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DIABETES
- Cut A1Cs!
- Patient Perspective on Group Visits
TOBACCO
- The Clean Indoor Air Law & You
VACCINES
- PA immunization expert sounds off about vaccine exemptions
- Discount vaccine program – Are you signed up?
COLORECTAL CANCER
- Phosphate Prep A Safety Risk for Patients With Impaired Renal Function & The Elderly
PEDIATRICS
- Data from the state’s Growth Screening Program
- Childhood Obesity Guideline Published
- MA Fee for Service Pays for Childhood Nutrition/Weight Management Services
DOMESTIC VIOLENCE- Screen moms for domestic abuse
DIABETES
Cut A1Cs!
Improving Performance in Practice (IPIP) is a national program managed in Pennsylvania by the PAFP Foundation. A practice from North Carolina cut in half the number of patients with A1Cs over 9 using a particular treatment algorithm. Download the algorithm.
Patient Perspective on Group Visits
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s flagship quality improvement program, with one site in south central Pennsylvania. The PAFP is one of the “aligning forces” because the IPIP program is helping to develop a pilot learning collaborative in the region.
One of AF4Q’s programs is “I Can,” which challenged five patients in the region in a “Biggest Loser” type program to improve their health, primarily in the context of their chronic diseases. Two patients delivered powerful testimonials on their experience at AF4Q’s 2009 annual meeting. Both patients lowered their A1Cs, lowered their cholesterol, lost weight and lessened or eliminated their need for medication. They’re also spreading the message to family, friends and neighbors. These patients noted that patients in similar circumstances can provide great peer support. One physician noted that it’s so different from the private, isolated way patients are typically seen. IPIP also promotes the use of group visits – or “patient teams” as one participant calls them. Get more information on group visits at the Family Practice Management toolbox website.
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TOBACCO
The Clean Indoor Air Law & You
Pennsylvania's Clean Indoor Air law is a perfect opportunity to help patients to quit.
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VACCINES
PA immunization expert sounds off about vaccine exemptions
Paul Offit, MD, was published in the online newspaper The Huffington Post, voicing his frustration over nonmedical exemptions to immunization. He noted a study connecting unvaccinated school children and outbreaks of pertussis and how how some parents are still scared – unnecessarily so, according to Dr. Offit – about the connection between vaccines and autism. Read the column. The column also links to the pertussis outbreak story. Dr. Offit is an immunization expert from Children’s Hospital of Philadelphia who has presented often for the Academy of Pediatrics-PA chapter’s Let’s Talk phone conference series (http://www.paiep.org/section.cfm?subID=76).
Discount vaccine program – Are you signed up?
The PAFP partners with Atlantic Health Partners, a free discount vaccine purchasing program, to help family practices decrease vaccine costs, get payment support with payers and receive timely updates about new products or changes. Hundreds of your colleagues have signed up and love the savings. Contact Jeff Winokur at -800-741-2044 or jwinokur@atlantichealthpartners.com for more information. Jeff will be a co-presenter for the aforementioned CES immunization session, shows physician how they can make providing immunization financially sustainable. Family Practice Management recently covered this topic. Download a PDF of the article.
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COLORECTAL CANCER
Phosphate Prep A Safety Risk for Patients With Impaired Renal Function & The Elderly
A 2006 background paper from the FDA documented the risk of acute phosphate nephropathy and warned physicians to use oral sodium phosphate (OSP) with caution in patients taking diuretics, ACE inhibitors, ARBs, and NSAIDs (www.fda.gov/cder/drug/infopage/OSP_solution/backgrounder.htm).
A 2008 study follows up that warning with a study that found that OSP prep in elderly patients can lead to renal damage even in patients with normal kidney function (Arch Intern Med. 2008;168:565-567, 593-597). The study authors write that, “if risk factors for adverse renal outcomes are identified (advanced age, decreased GFR, diabetes, and therapy with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or possibly nonsteroidal anti-inflammatory drugs), then a PEG [polyethylene glycol]-based approach may be preferred." Both the FDA and study authors note that renal failure and renal damage are rare but significant safety risks of using OSP. Physicians should continue to suggest colonoscopy as a colorectal cancer screening option when appropriate but be cognizant of OSP prep risk factors. >BACK TO TOP<
PEDIATRICS
Data from the state’s Growth Screening Program
As you know, school students in Pennsylvania are screened for BMI, which is reported to the state and generally reported to parents through a letter that encourages them to contact their family physician if they have questions about their child’s weight. Data from the 2006-07 school year shows 998,402 students screened with most (65%) in the 5th to 85th percentile. Unfortunately, 16% fall in the 85th to 95th percentile (that’s 160,490 students) and 17% above the 95th percentile (that’s 166,426 students). Statistics for adults aren’t any better. More than 66% of adult are overweight or obese.
Research shows that the “energy gap” for kids is just 110-165 calories a day in children. Nutritional change is easiest to impact on the individual level and simple change you can make to patients is to replace one can of soda per day with water or low/no-calorie beverages. Check out http://www.nrgbalance.org/resources.cfm for all kinds of stuff you can download and use in your practice to encourage healthy weight.
Childhood Obesity Guideline Published
The Endocrine Society has published a clinical practice guideline on childhood obesity available at www.endo-society.org/guidelines.
The guideline recommends that:
- Overweight be defined as having a body mass index (BMI) > 85th percentile by < 95th percentile, and obesity as BMI > 95th percentile.
- Prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment.
- Evaluating for obesity-associated co-morbidities in children with BMI > 85th percentile.
- Pharmacotherapy (in combination with lifestyle modification) be considered in 1) obese children only after failure of a formal program of intensive lifestyle modification and in 2) overweight children only if severe co-morbidities persist despite intensive lifestyle modification.
- Pharmacotherapy should be provided only by clinicians who are experienced in the use of anti-obesity agents and aware of the potential for adverse reactions.
- Bariatric surgery should be pursued for adolescents with BMI > 50, or > 40 with severe co-morbidities in whom lifestyle modification and/or pharmacotherapy have failed.
- Clinicians should emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 minutes of moderate to vigorous daily exercise in all grades.
MA Fee for Service Now Pays for Childhood Nutrition/Weight Management Services
Flier from DPW (Word, 59KB)
DPW began paying in fall 2007 for medical services to address childhood obesity. For example, a 45-minute initial assessment is payable at $61.14. Not perfect, but an important step. See Medical Assistant Bulletin 99-07-19 for details.
WIC Formula Rx Form
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DOMESTIC VIOLENCE
Screen moms for domestic abuse
Study results published in the Journal of Midwifery & Women's Health found that abused women were more likely to have called or visited a health provider because of concerns about their babies’ health. Reasons why they sought more care are not clear, but the senior researcher suggests that instituting regular, repeated screening of all mothers for intimate partner violence can identify women who would not otherwise request services directly for themselves. Read the consensus recommendations for family physicians on domestic violence at www.endabuse.org/section/programs/health_care/_consensus_recommendations.
rojects are most often tied to CDC and state priorities, and currently include topics such as childhood obesity, colorectal cancer screening, immunization and smoking cessation/prevention.
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