Many professional organizations offering help
If your computer system uses only the last two digits of each year to represent the current date, a year 2000 (Y2K) test is in order to see if your computer will think January 1, 2000, is Jan. 1, 1900.
"Many systems, especially newer computers and software programs, are Y2K compliant. Some systems may originally have been compliant but, because of customization, may now be noncompliant," says Joel Weber, PharmD, FCHSP, director of health system solutions at Bergen Brunswig Drug Co. in Orange, CA. The company has been consulting with its health system clients on Y2K compliance issues.
In one case, a California health care group found more than 110 systems had suspect dating applications during a Y2K inventory program. This year, the General Accounting Office issued an unflattering report of the Health Care Financing Adminis tration’s (HCFA) system readiness, an important development for pharmacies filing Medicare and Medicaid claims. HCFA has responded that its system will be trouble-free, and in its own letter to health care agencies, HCFA warned that hospitals should not delay testing their systems.
Another issue being discussed in the industry is that of patients hoarding or stockpiling drugs toward year’s end, something the American Red Cross has advised the public to do. That was the topic of the Y2K Supply Chain Conference held earlier this year in New Jersey.
The flow of drugs, from the ordering of raw materials all the way to dispensing, is forecasted by the wholesaler industry, which says stockpiling could be a bigger issue than computer system problems. Currently, the industry operates on about a one-month supply, meaning it will have to watch the coming months carefully to determine whether patients are stockpiling drugs.
The American Society of Health-System Pharmacists says information it has received from organizations like the Pharmaceutical Research and Manufacturers of America and the National Wholesale Druggists Association have left it feeling confident of the readiness of major vendors.
The bottom line of the conference was public relations —- making sure consumers don’t worry about getting their prescriptions. "If people believe there will be a disruption, then there will be a disruption," says Gary Loeb of drug wholesaler McKesson Corp. "Perception is going to drive the events leading up to the year 2000."
Y2K Web sites
New HEDIS measures
The National Committee for Quality Assurance has added five new outcomes measures to its Health Plan Employer Data (HEDIS) program. They are asthma, blood pressure, chla mydia, diabetes, and menopause. The performance standards are used for accrediting programs and consumer comparison shopping. The additions are part of the HEDIS 2000 program, bringing the total number of quality measures to just over 60.
[For details, contact NCQA at (800) 275-7585.]
Endostatin shows promise in reducing plaque
It also may work against cancerous tumors
A formulation of the natural protein endostatin, developed at Harvard University, created a lot of interest earlier this year as a potentially new kind of treatment against cancerous tumors.
The studies, conducted in mice, measured the protein’s ability to block the growth of blood vessels tumors need to survive. Now a similar study is showing early success for the drug’s ability to affect the growth of arterial plaque tissue that causes atherosclerosis, which leads to heart attack and angina.
Like tumors, blood cells and smooth muscle cells also rely on their own network of capillaries to grow. The study of 73 mice given a high-cholesterol diet found that mice given the drug had 85% less plaque build-up in heart aortas.
The study was published in the April 6 issue of the American Heart Association journal Circulation.
Anesthesiologist group issues herbal warning
The American Society of Anesthesiologists (ASA) says surgery patients should stop taking herbal medicines at least two to three weeks before a procedure as a safety precaution against the risk of an adverse reaction. The organization is not issuing the warning based on hard science or specific studies, but instead has been getting growing anecdotal evidence that "significant" changes in heart rate or blood pressure have occurred in patients later found to be taking an herbal product.
That, coupled with an in-house survey finding that seven of 10 patients taking herbals don’t tell their physicians about it, prompted the warning, as well as statistics showing that the public’s use of the products has grown by 60% in a year, according to ASA president John Neeld, MD.
"All we want to do is make the public aware that these products could pose a serious health risk if they are taken prior to surgery," he said. The statement echoes those of national pharmacy organizations, which have been urging hospital pharmacists to ask patients if they are taking herbals.
The ASA also is asking its members to urge patients to bring herbal containers for their physicians to see prior to surgery. The organization says the depression treatment St. John’s Wort may intensify the effects of narcotic anesthesia agents; the circulatory products ginkgo biloba and feverfew could reduce or interfere with platelet counts needed for post-surgery clotting; and ginseng has been linked to hypertension and tachycardia.
[For details, contact ASA at (847) 825-5586 or ASAhq.org.]
Pharmacists hail OTC labeling inclusion
"Ask your doctor or pharmacist." That simple phrase, now mandated by the Food and Drug Administration as part of its new, final regulations on over-the-counter labeling, is being seen as a hard-fought victory for the pharmacy industry. The FDA has added "pharmacist" to the phrase patients are accustomed to seeing on prescription brochure labeling after a nearly 20-year lobbying campaign by the industry.
"This is truly a landmark event and we applaud the FDA’s recognition of the pharmacist as a vital source of information that will reinforce the pharmacist’s role as an important member of the health care team as more prescriptions medicines are being switched to OTC status, meaning the need for consultation will only increase," says Calvin Anthony, executive vice president of the National Community Pharma cist Association.
Clinical pharmacy groups say the ruling will benefit hospital pharmacists and their patients, who regularly obtain retail OTCs. The American Pharmaceutical Association (APhA) says the new labeling will being appearing in early 2000. "We encourage the industry to implement labeling changes as quickly as possible and we look forward to providing additional assistance," says APhA executive vice president John Gans, MD.
Last year, the organization sponsored a consumer survey on OTC pain relievers that found high levels of confusion concerning which drugs to use and how to use them.
Study: Interventions fail to cut Medicaid costs
Pharmacist intervention projects aimed at reducing Medicaid costs failed clinically and financially, according to a review of two pilot programs overseen by the Health Care Financing Adminis tration (HCFA). Pharmacist reimbursement for the clinical interventions was included in the programs, modeled after Medicaid reimbursement piloted in Mississippi.
The programs were set up for pharmacists in treatment groups to review drug utilization when computer system messages signaled potential prescription problems. Interventions included the performance and documentation of cognitive services. Reimbursement rates were $4 for consultations of six minutes or less, and $6 for those lasting longer. Analysis of the programs found the interventions did not "change the utilization of or expenditures on prescription drugs, hospital admissions, professional services, emergency room encounters, or aggregate medical care."
[For details, contact HCFA at (410) 966-3000 and ask about the Abt Associates study.]
Antiformulary bills introduced in three states
Lawmakers in three states have introduced antiformulary bills into state legislatures. A New Hampshire bill (HB 321) would require health plans to cover any prescription medication submitted, regardless of a health plan’s formulary. Some pharmacy groups are opposed to the bill, arguing it could drive up costs and that most plans in the state already allow formulary exceptions by physician prescription.
Two Senate bills in Maryland (SB 135 and 109) would allow nonformulary exceptions in cases where a drug is prescribed by a patient’s health care provider and if the provider determines a drug is necessary.
A bill in Connecticut (HB 5682) would require health plans to accept drugs regardless of dosage or preauthorization if a health care provider deems them necessary.
Antibiotic resistance reviewed in 4,000 patients
Physicians should consider changing antibiotics when community resistance tracking rates reach between 15% and 20% in patients with urinary tract infections, advise the authors of an antibiotic resistance study published in the Journal of the American Medical Association (JAMA 1999; 281:736-38).
The study followed 4,000 patients from 1992 to 1996 enrolled in a Washington state HMO and found rising resistance to trimethoprim, ampicillin, cephalothin, and trimethoprin-sulfamethoxazole. The authors found more successful treatment resulted from the use of gentamicin, nitrofurantoin, and ciprofloxacin hydrochloride.