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'Grossly Excessive' Vioxx Verdict Tossed
A federal judge threw out a $50 million damage award against Vioxx maker Merck & Co. in August, calling the amount “grossly excessive.” Judge Eldon E. Fallon of the U.S. Eastern District Court of Louisiana ordered a new trial in the case of Barnett v. Merck on the grounds that “no reasonable jury” could have awarded the plaintiff $50 million in compensatory damages. In his ruling, Judge Fallon said he found no problem with the $1 million in punitive damages award in the case, but that the jury in the new trial would have to address both issues. A New Orleans jury found in favor of the plaintiff Gerald Barnett earlier in August. Mr. Barnett, a retired special agent with the FBI, claimed that Vioxx (rofecoxib) was responsible for his 2002 heart attack. In the original trial, the jury found that Merck was negligent in failing to warn Mr. Barnett's treating physicians of the medically known risk associated with the drug.
Psoriatic Arthritis Resources
The National Psoriasis Foundation has partnered with Abbott to provide psoriatic arthritis patients with online tools to manage their symptoms. The Web site—
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. DEA Administrator Karen P. Tandy said in a statement: “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.
Raising Paget's Disease Awareness
Officials at the National Institutes of Health are aiming to get seniors better informed about Paget's disease of bone by adding information on the condition to the agency's senior health Web site. The site—
Public Concern Over Medicare Access
About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. Dr. William A. Hazel, an AMA board member, said during a press conference to announce the poll results, that the AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.
'Grossly Excessive' Vioxx Verdict Tossed
A federal judge threw out a $50 million damage award against Vioxx maker Merck & Co. in August, calling the amount “grossly excessive.” Judge Eldon E. Fallon of the U.S. Eastern District Court of Louisiana ordered a new trial in the case of Barnett v. Merck on the grounds that “no reasonable jury” could have awarded the plaintiff $50 million in compensatory damages. In his ruling, Judge Fallon said he found no problem with the $1 million in punitive damages award in the case, but that the jury in the new trial would have to address both issues. A New Orleans jury found in favor of the plaintiff Gerald Barnett earlier in August. Mr. Barnett, a retired special agent with the FBI, claimed that Vioxx (rofecoxib) was responsible for his 2002 heart attack. In the original trial, the jury found that Merck was negligent in failing to warn Mr. Barnett's treating physicians of the medically known risk associated with the drug.
Psoriatic Arthritis Resources
The National Psoriasis Foundation has partnered with Abbott to provide psoriatic arthritis patients with online tools to manage their symptoms. The Web site—
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. DEA Administrator Karen P. Tandy said in a statement: “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.
Raising Paget's Disease Awareness
Officials at the National Institutes of Health are aiming to get seniors better informed about Paget's disease of bone by adding information on the condition to the agency's senior health Web site. The site—
Public Concern Over Medicare Access
About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. Dr. William A. Hazel, an AMA board member, said during a press conference to announce the poll results, that the AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.
'Grossly Excessive' Vioxx Verdict Tossed
A federal judge threw out a $50 million damage award against Vioxx maker Merck & Co. in August, calling the amount “grossly excessive.” Judge Eldon E. Fallon of the U.S. Eastern District Court of Louisiana ordered a new trial in the case of Barnett v. Merck on the grounds that “no reasonable jury” could have awarded the plaintiff $50 million in compensatory damages. In his ruling, Judge Fallon said he found no problem with the $1 million in punitive damages award in the case, but that the jury in the new trial would have to address both issues. A New Orleans jury found in favor of the plaintiff Gerald Barnett earlier in August. Mr. Barnett, a retired special agent with the FBI, claimed that Vioxx (rofecoxib) was responsible for his 2002 heart attack. In the original trial, the jury found that Merck was negligent in failing to warn Mr. Barnett's treating physicians of the medically known risk associated with the drug.
Psoriatic Arthritis Resources
The National Psoriasis Foundation has partnered with Abbott to provide psoriatic arthritis patients with online tools to manage their symptoms. The Web site—
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. DEA Administrator Karen P. Tandy said in a statement: “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.
Raising Paget's Disease Awareness
Officials at the National Institutes of Health are aiming to get seniors better informed about Paget's disease of bone by adding information on the condition to the agency's senior health Web site. The site—
Public Concern Over Medicare Access
About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. Dr. William A. Hazel, an AMA board member, said during a press conference to announce the poll results, that the AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.
SLE Drugs Found to Trigger Osteonecrosis
The use of cytotoxic drugs and glucocorticoids are both risk factors for the occurrence of symptomatic osteonecrosis in patients with systemic lupus erythematosus, Dr. Graciela S. Alarcón of the University of Alabama, Birmingham, and her colleagues reported.
The study confirmed previous findings that glucocorticoid use in systemic lupus erythematous (SLE) patients is associated with osteonecrosis. “Our data suggest that exposure to high doses of glucocorticoids and probably the duration of use are the most important factors underlying this known association,” the researchers reported (Ann. Rheum. Dis. 2006;65:785-90).
However, the researchers noted in the study that they could not draw any definitive conclusions about the glucocorticoid association related to the route of administration, the mean dose, the cumulative dose, or the highest dose used.
The findings highlight the fact that glucocorticoids and cytotoxic drugs should be used only when “strictly indicated,” the researchers wrote.
The findings are based on a nested matched case-control design drawing on patients from a large, multiethnic, longitudinal lupus cohort—the LUMINA (Lupus in Minority Populations: Nature vs. Nurture) trial. The trial was made up of 571 SLE patients at the time the case-control study was conducted. The LUMINA study included participants from three ethnic groups—Hispanics from Texas and Puerto Rico, African Americans, and whites.
Within the LUMINA cohort, the researchers identified 33 cases of symptomatic osteonecrosis. One case was excluded because the diagnosis of osteonecrosis was made before the SLE diagnosis. Using the LUMINA database, researchers attempted to match two controls for each osteonecrosis case included in the study. Controls were matched by age, sex, ethnicity, disease duration, and study location. In five cases, only one control subject could be matched.
Researchers analyzed 91 patients (32 cases and 59 controls). Most patients (57%) were African American, 22% were Hispanics from Texas, 2% were Hispanics from Puerto Rico, and 19% were white. The mean total disease duration of patients included in the study was about 46 months.
Patients were evaluated at baseline and received follow-up care every 6 months for the first year and annually thereafter.
The results of multivariate analyses show that both cytotoxic drug use and glucocorticoid use were associated with symptomatic osteonecrosis, but the average daily dose of glucocorticoids had only “borderline significance,” according to the researchers. The odds ratio for the use of cytotoxic drugs was 3.89 when analyzed by the average daily dose of glucocorticoids and 3.04 when evaluated looking at the highest dose of glucocorticoids. The odds ratio was 1.03 for glucocorticoid use in the average dose model, as well as in the highest dose model.
There was also a “significant” negative association between osteonecrosis and serum triglycerides. In the model of average daily dose of glucocorticoids, the odds ratio was 0.99 and was statistically significant. Serum triglycerides also had an odds ratio of 0.99 in the highest dose of glucocorticoids but the significance was “borderline,” the researchers wrote.
Despite the findings related to serum triglycerides, the researchers concluded that they could not identify any protective factors for symptomatic osteonecrosis. The study also failed to show a link between other suspected risk factors for osteonecrosis, such as Raynaud's phenomenon, arthritis, and antiphospholipid antibodies.
The use of cytotoxic drugs and glucocorticoids are both risk factors for the occurrence of symptomatic osteonecrosis in patients with systemic lupus erythematosus, Dr. Graciela S. Alarcón of the University of Alabama, Birmingham, and her colleagues reported.
The study confirmed previous findings that glucocorticoid use in systemic lupus erythematous (SLE) patients is associated with osteonecrosis. “Our data suggest that exposure to high doses of glucocorticoids and probably the duration of use are the most important factors underlying this known association,” the researchers reported (Ann. Rheum. Dis. 2006;65:785-90).
However, the researchers noted in the study that they could not draw any definitive conclusions about the glucocorticoid association related to the route of administration, the mean dose, the cumulative dose, or the highest dose used.
The findings highlight the fact that glucocorticoids and cytotoxic drugs should be used only when “strictly indicated,” the researchers wrote.
The findings are based on a nested matched case-control design drawing on patients from a large, multiethnic, longitudinal lupus cohort—the LUMINA (Lupus in Minority Populations: Nature vs. Nurture) trial. The trial was made up of 571 SLE patients at the time the case-control study was conducted. The LUMINA study included participants from three ethnic groups—Hispanics from Texas and Puerto Rico, African Americans, and whites.
Within the LUMINA cohort, the researchers identified 33 cases of symptomatic osteonecrosis. One case was excluded because the diagnosis of osteonecrosis was made before the SLE diagnosis. Using the LUMINA database, researchers attempted to match two controls for each osteonecrosis case included in the study. Controls were matched by age, sex, ethnicity, disease duration, and study location. In five cases, only one control subject could be matched.
Researchers analyzed 91 patients (32 cases and 59 controls). Most patients (57%) were African American, 22% were Hispanics from Texas, 2% were Hispanics from Puerto Rico, and 19% were white. The mean total disease duration of patients included in the study was about 46 months.
Patients were evaluated at baseline and received follow-up care every 6 months for the first year and annually thereafter.
The results of multivariate analyses show that both cytotoxic drug use and glucocorticoid use were associated with symptomatic osteonecrosis, but the average daily dose of glucocorticoids had only “borderline significance,” according to the researchers. The odds ratio for the use of cytotoxic drugs was 3.89 when analyzed by the average daily dose of glucocorticoids and 3.04 when evaluated looking at the highest dose of glucocorticoids. The odds ratio was 1.03 for glucocorticoid use in the average dose model, as well as in the highest dose model.
There was also a “significant” negative association between osteonecrosis and serum triglycerides. In the model of average daily dose of glucocorticoids, the odds ratio was 0.99 and was statistically significant. Serum triglycerides also had an odds ratio of 0.99 in the highest dose of glucocorticoids but the significance was “borderline,” the researchers wrote.
Despite the findings related to serum triglycerides, the researchers concluded that they could not identify any protective factors for symptomatic osteonecrosis. The study also failed to show a link between other suspected risk factors for osteonecrosis, such as Raynaud's phenomenon, arthritis, and antiphospholipid antibodies.
The use of cytotoxic drugs and glucocorticoids are both risk factors for the occurrence of symptomatic osteonecrosis in patients with systemic lupus erythematosus, Dr. Graciela S. Alarcón of the University of Alabama, Birmingham, and her colleagues reported.
The study confirmed previous findings that glucocorticoid use in systemic lupus erythematous (SLE) patients is associated with osteonecrosis. “Our data suggest that exposure to high doses of glucocorticoids and probably the duration of use are the most important factors underlying this known association,” the researchers reported (Ann. Rheum. Dis. 2006;65:785-90).
However, the researchers noted in the study that they could not draw any definitive conclusions about the glucocorticoid association related to the route of administration, the mean dose, the cumulative dose, or the highest dose used.
The findings highlight the fact that glucocorticoids and cytotoxic drugs should be used only when “strictly indicated,” the researchers wrote.
The findings are based on a nested matched case-control design drawing on patients from a large, multiethnic, longitudinal lupus cohort—the LUMINA (Lupus in Minority Populations: Nature vs. Nurture) trial. The trial was made up of 571 SLE patients at the time the case-control study was conducted. The LUMINA study included participants from three ethnic groups—Hispanics from Texas and Puerto Rico, African Americans, and whites.
Within the LUMINA cohort, the researchers identified 33 cases of symptomatic osteonecrosis. One case was excluded because the diagnosis of osteonecrosis was made before the SLE diagnosis. Using the LUMINA database, researchers attempted to match two controls for each osteonecrosis case included in the study. Controls were matched by age, sex, ethnicity, disease duration, and study location. In five cases, only one control subject could be matched.
Researchers analyzed 91 patients (32 cases and 59 controls). Most patients (57%) were African American, 22% were Hispanics from Texas, 2% were Hispanics from Puerto Rico, and 19% were white. The mean total disease duration of patients included in the study was about 46 months.
Patients were evaluated at baseline and received follow-up care every 6 months for the first year and annually thereafter.
The results of multivariate analyses show that both cytotoxic drug use and glucocorticoid use were associated with symptomatic osteonecrosis, but the average daily dose of glucocorticoids had only “borderline significance,” according to the researchers. The odds ratio for the use of cytotoxic drugs was 3.89 when analyzed by the average daily dose of glucocorticoids and 3.04 when evaluated looking at the highest dose of glucocorticoids. The odds ratio was 1.03 for glucocorticoid use in the average dose model, as well as in the highest dose model.
There was also a “significant” negative association between osteonecrosis and serum triglycerides. In the model of average daily dose of glucocorticoids, the odds ratio was 0.99 and was statistically significant. Serum triglycerides also had an odds ratio of 0.99 in the highest dose of glucocorticoids but the significance was “borderline,” the researchers wrote.
Despite the findings related to serum triglycerides, the researchers concluded that they could not identify any protective factors for symptomatic osteonecrosis. The study also failed to show a link between other suspected risk factors for osteonecrosis, such as Raynaud's phenomenon, arthritis, and antiphospholipid antibodies.
CMS Awaits McClellan Successor
With the fight underway to avoid a proposed 5.1% physician payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.
In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for the next few weeks to aid in the transition, which he expects to be wrapped up by early October.
Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy, and there's never a great time for it,” he said.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program. “We should keep looking closely at it,” he said.
The American Medical Association praised Dr. McClellan's expertise and experience as a physician and called for a replacement who would bring similar qualifications to the job. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.
With the fight underway to avoid a proposed 5.1% physician payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.
In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for the next few weeks to aid in the transition, which he expects to be wrapped up by early October.
Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy, and there's never a great time for it,” he said.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program. “We should keep looking closely at it,” he said.
The American Medical Association praised Dr. McClellan's expertise and experience as a physician and called for a replacement who would bring similar qualifications to the job. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.
With the fight underway to avoid a proposed 5.1% physician payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.
In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for the next few weeks to aid in the transition, which he expects to be wrapped up by early October.
Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy, and there's never a great time for it,” he said.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program. “We should keep looking closely at it,” he said.
The American Medical Association praised Dr. McClellan's expertise and experience as a physician and called for a replacement who would bring similar qualifications to the job. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.
Urban Practices Face Challenges in ADHD Care
PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.
The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia. “The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.
Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.
Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.
The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.
The racial and socioeconomic makeup of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.
Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.
Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.
But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.
For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.
“The urban physicians experienced a lot more trouble getting information about ADHD,” Dr. Power said.
The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.
The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.
PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.
The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia. “The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.
Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.
Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.
The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.
The racial and socioeconomic makeup of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.
Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.
Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.
But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.
For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.
“The urban physicians experienced a lot more trouble getting information about ADHD,” Dr. Power said.
The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.
The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.
PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.
The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia. “The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.
Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.
Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.
The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.
The racial and socioeconomic makeup of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.
Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.
Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.
But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.
For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.
“The urban physicians experienced a lot more trouble getting information about ADHD,” Dr. Power said.
The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.
The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.
Teens Face Unique Risks for STDs—Biological to Behavioral
NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biological, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.
Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.
Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.
Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.
Psychological and cognitive factors also make both female and male adolescents more vulnerable.
For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.
Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use.
And they may use sexual activity as a form of rebellion against their parents.
Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.
On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs.
Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.
The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.
Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.
Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.
Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.
“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.
Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.
Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.
Cost can be a barrier for adolescents.
Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.
NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biological, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.
Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.
Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.
Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.
Psychological and cognitive factors also make both female and male adolescents more vulnerable.
For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.
Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use.
And they may use sexual activity as a form of rebellion against their parents.
Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.
On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs.
Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.
The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.
Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.
Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.
Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.
“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.
Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.
Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.
Cost can be a barrier for adolescents.
Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.
NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biological, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.
Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.
Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.
Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.
Psychological and cognitive factors also make both female and male adolescents more vulnerable.
For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.
Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use.
And they may use sexual activity as a form of rebellion against their parents.
Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.
On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs.
Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.
The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.
Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.
Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.
Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.
“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.
Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.
Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.
Cost can be a barrier for adolescents.
Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.
Volunteer Disaster Medical Assistance Teams Need You
DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.
There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.
The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.
The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers.
All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.
These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said.
The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.
Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.
The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.
Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.
A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said.
Physicians who can't volunteer for a DMAT can still help in a disaster by staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.
There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.
Other federal teams that need physician volunteers include:
▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.
▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9–10 such teams in the country.
▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.
▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.
Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said. In addition, physicians get other protections during their deployment, including federal liability protection.
But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.
Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.
To learn more about volunteering for a federal medical response team, visit www.ndms.fema.govjack.beall@dhs.gov
DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.
There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.
The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.
The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers.
All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.
These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said.
The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.
Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.
The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.
Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.
A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said.
Physicians who can't volunteer for a DMAT can still help in a disaster by staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.
There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.
Other federal teams that need physician volunteers include:
▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.
▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9–10 such teams in the country.
▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.
▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.
Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said. In addition, physicians get other protections during their deployment, including federal liability protection.
But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.
Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.
To learn more about volunteering for a federal medical response team, visit www.ndms.fema.govjack.beall@dhs.gov
DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.
There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.
The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.
The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers.
All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.
These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said.
The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.
Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.
The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.
Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.
A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said.
Physicians who can't volunteer for a DMAT can still help in a disaster by staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.
There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.
Other federal teams that need physician volunteers include:
▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.
▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9–10 such teams in the country.
▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.
▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.
Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said. In addition, physicians get other protections during their deployment, including federal liability protection.
But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.
Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.
To learn more about volunteering for a federal medical response team, visit www.ndms.fema.govjack.beall@dhs.gov
Policy & Practice
Rising Nicotine Levels
Quitting smoking may be harder than it used to be, according to a new report from the Massachusetts Department of Public Health. The report, based on data on nicotine yields between 1998 and 2004 from all tobacco companies that sell cigarettes in Massachusetts, found that nicotine levels in cigarettes have increased over the last 6 years. The overall nicotine yields increased about 10% between 1998 and 2004, according to the Department of Public Health. And in 2004, 93% of all cigarette brands tested were in the highest nicotine range, compared to 84% in 1998. Philip Morris USA disputed the findings of the Department of Public Health, saying that the analysis did not include information from 1997 and 2005 and that the machine smoking methods used to determine the level of nicotine are not an accurate way to determine the amount of nicotine delivered to a smoker's lungs.
Screening Returning Soldiers
Sen. Maria Cantwell (D-Wash.) is calling on the Department of Defense to expand a pilot program to provide comprehensive mental health screening to more soldiers returning from combat. The pilot program, based at the Fort Lewis Army base in Washington state, assesses the mental health of returning soldiers through questionnaires and interviews. Any soldiers identified as being at risk for mental health issues are scheduled for follow-up appointments. Sen. Cantwell wants to see the program used as nationwide model for the Army, Army Reserve, and Army National Guard. Expanding this program could help to address the need for greater mental health referrals in the Army, Sen. Cantwell wrote in a letter to Defense Secretary Donald Rumsfeld. Earlier this year, the Government Accountability Office reported that the Army has referred only about 23% of returning soldiers who were potentially at risk for developing posttraumatic stress disorder for mental health evaluation.
Investigating Autism Causes
Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism–one with regression of normal development around age 3 and another considered nonregressive autism that begins possibly before birth–with other developmental disorders and with normal development. Researchers will also investigate possible treatments for autism, including the antibiotic minocycline in regressive autism and the use of chelation therapy. The studies will be conducted on the NIH campus in Bethesda, Md., as part of the intramural research program of the National Institute of Mental Health. More information on the trials is available online at
Prisoner Mental Health
More than half of all inmates in prisons and jails across the country have experienced symptoms of a mental disorder, according to a report by the Justice Department's Bureau of Justice Statistics. The report found that 56% of state prisoners, 45% of federal prisoners, and 64% of inmates in jails had a recent history or symptoms of mental illness. The findings, based on national survey data, show that many prisoners reported symptoms of mania, major depression, and psychotic disorder. For example, among inmates who had reported symptoms of a mental disorder, 54% of jail inmates and 43% of state prisoners reported symptoms of mania. Thirty percent of jail inmates and 23% of state prisoners reported symptoms associated with major depression. The full report is available online at
www.ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physician questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.”
Views on Medicare Part D
Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the programs helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. And 64% of physicians agreed that it benefits private health plans and pharmaceutical companies too much, according to the results of the Kaiser survey. Physicians also reported that the program increased their day-to-day hassles. The survey, conducted between April and July, is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program.
Rising Nicotine Levels
Quitting smoking may be harder than it used to be, according to a new report from the Massachusetts Department of Public Health. The report, based on data on nicotine yields between 1998 and 2004 from all tobacco companies that sell cigarettes in Massachusetts, found that nicotine levels in cigarettes have increased over the last 6 years. The overall nicotine yields increased about 10% between 1998 and 2004, according to the Department of Public Health. And in 2004, 93% of all cigarette brands tested were in the highest nicotine range, compared to 84% in 1998. Philip Morris USA disputed the findings of the Department of Public Health, saying that the analysis did not include information from 1997 and 2005 and that the machine smoking methods used to determine the level of nicotine are not an accurate way to determine the amount of nicotine delivered to a smoker's lungs.
Screening Returning Soldiers
Sen. Maria Cantwell (D-Wash.) is calling on the Department of Defense to expand a pilot program to provide comprehensive mental health screening to more soldiers returning from combat. The pilot program, based at the Fort Lewis Army base in Washington state, assesses the mental health of returning soldiers through questionnaires and interviews. Any soldiers identified as being at risk for mental health issues are scheduled for follow-up appointments. Sen. Cantwell wants to see the program used as nationwide model for the Army, Army Reserve, and Army National Guard. Expanding this program could help to address the need for greater mental health referrals in the Army, Sen. Cantwell wrote in a letter to Defense Secretary Donald Rumsfeld. Earlier this year, the Government Accountability Office reported that the Army has referred only about 23% of returning soldiers who were potentially at risk for developing posttraumatic stress disorder for mental health evaluation.
Investigating Autism Causes
Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism–one with regression of normal development around age 3 and another considered nonregressive autism that begins possibly before birth–with other developmental disorders and with normal development. Researchers will also investigate possible treatments for autism, including the antibiotic minocycline in regressive autism and the use of chelation therapy. The studies will be conducted on the NIH campus in Bethesda, Md., as part of the intramural research program of the National Institute of Mental Health. More information on the trials is available online at
Prisoner Mental Health
More than half of all inmates in prisons and jails across the country have experienced symptoms of a mental disorder, according to a report by the Justice Department's Bureau of Justice Statistics. The report found that 56% of state prisoners, 45% of federal prisoners, and 64% of inmates in jails had a recent history or symptoms of mental illness. The findings, based on national survey data, show that many prisoners reported symptoms of mania, major depression, and psychotic disorder. For example, among inmates who had reported symptoms of a mental disorder, 54% of jail inmates and 43% of state prisoners reported symptoms of mania. Thirty percent of jail inmates and 23% of state prisoners reported symptoms associated with major depression. The full report is available online at
www.ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physician questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.”
Views on Medicare Part D
Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the programs helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. And 64% of physicians agreed that it benefits private health plans and pharmaceutical companies too much, according to the results of the Kaiser survey. Physicians also reported that the program increased their day-to-day hassles. The survey, conducted between April and July, is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program.
Rising Nicotine Levels
Quitting smoking may be harder than it used to be, according to a new report from the Massachusetts Department of Public Health. The report, based on data on nicotine yields between 1998 and 2004 from all tobacco companies that sell cigarettes in Massachusetts, found that nicotine levels in cigarettes have increased over the last 6 years. The overall nicotine yields increased about 10% between 1998 and 2004, according to the Department of Public Health. And in 2004, 93% of all cigarette brands tested were in the highest nicotine range, compared to 84% in 1998. Philip Morris USA disputed the findings of the Department of Public Health, saying that the analysis did not include information from 1997 and 2005 and that the machine smoking methods used to determine the level of nicotine are not an accurate way to determine the amount of nicotine delivered to a smoker's lungs.
Screening Returning Soldiers
Sen. Maria Cantwell (D-Wash.) is calling on the Department of Defense to expand a pilot program to provide comprehensive mental health screening to more soldiers returning from combat. The pilot program, based at the Fort Lewis Army base in Washington state, assesses the mental health of returning soldiers through questionnaires and interviews. Any soldiers identified as being at risk for mental health issues are scheduled for follow-up appointments. Sen. Cantwell wants to see the program used as nationwide model for the Army, Army Reserve, and Army National Guard. Expanding this program could help to address the need for greater mental health referrals in the Army, Sen. Cantwell wrote in a letter to Defense Secretary Donald Rumsfeld. Earlier this year, the Government Accountability Office reported that the Army has referred only about 23% of returning soldiers who were potentially at risk for developing posttraumatic stress disorder for mental health evaluation.
Investigating Autism Causes
Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism–one with regression of normal development around age 3 and another considered nonregressive autism that begins possibly before birth–with other developmental disorders and with normal development. Researchers will also investigate possible treatments for autism, including the antibiotic minocycline in regressive autism and the use of chelation therapy. The studies will be conducted on the NIH campus in Bethesda, Md., as part of the intramural research program of the National Institute of Mental Health. More information on the trials is available online at
Prisoner Mental Health
More than half of all inmates in prisons and jails across the country have experienced symptoms of a mental disorder, according to a report by the Justice Department's Bureau of Justice Statistics. The report found that 56% of state prisoners, 45% of federal prisoners, and 64% of inmates in jails had a recent history or symptoms of mental illness. The findings, based on national survey data, show that many prisoners reported symptoms of mania, major depression, and psychotic disorder. For example, among inmates who had reported symptoms of a mental disorder, 54% of jail inmates and 43% of state prisoners reported symptoms of mania. Thirty percent of jail inmates and 23% of state prisoners reported symptoms associated with major depression. The full report is available online at
www.ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physician questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.”
Views on Medicare Part D
Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the programs helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. And 64% of physicians agreed that it benefits private health plans and pharmaceutical companies too much, according to the results of the Kaiser survey. Physicians also reported that the program increased their day-to-day hassles. The survey, conducted between April and July, is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program.
CMS Administrator Resigns, Touts Progress on Medicare Part D Benefit
As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had yet been named.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration, said he is considering a move to a think tank in the Washington area.
In a press briefing announcing his resignation, Dr. McClellan said he would stay on at CMS for the next few weeks to aid in the transition.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program.
The American Medical Association praised his expertise and experience as a physician and called for a replacement with similar qualifications. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had yet been named.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration, said he is considering a move to a think tank in the Washington area.
In a press briefing announcing his resignation, Dr. McClellan said he would stay on at CMS for the next few weeks to aid in the transition.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program.
The American Medical Association praised his expertise and experience as a physician and called for a replacement with similar qualifications. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.
Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 21/2-year tenure with the agency. At press time, no acting or permanent replacement had yet been named.
Dr. McClellan, who previously served as commissioner of the Food and Drug Administration, said he is considering a move to a think tank in the Washington area.
In a press briefing announcing his resignation, Dr. McClellan said he would stay on at CMS for the next few weeks to aid in the transition.
He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.
There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction. And regardless of the outcomes of this year's midterm congressional elections, Dr. McClellan said he expects to see continued congressional oversight of the program.
The American Medical Association praised his expertise and experience as a physician and called for a replacement with similar qualifications. “It is our hope, that before leaving CMS, Dr. McClellan will intensify his efforts to help physicians provide the best possible care to Medicare patients by supporting congressional efforts to ensure that the 2007 Medicare physician payment update will reflect the increase in physicians' practice costs,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.
Internet Sites Show Potential as Smoking Cessation Adjunct
ORLANDO – Smoking cessation Web sites show potential as an add-on to traditional smoking cessation treatments, according to two studies presented at the annual meeting of the Society for Research on Nicotine and Tobacco.
Sandra Japuntich of the University of Wisconsin-Madison, who presented the results of a study looking at the effects of Web site use on cessation and smoking relapse, said that smoking cessation Web sites are extremely prevalent and smokers are making use of them.
Ms. Japuntich and her colleagues randomized 284 smokers to either the experimental group–three one-on-one counseling sessions, bupropion, and 90 days of access to a smoking cessation Web site–or the control group–counseling and bupropion alone. GlaxoSmithKline provided bupropion for the study.
The researchers selected smokers who were motivated to quit. Those in the experimental group had to log in to the Web site once a day on computers with dial-up Internet access provided by the researchers.
The site included graphs to chart how the participants were doing in their quit attempts, a journal section, search features, and personal recommendations.
There were no statistically significant effects on either cessation or relapse prevention at 3 or 6 months, according to Ms. Japuntich. However, the participants who used the Web site more were more likely to stay abstinent at 3 months and 6 months, she said.
The results of another study reported at the meeting also showed the potential of the Internet to add to existing treatments. Lindsay Turner and her colleagues from the University of Illinois at Chicago studied the use of phone calls and Web site access to boost the success rates of group-based smoking counseling programs for adolescents.
The researchers randomized 351 high school students to receive the American Lung Association's Not On Tobacco (NOT) cessation program alone or the cessation program plus access to an antismoking Web site and phone calls from the group facilitator.
At the end of treatment, the quit rates were 8.5% among the standard care group and 12.2% among those smokers who also received Web site and phone support. At 3 months, the quit rate was 15.7% among the standard care group and 20.4% among the standard care plus group, Ms. Turner reported.
The researchers also compared the Web site effects with the phone support effects among the students and found that access to the Web site had a much greater effect on quitting than did phone support. Overall, the results show that Web site use had a prolonged effect on cessation, she said in an interview.
ORLANDO – Smoking cessation Web sites show potential as an add-on to traditional smoking cessation treatments, according to two studies presented at the annual meeting of the Society for Research on Nicotine and Tobacco.
Sandra Japuntich of the University of Wisconsin-Madison, who presented the results of a study looking at the effects of Web site use on cessation and smoking relapse, said that smoking cessation Web sites are extremely prevalent and smokers are making use of them.
Ms. Japuntich and her colleagues randomized 284 smokers to either the experimental group–three one-on-one counseling sessions, bupropion, and 90 days of access to a smoking cessation Web site–or the control group–counseling and bupropion alone. GlaxoSmithKline provided bupropion for the study.
The researchers selected smokers who were motivated to quit. Those in the experimental group had to log in to the Web site once a day on computers with dial-up Internet access provided by the researchers.
The site included graphs to chart how the participants were doing in their quit attempts, a journal section, search features, and personal recommendations.
There were no statistically significant effects on either cessation or relapse prevention at 3 or 6 months, according to Ms. Japuntich. However, the participants who used the Web site more were more likely to stay abstinent at 3 months and 6 months, she said.
The results of another study reported at the meeting also showed the potential of the Internet to add to existing treatments. Lindsay Turner and her colleagues from the University of Illinois at Chicago studied the use of phone calls and Web site access to boost the success rates of group-based smoking counseling programs for adolescents.
The researchers randomized 351 high school students to receive the American Lung Association's Not On Tobacco (NOT) cessation program alone or the cessation program plus access to an antismoking Web site and phone calls from the group facilitator.
At the end of treatment, the quit rates were 8.5% among the standard care group and 12.2% among those smokers who also received Web site and phone support. At 3 months, the quit rate was 15.7% among the standard care group and 20.4% among the standard care plus group, Ms. Turner reported.
The researchers also compared the Web site effects with the phone support effects among the students and found that access to the Web site had a much greater effect on quitting than did phone support. Overall, the results show that Web site use had a prolonged effect on cessation, she said in an interview.
ORLANDO – Smoking cessation Web sites show potential as an add-on to traditional smoking cessation treatments, according to two studies presented at the annual meeting of the Society for Research on Nicotine and Tobacco.
Sandra Japuntich of the University of Wisconsin-Madison, who presented the results of a study looking at the effects of Web site use on cessation and smoking relapse, said that smoking cessation Web sites are extremely prevalent and smokers are making use of them.
Ms. Japuntich and her colleagues randomized 284 smokers to either the experimental group–three one-on-one counseling sessions, bupropion, and 90 days of access to a smoking cessation Web site–or the control group–counseling and bupropion alone. GlaxoSmithKline provided bupropion for the study.
The researchers selected smokers who were motivated to quit. Those in the experimental group had to log in to the Web site once a day on computers with dial-up Internet access provided by the researchers.
The site included graphs to chart how the participants were doing in their quit attempts, a journal section, search features, and personal recommendations.
There were no statistically significant effects on either cessation or relapse prevention at 3 or 6 months, according to Ms. Japuntich. However, the participants who used the Web site more were more likely to stay abstinent at 3 months and 6 months, she said.
The results of another study reported at the meeting also showed the potential of the Internet to add to existing treatments. Lindsay Turner and her colleagues from the University of Illinois at Chicago studied the use of phone calls and Web site access to boost the success rates of group-based smoking counseling programs for adolescents.
The researchers randomized 351 high school students to receive the American Lung Association's Not On Tobacco (NOT) cessation program alone or the cessation program plus access to an antismoking Web site and phone calls from the group facilitator.
At the end of treatment, the quit rates were 8.5% among the standard care group and 12.2% among those smokers who also received Web site and phone support. At 3 months, the quit rate was 15.7% among the standard care group and 20.4% among the standard care plus group, Ms. Turner reported.
The researchers also compared the Web site effects with the phone support effects among the students and found that access to the Web site had a much greater effect on quitting than did phone support. Overall, the results show that Web site use had a prolonged effect on cessation, she said in an interview.
Two Part D Plans Cover AD Drugs With Less Red Tape
Two major Medicare Part D drug plans recently stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.
RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.
With these announcements, SilverScript, a subsidiary of Caremark, becomes the only national or near-national Part D drug plan sponsor that still requires prior authorization, according to the Alzheimer's Association.
The nine other national or near-national plans do not require prior authorization. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.
This summer, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had experienced in getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period on March 31. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.
“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association said in the letter. “The unfortunate consequence will be that patients will not receive the medications from which they will benefit.”
Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association. While officials at Caremark have yet to make a change in their policy, Ms. Fried said they are in contact with the company and are hopeful they will reverse the policy. “Now they are really an outlier,” she said.
Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.
The change being made by some companies is recognition not only that removing prior authorization requirements is good medicine and good public relations, but also that it's good business for the plans, Dr. Nuwer said.
Two major Medicare Part D drug plans recently stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.
RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.
With these announcements, SilverScript, a subsidiary of Caremark, becomes the only national or near-national Part D drug plan sponsor that still requires prior authorization, according to the Alzheimer's Association.
The nine other national or near-national plans do not require prior authorization. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.
This summer, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had experienced in getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period on March 31. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.
“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association said in the letter. “The unfortunate consequence will be that patients will not receive the medications from which they will benefit.”
Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association. While officials at Caremark have yet to make a change in their policy, Ms. Fried said they are in contact with the company and are hopeful they will reverse the policy. “Now they are really an outlier,” she said.
Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.
The change being made by some companies is recognition not only that removing prior authorization requirements is good medicine and good public relations, but also that it's good business for the plans, Dr. Nuwer said.
Two major Medicare Part D drug plans recently stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.
RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.
With these announcements, SilverScript, a subsidiary of Caremark, becomes the only national or near-national Part D drug plan sponsor that still requires prior authorization, according to the Alzheimer's Association.
The nine other national or near-national plans do not require prior authorization. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.
This summer, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had experienced in getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period on March 31. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.
“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association said in the letter. “The unfortunate consequence will be that patients will not receive the medications from which they will benefit.”
Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association. While officials at Caremark have yet to make a change in their policy, Ms. Fried said they are in contact with the company and are hopeful they will reverse the policy. “Now they are really an outlier,” she said.
Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.
The change being made by some companies is recognition not only that removing prior authorization requirements is good medicine and good public relations, but also that it's good business for the plans, Dr. Nuwer said.