Denise Napoli

BALTIMORE — The notion that the future burden of human papillomavirus will be greatly decreased thanks to the HPV vaccine may be unrealistic without a national school mandate, according to a new model.

That's because voluntary vaccination among the target population of 11- to 17-year-old girls so far has been modest, with just 7% of this cohort receiving all three doses in the first year of the vaccine's availability, according to Dr. Amanda Dempsey of the University of Michigan, Ann Arbor.

"Under no-mandate conditions, our model suggests that vaccine utilization may be suboptimal and that coverage of even 70% could take decades to achieve," Dr. Dempsey and David Mendez, Ph.D., also of the university, wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

The researchers created a model of HPV vaccine uptake among 11- to 17-year-old girls based on census data, published literature on parental attitudes toward HPV vaccination, adolescent health care utilization patterns, and expert physician opinion. The model assumed that a school mandate would be applied on a national level, and would be such that vaccination would be required for school attendance, with exceptions similar to those of other vaccine mandates.

They adjusted their model to accurately predict the numbers reported by the Centers for Disease Control and Prevention during the first year of the vaccine's availability: 25% of U.S. 11- to 17-year-old girls received the first dose, 17% received the first and second dose, and 7% received all three recommended doses of the vaccine.

Without a mandate in place, the authors predicted that 70% utilization of the vaccine would be reached by year 23 of its availability, or 2030.

Under that model, by year 50 (in 2057) just 78% of the cohort will have received all three doses, they predicted.

With a mandate, 70% of the 11- to 17-year-old cohort would be vaccinated with all three doses by year 8 (in 2015). At year 41 (by 2048), 90% would be vaccinated.

In an interview, Dr. Dempsey added that she and Dr. Mendez did not account for vaccination of other groups, including those aged 18–26 years. "We plan on expanding our model in the future to be more comprehensive," she said. However, "because we were focusing specifically on school mandates, we limited our model to those who would be affected by the mandate in the current environment."

Dr. Dempsey said that at the time the study was done and at the time of its presentation, she had no ties to the pharmaceutical industry. However, shortly after the conclusion of the PAS meeting, she said that she agreed to serve on a Merck & Co. advisory board for male HPV vaccination.

BALTIMORE — The notion that the future burden of human papillomavirus will be greatly decreased thanks to the HPV vaccine may be unrealistic without a national school mandate, according to a new model.

That's because voluntary vaccination among the target population of 11- to 17-year-old girls so far has been modest, with just 7% of this cohort receiving all three doses in the first year of the vaccine's availability, according to Dr. Amanda Dempsey of the University of Michigan, Ann Arbor.

"Under no-mandate conditions, our model suggests that vaccine utilization may be suboptimal and that coverage of even 70% could take decades to achieve," Dr. Dempsey and David Mendez, Ph.D., also of the university, wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

The researchers created a model of HPV vaccine uptake among 11- to 17-year-old girls based on census data, published literature on parental attitudes toward HPV vaccination, adolescent health care utilization patterns, and expert physician opinion. The model assumed that a school mandate would be applied on a national level, and would be such that vaccination would be required for school attendance, with exceptions similar to those of other vaccine mandates.

They adjusted their model to accurately predict the numbers reported by the Centers for Disease Control and Prevention during the first year of the vaccine's availability: 25% of U.S. 11- to 17-year-old girls received the first dose, 17% received the first and second dose, and 7% received all three recommended doses of the vaccine.

Without a mandate in place, the authors predicted that 70% utilization of the vaccine would be reached by year 23 of its availability, or 2030.

Under that model, by year 50 (in 2057) just 78% of the cohort will have received all three doses, they predicted.

With a mandate, 70% of the 11- to 17-year-old cohort would be vaccinated with all three doses by year 8 (in 2015). At year 41 (by 2048), 90% would be vaccinated.

In an interview, Dr. Dempsey added that she and Dr. Mendez did not account for vaccination of other groups, including those aged 18–26 years. "We plan on expanding our model in the future to be more comprehensive," she said. However, "because we were focusing specifically on school mandates, we limited our model to those who would be affected by the mandate in the current environment."

Dr. Dempsey said that at the time the study was done and at the time of its presentation, she had no ties to the pharmaceutical industry. However, shortly after the conclusion of the PAS meeting, she said that she agreed to serve on a Merck & Co. advisory board for male HPV vaccination.

BALTIMORE — The notion that the future burden of human papillomavirus will be greatly decreased thanks to the HPV vaccine may be unrealistic without a national school mandate, according to a new model.

That's because voluntary vaccination among the target population of 11- to 17-year-old girls so far has been modest, with just 7% of this cohort receiving all three doses in the first year of the vaccine's availability, according to Dr. Amanda Dempsey of the University of Michigan, Ann Arbor.

"Under no-mandate conditions, our model suggests that vaccine utilization may be suboptimal and that coverage of even 70% could take decades to achieve," Dr. Dempsey and David Mendez, Ph.D., also of the university, wrote in a poster presented at the annual meeting of the Pediatric Academic Societies.

The researchers created a model of HPV vaccine uptake among 11- to 17-year-old girls based on census data, published literature on parental attitudes toward HPV vaccination, adolescent health care utilization patterns, and expert physician opinion. The model assumed that a school mandate would be applied on a national level, and would be such that vaccination would be required for school attendance, with exceptions similar to those of other vaccine mandates.

They adjusted their model to accurately predict the numbers reported by the Centers for Disease Control and Prevention during the first year of the vaccine's availability: 25% of U.S. 11- to 17-year-old girls received the first dose, 17% received the first and second dose, and 7% received all three recommended doses of the vaccine.

Without a mandate in place, the authors predicted that 70% utilization of the vaccine would be reached by year 23 of its availability, or 2030.

Under that model, by year 50 (in 2057) just 78% of the cohort will have received all three doses, they predicted.

With a mandate, 70% of the 11- to 17-year-old cohort would be vaccinated with all three doses by year 8 (in 2015). At year 41 (by 2048), 90% would be vaccinated.

In an interview, Dr. Dempsey added that she and Dr. Mendez did not account for vaccination of other groups, including those aged 18–26 years. "We plan on expanding our model in the future to be more comprehensive," she said. However, "because we were focusing specifically on school mandates, we limited our model to those who would be affected by the mandate in the current environment."

Dr. Dempsey said that at the time the study was done and at the time of its presentation, she had no ties to the pharmaceutical industry. However, shortly after the conclusion of the PAS meeting, she said that she agreed to serve on a Merck & Co. advisory board for male HPV vaccination.

WASHINGTON — The average U.S. family spent an extra $1,017 on health care last year to help cover uncompensated care provided to the uninsured, according to report from Families USA.

Privately insured individuals spent an extra $368 last year for the same thing.

“That is the hidden health tax,” said the group's executive director, Ron Pollack. “Everybody … probably knows that there is such a hidden health tax, but they don't know how significant it is.”

According to the report, created with the help of Milliman Inc., an independent actuarial consulting firm, $116 billion of care from hospitals, doctors, and other health care professionals was provided to the uninsured last year. Of this, 37% was paid for out-of-pocket by the patients themselves. A further 26% of this was paid for by third-party sources, such as charities or community centers.

The remainder—amounting to $42.7 billion—was unpaid.

“Providers attempt to recover these uncompensated care dollars primarily by increasing charges for those with private insurance,” according to the report. “This cost shift is borne almost exclusively by private insurance programs because the federal Medicare program's rules do not allow Medicare provider payments to easily adjust upward in response to this pressure.”

At a press conference to release the report, Ron Williams, the chairman and chief executive officer of Aetna Inc., said that the report answers a question many consumers have, “which is, 'Why does my premium go up?'”

He added, “For every person who has private health insurance, there is a tax … that these community hospitals and other hospitals have to collect in order to be there as a safety net.”

Mr. Pollack stressed that the data in this report are from 2008, and that the huge amount of job loss still occurring in 2009 likely will mean that the amount borne by each U.S. family will grow to $1,100 this year. A similar study conducted in 2005 found that the average family paid an extra $922 to cover uncompensated care and the average individual paid an extra $341.

In a statement accompanying the release of the report, Sen. Max Baucus (D-Mont.), chairman of the Senate Finance committee and a leader on health care reform, said that, “As this report shows, that hidden tax will only continue to grow unless we do something about it. That's why I'm committed to passing comprehensive health care reform this year. We must repeal this hidden tax and lift the burden from American families and businesses by ensuring quality, affordable health care for all Americans.”

WASHINGTON — The average U.S. family spent an extra $1,017 on health care last year to help cover uncompensated care provided to the uninsured, according to report from Families USA.

Privately insured individuals spent an extra $368 last year for the same thing.

“That is the hidden health tax,” said the group's executive director, Ron Pollack. “Everybody … probably knows that there is such a hidden health tax, but they don't know how significant it is.”

According to the report, created with the help of Milliman Inc., an independent actuarial consulting firm, $116 billion of care from hospitals, doctors, and other health care professionals was provided to the uninsured last year. Of this, 37% was paid for out-of-pocket by the patients themselves. A further 26% of this was paid for by third-party sources, such as charities or community centers.

The remainder—amounting to $42.7 billion—was unpaid.

“Providers attempt to recover these uncompensated care dollars primarily by increasing charges for those with private insurance,” according to the report. “This cost shift is borne almost exclusively by private insurance programs because the federal Medicare program's rules do not allow Medicare provider payments to easily adjust upward in response to this pressure.”

At a press conference to release the report, Ron Williams, the chairman and chief executive officer of Aetna Inc., said that the report answers a question many consumers have, “which is, 'Why does my premium go up?'”

He added, “For every person who has private health insurance, there is a tax … that these community hospitals and other hospitals have to collect in order to be there as a safety net.”

Mr. Pollack stressed that the data in this report are from 2008, and that the huge amount of job loss still occurring in 2009 likely will mean that the amount borne by each U.S. family will grow to $1,100 this year. A similar study conducted in 2005 found that the average family paid an extra $922 to cover uncompensated care and the average individual paid an extra $341.

In a statement accompanying the release of the report, Sen. Max Baucus (D-Mont.), chairman of the Senate Finance committee and a leader on health care reform, said that, “As this report shows, that hidden tax will only continue to grow unless we do something about it. That's why I'm committed to passing comprehensive health care reform this year. We must repeal this hidden tax and lift the burden from American families and businesses by ensuring quality, affordable health care for all Americans.”

WASHINGTON — The average U.S. family spent an extra $1,017 on health care last year to help cover uncompensated care provided to the uninsured, according to report from Families USA.

Privately insured individuals spent an extra $368 last year for the same thing.

“That is the hidden health tax,” said the group's executive director, Ron Pollack. “Everybody … probably knows that there is such a hidden health tax, but they don't know how significant it is.”

According to the report, created with the help of Milliman Inc., an independent actuarial consulting firm, $116 billion of care from hospitals, doctors, and other health care professionals was provided to the uninsured last year. Of this, 37% was paid for out-of-pocket by the patients themselves. A further 26% of this was paid for by third-party sources, such as charities or community centers.

The remainder—amounting to $42.7 billion—was unpaid.

“Providers attempt to recover these uncompensated care dollars primarily by increasing charges for those with private insurance,” according to the report. “This cost shift is borne almost exclusively by private insurance programs because the federal Medicare program's rules do not allow Medicare provider payments to easily adjust upward in response to this pressure.”

At a press conference to release the report, Ron Williams, the chairman and chief executive officer of Aetna Inc., said that the report answers a question many consumers have, “which is, 'Why does my premium go up?'”

He added, “For every person who has private health insurance, there is a tax … that these community hospitals and other hospitals have to collect in order to be there as a safety net.”

Mr. Pollack stressed that the data in this report are from 2008, and that the huge amount of job loss still occurring in 2009 likely will mean that the amount borne by each U.S. family will grow to $1,100 this year. A similar study conducted in 2005 found that the average family paid an extra $922 to cover uncompensated care and the average individual paid an extra $341.

In a statement accompanying the release of the report, Sen. Max Baucus (D-Mont.), chairman of the Senate Finance committee and a leader on health care reform, said that, “As this report shows, that hidden tax will only continue to grow unless we do something about it. That's why I'm committed to passing comprehensive health care reform this year. We must repeal this hidden tax and lift the burden from American families and businesses by ensuring quality, affordable health care for all Americans.”

WASHINGTON — The availability of part time work and flexible scheduling could entice older and inactive physicians to reenter the workforce, a recent survey found.

This in turn could offer a partial solution to the nation's shortage of primary care physicians, who make up about 50% of this cohort.

“We really need to do a much better job of creating an environment that's much more flexible,” Ethan Alexander Jewett said at a physician workforce research conference that was sponsored by the Association of American Medical Colleges.

“When we lose these folks, we've lost the investment that we've made in medical education. And in an era when we have a physician shortage, we could be reabsorbing that investment and the expertise of these physicians,” both on a long-term basis or as needed in times of crisis.

However, he cautioned that reentering physicians will need support from employers and medical societies, given that 38% of them have not practiced medicine in 5–10 years, and 24% haven't practiced in longer than 10.

From January to March 2008, Mr. Jewett surveyed 4,975 physicians who were younger than age 65 years and who were listed as inactive in the American Medical Association's files. “Inactive” was defined as those who no longer practice, teach, research, or administer medicine.

A total of 1,520 physicians responded. Of these, 500 were truly inactive, about half of them were women. Primary care physicians comprised roughly half of this inactive group. Just over a quarter (27%) of the whole group were inactive in medicine but working in another field.

A total of 436 physicians were in fact retired—also half women. And 584 physicians were, despite their status with the AMA, currently active in medicine. This category included only about 40% women, said Mr. Jewett, a policy analyst at the American Academy of Pediatrics.

When asked what would make them return to the workplace, 58% of women and 42% of men said that the availability of flexible, part-time scheduling would be the “number one driver,” Mr. Jewett said.

About 50% of the inactive physicians surveyed said that they had already explored the possibility of reentering the medical workforce. Mr. Jewett pointed out that his survey took place before the recession, so even more physicians may now be seeking to reenter the workforce.

He did not report any disclosures related to his presentation.

WASHINGTON — The availability of part time work and flexible scheduling could entice older and inactive physicians to reenter the workforce, a recent survey found.

This in turn could offer a partial solution to the nation's shortage of primary care physicians, who make up about 50% of this cohort.

“We really need to do a much better job of creating an environment that's much more flexible,” Ethan Alexander Jewett said at a physician workforce research conference that was sponsored by the Association of American Medical Colleges.

“When we lose these folks, we've lost the investment that we've made in medical education. And in an era when we have a physician shortage, we could be reabsorbing that investment and the expertise of these physicians,” both on a long-term basis or as needed in times of crisis.

However, he cautioned that reentering physicians will need support from employers and medical societies, given that 38% of them have not practiced medicine in 5–10 years, and 24% haven't practiced in longer than 10.

From January to March 2008, Mr. Jewett surveyed 4,975 physicians who were younger than age 65 years and who were listed as inactive in the American Medical Association's files. “Inactive” was defined as those who no longer practice, teach, research, or administer medicine.

A total of 1,520 physicians responded. Of these, 500 were truly inactive, about half of them were women. Primary care physicians comprised roughly half of this inactive group. Just over a quarter (27%) of the whole group were inactive in medicine but working in another field.

A total of 436 physicians were in fact retired—also half women. And 584 physicians were, despite their status with the AMA, currently active in medicine. This category included only about 40% women, said Mr. Jewett, a policy analyst at the American Academy of Pediatrics.

When asked what would make them return to the workplace, 58% of women and 42% of men said that the availability of flexible, part-time scheduling would be the “number one driver,” Mr. Jewett said.

About 50% of the inactive physicians surveyed said that they had already explored the possibility of reentering the medical workforce. Mr. Jewett pointed out that his survey took place before the recession, so even more physicians may now be seeking to reenter the workforce.

He did not report any disclosures related to his presentation.

WASHINGTON — The availability of part time work and flexible scheduling could entice older and inactive physicians to reenter the workforce, a recent survey found.

This in turn could offer a partial solution to the nation's shortage of primary care physicians, who make up about 50% of this cohort.

“We really need to do a much better job of creating an environment that's much more flexible,” Ethan Alexander Jewett said at a physician workforce research conference that was sponsored by the Association of American Medical Colleges.

“When we lose these folks, we've lost the investment that we've made in medical education. And in an era when we have a physician shortage, we could be reabsorbing that investment and the expertise of these physicians,” both on a long-term basis or as needed in times of crisis.

However, he cautioned that reentering physicians will need support from employers and medical societies, given that 38% of them have not practiced medicine in 5–10 years, and 24% haven't practiced in longer than 10.

From January to March 2008, Mr. Jewett surveyed 4,975 physicians who were younger than age 65 years and who were listed as inactive in the American Medical Association's files. “Inactive” was defined as those who no longer practice, teach, research, or administer medicine.

A total of 1,520 physicians responded. Of these, 500 were truly inactive, about half of them were women. Primary care physicians comprised roughly half of this inactive group. Just over a quarter (27%) of the whole group were inactive in medicine but working in another field.

A total of 436 physicians were in fact retired—also half women. And 584 physicians were, despite their status with the AMA, currently active in medicine. This category included only about 40% women, said Mr. Jewett, a policy analyst at the American Academy of Pediatrics.

When asked what would make them return to the workplace, 58% of women and 42% of men said that the availability of flexible, part-time scheduling would be the “number one driver,” Mr. Jewett said.

About 50% of the inactive physicians surveyed said that they had already explored the possibility of reentering the medical workforce. Mr. Jewett pointed out that his survey took place before the recession, so even more physicians may now be seeking to reenter the workforce.

He did not report any disclosures related to his presentation.

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

Previously, applicants had a fixed, annual 30-day window to apply, but “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model,” said Dr. Wakefield, adding that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, regardless of the actual need.

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

Previously, applicants had a fixed, annual 30-day window to apply, but “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model,” said Dr. Wakefield, adding that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, regardless of the actual need.

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

Previously, applicants had a fixed, annual 30-day window to apply, but “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model,” said Dr. Wakefield, adding that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, regardless of the actual need.

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”

Rheumatoid arthritis patients taking tumor necrosis factor inhibitors switch agents often, resulting in low 2-year continuation rates for these agents, despite the fact that no large, controlled studies have been done on the effects of frequent switching.

“Increased expectations on the part of the patient or the physician could play a role in creating impatience when immediate results are not seen” with given anti-TNF inhibitors, wrote Dr. Yusuf Yazici from the New York University Hospital for Joint Diseases, and colleagues.

And although much of the existing literature does support switching to another anti-TNF agent after initial failure, “these results have been reported mostly in small, short-term studies that focus on efficacy outcomes, not TNF inhibitor survival in the 'real world,'” he added.

In a study to assess anti-TNF treatment patterns, Dr. Yazici and colleagues looked at insurance claims data from 90 managed care organizations on 50 million patients in the United States. They analyzed data on all patients with RA who initiated anti-TNF therapy between Jan. 1, 2000, and July 1, 2005. A subsidiary cohort of the 6,070 patients who started an anti-TNF agent between 2003 and 2005 was also analyzed to assess use of adalimumab, which was not commercially available until 2003.

Patients on infliximab had the highest percentage of continuation on the drug in both cohorts. However, at 2 years, this figure was only 50%.

Furthermore, 40% of patients starting on infliximab needed one or more dose escalation over the study period, which has “important implications, given the drugs and administration costs associated with more medication use,” wrote the authors (J. Rheumatol. 2009 March 30 [doi:10.3899/jrheum.080592]).

Additionally, despite the relatively high continuation rate seen with infliximab, the authors found that etanercept was the most commonly prescribed initial anti-TNF agent, used by about 50% of patients in both cohorts who were starting anti-TNF therapy for the first time. However, at 2 years in both cohorts, only about 20% of the initial etanercept patients remained on the drug.

In the subcohort, adalimumab was the initial drug started by 1,365 patients (23% of the cohort); the continuation rates closely mirrored those seen with etanercept.

Dr. Yazici and his colleagues speculated that the flexibility of infliximab scheduling and dosing, and the ability of a majority of patients to increase their dose, may explain why infliximab had higher continuation rates than did the two other agents. Additionally, the authors postulated that because infliximab is an agent that is given by infusion and thus requires regular follow-up, “seeing a physician regularly may encourage a patient to remain” on the regimen.

They recommend that other agents now on the market, like abatacept and rituximab, also be investigated in a real world setting.

“TNF inhibitor use patterns are changing with time, with more frequent changes and shorter duration of treatment before the change,” wrote the authors. “Further research needs to be conducted to determine if those tends remain constant with the availability of new biologic treatment options, and how these newer treatments influence the treatment algorithm.”

Dr. Yazici has served as a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Hoffmann-La Roche Inc., and UCB SA. One of the authors on the current study is an employee of Bristol-Myers Squibb.

Rheumatoid arthritis patients taking tumor necrosis factor inhibitors switch agents often, resulting in low 2-year continuation rates for these agents, despite the fact that no large, controlled studies have been done on the effects of frequent switching.

“Increased expectations on the part of the patient or the physician could play a role in creating impatience when immediate results are not seen” with given anti-TNF inhibitors, wrote Dr. Yusuf Yazici from the New York University Hospital for Joint Diseases, and colleagues.

And although much of the existing literature does support switching to another anti-TNF agent after initial failure, “these results have been reported mostly in small, short-term studies that focus on efficacy outcomes, not TNF inhibitor survival in the 'real world,'” he added.

In a study to assess anti-TNF treatment patterns, Dr. Yazici and colleagues looked at insurance claims data from 90 managed care organizations on 50 million patients in the United States. They analyzed data on all patients with RA who initiated anti-TNF therapy between Jan. 1, 2000, and July 1, 2005. A subsidiary cohort of the 6,070 patients who started an anti-TNF agent between 2003 and 2005 was also analyzed to assess use of adalimumab, which was not commercially available until 2003.

Patients on infliximab had the highest percentage of continuation on the drug in both cohorts. However, at 2 years, this figure was only 50%.

Furthermore, 40% of patients starting on infliximab needed one or more dose escalation over the study period, which has “important implications, given the drugs and administration costs associated with more medication use,” wrote the authors (J. Rheumatol. 2009 March 30 [doi:10.3899/jrheum.080592]).

Additionally, despite the relatively high continuation rate seen with infliximab, the authors found that etanercept was the most commonly prescribed initial anti-TNF agent, used by about 50% of patients in both cohorts who were starting anti-TNF therapy for the first time. However, at 2 years in both cohorts, only about 20% of the initial etanercept patients remained on the drug.

In the subcohort, adalimumab was the initial drug started by 1,365 patients (23% of the cohort); the continuation rates closely mirrored those seen with etanercept.

Dr. Yazici and his colleagues speculated that the flexibility of infliximab scheduling and dosing, and the ability of a majority of patients to increase their dose, may explain why infliximab had higher continuation rates than did the two other agents. Additionally, the authors postulated that because infliximab is an agent that is given by infusion and thus requires regular follow-up, “seeing a physician regularly may encourage a patient to remain” on the regimen.

They recommend that other agents now on the market, like abatacept and rituximab, also be investigated in a real world setting.

“TNF inhibitor use patterns are changing with time, with more frequent changes and shorter duration of treatment before the change,” wrote the authors. “Further research needs to be conducted to determine if those tends remain constant with the availability of new biologic treatment options, and how these newer treatments influence the treatment algorithm.”

Dr. Yazici has served as a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Hoffmann-La Roche Inc., and UCB SA. One of the authors on the current study is an employee of Bristol-Myers Squibb.

Rheumatoid arthritis patients taking tumor necrosis factor inhibitors switch agents often, resulting in low 2-year continuation rates for these agents, despite the fact that no large, controlled studies have been done on the effects of frequent switching.

“Increased expectations on the part of the patient or the physician could play a role in creating impatience when immediate results are not seen” with given anti-TNF inhibitors, wrote Dr. Yusuf Yazici from the New York University Hospital for Joint Diseases, and colleagues.

And although much of the existing literature does support switching to another anti-TNF agent after initial failure, “these results have been reported mostly in small, short-term studies that focus on efficacy outcomes, not TNF inhibitor survival in the 'real world,'” he added.

In a study to assess anti-TNF treatment patterns, Dr. Yazici and colleagues looked at insurance claims data from 90 managed care organizations on 50 million patients in the United States. They analyzed data on all patients with RA who initiated anti-TNF therapy between Jan. 1, 2000, and July 1, 2005. A subsidiary cohort of the 6,070 patients who started an anti-TNF agent between 2003 and 2005 was also analyzed to assess use of adalimumab, which was not commercially available until 2003.

Patients on infliximab had the highest percentage of continuation on the drug in both cohorts. However, at 2 years, this figure was only 50%.

Furthermore, 40% of patients starting on infliximab needed one or more dose escalation over the study period, which has “important implications, given the drugs and administration costs associated with more medication use,” wrote the authors (J. Rheumatol. 2009 March 30 [doi:10.3899/jrheum.080592]).

Additionally, despite the relatively high continuation rate seen with infliximab, the authors found that etanercept was the most commonly prescribed initial anti-TNF agent, used by about 50% of patients in both cohorts who were starting anti-TNF therapy for the first time. However, at 2 years in both cohorts, only about 20% of the initial etanercept patients remained on the drug.

In the subcohort, adalimumab was the initial drug started by 1,365 patients (23% of the cohort); the continuation rates closely mirrored those seen with etanercept.

Dr. Yazici and his colleagues speculated that the flexibility of infliximab scheduling and dosing, and the ability of a majority of patients to increase their dose, may explain why infliximab had higher continuation rates than did the two other agents. Additionally, the authors postulated that because infliximab is an agent that is given by infusion and thus requires regular follow-up, “seeing a physician regularly may encourage a patient to remain” on the regimen.

They recommend that other agents now on the market, like abatacept and rituximab, also be investigated in a real world setting.

“TNF inhibitor use patterns are changing with time, with more frequent changes and shorter duration of treatment before the change,” wrote the authors. “Further research needs to be conducted to determine if those tends remain constant with the availability of new biologic treatment options, and how these newer treatments influence the treatment algorithm.”

Dr. Yazici has served as a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Hoffmann-La Roche Inc., and UCB SA. One of the authors on the current study is an employee of Bristol-Myers Squibb.

WASHINGTON — Use of a comprehensive electronic health records system in the Kaiser Permanente Hawaii region reduced physician visits by 26% per member between 2004 and 2007, while scheduled “telephone visits” per member increased nearly 10-fold.

The “sit up and take notice” finding was reported at a briefing held by the journal Health Affairs.

According to Dr. Louise Liang, former senior vice president of Kaiser's quality and clinical systems support division, who continues to consult with Kaiser, in 2004 the Hawaii region implemented a health information system known as KP HealthConnect. The system includes an EHR that allows documentation in both inpatient and outpatient settings, with real-time connections to the laboratory, pharmacies, radiology clinics, and other systems; Web-based messaging between patients and providers; and electronic interprovider messaging that is automatically entered into a personal health record.

Among the roughly 225,000 Hawaii Kaiser Permanente members, total office visits, including visits with nonphysician providers, fell from an average of 5.01 per member in 2004 to 3.70 in 2007, a highly significant net change of 26% (Health Affairs 2009;28:323–33). The decrease was seen in specialist visits (down 21%) as well as primary care visits (down 25%).

During the same time frame, scheduled telephone visits increased from an average of 0.17 per member in 2004 to 1.68 per member in 2007, or nearly 10-fold.

WASHINGTON — Use of a comprehensive electronic health records system in the Kaiser Permanente Hawaii region reduced physician visits by 26% per member between 2004 and 2007, while scheduled “telephone visits” per member increased nearly 10-fold.

The “sit up and take notice” finding was reported at a briefing held by the journal Health Affairs.

According to Dr. Louise Liang, former senior vice president of Kaiser's quality and clinical systems support division, who continues to consult with Kaiser, in 2004 the Hawaii region implemented a health information system known as KP HealthConnect. The system includes an EHR that allows documentation in both inpatient and outpatient settings, with real-time connections to the laboratory, pharmacies, radiology clinics, and other systems; Web-based messaging between patients and providers; and electronic interprovider messaging that is automatically entered into a personal health record.

Among the roughly 225,000 Hawaii Kaiser Permanente members, total office visits, including visits with nonphysician providers, fell from an average of 5.01 per member in 2004 to 3.70 in 2007, a highly significant net change of 26% (Health Affairs 2009;28:323–33). The decrease was seen in specialist visits (down 21%) as well as primary care visits (down 25%).

During the same time frame, scheduled telephone visits increased from an average of 0.17 per member in 2004 to 1.68 per member in 2007, or nearly 10-fold.

WASHINGTON — Use of a comprehensive electronic health records system in the Kaiser Permanente Hawaii region reduced physician visits by 26% per member between 2004 and 2007, while scheduled “telephone visits” per member increased nearly 10-fold.

The “sit up and take notice” finding was reported at a briefing held by the journal Health Affairs.

According to Dr. Louise Liang, former senior vice president of Kaiser's quality and clinical systems support division, who continues to consult with Kaiser, in 2004 the Hawaii region implemented a health information system known as KP HealthConnect. The system includes an EHR that allows documentation in both inpatient and outpatient settings, with real-time connections to the laboratory, pharmacies, radiology clinics, and other systems; Web-based messaging between patients and providers; and electronic interprovider messaging that is automatically entered into a personal health record.

Among the roughly 225,000 Hawaii Kaiser Permanente members, total office visits, including visits with nonphysician providers, fell from an average of 5.01 per member in 2004 to 3.70 in 2007, a highly significant net change of 26% (Health Affairs 2009;28:323–33). The decrease was seen in specialist visits (down 21%) as well as primary care visits (down 25%).

During the same time frame, scheduled telephone visits increased from an average of 0.17 per member in 2004 to 1.68 per member in 2007, or nearly 10-fold.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the child health evaluation and research unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or they were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot.

“Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski said that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the child health evaluation and research unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or they were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot.

“Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski said that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the child health evaluation and research unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or they were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot.

“Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski said that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.

“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010.

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.

“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010.

WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.

And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.

Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”

The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.

But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.

The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.

A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.

HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.

“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”

The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010.

BALTIMORE — A highly accurate two-question screening tool for food insecurity can be administered easily and quickly in the primary care setting, according to its developers.

Answers of “sometimes true” or “often true” to either or both of the tool's two questions—“We worried whether our food would run out before we got money to buy more,” and “the food we bought just didn't last and we didn't have money to get more”—indicate that a family is likely experiencing food insecurity and should be referred to social workers, local food banks, or food stamp programs. Two answers of “never true” indicate food security.

Food insecurity is not the same as hunger, although they are often confused, Dr. Erin R. Hager said in a presentation at the annual meeting of the Pediatric Academic Societies. Hunger is a physiological response to a lack of food, but food insecurity is a psychological response to a perceived future lack of food for all household members because of financial issues, explained Dr. Hager of the pediatrics department at the University of Maryland, Baltimore.

“There's a lot of evidence to suggest that food insecurity increases young children's risk for poor health and development,” said Dr. Hager. Food-insecure households also have an increased risk of the caregiver being in poor health and a greater number of lifetime hospitalizations for young children. There also is an increased likelihood that young children will have developmental and behavioral problems, she added, including aggression, anxiety, depression, inattention, and hyperactivity.

In addition, there is evidence that caregivers in food-insecure households are at an increased risk for depression, said Dr. Hager.

The researchers assessed low-income families with children aged 3 years or younger. The families were recruited from emergency departments at seven urban hospitals through the Children's HealthWatch program, formerly known as the Children's Sentinel Nutrition Assessment Program.

Food security was initially assessed using an 18-question survey from the U.S. Department of Agriculture. Scores positive for food insecurity on that longer survey were considered to be true positives; negative food insecurity scores were considered to be true negatives.

A total of 26,350 families were assessed across the country; 23% were found to be experiencing food insecurity. The national average is 11%, said Dr. Hager, reflecting the higher prevalence of food insecurity among the lower-income families surveyed.

The researchers then determined that among families with food insecurity, the two questions were the most frequently endorsed—92% of families answered yes to the first question, and 82% of families answered yes to the second. The two questions together identified food insecurity with 97% sensitivity and 83% specificity.

Since the two-question tool's development this year, the Baltimore city health commissioner has called for all pediatricians to use the screening method with all families, said Dr. Hager. Since January 2009, the Minnesota Department of Health has screened more than 10,000 families with it.

The food-insecurity screen could be used outside of the clinical setting, suggested session moderator Dr. Ian Paul, of the Penn State Hershey Children's Hospital. “Put this up in the supermarket and say, 'If you answer “yes” to either of these questions, here's a number to call,'” he said.

Dr. Hager reported having no conflicts of interest in regard to her study.

BALTIMORE — A highly accurate two-question screening tool for food insecurity can be administered easily and quickly in the primary care setting, according to its developers.

Answers of “sometimes true” or “often true” to either or both of the tool's two questions—“We worried whether our food would run out before we got money to buy more,” and “the food we bought just didn't last and we didn't have money to get more”—indicate that a family is likely experiencing food insecurity and should be referred to social workers, local food banks, or food stamp programs. Two answers of “never true” indicate food security.

Food insecurity is not the same as hunger, although they are often confused, Dr. Erin R. Hager said in a presentation at the annual meeting of the Pediatric Academic Societies. Hunger is a physiological response to a lack of food, but food insecurity is a psychological response to a perceived future lack of food for all household members because of financial issues, explained Dr. Hager of the pediatrics department at the University of Maryland, Baltimore.

“There's a lot of evidence to suggest that food insecurity increases young children's risk for poor health and development,” said Dr. Hager. Food-insecure households also have an increased risk of the caregiver being in poor health and a greater number of lifetime hospitalizations for young children. There also is an increased likelihood that young children will have developmental and behavioral problems, she added, including aggression, anxiety, depression, inattention, and hyperactivity.

In addition, there is evidence that caregivers in food-insecure households are at an increased risk for depression, said Dr. Hager.

The researchers assessed low-income families with children aged 3 years or younger. The families were recruited from emergency departments at seven urban hospitals through the Children's HealthWatch program, formerly known as the Children's Sentinel Nutrition Assessment Program.

Food security was initially assessed using an 18-question survey from the U.S. Department of Agriculture. Scores positive for food insecurity on that longer survey were considered to be true positives; negative food insecurity scores were considered to be true negatives.

A total of 26,350 families were assessed across the country; 23% were found to be experiencing food insecurity. The national average is 11%, said Dr. Hager, reflecting the higher prevalence of food insecurity among the lower-income families surveyed.

The researchers then determined that among families with food insecurity, the two questions were the most frequently endorsed—92% of families answered yes to the first question, and 82% of families answered yes to the second. The two questions together identified food insecurity with 97% sensitivity and 83% specificity.

Since the two-question tool's development this year, the Baltimore city health commissioner has called for all pediatricians to use the screening method with all families, said Dr. Hager. Since January 2009, the Minnesota Department of Health has screened more than 10,000 families with it.

The food-insecurity screen could be used outside of the clinical setting, suggested session moderator Dr. Ian Paul, of the Penn State Hershey Children's Hospital. “Put this up in the supermarket and say, 'If you answer “yes” to either of these questions, here's a number to call,'” he said.

Dr. Hager reported having no conflicts of interest in regard to her study.

BALTIMORE — A highly accurate two-question screening tool for food insecurity can be administered easily and quickly in the primary care setting, according to its developers.

Answers of “sometimes true” or “often true” to either or both of the tool's two questions—“We worried whether our food would run out before we got money to buy more,” and “the food we bought just didn't last and we didn't have money to get more”—indicate that a family is likely experiencing food insecurity and should be referred to social workers, local food banks, or food stamp programs. Two answers of “never true” indicate food security.

Food insecurity is not the same as hunger, although they are often confused, Dr. Erin R. Hager said in a presentation at the annual meeting of the Pediatric Academic Societies. Hunger is a physiological response to a lack of food, but food insecurity is a psychological response to a perceived future lack of food for all household members because of financial issues, explained Dr. Hager of the pediatrics department at the University of Maryland, Baltimore.

“There's a lot of evidence to suggest that food insecurity increases young children's risk for poor health and development,” said Dr. Hager. Food-insecure households also have an increased risk of the caregiver being in poor health and a greater number of lifetime hospitalizations for young children. There also is an increased likelihood that young children will have developmental and behavioral problems, she added, including aggression, anxiety, depression, inattention, and hyperactivity.

In addition, there is evidence that caregivers in food-insecure households are at an increased risk for depression, said Dr. Hager.

The researchers assessed low-income families with children aged 3 years or younger. The families were recruited from emergency departments at seven urban hospitals through the Children's HealthWatch program, formerly known as the Children's Sentinel Nutrition Assessment Program.

Food security was initially assessed using an 18-question survey from the U.S. Department of Agriculture. Scores positive for food insecurity on that longer survey were considered to be true positives; negative food insecurity scores were considered to be true negatives.

A total of 26,350 families were assessed across the country; 23% were found to be experiencing food insecurity. The national average is 11%, said Dr. Hager, reflecting the higher prevalence of food insecurity among the lower-income families surveyed.

The researchers then determined that among families with food insecurity, the two questions were the most frequently endorsed—92% of families answered yes to the first question, and 82% of families answered yes to the second. The two questions together identified food insecurity with 97% sensitivity and 83% specificity.

Since the two-question tool's development this year, the Baltimore city health commissioner has called for all pediatricians to use the screening method with all families, said Dr. Hager. Since January 2009, the Minnesota Department of Health has screened more than 10,000 families with it.

The food-insecurity screen could be used outside of the clinical setting, suggested session moderator Dr. Ian Paul, of the Penn State Hershey Children's Hospital. “Put this up in the supermarket and say, 'If you answer “yes” to either of these questions, here's a number to call,'” he said.

Dr. Hager reported having no conflicts of interest in regard to her study.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the Child Health Evaluation and Research Unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot. “Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski disclosed that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the Child Health Evaluation and Research Unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot. “Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski disclosed that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.

BALTIMORE — Among children with asthma who received a recommendation from their physician to get the influenza vaccine, the rate of subsequent vaccination was 76%, compared with 16% among children who reported not receiving a recommendation from their physician.

The low vaccination rate among the children who did not receive a recommendation, therefore, contributed to a relatively low vaccination rate among the entire cohort (57%), for whom the flu shot is strongly recommended.

The data, presented in a poster at the annual meeting of the Pediatric Academic Societies, should serve as a reminder to physicians treating pediatric asthma patients that their guidance really does have a profound effect, according to study author Dr. Kevin J. Dombkowski.

Dr. Dombkowski is from the Child Health Evaluation and Research Unit in the division of general pediatrics at the University of Michigan, Ann Arbor.

A total of 189 parents of children with asthma were interviewed over the phone between April and June 2008. The children were between ages 5 and 18 years, and were culled from Michigan Medicaid and Title V files. Parents were asked about health care utilization during the prior 2007–2008 influenza season, as well as vaccination during that season.

Overall, 153 patients, or 81%, had seen their physician for asthma management or treatment sometime during the flu season, whether for a regular checkup or after an acute problem.

“Most [patients] have an office visit at which influenza vaccine could be given,” wrote the authors, or during which a strong recommendation to receive the shot could be communicated.

The data also revealed a lack of education about influenza vaccine among these high-risk children and their parents. When the 82 parents who reported that their child did not receive a flu vaccine were asked why, some of the top reasons included that no one had told them that a flu shot was needed for their child (15%); they thought that their child did not need one (18%); or were concerned that the influenza vaccine would result in their child getting the flu (10%).

Although 70% of patients reported receiving a recommendation from their physician in this study, Dr. Dombkowski said in an interview that physicians can do better. He referenced a study he conducted several years ago in a different setting, which showed that only 20% of asthmatic patients had received the flu shot. “Meanwhile, over 60% of these kids [in the study] had been in the office during flu season,” he said, revealing the “missed opportunities” for influenza vaccine education, recommendation, and administration.

Dr. Dombkowski disclosed that the study was funded by the Blue Cross Blue Shield of Michigan Foundation.