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Prescription Monitoring Programs Focus on “Doctor Shopping”

New research presented at the American Academy of Pain Medicine’s (AAPM) 26th Annual Meeting sheds light on the problem of controlled substance abuse and the tactic known as “doctor shopping” by individuals who seek multiple prescriptions from multiple health care providers. California’s prescription monitoring program (PMP), known as the Controlled Substances Utilization Review and Evaluation System, was the subject of this research, and represents an area where published data have thus far been limited.

The study found that there was a 2-fold increase in the likelihood of individuals receiving opioids from multiple providers when they were also prescribed a single additional class of controlled substances, for example, benzodiazepines or amphetamines. When there was more than 1 additional drug class involved, there was a 13-fold increase.

The data show that multiple prescribing of controlled substances continues to be a real problem. The issue is being addressed state by state, with more than 34 states currently having a PMP in place to combat drug abuse, addiction, and diversion. Scott Fishman, MD—AAPM’s director at large—notes, “The AAPM has long advocated for PMPs that make useful data available to prescribers at the point of care so they can help mitigate this problem.” For more information, visit www.painmed.org.


Rethinking Mental Illness
The American Psychiatric Association (APA) announced in February its intention to revise the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition is expected to be published in May 2013 and will reflect the first major revision of the manual since 1994.

As the primary handbook for mental health professionals, the DSM defines diagnostic criteria and standardizes the language used to identify and describe mental disorders. Even minor alterations to the text can profoundly impact treatment regimens.

One proposed change is to add a pediatric diagnosis called “temper dysregulation disorder with dysphoria,” which, in many cases, would replace a diagnosis of bipolar disorder in tantrumprone children. The change could initiate a shift in treatment practices from a medication-based approach to a model that stresses behavioral therapy.

Similar revisions to the diag- nostic criteria for autism spectrum disorders, substance abuse and addiction disorders, anxiety and depression, and eating disorders have also been recommended. The APA has posted a complete list of revisions online at www.dsm5.org, and will be accepting comments and suggestions from the public until April 10.


CDC Releases Health Report Card for US Population
Health, United States, 2009—a report released February 17, 2010, from the Centers for Disease Control and Prevention’s National Center for Health Statistics—says that an aging population and increasing life expectancy mean a higher prevalence of chronic diseases and conditions in the United States.

Life expectancy reached an all-time high of 77.9 years in 2007, up 2.5 years from 1990. Men saw their average life expectancy increase by 3.5 years from 1990 to 2007, while women saw a more modest increase of 1.6 years. Despite the aging of the US population, the report also reveals that deaths from heart disease, stroke, and cancer are declining, while deaths due to accidental injuries and chronic lower respiratory diseases are not.

The percentage of the US population taking at least 1 prescription drug increased from 39% in 1988-1994 to 47% in 2003-2006. The percentage of individuals taking at least 3 prescription drugs increased from 11% to 21% in the same time period. In patients aged 45 and older, the use of antidiabetic drugs went up 50%, and the use of statins increased 10-fold.

The report notes that the United States spends more on health care per capita than any other country, and costs continue to rise. In 2007, health expenditures totaled $2.2 trillion—a 6% increase from 2006.

The impact that rising costs are having on the average American was also reflected in the statistics. Of adults aged 18 to 64, 10% did not get needed prescription drugs due to cost in 2007, compared with 6% in 1997. In this same demographic, 8% in 2007 reported not getting needed medical care because of the cost, an increase of 2% from 1997. A full copy of the report is available at www.cdc.gov/nchs/hus.htm.


WHO Adds H1N1 Protection to Flu Vaccine

The World Health Organization (WHO) has recommended that protection against the H1N1 virus be added to the seasonal influenza vaccine for the northern hemisphere’s 2010-2011 flu season. Influenza experts met in closed door sessions to review the pandemic. H1N1 has killed 12,799 people worldwide since the virus first emerged, according to WHO, and more than half of the H1N1-related deaths occurred in the Americas.

While the pandemic is waning, the Centers for Disease Control and Prevention cautions for vigilance. In week 8 of the flu season, ending February 27, 2010, no states in the country reported widespread influenza activity; 4 states reported regional activity; 8 states and Puerto Rico reported local activity; 34 states plus Guam and the District of Columbia reported sporadic activity; and 4 states reported no activity.

Immunization experts also recommended the expansion of the annual influenza vaccination to include all people aged 6 months and older starting in the 2010-2011 influenza season. More influenza vaccine doses will be required; however, based on current projections, more licensed types and brands of seasonal influenza vaccines will be available. For weekly updates on the flu season, visit www.cdc.gov/flu/weekly.


Pharmacy Workforce Survey Reveals Shift to More Patient Care
A much anticipated survey was released in March by the Pharmacy Manpower Project’s (PMP) 2009 National Pharmacist Workforce Survey—and it revealed key shifts in the profession that reflect both the current economy and the health care reform discussion. The survey, established in 1989, provides valuable snapshots of work contributions, as well as demographic and work characteristics, of the pharmacist workforce in the United States during 2009.

It highlighted trends that include a shift in the pharmacy profession toward more patient care, as definitions for work activities were updated to be broader in scope and include patient care, research, and education activities. The survey also revealed that part-time work has increased slightly from the last study in 2004; the proportion of pharmacists working full-time decreased from 73% in 2000 to 68% in 2004, and finally to 67% in 2009. This may be due to the decreased availability of full-time hours due to reduced staffing levels. This trend included both men and women, with 29% of female pharmacists working part-time in 2009, up from 26% in 2004 and 23% in 2000. Male pharmacists working part-time increased to 18% in 2009, from 15% in 2004, and 11% in 2000.

The pharmacy profession has seen a significant increase in women practicing, according to the survey, and they comprised 46.4% of the workforce in 2009. Nearly half of active women pharmacists are between the ages of 31 and 45, while 40% are between 46 and 60 years of age, and only 4% are older than age 60. In comparison, men in pharmacy tend to be older, with 48% of practicing male pharmacists older than 46 years and 30% older than 60 years of age.

For more information on the PMP survey, visit the American Association of Colleges of Pharmacy Web site at www. aacp.org/resources/research.


Use of Medical Technology on the Rise, but Access Is Uneven
In a special feature released as part of a report from its National Center for Health Statistics (see above), the Centers for Disease Control and Prevention (CDC) states that the use of medical technologies is increasing in the United States.

For the purposes of the report, medical technologies are defined as “the application of science to develop solutions to health problems or issues, such as the prevention or delay of onset of disease or the promotion and monitoring of good health.” Examples include medical and surgical procedures, diagnostic tests, drugs, medical devices, and new support systems—such as electronic medical records.

The report’s executive summary notes that an increase in medical technology use results from many technologies becoming cheaper, more portable, and easier to use. For example, patients no longer have to go to the hospital for some diagnostic testing; many provider offices and outpatient facilities can perform tests and procedures that were once exclusive to health systems.

The CDC report also notes that access to technology varies depending on sex, race, ethnicity, and geographic location, and there is some concern that populations who could benefit from these advances are being underserved. For more information, visit www.cdc.gov/ nchs/hus.htm. ■


➜ Haiti Resources Paint the Whole Picture
To keep track of all the developments in Haiti, visit HCPLive’s Haiti Earthquake: Special Coverage page to access the latest health care–related news, articles, reports, blogs, and podcasts about the ongoing crisis: www. hcplive.com/haiti_earthquake