their release and shipment to distribution centers, but had decreased potency with subsequent testing. Potency of the recalled lots fell only slightly below the specified range; therefore, there is no need to revaccinate children who have received a dose from those four lots, and there are no safety concerns associated with the recalled vaccine. The recall does not include Sanofi Pasteur's H1N1 vaccine shipped in multidose vials or single-dose 0.5-mL prefilled syringes. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20091215h1n1pediatric-recall.html.

ACC and AHA Update Guidelines for Perioperative Beta Blockers

The American College of Cardiology (ACC) and the American Heart Association (AHA) released guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery two years ago. However, the organizations released a focused update in November 2009, prompted by results of a study in which fixed, higher doses of the beta blocker metoprolol were initiated in more than 8,000 patients on the day of noncardiac surgery. That study confirmed a reduction in cardiac events, including cardiovascular death, myocardial infarction, and cardiac arrest, with perioperative beta-blocker therapy. However, the benefit was offset by an increased risk of stroke and total mortality. Evidence suggests that when possible and where indicated, beta blockers should be started days to weeks before elective surgery. Furthermore, the dose should be titrated to achieve adequate heart rate control and increase the likelihood that the patient will benefit from the medication while minimizing the risks of hypotension and bradycardia. The ACC and AHA advise that beta blockers are reasonable to consider in patients at high risk of cardiac complications because of abnormal stress test results or known coronary artery disease who undergo vascular surgery; and in high-risk patients undergoing intermediate-risk surgery or who have multiple risk factors for complications. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20091215betablockers.html.

President Obama Announces Funds for CHCs and PCMH Pilot Project

During a December 9, 2009, White House press conference, President Obama announced the release of $515 million in capital improvement funds for 85 community health centers (CHCs) nationwide, and another $88 million in funds to help CHC networks adopt electronic health records and other health information technology systems. The funds were awarded through a competitive grant process. Overall, CHCs should be able to provide care to more than 500,000 additional patients in under-served areas with the newly released funds. Obama also announced the creation of a PCMH demonstration project for Medicare beneficiaries who go to CHCs. For more information, visit https://www.aafp.org/news-now/government-medicine/20091216chcs-pcmh-funds.html.

FDA, Manufacturers Issue Notifications Involving Various Medications

The U.S. Food and Drug Administration (FDA) and various pharmaceutical manufacturers recently issued notifications about a number of products, including the anticonvulsant valproate (Depacon) and related drugs; the weight-loss drug sibutramine (Meridia); products containing the nonsteroidal anti-inflammatory drug diclofenac, including the topical gel Voltaren; and the protease inhibitor fosamprenavir (Lexiva). The FDA reminded physicians about the increased risk of neural tube defects and other major birth defects in infants exposed to valproate and related products, such as valproic acid (Depakene), in utero. The FDA is reviewing preliminary data from a study that suggests patients using sibutramine have a higher number of cardiovascular events than patients using a placebo, and said that preliminary study findings reinforce the importance of avoiding its use in patients with a history of coronary artery disease, congestive heart failure, arrhythmias, or stroke. Manufacturers of diclofenac revised prescribing information, adding new precautions about the potential for elevation in liver function tests, and said that severe hepatic reactions have been reported, with some cases resulting in liver transplantation or death. The FDA and pharmaceutical manufacturer GlaxoSmithKline notified physicians of a potential association between fosamprenavir and myocardial infarction and hypercholesterolemia in adults with human immunodeficiency virus. Physicians are encouraged to report adverse reactions associated with any of these products to the FDA's MedWatch program. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20091211fda-notices.html.

Supply of Erythromycin Ophthalmic Ointment Is Increasing After Shortage

A nationwide shortage of erythromycin 0.5% ophthalmic ointment appears to be nearing its end, but hospitals and others are being asked to limit their orders to quantities that meet their immediate needs. The FDA said that production has increased and is expected to increase again after the first quarter of 2010, allowing customers to build inventory. The AAFP, American Academy of Pediatrics, and U.S. Preventive Services Task Force recommend the use of prophylactic ocular topical medication in all newborns to prevent gonococcal ophthalmia neonatorum, or neonatal conjunctivitis. This prophylaxis is required by law in most states. In 2009, the CDC updated its recommendations to physicians for prophylaxis against ophthalmia neonatorum, in response to the shortage, including advice on alternative products. One of those products, gentamicin 0.3% ophthalmic ointment, was later linked to adverse events. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20091215ointment-shortage-ends.html.

AAFP Voices Opposition to Senate Amendment to Health Care Bill

In a prepared statement, the AAFP voiced its strong opposition to a Senate amendment to the health care reform bill, H.R. 3590. The amendment would postpone for one year a Centers for Medicare and Medicaid Services rule that eliminates Medicare payment for consultation codes and redistributes the savings to office visits and selected other evaluation and management services. The elimination of the Medicare consulting fees would result in a 6 percent increase in the work relative value units for office visits in 2010 and would serve as part of a projected overall increase of 4 percent in Medicare-allowed charges for family physicians contained in the 2010 Medicare rule. For more information, visit https://www.aafp.org/news-now/government-medicine/20091216specter-amndmt.html.

Report Shows Decrease in Colorectal Cancer Diagnoses and Deaths

A recent report shows that from 1975 to 2000, colorectal cancer rates fell 22 percent in the United States, and deaths attributed to the disease fell 26 percent, because of increased screening, changes in risk factors, and improved treatment. According to the annual report on cancer from the National Cancer Institute, the CDC, the American Cancer Society, and the North American Association of Central Cancer Registries, Americans could see a 36 percent decline in colorectal cancer mortality if current trends persist, and with accelerated cancer control efforts, colorectal cancer mortality could be cut in half by 2020. The prediction is based on potential reductions in risk factors, such as smoking, obesity, and red meat consumption, and also includes factors that could decrease risks, including exercise and supplement use. Although overall rates are declining, researchers expressed concern about increasing incidence rates among men and women younger than 50 years. Overall, rates of new diagnoses and deaths of all cancers fell significantly from 2000 to 2006 for men and women and for most racial and ethnic populations. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20091215colorectalcancer.html or http://www3.interscience.wiley.com/cgi-bin/fulltext/123206036/PDFSTART.

— AFP and AAFP NEWS NOW staff