Nurse Practitioners Ready to Mind the Gap

Obamacare’ is expected to expand health insurance to 32 million Americans over the next decade. This will inevitably lead to a spike in demand for medical services; leading many people to wonder who will provide that care. Maybe we need to wonder no more.

As you read this post, nurse practitioners (NPs) are throwing their hats in the ring and gearing up to be among the front runners.

Through advertisements, public service announcements and events, the American Academy of Nurse Practitioners (AANP) will try to raise the profile of the country’s 155,000 nurse practitioners.  Their campaign aims to explain exactly what nurse practitioners do and why patients should trust them with their medical needs.

AANP will also exploit the very real, looming doctor shortage. According to the Association of American Medical Colleges  the country will have 63,000 too few doctors by 2015.

With the serious shortage of family doctors in many parts of the country, nurse practitioners  will claim, in a series of radio public service announcements, that they can provide expert, compassionate and affordable care. The AANP will follow up on the public relations blitz with state-level lobbying efforts, looking to pass bills that will expand the range of medical procedures that their membership can perform.

A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and make the health-care system more affordable for patients all across America,” ­ says Penny Kaye Jensen, president of the AANP. “It is our goal to empower health care consumers in all 50 states with clear confirmation that NPs provide professional, compassionate and cost-effective primary health care, as we have done for more than forty years.”

In 16 states, “scope of practice” laws allow nurse practitioners to practice without the supervision of a doctor. Other states, however, require a physician to sign off on a nurse practitioner’s prescriptions, and/or diagnostic tests.

As the health insurance expansion looms, expanding those rules to other states has become a crucial priority for NPs. “We’re all educated and prepared to provide a full range of services,” said Taynin Kopanos, AANP’s director of state government affairs.

The nurse practitioners’ campaign, however, is unlikely to move forward without a fight. Physician groups, such as the American Medical Association (AMA), contend that such laws could put patients at risk and oppose the efforts of other professional societies to expand their medical authorities.

Nurse practitioners argue that they do have the skills necessary to treat patients with more autonomy. Unlike other nurses, all nurse practitioners hold either a master’s or doctorate degree in medical education.

Alongside the legislative push, the group also will focus on public education. Data suggest that they have their work cut out for them.

A 2010 AANP poll found that while most Americans report having been seen by a nurse practitioner, few knew that their medical expertise goes beyond that of traditional, registered nurses.

Only 14% of the adults surveyed thought that nurse practitioners could prescribe medication, an authority they have in all states and only 18% thought NPs could order diagnostic tests such as X-rays and MRIs.

People stop at the word nurse and don’t understand the word practitioner,” Jensen said. “Obviously we are nurses, but we also have advanced education. We think there’s a misunderstanding on the patients’ behalf.”

Lend your voice to the healthcare debate by sharing with us your thoughts on NPs, their visibility, their scope of practice and their role in the healthcare of our nation.

Top Ten Healthy Gifts for the Holidays

Happy Black Friday to all of our readers.  Before you head out to the stores this morning to buy the perfect presents for your loved ones, why not consider giving the greatest gift of all – health.

“Health truly is the gift that keeps on giving,” says James Rohack, past-president of the American Medical Association.

With disposable income more scarce than ever this year, giving practical gifts is in vogue. And what could be more useful than a well-woman exam, or a gym membership?

Here’s SRxA’s Word on Health’s 10 suggestions to help make 2011 gift-giving a little healthier:

1. Be a Tooth Fairy. We’re not suggesting you add free root canals to your Christmas stockings, but since dental coverage is either limited or non-existent for so many people, a tooth cleaning could make a great gift for anyone who’s been putting off getting dental care because of cost. Most dentists offer gift certificates. A  $50 certificate might get you a basic cleaning, and for a little more you could give a professional whitening treatment.

If you’re buying for kids, consider a cool toothbrush such as Tooth Tunes Musical Toothbrush or a fun Spinbrush. For grown-up gadget fans, a high-end electric toothbrush or flosser can be a great present.

2. Office Visits. With almost 50 million Americans lacking health insurance and skyrocketing co-pays and deductibles, a pre-paid visit to the doctor’s office or a drug-store gift card for someone who has high pharmaceutical bills makes a useful present.

These may be especially appropriate for young, single women. National Center for Health Statistics data show that unmarried women ages 25 to 64 were more likely to be uninsured than married with in the same age group.

3. Fancy Foods. Organic fruits and vegetables are often pricey and end up being one of the first things to be cut from the family budget when times are tight. Even non-organic fruit can seem expensive these days, so consider a monthly shipment of produce or other healthy treats. Visit on-line sites such as or check with a local organic farm.

4. Fit Club.  Splurge for a friend or family member who enjoys working out. If they are already a member or if a full years gym membership is beyond your means, how about a gift certificate for a personal-training session?

5. Yoga Stuff. Is there a better gift than inner peace?  Yoga helps with stress, flexibility and blood flow. “It’s one of those forms of exercise that not only works your body but works your mind, works your soul, your spirit,” says yoga instructor Peter Sterios. Buy the yoga lover in your life some great gear, a fabulous mat or a gift certificate for classes at a local yoga studio.

6. A Rub Down.  After a workout, or a stressful day, a massage can go a long way to making you feel better. To find a massage therapist who meets all state or local licensing requirements, visit:

7. Exercise Gear. Good shoes are a runner’s best friend, but they’re expensive. And it’s not just about fashion. If you don’t have good foot support, then you wind up getting foot injuries, and then your motivation to get healthy is limited. So don’t let your favorite amateur athlete work out in worn-out gear. Buy them a gift certificate to a good sports supply store.

8. Health Monitoring Gadgets. While buying someone a bathroom scale might be a bit insulting, high-tech at-home self-test kits such as a blood-pressure monitor could be just the ticket. Eighty million Americans have high blood pressure, and only a third of them have it under control.

9. Pick Up the Check. Most restaurants now offer healthy options. One way to find good spots: the National Restaurant Association‘s (NRA) partner site, According to the NRA, 77% percent of consumers say they would like to receive a restaurant gift card.

10. Good-For-You Reads. Skip the fads and invest in books like the American Medical Association’s “Complete Guide to Prevention and Wellness,” the American Pediatric Association’s “Caring for Your Baby and Young Child” ; “The Pill Book: An Illustrated Guide to the Most-Prescribed Drugs in the United States.or even the hard-core Merck Manual.

Happy Shopping!

Pharma-Physician Interactions Perceived Positively

According to a survey released last week, nearly eight out of 10 physicians view pharmaceutical research companies and their sales representatives as useful sources of information on prescription medicines.

That’s good news for pharmaceutical marketers who spent $24 billion between October 2009 and September 2010 on physician-targeted promotional spending, and an additional $1 billion on continuing medical education.

The telephone survey of more than 500 American Medical Association members found that physicians consider a range of sources useful for staying informed about medicines. In addition to sales reps and company-sponsored peer education programs, doctors also rated continuing medical education (CME) courses, peer-reviewed medical journals, and their fellow physicians as useful sources of information.

The survey also found that physicians consider a broad range of factors in making their prescribing decisions, with almost all respondents relying on their clinical knowledge and experience as well as a patient’s response to a particular medicine. More than 80% reported that they take into consideration a patient’s insurance factors, such as formulary and prior authorization requirements, with just under 70% using information provided by pharmaceutical company representatives

The survey, which was supported by PhRMA, also looked closely at how physician respondents view their interactions with pharmaceutical company representatives.

More than 90% responded that interactions with representatives allow them to learn about new indications for approved medicines, potential side effects of medicines, and both emerging benefits and risks of medicines.  In addition, 84% of physicians said that interactions with representatives allow them the opportunity to provide feedback to a pharmaceutical company about their experiences with a specific medicine.  Large majorities also found information from company representatives to be up-to-date and timely (94 %), useful (92%), and reliable (84%).

The survey also included several questions about company-sponsored peer education programs, in which physicians present to their peers. Nearly 9 out of 10 of physicians who reported attending these programs said the information was up-to-date, useful and reliable.

Physicians attending peer education programs reported gaining a range of information, including: improved clinical knowledge (98%), potential side effects of medicines (97% ), new uses of medicines (97%), the range of treatment options (97%), and emerging drug risks (95%). Importantly, 94% said the programs strengthened their ability to care for patients.

Peer education programs allow physicians to have important dialogues with their expert colleagues. This sharing of information ultimately benefits the patients they treat,” said PhRMA’s John Castellani.

SRxA and its team of independent Clinical Advisors specializes in providing support to the pharmaceutical industry and has developed a number of highly successful and unique peer-to-peer education programs. For more information, contact us today.

FDA Criticized by the Government Accountability Office

Normally, it’s  pharmaceutical companies that come under the scrutiny of the FDA.  However, in an interesting twist of fate, the FDA  itself is now under fire for not enforcing its own rules.

Physicians have an innate tendency to trust governing medical entities such as the American Medical Association (AMA), Food and Drug Administration (FDA) and Centers for Disease Control (CDC). Maintaining a reproducible and sustainable standard for reporting clinically relevant pharmaceutical data for new and established drugs has always been a priority for the FDA.

In December 2000, the  FDA issued a call to improve the professional labeling of drug  package inserts and other accredited drug information sources i.e.  the Physician Drug Reference (PDR). In 2006, the standard format for package inserts was modified in an attempt to make it more user-friendly and to serve as an efficient resource tool for patients, physicians, and researchers.

In today’s fast-changing challenging healthcare environment, physicians tend to accept this reported data, and the lack of it, as this is all there is available to them.

However, many would like to know more. For example, how to manipulate a drug dose for a patient with renal failure based on given elimination half life.  Although vital to the management of such patients, all too often, such information is not yet an option for many of FDA approved drugs.

The United States Government Accountability Office (GAO) recently concluded that the FDA lacks a clear and effective process for postmarket drug safety issues. The GAO  also observed that there is a lack of criteria for determining what safety actions to take and when to take them.

This finding is supported by research from  Wesley College, Delaware.   Using the commercially available KnowItAll® informatics platform from Bio-Rad Laboratories, researchers built a Cancer Drug Database containing 85 chemotherapy drugs.  They found that the  reporting of important biological properties such as bioavailability (BIO), plasma protein binding (PPB), elimination half-life (t1/2), volume of distribution (VD), and water solubility were found to be markedly deficient.

According to Malcolm J. D’Souza, Ph.D The evidence is so compelling that the apparent laxity in enforcing reporting regulations for many of these pharmaceuticals is alarming.”

Perhaps the real impact of this research is the red flags it raises.  The FDA guidelines need to be revisited with emphasis on vigilance in reporting all parameters that directly or indirectly affect patient care.

Until the FDA has its house in order, we wonder how much, and for how long either physicians and pharma will continue to trust their own regulatory bodies.  Let us know what you think.

Medicine for Marketers

We were interested to learn that physicians are now turning the tables and offering education to the pharmaceutical industry.

For years, the pharmaceutical industry has been involved, either directly or indirectly, with the provision of education to doctors. New guidelines seem certain to change all that. As previously noted in Word on Health, the ACCME, IOM, AMA and others are all seeking to limit the financial relationship between industry and clinicians.

In a joint effort between the University of Chicago Booth School of Business and the University of Chicago Medical Center, a program entitled Understanding the New Breed of Healthcare Decision Makers will launch this May.

The program will focus on the healthcare issues that will dominate the next decade and is designed to provide an insider’s view on how decisions are made by physicians and hospital administrators.

Over the course of five tightly packed days, the course aims to provide sales, marketing, and product management personnel from the pharmaceutical, device and biotech industry with the skills to:

  • Improve sales and marketing decision making skills by exploring the doctor-patient relationship and gaining insight into how physicians and surgeons make decisions
  • Better anticipate the business impact of current healthcare issues
  • Improve marketing strategies by exploring modes of thinking within medical specialties and subspecialties
  • Make better resource deployment decisions as the result of improved understanding of hospital supply chain, purchasing, patient flow and operations
  • Better anticipate market needs as the result of exposure to key opinion leaders
  • Improve product & service positioning strategies by learning how doctors and hospitals define value
  • Better understand and empathize with customer s through a unique immersion experience  in clinical settings

The cost for the course will be $7,650.

SRxA’s Word on Health would love to hear from you if you’ve signed up.