Wednesday, May 28, 2008

Newly Proposed Drug Label System

USA Today reports on a newly proposed drug labeling system that will attempt to enhance information about the effects of medicines used during pregnancy and breast-feeding. The following is from the FDA's press release:

"With this proposal, FDA's goal is to help women, their physicians and their pharmacists have better information about the effects of prescription medicines so that pregnant women, nursing mothers, and breast-feeding infants will benefit," said Rear Admiral Sandra Kweder, M.D., Center for Drug Evaluation and Research, FDA. "This proposal would help make drug labeling a better communication tool, and would potentially have a huge impact on public health and well being for women."

The proposal would eliminate the current pregnancy categories A, B, C, D, and X and replace them with a consistent format for providing information about the risks and benefits of medicine use during pregnancy and lactation.

The USA Today article goes on to say that the FDA has been working on this labeling issue since 1997. I am in full support of this initiative yet at the same time shocked that it has taken 11 years to propose an improved process that should improve medication safety and patient outcomes. I've googled this issue and found information from April 2007 urging the FDA to take prompt action. Here we are, 13 months later still trying to sort it out. Where are the priorities? For an agency that has relaxed the rules (back in 1997) requiring pharmaceutical companies to disclose all side effects and adverse events of medications to now only a brief statement (direct to consumer advertising where companies are spending an estimated $3 billion dollars/year), it seems as if they don't have the public's best interests at stake.

If you'd like to read more on this issue, visit this link that will take you to the FDA website, "Pregnancy and Lactation Labeling."

Also, the FDA will accept electronic comments for 90 days on this proposal at In typical hard to navigate fashion, I cannot locate the proposal on that website in order to submit a comment. I will check back and provide an update when its available. I believe healthcare professionals and patients alike should strongly support this proposal. When can we expect this to go into effect? Here is the FAQ from the FDA website:

"The version of the rule being published today is only a proposal. FDA expects to receive numerous comments on the proposed rule, and those comments will need to be considered carefully before we publish a final rule. This process will take some time."

How many more medication errors and complications must occur before this archaic system is updated? What are we waiting for?!?

Thursday, May 22, 2008

The Medical Home...Are we on to something?

There have been 2 recent articles (one in a Boston publication and one in an upstate New York publication) about the concept of the medical home. This term is thrown around an awful lot these days and means much more than just a solo or group of primary care providers. This is a patient-centered approach to care that uses a coordinated effort by a team of health care professionals focusing on preventative health services right through hospitalizations. You can see the wikipedia definition of medical home here. Professional organizations such as the AAFP, AAP, & ACP (among others) have even adopted formal policy statements on this.

One of the main reasons that this concept hasn't gone anywhere is because the coordination of this type of care (the phone call consults, e-mails, paperwork, etc) hasn't traditional been reimbursed by insurance companies. These new pilot projects are attempting to remedy that. Also encouraging is that NPs are being utilized in this model and are leading the team of professionals.

I am encouraged by this model and anticipate that it will not only improve patient outcomes but will also drive down costs of health care. This is the part that is largely unknown: will it curb the needless spending and duplication of tests/screenings ordered for what is largely considered defensive medicine and will outcomes improve by keeping folks out of the hospital?

Communication and team work are the cornerstones to the success of the model. I am hopeful that healthcare professionals will understand this, work together and keep it patient-focused. Stay tuned....

Friday, May 16, 2008

Recent NP-related Articles

Here is a comprehensive article written in the Physician's News Digest entitled, "Growing role of nurse practitioners." This balanced article gives a synopsis of the current state of the profession and where we might be headed.

Also written this past week was an article about nurse practitioner-staffed retail clinics in Atlanta.

Friday, May 9, 2008


Here is a great little post about the use and overuse of antibiotics from an ER physician blog, entitled, "We are so screwed." We all know that it is easier to write a script for someone demanding antibiotics rather than explain the risks, benefits and commitment of taking antibiotics. It is so important to not give in. I'll never forget the patient that I saw with a 1-2 day history of nasal congestion and very mild symptoms. I went into my whole routine of explaining why I felt her condition was viral and antibiotics weren't necessary. After that whole little dialogue, I asked her if she had any questions and she says, "Uhh, can't I just get a Z-Pak?" What??? Were you even listening for the past 3 minutes??? (FYI, I did not write for the Z-Pak.) I'll never understand the rationale of wanting to take a medication that isn't clearly indicated, can cause gastrointestinal issues, can be expensive and is usually a commitment for 10 days (that's 1/3 of a month!)

I also came across a blurb about the CDC's "Get Smart" campaign. This campaign has been around since the mid 1990's and its main goal is to increase public education about the proper uses of antibiotics in the hopes of driving down the expectation of receiving antibiotics for common respiratory illnesses (common cold, ear infection, sinus infection, bronchitis, etc) and to help curb antibiotic resistance. The CDC has even designated October 6-10, 2008 as "Get Smart About Antibiotics Week" to increase the awareness among patients and clinicians, so mark your calendars!

Have a great weekend and Happy Mother's Day to all Mom's out there!

Thursday, May 8, 2008

Some Brief History

Once again, an article about retail health appears on the WSJ Health Blog site and the discussion ends up being about NPs versus MDs. Under that thread, a whole firestorm is set off when someone by the alias of "real doctor" claims that patients have returned to his office following visits to the retail clinics because they "were not treated appropriately." I certainly felt the need to respond to this arrogant attack on NPs and did so as "Real Nurse Practitioner."

So what follows is the typical rhetoric from purported physicians and includes: if you want to be a doctor go to medical school, being a doctor means that you have to spend 11 to 15 years of post graduate training after high school, wearing a stethoscope and a white coat doesn't make you a doctor and the list goes on.

NPs don't become NPs to "play" doctor. This is a profession that was borne from a need of primary care and pediatrician shortages in under-served areas. In 1965, the first NP program was headed up by nurse pioneer Loretta Ford and pediatrician Henry Silver at the University of Colorado to address this need. The rest as they say is history. However, we still are subject to inaccurate and baseless attacks from other "professionals." If the care that we provide is unsafe, prove it. If we are harming patients rather than helping them, I'd take a step back and examine my role in the profession. As far as I know, these doomsday scenarios aren't happening. In fact, it's the contrary. Patients are choosing to see nurse practitioners because of the way that we synthesize nursing and medical care. We focus on the whole person when treating specific health problems and provide extensive health information on the impact of those problems on patients, their families and the community. We work as part of the health care team to care for our patients.

I would not nor would I insinuate that NP care is better than physician care. It's different yet has the same goal and outcomes. It wasn't long ago that osteopathic physicians were treated as second class citizens in medical communities and some still are. I guess it would be naive of me to think that NPs would be accepted with open arms. However, I didn't think that we'd be subject to school yard, sand-box type attacks.

Tuesday, May 6, 2008

NPs in Pennsylvania

An article about nurse practitioners from Pennsylvania's appears on their website today, "Popularity of practitioners growing." The article discusses an NP practice in Kingston Pennsylvania, Women to Women, that specializes in women's health.

It's great to see more and more NP practices gaining headlines. It's also great to get support from our elected leaders such as PA Gov. Ed Rendell. He was integral in expanding the NP role in Pennsylvania in the hopes of making health care more accessible. It certainly seems like they are well on their way.

Patients that utilize our services appreciate the access, the patient-centered approach and the high-quality care that NPs are known for. It's also encouraging that other members of the health care team are becoming increasingly aware and accepting of our roles on the team in an attempt to fill in the many gaps in health care.