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Governor's Newsletter, Spring 2002

H. James Williams, MD, FACP
Governor, Utah Chapter

A Message from Your Governor

The Annual Meeting of the ACP-ASIM was held in Philadelphia in April. Several members of our chapter were in attendance and two received special recognition. Dr. Jeffrey Anderson, a Past Governor of the Chapter, was recognized as a new Master in the College. This is a singular honor for Dr. Anderson. He is only the third Master in our chapter, the other two being Dr. William Odell and Dr. Merle Sande. Dr. Quinton Harris was also recognized as the 2001 Laureate Award from the Utah Chapter.

The Board of Governors met just before the Annual Meeting and the major topic of interest was board certification. The Governors recommended to the Board of Regents that the ACP-ASIM work with the American Board of Internal Medicine (ABIM) to establish multiple pathways to recertification. There was little enthusiasm for the current proposal from the ABIM. It was further proposed that the pathways be sensitive to cost and time, eliminate redundancy, be relevant to practice and accommodate different learning styles. The Board of Regents approved these recommendations and sent them to the team negotiating with the ABIM. This arena is one area that shows the value of the ACP-ASIM. As internists, we would have little clout with the ABIM but we have a strong national organization to help us.

Walter McDonald, MD, FACP, retired from his post of Executive Vice President and Chief Executive Officer of the ACP-ASIM and was replaced by John Tooker, MD, MBA, FACP, who had been the Deputy Executive Vice President and Chief Operating Officer of the College. We can be grateful for the seven years of service by Dr. McDonald who strengthened the College during his tenure. The next annual meeting of the ACP-ASIM will be held in San Diego from April 2 to April 5, 2003. This is close to Utah and will be a welcome reprieve as winter winds down. Plan to attend.

New E-Newsletter for Members

A new monthly electronic newsletter for College members will debut on May 1, 2002. The newsletter will cover new College programs, products and services, and will also keep members updated on ACP-ASIM's advocacy efforts on behalf of internists. The nearly 50,000 members who have provided the College with their e-mail addresses will receive the newsletter the first Wednesday of each month; recipients will have the opportunity to opt-out of receiving the publication at any time.

The newsletter will provide brief articles (two to three paragraphs) about College activities and services that directly affect members. Readers who wish to learn more about a particular topic will be referred to more information on the Web (when available). Members who do not have e-mail may also access the newsletter on ACP-ASIM Online. For more information please contact Allison Ewing at (800-523-1546, ext. 2649) or (aewing@acponline.org).

Combatting Antimicrobial Resistance

One of the most important tools of modern medicine is in danger of becoming obsolete. For nearly 60 years, the widespread availability of penicillin and other antibiotics has revolutionized health care, significantly reducing illness and death from infectious diseases. However, bacteria and other microorganisms have the ability to mutate and become resistant to antimicrobial drugs. The earliest detected case of antimicrobial resistance occurred in 1944 with the discovery of penicillin-resistant staphylococci. In the past decade, cases of antimicrobial resistance have increased so dramatically that some experts envision a future in which antibiotics are rendered completely ineffective. Not only does antimicrobial resistance limit the ability of health care providers to treat disease, it also contributes to higher costs.

Investigators at the University of Utah have conducted prospective surveillance studies of pneumococcal resistance in two rural Utah communities, involving healthy children under the age of seven.1 Twenty percent of children were colonized with Streptococcus pneumoniae and approximately one third of the pneumococcal isolates exhibited reduced susceptibility to antibiotics. While the percentage of resistance strains increased by about 3% each year from 1998-2000, the percentage of fully penicillin resistant strains increased tenfold (from less than 5% to nearly 50% of all the resistant strains). The same study showed that about 80% of these children had an antibiotic prescription in the year prior to the culture.

One of the primary causes for the increase in antimicrobial resistance is the widespread use and misuse of antibiotics. Respiratory infections account for more than 75% of antimicrobial drug prescriptions written annually in physicians' offices. Many of these visits are for colds, upper respiratory infections (URIs), and bronchitis. The great majority of these result from a viral cause, for which there is no evidence that antibiotic treatment is helpful. Studies in the U.S. have shown that more than 50% of adult patients diagnosed with colds and upper respiratory tract infections, and up to 80% of patients diagnosed with bronchitis, are treated with antibiotics.2

HealthInsight, the University of Utah, and Intermountain Health Care recently joined forces on a pilot project in Delta, Utah, to test methods of controlling antimicrobial resistance. Delta is one of the rural communities in which the University of Utah has been involved in the aforementioned epidemiological study to track the spread of resistant S. pneumoniae bacteria. The University has worked in Delta since 1998, where they have gathered over 2700 cultures. Building on the University's surveillance efforts, HealthInsight piloted a project that involved working with Delta physicians to improve prescribing practices and to provide greater availability of educational materials to parent and patients. Drs. Dan Egan, Steve Shamo, and Alan Smith of Delta used a customized algorithm for diagnosing and treating all patients presenting with respiratory tract infections. Analysis of the algorithm data indicate extremely low rates of antibiotic prescribing for bronchitis, URI, and otitis media with effusion during the intervention period (3%, 1%, and 8%, respectively). In addition over 70% of antibiotics prescribed for respiratory tract infections were narrow spectrum antibiotics and the use of broader spectrum, more expensive antibiotic decreased. Future analysis will include examining changes in prescribing pattern in the community using pharmacy data.

1. Samore M, Magill M, Alder S, Severina E, Morrison-de Boer L, Lyon JL, Carroll K, Leary J, Stone M, Bradofrd D, Reading J, Tomasz A, Sande MA. High Rates of Multiple Antibiotic Resistance in Streptococcus pneumoniae From Healthy Children Living in Isolated Rural Communities: Association With Cephalosporin Use and Intrafamilial Transmission. Pediatrics. In press.

2. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901-904.

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Drug Prescribing in Renal Failure Now Available for Palm OS

The best selling ACP-ASIM book, Drug Prescribing in Renal Failure, is now available as a Palm handheld computer application. Containing information on over 450 drugs, this is the most extensive collection of drug-dosing information ever published for patients with impaired renal function. Factors for determining drug dosage are available at the tap of a button. A GFR calculator, including an ideal body weight calculator, is built into the application. The Palm application is available for $19.95. The application and the Drug Prescribing in Renal Failure book can be purchased for $39.95 (members $34.95).

For ordering information and a free demo, visit the College's PDA Portal. (Please note this product is only available as a download from the Web, so it must be ordered through http://www.acponline.org.)

Free CD-ROM Immunization Resource to be Sent to Members

The ACP-ASIM Adult Immunization Initiative will release a CD-based Adult Immunization Toolkit the first week of April 2002. This free CD-ROM will be distributed by mail to general internist members and will be available on request to all members. It will include a variety of immunization resources, including:

  • An immunization program from the Centers for Disease Control and Prevention (CME credit available)
  • Electronic files of all the immunization educational materials developed by the Adult Immunization Initiative
  • PDA downloads with vaccine reference information
  • A copy of the Guide to Billing and Coding for Adult Immunization
  • A presentation module including slides and speaking points for members who want to educate the public about adult immunization
  • The Adult Immunization Harmonized Schedule from the Advisory Committee on Immunization Practices

Additional components may include reminder recall materials, professionally designed ads to help members advertise their immunization services, and more. Copies of the CD-ROM Toolkit will also be available at the Adult Immunization Booth in the exhibit hall at Annual Session 2002.

For more information on the Adult Immunization Initiative please contact Leslie Gurowitz at 800-523-1546, ext. 2477 (lgurowitz@acponline.org).

College Mounts Public Affairs Effort on Excessive Medicare Cuts

The College's Public Affairs office has mounted a campaign to educate the public about the recent cuts in Medicare and what they will mean to the future quality of care in the United States. In mid-March ACP-ASIM released a video news release featuring College President William Hall, MD, FACP, which dramatized the impact of excessive Medicare cuts on patient care. The release, titled "Medicare Cuts May Mean Trouble Ahead for Patients and the Physicians Who Treat Them," noted that Medicare patients may soon be faced with a serious reduction in available physicians and services if Congress doesn't act soon. A nearly 30 percent decrease in physician reimbursement over four years is forcing physicians to cut practice expenses and reconsider their participation in the Medicare program. In Dr. Hall's geriatric practice in New York state a five percent cut in funding has already led to the reduction of two staff positions. The College is working with Congress to avoid additional cuts that will force further reductions in services for Medicare patients between now and 2005.

In addition to the video news release, Public Affairs is working with members around the country to write and place op-ed letters in local newspapers. Op-ed pieces are an excellent tool to reach a broad audience with a targeted message. Physicians who are interested in lending their name and support to an op-ed piece may contact Carolyn Albert in the Public Affairs office at (800-338-2746) or (calbert@acponline.org).

New Patient Education Brochures Published

ACP-ASIM recently published two new brochures on diabetes and headache as part of its patient education series. The brochures are written in language suitable for the layperson and are designed to help educate patients on the different aspects of the illnesses.

The headache/migraine brochure supports the College's recent migraine guidelines. It helps patients understand the three most common types of headaches (tension, cluster and migraine), defines the three types in lay terms, and lets patients know that many new treatment options are available.

The diabetes brochure introduces the various types of diabetes, but focuses on type 2 diabetes and its risk factors and symptoms. It encourages patients to talk to their internist if they have risk factors and/or symptoms, and to eat correctly and live a healthy lifestyle. It also comments on the link between diabetes and heart disease and high blood pressure.

The colorful tri-fold brochures are available in shrink-wrapped package of 100 for $20 (includes S&H). The two new brochures join the five existing brochures in the series (depression, heart disease and stroke, adult immunization, antibiotic resistance, and obesity), all of which may be ordered by calling ACP-ASIM Customer Service at 800-523-1546, ext. 2600. (Headache brochure product code #700100220, diabetes brochure product code #700100120.) The brochures are also available for free download at (http://www.doctorsforadults.com).

Bioterrorism Resource Web Site Updated

The College's Bioterrorism web site has been revised for easier navigation, and features new clinical information, images, and support tools. The site has received praise from the Centers for Disease Control and Prevention and other viewers for its comprehensiveness and content.

Recent additions include new support tools on cutaneous and inhalation anthrax, self-assessment questions on biological and chemical agents, and new information about biotoxins, nerve agents, and toxic gasses. Physicians are urged to visit the site to increase their knowledge of bioterrorism agents and to learn how to deal with a suspected bioterroristic attack.

Advancing from Membership to Fellowship

The College has established 4 Pathways that serve as guidelines to qualify for Fellowship. For each of the following pathways, the candidates must meet the basic Requirements. Pathways-

Pathway 1: Members must have demonstrated skill in written medical communication.

Pathway 2: Members must have significant and continuing certification activities and/or teaching (both institutional and community-based), and/or community activities that indicate professional achievement and scholarship; they must have undergone Recertification, or they must have participated in the Medical Knowledge Self-Assessment Program (MKSAP) with a passing score. In addition, subspecialty certification or certificates of special competence in adolescent medicine, critical care medicine, clinical cardiac electrophysiology, geriatrics, or sports medicine can qualify a candidate for this pathway, but are not adequate by themselves.

Pathway 3: Members must have been active Members in ACP or ASIM for at least 10 years, with substantial participation in programs and activities, as well as demonstration of other professional accomplishments. Note: Outstanding candidates who have been active Members for fewer than 10 years may qualify by combining Pathways 1 and/or 2 with Pathway 3.

Pathway 4: Members must have distinguished professional activity in teaching, patient care or professional service over many years.

Requirements:

  • Be certified by the American Board of Internal Medicine, the Royal College of Physicians and Surgeons of Canada or the American Osteopathic Board of Internal Medicine.
  • Have been a member in good standing for two years in either ACP or ASIM and have held a position in practice or in academia for at least two years since completion of training.
  • Have an active medical license in good standing (if in clinical practice).
  • Have confined professional activity to internal medicine or a subspecialty of internal medicine.
  • Be proposed and seconded with detailed letters of support from two current Masters or Fellows with reference to character, ethics and medical activities, and outlining professional contributions and accomplishments.
  • Be endorsed by the appropriate ACP-ASIM Governor.
  • Have shown continuing scholarship and professional accomplishments.
  • Document continuing professional activities, including teaching (both institutional and community-based); hospital committee work; public service and community activities; and participation in continuing medical education activities as both student and teacher.

For additional information contact ACP-ASIM Customer Service (1-800-523-1546 ext. 2600), or visit the College website.