Mary Ellen Schneider

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety (this does not include user fee funds that will also go to that effort) and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Coalition for a Stronger FDA, a Washington-based consumer-, patient-, and industry-supported group, said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Medicare Generic Drug Use Rises

Generic drugs accounted for 60% of the prescriptions dispensed to people who receive benefits through either Part D or Medicare Advantage plans for the first three quarters of 2006, the Centers for Medicare and Medicaid Services announced. Generic drug use in Part D enrollees is 13% higher than for Americans who receive benefits through private payers, CMS said. In comparison, generics accounted for 53% of prescriptions dispensed to privately insured Americans last year. Greater use of generics will translate into lower costs for the Part D program and possibly expanded coverage for beneficiaries, said CMS. “We will continue to promote generics where they are available as an important strategy to keep the new drug benefit affordable over the long term,” acting administrator Leslie Norwalk said in a statement.

Edwards Proposes Health Plan

Former North Carolina Senator and 2008 presidential candidate John Edwards is calling for universal health care but modeling his proposal after a plan that is in effect in Massachusetts. The plan would essentially require all Americans to have insurance by 2012. To make coverage affordable, Sen. Edwards' plan would require employers to cover employees or to help them finance their coverage, and would create regional purchasing pools. The plan also would create tax credits, expand Medicaid and the State Children's Health Insurance Plan, and reform insurance laws. He also said his plan would provide incentives to improve the quality of care, by promoting evidence-based medicine and more quickly getting information on advances into physicians' hands.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Duke University, and Wake Forest University have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other common conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, Baltimore, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

Health IT Privacy Milestones

Federal health officials need to develop an overall strategy for protecting patient privacy as health information technologies take off, according to a report from the Government Accountability Office. Although the Health and Human Services department has designated consumer privacy a top priority and has made some initial progress in that area, a more comprehensive approach is needed, the GAO report concluded. Specifically, HHS officials need to set milestones for integrating privacy-related initiatives and select an entity responsible for implementing these initiatives. But in comments on the report, HHS officials said setting specific milestones would hamper their ability to incorporate stakeholder ideas as they move forward. Since 2005, HHS has awarded several contracts aimed at addressing the privacy of personal health information exchanged within an electronic national health information network. In 2006, an HHS contractor selected sites to perform assessments of privacy and security policies. Also in 2006, the National Committee on Vital and Health Statistics and the American Health Information Community worked on privacy and security issues related to a nationwide health information network. The report was requested by Sen. Daniel Akaka (D-Hawaii) and Sen. Edward Kennedy (D-Mass.).

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety (this does not include user fee funds that will also go to that effort) and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Coalition for a Stronger FDA, a Washington-based consumer-, patient-, and industry-supported group, said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Medicare Generic Drug Use Rises

Generic drugs accounted for 60% of the prescriptions dispensed to people who receive benefits through either Part D or Medicare Advantage plans for the first three quarters of 2006, the Centers for Medicare and Medicaid Services announced. Generic drug use in Part D enrollees is 13% higher than for Americans who receive benefits through private payers, CMS said. In comparison, generics accounted for 53% of prescriptions dispensed to privately insured Americans last year. Greater use of generics will translate into lower costs for the Part D program and possibly expanded coverage for beneficiaries, said CMS. “We will continue to promote generics where they are available as an important strategy to keep the new drug benefit affordable over the long term,” acting administrator Leslie Norwalk said in a statement.

Edwards Proposes Health Plan

Former North Carolina Senator and 2008 presidential candidate John Edwards is calling for universal health care but modeling his proposal after a plan that is in effect in Massachusetts. The plan would essentially require all Americans to have insurance by 2012. To make coverage affordable, Sen. Edwards' plan would require employers to cover employees or to help them finance their coverage, and would create regional purchasing pools. The plan also would create tax credits, expand Medicaid and the State Children's Health Insurance Plan, and reform insurance laws. He also said his plan would provide incentives to improve the quality of care, by promoting evidence-based medicine and more quickly getting information on advances into physicians' hands.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Duke University, and Wake Forest University have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other common conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, Baltimore, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

Health IT Privacy Milestones

Federal health officials need to develop an overall strategy for protecting patient privacy as health information technologies take off, according to a report from the Government Accountability Office. Although the Health and Human Services department has designated consumer privacy a top priority and has made some initial progress in that area, a more comprehensive approach is needed, the GAO report concluded. Specifically, HHS officials need to set milestones for integrating privacy-related initiatives and select an entity responsible for implementing these initiatives. But in comments on the report, HHS officials said setting specific milestones would hamper their ability to incorporate stakeholder ideas as they move forward. Since 2005, HHS has awarded several contracts aimed at addressing the privacy of personal health information exchanged within an electronic national health information network. In 2006, an HHS contractor selected sites to perform assessments of privacy and security policies. Also in 2006, the National Committee on Vital and Health Statistics and the American Health Information Community worked on privacy and security issues related to a nationwide health information network. The report was requested by Sen. Daniel Akaka (D-Hawaii) and Sen. Edward Kennedy (D-Mass.).

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety (this does not include user fee funds that will also go to that effort) and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Coalition for a Stronger FDA, a Washington-based consumer-, patient-, and industry-supported group, said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Medicare Generic Drug Use Rises

Generic drugs accounted for 60% of the prescriptions dispensed to people who receive benefits through either Part D or Medicare Advantage plans for the first three quarters of 2006, the Centers for Medicare and Medicaid Services announced. Generic drug use in Part D enrollees is 13% higher than for Americans who receive benefits through private payers, CMS said. In comparison, generics accounted for 53% of prescriptions dispensed to privately insured Americans last year. Greater use of generics will translate into lower costs for the Part D program and possibly expanded coverage for beneficiaries, said CMS. “We will continue to promote generics where they are available as an important strategy to keep the new drug benefit affordable over the long term,” acting administrator Leslie Norwalk said in a statement.

Edwards Proposes Health Plan

Former North Carolina Senator and 2008 presidential candidate John Edwards is calling for universal health care but modeling his proposal after a plan that is in effect in Massachusetts. The plan would essentially require all Americans to have insurance by 2012. To make coverage affordable, Sen. Edwards' plan would require employers to cover employees or to help them finance their coverage, and would create regional purchasing pools. The plan also would create tax credits, expand Medicaid and the State Children's Health Insurance Plan, and reform insurance laws. He also said his plan would provide incentives to improve the quality of care, by promoting evidence-based medicine and more quickly getting information on advances into physicians' hands.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Duke University, and Wake Forest University have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other common conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, Baltimore, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

Health IT Privacy Milestones

Federal health officials need to develop an overall strategy for protecting patient privacy as health information technologies take off, according to a report from the Government Accountability Office. Although the Health and Human Services department has designated consumer privacy a top priority and has made some initial progress in that area, a more comprehensive approach is needed, the GAO report concluded. Specifically, HHS officials need to set milestones for integrating privacy-related initiatives and select an entity responsible for implementing these initiatives. But in comments on the report, HHS officials said setting specific milestones would hamper their ability to incorporate stakeholder ideas as they move forward. Since 2005, HHS has awarded several contracts aimed at addressing the privacy of personal health information exchanged within an electronic national health information network. In 2006, an HHS contractor selected sites to perform assessments of privacy and security policies. Also in 2006, the National Committee on Vital and Health Statistics and the American Health Information Community worked on privacy and security issues related to a nationwide health information network. The report was requested by Sen. Daniel Akaka (D-Hawaii) and Sen. Edward Kennedy (D-Mass.).

Hospitals are reporting consistent quality improvements across five clinical areas as part of a Medicare pay-for-performance demonstration, officials at the Centers for Medicare and Medicaid Services have announced.

In the second year of the demonstration project, the average improvement across the more than 250 participating hospitals was 6.7%, according to the CMS. Agency officials also reported a total gain of 11.8% over the 2-year period.

"The results today provide more solid evidence that pay for performance is working to improve the quality of health care at our nation's hospitals," Herb Kuhn, CMS acting deputy administrator, said during a teleconference to announce the second-year results of the Premier Hospital Quality Improvement Demonstration.

The program was launched in October 2003 by the CMS and the Premier Inc. health care alliance to test whether providing incentives to hospitals would help to speed quality gains. Under the demonstration, the CMS provides financial incentives to the top 20% of high-scoring hospitals in each of five clinical areas—acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement. Performance in the five clinical areas is measured by more than 30 nationally recognized quality standards.

Hospitals in the top 10% receive a 2% incentive payment, while hospitals in the next 10% receive a 1% payment. Any hospital that ranks in the top half in each clinical area is recognized on the CMS Web site. In the third year of the program—from October 2006 to September 2007—hospitals that fail to improve over baseline could face penalties.

In the second year of the program, the CMS paid more than $8.6 million to 115 high-performing hospitals.

Data from the second year showed that hospitals improved in acute myocardial infarction (87.5% to 94.4%); coronary artery bypass graft (84.8% to 93.8%); heart failure (64.5% to 82.4%); pneumonia (69.3% to 85.8%); and hip and knee replacement (84.6% to 93.4%).

"This demonstration is really helping us to understand what's needed to improve our health care system," Mr. Kuhn said.

As part of the Deficit Reduction Act of 2005, the CMS is required to propose a program design for a value-based purchasing system for hospitals for potential implementation in fiscal year 2009. That report to Congress is expected sometime this summer.

In the meantime, the CMS is seeking input from health care providers, consumers, and purchasers.

More information about the hospital demonstration program is available online at www.cms.hhs.gov/HospitalQualityInits

Hospitals are reporting consistent quality improvements across five clinical areas as part of a Medicare pay-for-performance demonstration, officials at the Centers for Medicare and Medicaid Services have announced.

In the second year of the demonstration project, the average improvement across the more than 250 participating hospitals was 6.7%, according to the CMS. Agency officials also reported a total gain of 11.8% over the 2-year period.

"The results today provide more solid evidence that pay for performance is working to improve the quality of health care at our nation's hospitals," Herb Kuhn, CMS acting deputy administrator, said during a teleconference to announce the second-year results of the Premier Hospital Quality Improvement Demonstration.

The program was launched in October 2003 by the CMS and the Premier Inc. health care alliance to test whether providing incentives to hospitals would help to speed quality gains. Under the demonstration, the CMS provides financial incentives to the top 20% of high-scoring hospitals in each of five clinical areas—acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement. Performance in the five clinical areas is measured by more than 30 nationally recognized quality standards.

Hospitals in the top 10% receive a 2% incentive payment, while hospitals in the next 10% receive a 1% payment. Any hospital that ranks in the top half in each clinical area is recognized on the CMS Web site. In the third year of the program—from October 2006 to September 2007—hospitals that fail to improve over baseline could face penalties.

In the second year of the program, the CMS paid more than $8.6 million to 115 high-performing hospitals.

Data from the second year showed that hospitals improved in acute myocardial infarction (87.5% to 94.4%); coronary artery bypass graft (84.8% to 93.8%); heart failure (64.5% to 82.4%); pneumonia (69.3% to 85.8%); and hip and knee replacement (84.6% to 93.4%).

"This demonstration is really helping us to understand what's needed to improve our health care system," Mr. Kuhn said.

As part of the Deficit Reduction Act of 2005, the CMS is required to propose a program design for a value-based purchasing system for hospitals for potential implementation in fiscal year 2009. That report to Congress is expected sometime this summer.

In the meantime, the CMS is seeking input from health care providers, consumers, and purchasers.

More information about the hospital demonstration program is available online at www.cms.hhs.gov/HospitalQualityInits

Hospitals are reporting consistent quality improvements across five clinical areas as part of a Medicare pay-for-performance demonstration, officials at the Centers for Medicare and Medicaid Services have announced.

In the second year of the demonstration project, the average improvement across the more than 250 participating hospitals was 6.7%, according to the CMS. Agency officials also reported a total gain of 11.8% over the 2-year period.

"The results today provide more solid evidence that pay for performance is working to improve the quality of health care at our nation's hospitals," Herb Kuhn, CMS acting deputy administrator, said during a teleconference to announce the second-year results of the Premier Hospital Quality Improvement Demonstration.

The program was launched in October 2003 by the CMS and the Premier Inc. health care alliance to test whether providing incentives to hospitals would help to speed quality gains. Under the demonstration, the CMS provides financial incentives to the top 20% of high-scoring hospitals in each of five clinical areas—acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement. Performance in the five clinical areas is measured by more than 30 nationally recognized quality standards.

Hospitals in the top 10% receive a 2% incentive payment, while hospitals in the next 10% receive a 1% payment. Any hospital that ranks in the top half in each clinical area is recognized on the CMS Web site. In the third year of the program—from October 2006 to September 2007—hospitals that fail to improve over baseline could face penalties.

In the second year of the program, the CMS paid more than $8.6 million to 115 high-performing hospitals.

Data from the second year showed that hospitals improved in acute myocardial infarction (87.5% to 94.4%); coronary artery bypass graft (84.8% to 93.8%); heart failure (64.5% to 82.4%); pneumonia (69.3% to 85.8%); and hip and knee replacement (84.6% to 93.4%).

"This demonstration is really helping us to understand what's needed to improve our health care system," Mr. Kuhn said.

As part of the Deficit Reduction Act of 2005, the CMS is required to propose a program design for a value-based purchasing system for hospitals for potential implementation in fiscal year 2009. That report to Congress is expected sometime this summer.

In the meantime, the CMS is seeking input from health care providers, consumers, and purchasers.

More information about the hospital demonstration program is available online at www.cms.hhs.gov/HospitalQualityInits

The vast majority of dermatologists still aren't using electronic medical records in their practices, but those who have made the switch say they would never go back.

"It's sort of like a marriage. You've got to commit to it," said Dr. Artis P. Truett, an Owensboro, Ky., dermatologist whose practice has been virtually paperless for the last 5 years.

The transition can be daunting, especially for those who aren't comfortable with computers, but it's worth it in the long run, he said. It's made practicing easier and more efficient, and has improved the quality of care, Dr. Truett added.

But most dermatologists have been reluctant to take that leap. About 7.5% of dermatology practices have fully implemented EMRs and about 11% report some type of EMR use, the American Academy of Dermatology Association (AADA) said in a questionnaire submitted to the Certification Commission for Healthcare Information Technology (CCHIT).

Some may be wary of the financial investment in EMR software, hardware, and maintenance. But others may be waiting for the right system. Current EMR systems lack the functionality needed to meet the needs of dermatologists, the AADA said.

Specifically, AADA cited a need for digital-imaging capture and storage, anatomical graphic management capabilities, and dermatopathology lab interface for biopsy tracking and management.

"Very few of the [software] programs are geared toward us," said Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa.

Many of the EMR products on the market today don't have the features that allow physicians to keep disease registries that could be helpful as more insurance companies move toward pay-for-performance programs, he said. Dermatologists also need functionality that will help to make coding more exact and efficient. Interoperability that would allow for the easy transfer of laboratory results is also important, he said.

But although it's easy to get hung up on what's missing from many systems, most still have the basic features necessary for keeping a complete medical record and for billing an insurance company, said Dr. Neil Brody of the department of dermatology of the State University of New York, Brooklyn, who practices in Manhasset, N.Y. He was able to find software that also allows him to store and display clinical images.

Dr. Brody's practice went paperless—with some minor exceptions—about 3 years ago. When he went shopping for his EMR system, he found that products were sort of strung together, he said. He advises physicians who are looking for an EMR system to do their research. Try out a lot of systems and go online to find out where the industry is. And don't rely on the demonstration by the salesperson, he said.

Be skeptical about the return on investment promised by vendors, Dr. Brody cautioned. His experience has been that savings aren't realized by reducing staff.

But he said that he has found that the switch to an EMR makes his day more pleasant, and he believes the quality of care is higher. With his system, he is able to see the other medicines that the patient is taking, even when they are prescribed by another physician, and he can check for drug-drug interactions.

Where he has seen some financial benefit is in the space saved by not having to house thousands of paper charts.

Those who switch to an EMR should also expect to experience some growing pains during the transition. "In the beginning, no one is good at [using] an EMR," said Dr. Anthony Wong, a Mohs surgeon in Smithtown, N.Y.

Dr. Wong and his colleagues have been using their EMR system, which they leased instead of purchasing, for nearly 2 years. Although they are happy with the new system, he said, they had to make some minor adjustments. For example, one of his colleagues doesn't type very well, so he now uses voice recognition software to dictate his notes.

Dr. Michael Crowe, a dermatologist who practices with Dr. Truett in Owensboro, Ky., said they quickly found that it was not efficient to use the computer while in the exam room with patients. Instead, he has an assistant in the room with him who can help to enter information during the visit and can pull up photos and lab results as needed.

The vast majority of dermatologists still aren't using electronic medical records in their practices, but those who have made the switch say they would never go back.

"It's sort of like a marriage. You've got to commit to it," said Dr. Artis P. Truett, an Owensboro, Ky., dermatologist whose practice has been virtually paperless for the last 5 years.

The transition can be daunting, especially for those who aren't comfortable with computers, but it's worth it in the long run, he said. It's made practicing easier and more efficient, and has improved the quality of care, Dr. Truett added.

But most dermatologists have been reluctant to take that leap. About 7.5% of dermatology practices have fully implemented EMRs and about 11% report some type of EMR use, the American Academy of Dermatology Association (AADA) said in a questionnaire submitted to the Certification Commission for Healthcare Information Technology (CCHIT).

Some may be wary of the financial investment in EMR software, hardware, and maintenance. But others may be waiting for the right system. Current EMR systems lack the functionality needed to meet the needs of dermatologists, the AADA said.

Specifically, AADA cited a need for digital-imaging capture and storage, anatomical graphic management capabilities, and dermatopathology lab interface for biopsy tracking and management.

"Very few of the [software] programs are geared toward us," said Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa.

Many of the EMR products on the market today don't have the features that allow physicians to keep disease registries that could be helpful as more insurance companies move toward pay-for-performance programs, he said. Dermatologists also need functionality that will help to make coding more exact and efficient. Interoperability that would allow for the easy transfer of laboratory results is also important, he said.

But although it's easy to get hung up on what's missing from many systems, most still have the basic features necessary for keeping a complete medical record and for billing an insurance company, said Dr. Neil Brody of the department of dermatology of the State University of New York, Brooklyn, who practices in Manhasset, N.Y. He was able to find software that also allows him to store and display clinical images.

Dr. Brody's practice went paperless—with some minor exceptions—about 3 years ago. When he went shopping for his EMR system, he found that products were sort of strung together, he said. He advises physicians who are looking for an EMR system to do their research. Try out a lot of systems and go online to find out where the industry is. And don't rely on the demonstration by the salesperson, he said.

Be skeptical about the return on investment promised by vendors, Dr. Brody cautioned. His experience has been that savings aren't realized by reducing staff.

But he said that he has found that the switch to an EMR makes his day more pleasant, and he believes the quality of care is higher. With his system, he is able to see the other medicines that the patient is taking, even when they are prescribed by another physician, and he can check for drug-drug interactions.

Where he has seen some financial benefit is in the space saved by not having to house thousands of paper charts.

Those who switch to an EMR should also expect to experience some growing pains during the transition. "In the beginning, no one is good at [using] an EMR," said Dr. Anthony Wong, a Mohs surgeon in Smithtown, N.Y.

Dr. Wong and his colleagues have been using their EMR system, which they leased instead of purchasing, for nearly 2 years. Although they are happy with the new system, he said, they had to make some minor adjustments. For example, one of his colleagues doesn't type very well, so he now uses voice recognition software to dictate his notes.

Dr. Michael Crowe, a dermatologist who practices with Dr. Truett in Owensboro, Ky., said they quickly found that it was not efficient to use the computer while in the exam room with patients. Instead, he has an assistant in the room with him who can help to enter information during the visit and can pull up photos and lab results as needed.

The vast majority of dermatologists still aren't using electronic medical records in their practices, but those who have made the switch say they would never go back.

"It's sort of like a marriage. You've got to commit to it," said Dr. Artis P. Truett, an Owensboro, Ky., dermatologist whose practice has been virtually paperless for the last 5 years.

The transition can be daunting, especially for those who aren't comfortable with computers, but it's worth it in the long run, he said. It's made practicing easier and more efficient, and has improved the quality of care, Dr. Truett added.

But most dermatologists have been reluctant to take that leap. About 7.5% of dermatology practices have fully implemented EMRs and about 11% report some type of EMR use, the American Academy of Dermatology Association (AADA) said in a questionnaire submitted to the Certification Commission for Healthcare Information Technology (CCHIT).

Some may be wary of the financial investment in EMR software, hardware, and maintenance. But others may be waiting for the right system. Current EMR systems lack the functionality needed to meet the needs of dermatologists, the AADA said.

Specifically, AADA cited a need for digital-imaging capture and storage, anatomical graphic management capabilities, and dermatopathology lab interface for biopsy tracking and management.

"Very few of the [software] programs are geared toward us," said Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa.

Many of the EMR products on the market today don't have the features that allow physicians to keep disease registries that could be helpful as more insurance companies move toward pay-for-performance programs, he said. Dermatologists also need functionality that will help to make coding more exact and efficient. Interoperability that would allow for the easy transfer of laboratory results is also important, he said.

But although it's easy to get hung up on what's missing from many systems, most still have the basic features necessary for keeping a complete medical record and for billing an insurance company, said Dr. Neil Brody of the department of dermatology of the State University of New York, Brooklyn, who practices in Manhasset, N.Y. He was able to find software that also allows him to store and display clinical images.

Dr. Brody's practice went paperless—with some minor exceptions—about 3 years ago. When he went shopping for his EMR system, he found that products were sort of strung together, he said. He advises physicians who are looking for an EMR system to do their research. Try out a lot of systems and go online to find out where the industry is. And don't rely on the demonstration by the salesperson, he said.

Be skeptical about the return on investment promised by vendors, Dr. Brody cautioned. His experience has been that savings aren't realized by reducing staff.

But he said that he has found that the switch to an EMR makes his day more pleasant, and he believes the quality of care is higher. With his system, he is able to see the other medicines that the patient is taking, even when they are prescribed by another physician, and he can check for drug-drug interactions.

Where he has seen some financial benefit is in the space saved by not having to house thousands of paper charts.

Those who switch to an EMR should also expect to experience some growing pains during the transition. "In the beginning, no one is good at [using] an EMR," said Dr. Anthony Wong, a Mohs surgeon in Smithtown, N.Y.

Dr. Wong and his colleagues have been using their EMR system, which they leased instead of purchasing, for nearly 2 years. Although they are happy with the new system, he said, they had to make some minor adjustments. For example, one of his colleagues doesn't type very well, so he now uses voice recognition software to dictate his notes.

Dr. Michael Crowe, a dermatologist who practices with Dr. Truett in Owensboro, Ky., said they quickly found that it was not efficient to use the computer while in the exam room with patients. Instead, he has an assistant in the room with him who can help to enter information during the visit and can pull up photos and lab results as needed.

ACOG Committee on Sex Selection

While it is ethical for physicians to use sex selection to prevent sex-linked genetic disorders, they should not participate in sex selection for other reasons, according to an opinion from the American College of Obstetricians and Gynecologists Committee on Ethics. The committee opposed the use of sex selection for social, economic, cultural, and personal reasons, including family balancing. However, in some cases physicians may not be able to avoid providing information that may lead to sex selection. For example, when performing a procedure that reveals the sex of the future child, the information should not be withheld from a pregnant woman who requests it, the committee wrote. “To minimize the possibility that they will unknowingly participate in sex selection, physicians should foster open communication with patients aimed at clarifying patients' goals,” the committee wrote. “Although health care providers may not ethically withhold medical information from patients who request it, they are not obligated to perform an abortion, or other medical procedure, to select fetal sex.”

FDA Guidance on Cord Blood Products

Under draft guidance published in January, the Food and Drug Administration outlined a new approach for regulating cord blood hematopoietic stem/progenitor cells that are minimally manipulated, used to replenish bone marrow in patients with blood-related malignancies, and used in recipients unrelated to the donor of the stem cells. Under the draft guidance, cord blood banks could cite existing data in their biologics licensure applications, instead of having to submit their own clinical data. “Cord blood hematopoietic stem/progenitor cells offer the potential for tremendous therapeutic benefit,” Dr. Jesse Goodman, director of FDA's Center for Biologics Evaluation and Research, said in a statement. “In this draft guidance, FDA provides recommendations on a streamlined path to licensure for these promising products that also ensures their safety and effectiveness.” The document is available at

www.fda.gov/cber/gdlns/cordbld.pdf

Pharmacy Refusals Likely to Continue

Despite FDA's decision to make emergency contraception available to women 18 and older without a prescription, women may still encounter access problems, according to a report from the National Women's Law Center. Since emergency contraception is now available behind the counter, women must still ask a pharmacist or other pharmacy personnel to get it, the group noted in a report outlining various pharmacy refusal laws and practices. And the report noted that Michigan and Missouri both have pending legislation to counteract FDA's decision.

Birth Defects Tab: $2.6 Billion

Birth defects accounted for 139,100 hospital admissions and $2.6 billion in treatment costs in 2004, according to a report compiled by the Agency for Healthcare Research and Quality. Heart anomalies, such as atrial and ventricular septal defects, were the deadliest and accounted for the highest number of admissions—one-third—and the highest costs, $1.4 billion. The second-most common cause of admission was for digestive conditions such as pyloric stenosis. According to the report, between 1997 and 2004, the rate of admission increased by more than 25% for these two leading categories of birth defects, when they were listed as either the principal or coexisting condition. Genitourinary defects and nervous system anomalies accounted for the third- and fourth-leading causes of admissions, followed by other problems such as cleft palate, hip deformity, skull and facial bone defects, and spinal and foot deformities. The report can be found at

www.hcup-us.ahrq.gov/reports/statbriefs/sb24.pdf

Antidepressant Side Effects Vary

Second-generation antidepressants generally have similar rates of effectiveness but have variable side effects, according to an analysis from the Agency for Healthcare Research and Quality. On average, about 61% of patients will experience at least one side effect from taking a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), according to the analysis. However, the type of side effect varies by drug. AHRQ researchers analyzed 293 published studies to compare the risks and benefits of second-generation antidepressants in the treatment of major depressive disorder, dysthymia, and subsyndromal depression. “Second-generation antidepressants provide hope for many of the millions of Americans who struggle with depression,” Dr. Carolyn Clancy, AHRQ director, said in a statement. “But often, trying to find the right drug is trial and error, and in many cases relief is temporary or comes with serious side effects. It's clear we need more evidence to help patients and their doctors make the best choices.” The study is available at

http://effectivehealthcare.ahrq.gov

ACOG Committee on Sex Selection

While it is ethical for physicians to use sex selection to prevent sex-linked genetic disorders, they should not participate in sex selection for other reasons, according to an opinion from the American College of Obstetricians and Gynecologists Committee on Ethics. The committee opposed the use of sex selection for social, economic, cultural, and personal reasons, including family balancing. However, in some cases physicians may not be able to avoid providing information that may lead to sex selection. For example, when performing a procedure that reveals the sex of the future child, the information should not be withheld from a pregnant woman who requests it, the committee wrote. “To minimize the possibility that they will unknowingly participate in sex selection, physicians should foster open communication with patients aimed at clarifying patients' goals,” the committee wrote. “Although health care providers may not ethically withhold medical information from patients who request it, they are not obligated to perform an abortion, or other medical procedure, to select fetal sex.”

FDA Guidance on Cord Blood Products

Under draft guidance published in January, the Food and Drug Administration outlined a new approach for regulating cord blood hematopoietic stem/progenitor cells that are minimally manipulated, used to replenish bone marrow in patients with blood-related malignancies, and used in recipients unrelated to the donor of the stem cells. Under the draft guidance, cord blood banks could cite existing data in their biologics licensure applications, instead of having to submit their own clinical data. “Cord blood hematopoietic stem/progenitor cells offer the potential for tremendous therapeutic benefit,” Dr. Jesse Goodman, director of FDA's Center for Biologics Evaluation and Research, said in a statement. “In this draft guidance, FDA provides recommendations on a streamlined path to licensure for these promising products that also ensures their safety and effectiveness.” The document is available at

www.fda.gov/cber/gdlns/cordbld.pdf

Pharmacy Refusals Likely to Continue

Despite FDA's decision to make emergency contraception available to women 18 and older without a prescription, women may still encounter access problems, according to a report from the National Women's Law Center. Since emergency contraception is now available behind the counter, women must still ask a pharmacist or other pharmacy personnel to get it, the group noted in a report outlining various pharmacy refusal laws and practices. And the report noted that Michigan and Missouri both have pending legislation to counteract FDA's decision.

Birth Defects Tab: $2.6 Billion

Birth defects accounted for 139,100 hospital admissions and $2.6 billion in treatment costs in 2004, according to a report compiled by the Agency for Healthcare Research and Quality. Heart anomalies, such as atrial and ventricular septal defects, were the deadliest and accounted for the highest number of admissions—one-third—and the highest costs, $1.4 billion. The second-most common cause of admission was for digestive conditions such as pyloric stenosis. According to the report, between 1997 and 2004, the rate of admission increased by more than 25% for these two leading categories of birth defects, when they were listed as either the principal or coexisting condition. Genitourinary defects and nervous system anomalies accounted for the third- and fourth-leading causes of admissions, followed by other problems such as cleft palate, hip deformity, skull and facial bone defects, and spinal and foot deformities. The report can be found at

www.hcup-us.ahrq.gov/reports/statbriefs/sb24.pdf

Antidepressant Side Effects Vary

Second-generation antidepressants generally have similar rates of effectiveness but have variable side effects, according to an analysis from the Agency for Healthcare Research and Quality. On average, about 61% of patients will experience at least one side effect from taking a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), according to the analysis. However, the type of side effect varies by drug. AHRQ researchers analyzed 293 published studies to compare the risks and benefits of second-generation antidepressants in the treatment of major depressive disorder, dysthymia, and subsyndromal depression. “Second-generation antidepressants provide hope for many of the millions of Americans who struggle with depression,” Dr. Carolyn Clancy, AHRQ director, said in a statement. “But often, trying to find the right drug is trial and error, and in many cases relief is temporary or comes with serious side effects. It's clear we need more evidence to help patients and their doctors make the best choices.” The study is available at

http://effectivehealthcare.ahrq.gov

ACOG Committee on Sex Selection

While it is ethical for physicians to use sex selection to prevent sex-linked genetic disorders, they should not participate in sex selection for other reasons, according to an opinion from the American College of Obstetricians and Gynecologists Committee on Ethics. The committee opposed the use of sex selection for social, economic, cultural, and personal reasons, including family balancing. However, in some cases physicians may not be able to avoid providing information that may lead to sex selection. For example, when performing a procedure that reveals the sex of the future child, the information should not be withheld from a pregnant woman who requests it, the committee wrote. “To minimize the possibility that they will unknowingly participate in sex selection, physicians should foster open communication with patients aimed at clarifying patients' goals,” the committee wrote. “Although health care providers may not ethically withhold medical information from patients who request it, they are not obligated to perform an abortion, or other medical procedure, to select fetal sex.”

FDA Guidance on Cord Blood Products

Under draft guidance published in January, the Food and Drug Administration outlined a new approach for regulating cord blood hematopoietic stem/progenitor cells that are minimally manipulated, used to replenish bone marrow in patients with blood-related malignancies, and used in recipients unrelated to the donor of the stem cells. Under the draft guidance, cord blood banks could cite existing data in their biologics licensure applications, instead of having to submit their own clinical data. “Cord blood hematopoietic stem/progenitor cells offer the potential for tremendous therapeutic benefit,” Dr. Jesse Goodman, director of FDA's Center for Biologics Evaluation and Research, said in a statement. “In this draft guidance, FDA provides recommendations on a streamlined path to licensure for these promising products that also ensures their safety and effectiveness.” The document is available at

www.fda.gov/cber/gdlns/cordbld.pdf

Pharmacy Refusals Likely to Continue

Despite FDA's decision to make emergency contraception available to women 18 and older without a prescription, women may still encounter access problems, according to a report from the National Women's Law Center. Since emergency contraception is now available behind the counter, women must still ask a pharmacist or other pharmacy personnel to get it, the group noted in a report outlining various pharmacy refusal laws and practices. And the report noted that Michigan and Missouri both have pending legislation to counteract FDA's decision.

Birth Defects Tab: $2.6 Billion

Birth defects accounted for 139,100 hospital admissions and $2.6 billion in treatment costs in 2004, according to a report compiled by the Agency for Healthcare Research and Quality. Heart anomalies, such as atrial and ventricular septal defects, were the deadliest and accounted for the highest number of admissions—one-third—and the highest costs, $1.4 billion. The second-most common cause of admission was for digestive conditions such as pyloric stenosis. According to the report, between 1997 and 2004, the rate of admission increased by more than 25% for these two leading categories of birth defects, when they were listed as either the principal or coexisting condition. Genitourinary defects and nervous system anomalies accounted for the third- and fourth-leading causes of admissions, followed by other problems such as cleft palate, hip deformity, skull and facial bone defects, and spinal and foot deformities. The report can be found at

www.hcup-us.ahrq.gov/reports/statbriefs/sb24.pdf

Antidepressant Side Effects Vary

Second-generation antidepressants generally have similar rates of effectiveness but have variable side effects, according to an analysis from the Agency for Healthcare Research and Quality. On average, about 61% of patients will experience at least one side effect from taking a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), according to the analysis. However, the type of side effect varies by drug. AHRQ researchers analyzed 293 published studies to compare the risks and benefits of second-generation antidepressants in the treatment of major depressive disorder, dysthymia, and subsyndromal depression. “Second-generation antidepressants provide hope for many of the millions of Americans who struggle with depression,” Dr. Carolyn Clancy, AHRQ director, said in a statement. “But often, trying to find the right drug is trial and error, and in many cases relief is temporary or comes with serious side effects. It's clear we need more evidence to help patients and their doctors make the best choices.” The study is available at

http://effectivehealthcare.ahrq.gov

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year. The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year. The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year. The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

BOSTON — A controversial ad campaign aimed at encouraging women to breast-feed has increased awareness of the importance of breast-feeding and how long to do it, according to data presented at the annual meeting of the American Public Health Association.

About 68% of women surveyed after the campaign said that the best way to feed a baby is through breast-feeding, compared with 51% polled before the campaigned was launched, according to the results of a tracking survey.

Anne Merewood, director of the Breastfeeding Center at Boston Medical Center, outlined the findings of the tracking survey.

The survey examines whether attitudes about breast-feeding changed after the National Breastfeeding Awareness Campaign was launched in June 2004. Ms. Merewood was the director of the Boston-area community demonstration project, 1 of 16 community-based projects around the country that partnered with the federal government to implement the campaign at the local level.

The national campaign included television, radio, and print advertisements. The controversial television ads featured women who were far along in their pregnancies engaging in risky activities such as logrolling and riding a mechanical bull. The ad said: “You wouldn't take risks before your baby's born. Why start after?” It also stated that babies who are breast-fed are less likely to develop ear infections, respiratory illnesses, and diarrhea.

The goal of the campaign was to increase the proportion of mothers who breast-feed their babies during the early postpartum period from 69% to 75%, and from 33% to 50% after 6 months, by the year 2010.

The campaign was funded by the Office of Women's Health, part of the Department of Health and Human Services.

The Ad Council, which produced the campaign, conducted a tracking survey of 70 women aged 18–34 years from April 18 to May 15, 2004, before the launch of the ads. Officials at the Ad Council also conducted a postcampaign survey of 606 women aged 18–34 years from Sept. 9 to Sept. 22, 2005.

The two surveys show that following the national campaign, more women agreed that breast-feeding is the best way to feed a baby and fewer women endorsed formula only or a combination of formula and breast-feeding as the best method.

The number of women who said that breast-feeding and formula were equivalent dropped from 29% to 20%. The proportion of women who favored a mix of breast-feeding and formula also dropped. In 2004, 16% said a combination of breast-feeding and formula was the best approach, compared with 8% in 2005.

Only a small percentage of women—4%—said that formula was the best way to feed a baby in 2004, and that figure dropped even lower in 2005 to 2%.

The Ad Council survey also polled women on what they thought was the recommended number of months to exclusively breast-feed. In 2005, 36% of women responded that exclusive breast-feeding for 6 months was recommended, compared with 26% of women in 2004.

However, there also were some contradictions in the survey data. While only 2% of women in 2005 cited formula as the best way to feed a baby, during that same time period 32% of women also stated that infant formula is just as good as breast milk. This figure is down from 50% the previous year.

“We're seeing in the data here that women think breast-feeding is better, but don't think that formula feeding is worse,” Ms. Merewood said.

Some of this disconnect may be due to the fact that women recognize the benefits of breast-feeding, but see in their own personal experiences that formula feeding didn't harm their children, Ms. Merewood said.

This is a different point of view than the population-wide perspective that formula feeding carries risks, she said.

BOSTON — A controversial ad campaign aimed at encouraging women to breast-feed has increased awareness of the importance of breast-feeding and how long to do it, according to data presented at the annual meeting of the American Public Health Association.

About 68% of women surveyed after the campaign said that the best way to feed a baby is through breast-feeding, compared with 51% polled before the campaigned was launched, according to the results of a tracking survey.

Anne Merewood, director of the Breastfeeding Center at Boston Medical Center, outlined the findings of the tracking survey.

The survey examines whether attitudes about breast-feeding changed after the National Breastfeeding Awareness Campaign was launched in June 2004. Ms. Merewood was the director of the Boston-area community demonstration project, 1 of 16 community-based projects around the country that partnered with the federal government to implement the campaign at the local level.

The national campaign included television, radio, and print advertisements. The controversial television ads featured women who were far along in their pregnancies engaging in risky activities such as logrolling and riding a mechanical bull. The ad said: “You wouldn't take risks before your baby's born. Why start after?” It also stated that babies who are breast-fed are less likely to develop ear infections, respiratory illnesses, and diarrhea.

The goal of the campaign was to increase the proportion of mothers who breast-feed their babies during the early postpartum period from 69% to 75%, and from 33% to 50% after 6 months, by the year 2010.

The campaign was funded by the Office of Women's Health, part of the Department of Health and Human Services.

The Ad Council, which produced the campaign, conducted a tracking survey of 70 women aged 18–34 years from April 18 to May 15, 2004, before the launch of the ads. Officials at the Ad Council also conducted a postcampaign survey of 606 women aged 18–34 years from Sept. 9 to Sept. 22, 2005.

The two surveys show that following the national campaign, more women agreed that breast-feeding is the best way to feed a baby and fewer women endorsed formula only or a combination of formula and breast-feeding as the best method.

The number of women who said that breast-feeding and formula were equivalent dropped from 29% to 20%. The proportion of women who favored a mix of breast-feeding and formula also dropped. In 2004, 16% said a combination of breast-feeding and formula was the best approach, compared with 8% in 2005.

Only a small percentage of women—4%—said that formula was the best way to feed a baby in 2004, and that figure dropped even lower in 2005 to 2%.

The Ad Council survey also polled women on what they thought was the recommended number of months to exclusively breast-feed. In 2005, 36% of women responded that exclusive breast-feeding for 6 months was recommended, compared with 26% of women in 2004.

However, there also were some contradictions in the survey data. While only 2% of women in 2005 cited formula as the best way to feed a baby, during that same time period 32% of women also stated that infant formula is just as good as breast milk. This figure is down from 50% the previous year.

“We're seeing in the data here that women think breast-feeding is better, but don't think that formula feeding is worse,” Ms. Merewood said.

Some of this disconnect may be due to the fact that women recognize the benefits of breast-feeding, but see in their own personal experiences that formula feeding didn't harm their children, Ms. Merewood said.

This is a different point of view than the population-wide perspective that formula feeding carries risks, she said.

BOSTON — A controversial ad campaign aimed at encouraging women to breast-feed has increased awareness of the importance of breast-feeding and how long to do it, according to data presented at the annual meeting of the American Public Health Association.

About 68% of women surveyed after the campaign said that the best way to feed a baby is through breast-feeding, compared with 51% polled before the campaigned was launched, according to the results of a tracking survey.

Anne Merewood, director of the Breastfeeding Center at Boston Medical Center, outlined the findings of the tracking survey.

The survey examines whether attitudes about breast-feeding changed after the National Breastfeeding Awareness Campaign was launched in June 2004. Ms. Merewood was the director of the Boston-area community demonstration project, 1 of 16 community-based projects around the country that partnered with the federal government to implement the campaign at the local level.

The national campaign included television, radio, and print advertisements. The controversial television ads featured women who were far along in their pregnancies engaging in risky activities such as logrolling and riding a mechanical bull. The ad said: “You wouldn't take risks before your baby's born. Why start after?” It also stated that babies who are breast-fed are less likely to develop ear infections, respiratory illnesses, and diarrhea.

The goal of the campaign was to increase the proportion of mothers who breast-feed their babies during the early postpartum period from 69% to 75%, and from 33% to 50% after 6 months, by the year 2010.

The campaign was funded by the Office of Women's Health, part of the Department of Health and Human Services.

The Ad Council, which produced the campaign, conducted a tracking survey of 70 women aged 18–34 years from April 18 to May 15, 2004, before the launch of the ads. Officials at the Ad Council also conducted a postcampaign survey of 606 women aged 18–34 years from Sept. 9 to Sept. 22, 2005.

The two surveys show that following the national campaign, more women agreed that breast-feeding is the best way to feed a baby and fewer women endorsed formula only or a combination of formula and breast-feeding as the best method.

The number of women who said that breast-feeding and formula were equivalent dropped from 29% to 20%. The proportion of women who favored a mix of breast-feeding and formula also dropped. In 2004, 16% said a combination of breast-feeding and formula was the best approach, compared with 8% in 2005.

Only a small percentage of women—4%—said that formula was the best way to feed a baby in 2004, and that figure dropped even lower in 2005 to 2%.

The Ad Council survey also polled women on what they thought was the recommended number of months to exclusively breast-feed. In 2005, 36% of women responded that exclusive breast-feeding for 6 months was recommended, compared with 26% of women in 2004.

However, there also were some contradictions in the survey data. While only 2% of women in 2005 cited formula as the best way to feed a baby, during that same time period 32% of women also stated that infant formula is just as good as breast milk. This figure is down from 50% the previous year.

“We're seeing in the data here that women think breast-feeding is better, but don't think that formula feeding is worse,” Ms. Merewood said.

Some of this disconnect may be due to the fact that women recognize the benefits of breast-feeding, but see in their own personal experiences that formula feeding didn't harm their children, Ms. Merewood said.

This is a different point of view than the population-wide perspective that formula feeding carries risks, she said.

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23.

Physicians who are not using an NPI after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid. National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” said Aaron Hase, a CMS spokesman.

As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

As the May deadline approaches and more and more physicians get registered, the next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23.

Physicians who are not using an NPI after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid. National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” said Aaron Hase, a CMS spokesman.

As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

As the May deadline approaches and more and more physicians get registered, the next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23.

Physicians who are not using an NPI after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid. National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” said Aaron Hase, a CMS spokesman.

As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

As the May deadline approaches and more and more physicians get registered, the next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

Members of the mental health community are working on ways to improve coordination of primary care and mental health in an effort to decrease early death among individuals with serious mental illness.

Individuals being treated for serious mental illness by public mental health systems die 25 years earlier, on average, than do members of the general population, according to a report released last fall by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. About 60% of these premature deaths are attributable to medical conditions such as cardiovascular and pulmonary disease.

The report, “Morbidity and Mortality in People with Serious Mental Illness,” outlines the factors contributing to this disparity in death and disease.

“This is a virtual epidemic of death,” said Dr. Joseph Parks, medical director for the Missouri Department of Mental Health and president of the NASMHPD Medical Directors Council.

The report has become a sort of “rallying point,” Dr. Parks said. NASMHPD is in the process of drafting a position paper on this topic and has held a series of meetings with stakeholders throughout the mental health community.

The report found that the increased mortality and morbidity is attributable in large part to preventable conditions such as cardiovascular disease, diabetes, respiratory diseases, and infectious disease, including HIV/AIDS. Mental health patients also are at greater risk for death and disease because they have generally higher rates of smoking, alcohol and drug use, poor nutrition and obesity, and unsafe sexual behavior.

Second-generation antipsychotic medications also have been associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome, according to the report.

Access to health care is another significant factor in the higher morbidity and mortality among the seriously mentally ill, the report noted.

The report recommends a variety of national, state, and clinician-level solutions including:

▸ Designating the seriously mentally ill as a health disparities population.

▸ Adopting national surveillance activities on the health status of individuals with serious mental illness.

▸ Improving access to physical health care services.

▸ Promoting coordinated and integrated mental and physical health care services.

▸ Increasing Medicaid funding to cover smoking cessation and weight reduction treatments for seriously mental ill patients.

▸ Improving comprehensive health care evaluations by physicians.

One key strategy to improving coordination is moving toward the co-location of mental health and primary care services, Dr. Parks said. The body of literature on integrating care shows coordination that requires patients to shuttle from one clinic to another often breaks down over time.

Co-location models generally involve either a nurse practitioner providing primary care at a mental health site or a clinician providing psychiatric care in a primary care setting. This type of physical proximity allows providers to work off the same chart and see each other in the hallway.

This could, in turn, lead to informal discussions that improve patient care, Dr. Parks said.

There's been a piecemeal movement toward co-location, he said, with federally qualified community health centers and community mental health centers leading the way. All new federally qualified community health centers have been required to provide mental health services, along with dental care and substance abuse services.

The problem with moving toward co-location is that historically, physical health care, mental health care, and substance abuse treatment have all been separated, said Dr. Mary Ellen Foti, state medical director for the Massachusetts Department of Mental Health.

“You basically have diagnosis identified treatment silos in many states,” she said.

In addition, primary care physicians may be reluctant to take referrals of patients with serious mental illness because they feel inadequately prepared to deal with those unique issues. And many psychiatrists feel inadequately trained to handle even basic medical conditions.

It's not that providers aren't willing to coordinate their care, it's that they don't have the systems to do it well, said Dr. Foti, who was one of the editors of the NASMHPD report.

Dr. Foti is optimistic about making progress because the report takes the first step in identifying the problems and providing recommendations and solutions. Now state and federal agencies can begin to design quality improvement programs that target patients' risk factors for disease. For example, patients with serious mental illness are obviously in need of smoking cessation programs.

The implementation of evidence-based treatment guidelines combined with the widespread adoption of electronic medical records could also go a long way in improving care for the seriously mentally ill, said Dr. Clifford K. Moy, a psychiatrist based in Austin, Tex., and associate medical director for the Texas Medicaid and Healthcare Partnership.

Electronic medical records could help to ensure that physicians have complete information when patients seek either mental health or primary care treatment.

Without this, many physicians are left without a comprehensive, up-to-date view of the patient's medical needs, he said.

Members of the mental health community are working on ways to improve coordination of primary care and mental health in an effort to decrease early death among individuals with serious mental illness.

Individuals being treated for serious mental illness by public mental health systems die 25 years earlier, on average, than do members of the general population, according to a report released last fall by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. About 60% of these premature deaths are attributable to medical conditions such as cardiovascular and pulmonary disease.

The report, “Morbidity and Mortality in People with Serious Mental Illness,” outlines the factors contributing to this disparity in death and disease.

“This is a virtual epidemic of death,” said Dr. Joseph Parks, medical director for the Missouri Department of Mental Health and president of the NASMHPD Medical Directors Council.

The report has become a sort of “rallying point,” Dr. Parks said. NASMHPD is in the process of drafting a position paper on this topic and has held a series of meetings with stakeholders throughout the mental health community.

The report found that the increased mortality and morbidity is attributable in large part to preventable conditions such as cardiovascular disease, diabetes, respiratory diseases, and infectious disease, including HIV/AIDS. Mental health patients also are at greater risk for death and disease because they have generally higher rates of smoking, alcohol and drug use, poor nutrition and obesity, and unsafe sexual behavior.

Second-generation antipsychotic medications also have been associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome, according to the report.

Access to health care is another significant factor in the higher morbidity and mortality among the seriously mentally ill, the report noted.

The report recommends a variety of national, state, and clinician-level solutions including:

▸ Designating the seriously mentally ill as a health disparities population.

▸ Adopting national surveillance activities on the health status of individuals with serious mental illness.

▸ Improving access to physical health care services.

▸ Promoting coordinated and integrated mental and physical health care services.

▸ Increasing Medicaid funding to cover smoking cessation and weight reduction treatments for seriously mental ill patients.

▸ Improving comprehensive health care evaluations by physicians.

One key strategy to improving coordination is moving toward the co-location of mental health and primary care services, Dr. Parks said. The body of literature on integrating care shows coordination that requires patients to shuttle from one clinic to another often breaks down over time.

Co-location models generally involve either a nurse practitioner providing primary care at a mental health site or a clinician providing psychiatric care in a primary care setting. This type of physical proximity allows providers to work off the same chart and see each other in the hallway.

This could, in turn, lead to informal discussions that improve patient care, Dr. Parks said.

There's been a piecemeal movement toward co-location, he said, with federally qualified community health centers and community mental health centers leading the way. All new federally qualified community health centers have been required to provide mental health services, along with dental care and substance abuse services.

The problem with moving toward co-location is that historically, physical health care, mental health care, and substance abuse treatment have all been separated, said Dr. Mary Ellen Foti, state medical director for the Massachusetts Department of Mental Health.

“You basically have diagnosis identified treatment silos in many states,” she said.

In addition, primary care physicians may be reluctant to take referrals of patients with serious mental illness because they feel inadequately prepared to deal with those unique issues. And many psychiatrists feel inadequately trained to handle even basic medical conditions.

It's not that providers aren't willing to coordinate their care, it's that they don't have the systems to do it well, said Dr. Foti, who was one of the editors of the NASMHPD report.

Dr. Foti is optimistic about making progress because the report takes the first step in identifying the problems and providing recommendations and solutions. Now state and federal agencies can begin to design quality improvement programs that target patients' risk factors for disease. For example, patients with serious mental illness are obviously in need of smoking cessation programs.

The implementation of evidence-based treatment guidelines combined with the widespread adoption of electronic medical records could also go a long way in improving care for the seriously mentally ill, said Dr. Clifford K. Moy, a psychiatrist based in Austin, Tex., and associate medical director for the Texas Medicaid and Healthcare Partnership.

Electronic medical records could help to ensure that physicians have complete information when patients seek either mental health or primary care treatment.

Without this, many physicians are left without a comprehensive, up-to-date view of the patient's medical needs, he said.

Members of the mental health community are working on ways to improve coordination of primary care and mental health in an effort to decrease early death among individuals with serious mental illness.

Individuals being treated for serious mental illness by public mental health systems die 25 years earlier, on average, than do members of the general population, according to a report released last fall by the National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. About 60% of these premature deaths are attributable to medical conditions such as cardiovascular and pulmonary disease.

The report, “Morbidity and Mortality in People with Serious Mental Illness,” outlines the factors contributing to this disparity in death and disease.

“This is a virtual epidemic of death,” said Dr. Joseph Parks, medical director for the Missouri Department of Mental Health and president of the NASMHPD Medical Directors Council.

The report has become a sort of “rallying point,” Dr. Parks said. NASMHPD is in the process of drafting a position paper on this topic and has held a series of meetings with stakeholders throughout the mental health community.

The report found that the increased mortality and morbidity is attributable in large part to preventable conditions such as cardiovascular disease, diabetes, respiratory diseases, and infectious disease, including HIV/AIDS. Mental health patients also are at greater risk for death and disease because they have generally higher rates of smoking, alcohol and drug use, poor nutrition and obesity, and unsafe sexual behavior.

Second-generation antipsychotic medications also have been associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome, according to the report.

Access to health care is another significant factor in the higher morbidity and mortality among the seriously mentally ill, the report noted.

The report recommends a variety of national, state, and clinician-level solutions including:

▸ Designating the seriously mentally ill as a health disparities population.

▸ Adopting national surveillance activities on the health status of individuals with serious mental illness.

▸ Improving access to physical health care services.

▸ Promoting coordinated and integrated mental and physical health care services.

▸ Increasing Medicaid funding to cover smoking cessation and weight reduction treatments for seriously mental ill patients.

▸ Improving comprehensive health care evaluations by physicians.

One key strategy to improving coordination is moving toward the co-location of mental health and primary care services, Dr. Parks said. The body of literature on integrating care shows coordination that requires patients to shuttle from one clinic to another often breaks down over time.

Co-location models generally involve either a nurse practitioner providing primary care at a mental health site or a clinician providing psychiatric care in a primary care setting. This type of physical proximity allows providers to work off the same chart and see each other in the hallway.

This could, in turn, lead to informal discussions that improve patient care, Dr. Parks said.

There's been a piecemeal movement toward co-location, he said, with federally qualified community health centers and community mental health centers leading the way. All new federally qualified community health centers have been required to provide mental health services, along with dental care and substance abuse services.

The problem with moving toward co-location is that historically, physical health care, mental health care, and substance abuse treatment have all been separated, said Dr. Mary Ellen Foti, state medical director for the Massachusetts Department of Mental Health.

“You basically have diagnosis identified treatment silos in many states,” she said.

In addition, primary care physicians may be reluctant to take referrals of patients with serious mental illness because they feel inadequately prepared to deal with those unique issues. And many psychiatrists feel inadequately trained to handle even basic medical conditions.

It's not that providers aren't willing to coordinate their care, it's that they don't have the systems to do it well, said Dr. Foti, who was one of the editors of the NASMHPD report.

Dr. Foti is optimistic about making progress because the report takes the first step in identifying the problems and providing recommendations and solutions. Now state and federal agencies can begin to design quality improvement programs that target patients' risk factors for disease. For example, patients with serious mental illness are obviously in need of smoking cessation programs.

The implementation of evidence-based treatment guidelines combined with the widespread adoption of electronic medical records could also go a long way in improving care for the seriously mentally ill, said Dr. Clifford K. Moy, a psychiatrist based in Austin, Tex., and associate medical director for the Texas Medicaid and Healthcare Partnership.

Electronic medical records could help to ensure that physicians have complete information when patients seek either mental health or primary care treatment.

Without this, many physicians are left without a comprehensive, up-to-date view of the patient's medical needs, he said.

BOSTON — In the event of an avian influenza pandemic, old-fashioned containment strategies will need to be the first line of defense to limit exposure, David Heyman, a terrorism expert, said at the annual meeting of the American Public Health Association.

The best countermeasure in the case of a pandemic is vaccine, but vaccine is unlikely to be available for at least 4–6 months after the onset of the outbreak.

Antiviral treatment could help improve outcomes but has been shown to have only a modest effect on transmission and may also be in short supply in the event of an influenza pandemic, said Mr. Heyman, director and senior fellow for the Center for Strategic and International Studies' Homeland Security Program in Washington.

The U.S. strategy for responding to an avian influenza pandemic has so far centered on vaccine production and development, stockpiling of antiviral medications, and state plans for distribution. Although it is important to focus on vaccines and antivirals, those treatments are unlikely to be ready in time for the first wave of a pandemic, he said.

“There are a number of tools in our toolbox. The strategy needs to be figured out. We don't have a specific strategy right now,” Mr. Hewitt said.

One factor that will be key to bringing a pandemic under control would be to slow transmission until vaccines and other medicines become available. Some of the possible elements of a disease-containment strategy that are being considered by the U.S. government include closing schools, encouraging social distancing, voluntary household quarantines, and masking and good infection control.

It is important that the least restrictive measures necessary are used, and the public must be engaged as a partner in the response, he said. “They need to be educated, starting today.”

However, implementing such containment strategies would be a challenge because many people are resistant to strategies that involve quarantine because of “the historical use of quarantines that led to deprivation of rights and privacy,” he said.

BOSTON — In the event of an avian influenza pandemic, old-fashioned containment strategies will need to be the first line of defense to limit exposure, David Heyman, a terrorism expert, said at the annual meeting of the American Public Health Association.

The best countermeasure in the case of a pandemic is vaccine, but vaccine is unlikely to be available for at least 4–6 months after the onset of the outbreak.

Antiviral treatment could help improve outcomes but has been shown to have only a modest effect on transmission and may also be in short supply in the event of an influenza pandemic, said Mr. Heyman, director and senior fellow for the Center for Strategic and International Studies' Homeland Security Program in Washington.

The U.S. strategy for responding to an avian influenza pandemic has so far centered on vaccine production and development, stockpiling of antiviral medications, and state plans for distribution. Although it is important to focus on vaccines and antivirals, those treatments are unlikely to be ready in time for the first wave of a pandemic, he said.

“There are a number of tools in our toolbox. The strategy needs to be figured out. We don't have a specific strategy right now,” Mr. Hewitt said.

One factor that will be key to bringing a pandemic under control would be to slow transmission until vaccines and other medicines become available. Some of the possible elements of a disease-containment strategy that are being considered by the U.S. government include closing schools, encouraging social distancing, voluntary household quarantines, and masking and good infection control.

It is important that the least restrictive measures necessary are used, and the public must be engaged as a partner in the response, he said. “They need to be educated, starting today.”

However, implementing such containment strategies would be a challenge because many people are resistant to strategies that involve quarantine because of “the historical use of quarantines that led to deprivation of rights and privacy,” he said.

BOSTON — In the event of an avian influenza pandemic, old-fashioned containment strategies will need to be the first line of defense to limit exposure, David Heyman, a terrorism expert, said at the annual meeting of the American Public Health Association.

The best countermeasure in the case of a pandemic is vaccine, but vaccine is unlikely to be available for at least 4–6 months after the onset of the outbreak.

Antiviral treatment could help improve outcomes but has been shown to have only a modest effect on transmission and may also be in short supply in the event of an influenza pandemic, said Mr. Heyman, director and senior fellow for the Center for Strategic and International Studies' Homeland Security Program in Washington.

The U.S. strategy for responding to an avian influenza pandemic has so far centered on vaccine production and development, stockpiling of antiviral medications, and state plans for distribution. Although it is important to focus on vaccines and antivirals, those treatments are unlikely to be ready in time for the first wave of a pandemic, he said.

“There are a number of tools in our toolbox. The strategy needs to be figured out. We don't have a specific strategy right now,” Mr. Hewitt said.

One factor that will be key to bringing a pandemic under control would be to slow transmission until vaccines and other medicines become available. Some of the possible elements of a disease-containment strategy that are being considered by the U.S. government include closing schools, encouraging social distancing, voluntary household quarantines, and masking and good infection control.

It is important that the least restrictive measures necessary are used, and the public must be engaged as a partner in the response, he said. “They need to be educated, starting today.”

However, implementing such containment strategies would be a challenge because many people are resistant to strategies that involve quarantine because of “the historical use of quarantines that led to deprivation of rights and privacy,” he said.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced a myocardial infarction.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to myocardial infarction, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness. “The perception is that the African American community is not at risk, particularly for heart attacks. Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their myocardial infarction as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support. Other factors include a possible lack of trust of physicians by African American patients, a belief that they have not received the best medicine, and a lack of education about potential side effects.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced a myocardial infarction.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to myocardial infarction, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness. “The perception is that the African American community is not at risk, particularly for heart attacks. Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their myocardial infarction as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support. Other factors include a possible lack of trust of physicians by African American patients, a belief that they have not received the best medicine, and a lack of education about potential side effects.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced a myocardial infarction.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to myocardial infarction, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness. “The perception is that the African American community is not at risk, particularly for heart attacks. Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their myocardial infarction as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support. Other factors include a possible lack of trust of physicians by African American patients, a belief that they have not received the best medicine, and a lack of education about potential side effects.