Mary Ellen Schneider

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older. The researchers analyzed five employer-sponsored drug plans: two with a single copayment tier, and three with a three-tiered structure.

The study is further confirmation that the retiree population is sensitive to price, Boyd H. Gilman, Ph.D., one of the study authors and a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview. “They do respond to price, but we don't know what that means in terms of health outcomes.”

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans. Both findings were statistically significant.

The average annual expenditures by the drug plan per enrollee were higher in single-tiered plans, whereas enrollee out-of-pocket costs were higher among those enrolled in three-tiered drug plans, despite their lower drug utilization.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans. These results were also statistically significant.

When they examined trends among individuals who filled prescriptions for chronic conditions, the researchers found that cost containment strategies had less of an effect on prescription drug use. Total expenditures and the number of prescriptions filled were still lower among beneficiaries enrolled in three-tiered plans, but to a lesser extent than when these individuals filled prescriptions for episodic care.

The findings were published online on Sept. 11 in the journal Health Services Research (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007. 0774.x]). The study was funded by an internal grant from RTI International.

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older. The researchers analyzed five employer-sponsored drug plans: two with a single copayment tier, and three with a three-tiered structure.

The study is further confirmation that the retiree population is sensitive to price, Boyd H. Gilman, Ph.D., one of the study authors and a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview. “They do respond to price, but we don't know what that means in terms of health outcomes.”

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans. Both findings were statistically significant.

The average annual expenditures by the drug plan per enrollee were higher in single-tiered plans, whereas enrollee out-of-pocket costs were higher among those enrolled in three-tiered drug plans, despite their lower drug utilization.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans. These results were also statistically significant.

When they examined trends among individuals who filled prescriptions for chronic conditions, the researchers found that cost containment strategies had less of an effect on prescription drug use. Total expenditures and the number of prescriptions filled were still lower among beneficiaries enrolled in three-tiered plans, but to a lesser extent than when these individuals filled prescriptions for episodic care.

The findings were published online on Sept. 11 in the journal Health Services Research (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007. 0774.x]). The study was funded by an internal grant from RTI International.

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older. The researchers analyzed five employer-sponsored drug plans: two with a single copayment tier, and three with a three-tiered structure.

The study is further confirmation that the retiree population is sensitive to price, Boyd H. Gilman, Ph.D., one of the study authors and a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview. “They do respond to price, but we don't know what that means in terms of health outcomes.”

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans. Both findings were statistically significant.

The average annual expenditures by the drug plan per enrollee were higher in single-tiered plans, whereas enrollee out-of-pocket costs were higher among those enrolled in three-tiered drug plans, despite their lower drug utilization.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans. These results were also statistically significant.

When they examined trends among individuals who filled prescriptions for chronic conditions, the researchers found that cost containment strategies had less of an effect on prescription drug use. Total expenditures and the number of prescriptions filled were still lower among beneficiaries enrolled in three-tiered plans, but to a lesser extent than when these individuals filled prescriptions for episodic care.

The findings were published online on Sept. 11 in the journal Health Services Research (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007. 0774.x]). The study was funded by an internal grant from RTI International.

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study to determine whether the medications used to treat attention-deficit hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The study will include all drugs being marketed for ADHD treatment and is expected to be completed in about 2 years.

Its launch follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. In 2006, the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems.

Earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications. The agency also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

The main question will be whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when on these medications, said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. He is the recipient of unrestricted educational grants from Eli Lilly and Co., maker of Strattera, and a member of the Strattera Pediatric Advisory Board.

The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD. The federally funded study could lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, said Dr. Pliszka, who has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the Agency for Healthcare and Research Quality. The national price tag for the three medications was about $1.3 billion in 2004.

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study to determine whether the medications used to treat attention-deficit hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The study will include all drugs being marketed for ADHD treatment and is expected to be completed in about 2 years.

Its launch follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. In 2006, the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems.

Earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications. The agency also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

The main question will be whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when on these medications, said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. He is the recipient of unrestricted educational grants from Eli Lilly and Co., maker of Strattera, and a member of the Strattera Pediatric Advisory Board.

The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD. The federally funded study could lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, said Dr. Pliszka, who has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the Agency for Healthcare and Research Quality. The national price tag for the three medications was about $1.3 billion in 2004.

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study to determine whether the medications used to treat attention-deficit hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The study will include all drugs being marketed for ADHD treatment and is expected to be completed in about 2 years.

Its launch follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. In 2006, the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems.

Earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications. The agency also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

The main question will be whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when on these medications, said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. He is the recipient of unrestricted educational grants from Eli Lilly and Co., maker of Strattera, and a member of the Strattera Pediatric Advisory Board.

The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD. The federally funded study could lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, said Dr. Pliszka, who has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the Agency for Healthcare and Research Quality. The national price tag for the three medications was about $1.3 billion in 2004.

Treating testosterone deficiency in men with erectile dysfunction, diabetes, or cardiovascular disease not only relieves typical symptoms of hypogonadism but can have other clinical benefits, according to a review article published in European Urology Supplements.

Pilot studies show that treatment with testosterone could be promising, but more long-term studies are needed to determine if the effects would be sustained over time and if they would reduce morbidity and mortality, wrote Dr. T. Hugh Jones of the diabetes endocrinology and metabolism unit of the University of Sheffield, England (European Urology Supplements 2007;6:847–57).

Dr. Jones has received honoraria from Prostrakan advisory boards. The Scotland-based company markets Tostrex gel, a transdermal testosterone replacement therapy for use in hypogonadal men. The product is currently marketed in Sweden.

Testosterone therapy appears to have benefits in hypogonadal men with type 2 diabetes, with some studies demonstrating that testosterone replacement can improve glycemic control. In one randomized, placebo-controlled crossover study of 24 hypogonadal men, researchers found improvements in fasting blood glucose and glycated hemoglobin levels (Eur. J. Endocrinol. 2006;154:899–906).

The review article also noted improvements in treating erectile dysfunction with testosterone. In a study of 49 hypogonadal men with erectile dysfunction, about 63% experienced an increase in sexual desire and regained erectile function when treated with testosterone therapy (J. Urol. 2005;173:530–2).

In cardiovascular disease, laboratory and clinical studies indicate that testosterone is a rapidly acting vasodilator, according to the review article.

Treating testosterone deficiency in men with erectile dysfunction, diabetes, or cardiovascular disease not only relieves typical symptoms of hypogonadism but can have other clinical benefits, according to a review article published in European Urology Supplements.

Pilot studies show that treatment with testosterone could be promising, but more long-term studies are needed to determine if the effects would be sustained over time and if they would reduce morbidity and mortality, wrote Dr. T. Hugh Jones of the diabetes endocrinology and metabolism unit of the University of Sheffield, England (European Urology Supplements 2007;6:847–57).

Dr. Jones has received honoraria from Prostrakan advisory boards. The Scotland-based company markets Tostrex gel, a transdermal testosterone replacement therapy for use in hypogonadal men. The product is currently marketed in Sweden.

Testosterone therapy appears to have benefits in hypogonadal men with type 2 diabetes, with some studies demonstrating that testosterone replacement can improve glycemic control. In one randomized, placebo-controlled crossover study of 24 hypogonadal men, researchers found improvements in fasting blood glucose and glycated hemoglobin levels (Eur. J. Endocrinol. 2006;154:899–906).

The review article also noted improvements in treating erectile dysfunction with testosterone. In a study of 49 hypogonadal men with erectile dysfunction, about 63% experienced an increase in sexual desire and regained erectile function when treated with testosterone therapy (J. Urol. 2005;173:530–2).

In cardiovascular disease, laboratory and clinical studies indicate that testosterone is a rapidly acting vasodilator, according to the review article.

Treating testosterone deficiency in men with erectile dysfunction, diabetes, or cardiovascular disease not only relieves typical symptoms of hypogonadism but can have other clinical benefits, according to a review article published in European Urology Supplements.

Pilot studies show that treatment with testosterone could be promising, but more long-term studies are needed to determine if the effects would be sustained over time and if they would reduce morbidity and mortality, wrote Dr. T. Hugh Jones of the diabetes endocrinology and metabolism unit of the University of Sheffield, England (European Urology Supplements 2007;6:847–57).

Dr. Jones has received honoraria from Prostrakan advisory boards. The Scotland-based company markets Tostrex gel, a transdermal testosterone replacement therapy for use in hypogonadal men. The product is currently marketed in Sweden.

Testosterone therapy appears to have benefits in hypogonadal men with type 2 diabetes, with some studies demonstrating that testosterone replacement can improve glycemic control. In one randomized, placebo-controlled crossover study of 24 hypogonadal men, researchers found improvements in fasting blood glucose and glycated hemoglobin levels (Eur. J. Endocrinol. 2006;154:899–906).

The review article also noted improvements in treating erectile dysfunction with testosterone. In a study of 49 hypogonadal men with erectile dysfunction, about 63% experienced an increase in sexual desire and regained erectile function when treated with testosterone therapy (J. Urol. 2005;173:530–2).

In cardiovascular disease, laboratory and clinical studies indicate that testosterone is a rapidly acting vasodilator, according to the review article.

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the suit.

UnitedHealthcare has also agreed to a 3-year process improvement plan. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, a lead party in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators. “This new, forward-thinking approach focuses the regulatory process for the states and our company on a practical set of uniform performance standards, while providing clearer and more meaningful means of assessing how well we are serving customers,” Kenneth A. Burdick, CEO of UnitedHealthcare, said in a statement.

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the suit.

UnitedHealthcare has also agreed to a 3-year process improvement plan. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, a lead party in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators. “This new, forward-thinking approach focuses the regulatory process for the states and our company on a practical set of uniform performance standards, while providing clearer and more meaningful means of assessing how well we are serving customers,” Kenneth A. Burdick, CEO of UnitedHealthcare, said in a statement.

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the suit.

UnitedHealthcare has also agreed to a 3-year process improvement plan. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, a lead party in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators. “This new, forward-thinking approach focuses the regulatory process for the states and our company on a practical set of uniform performance standards, while providing clearer and more meaningful means of assessing how well we are serving customers,” Kenneth A. Burdick, CEO of UnitedHealthcare, said in a statement.

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study aimed at determining whether the medications used to treat attention-deficit/hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The federal study will include all drugs currently being marketed for the treatment of ADHD. The study is expected to be completed in about 2 years.

The launch of the study follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. As a result of these reports, in 2006 the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems. And earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications.

At that time, the FDA also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

“It's an important study to do,” said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. Dr. Stein is the recipient of unrestricted educational grants from Eli Lilly and Co., which makes Strattera, and is a member of the Strattera Pediatric Advisory Board.

The main question that pediatricians will be looking to have answered is whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when taking these medications, Dr. Stein said. The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD in association with a cardiovascular disorder. The federally funded study has the potential to lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, he said. Dr. Pliszka has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. ADHD medications are widely prescribed to children and adolescents, according to government data. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the AHRQ. And the agency estimates that the national price tag for those three medications was about $1.3 billion in 2004.

In addition to providing information for physicians and families, federal officials expect that the results of the study will also influence reimbursement for drugs under Medicare, Medicaid, and the State Children's Health Insurance Program.

The jury is still out on the risk of taking ADHD meds in association with cardiovascular disorders. DR. STEIN

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study aimed at determining whether the medications used to treat attention-deficit/hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The federal study will include all drugs currently being marketed for the treatment of ADHD. The study is expected to be completed in about 2 years.

The launch of the study follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. As a result of these reports, in 2006 the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems. And earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications.

At that time, the FDA also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

“It's an important study to do,” said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. Dr. Stein is the recipient of unrestricted educational grants from Eli Lilly and Co., which makes Strattera, and is a member of the Strattera Pediatric Advisory Board.

The main question that pediatricians will be looking to have answered is whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when taking these medications, Dr. Stein said. The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD in association with a cardiovascular disorder. The federally funded study has the potential to lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, he said. Dr. Pliszka has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. ADHD medications are widely prescribed to children and adolescents, according to government data. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the AHRQ. And the agency estimates that the national price tag for those three medications was about $1.3 billion in 2004.

In addition to providing information for physicians and families, federal officials expect that the results of the study will also influence reimbursement for drugs under Medicare, Medicaid, and the State Children's Health Insurance Program.

The jury is still out on the risk of taking ADHD meds in association with cardiovascular disorders. DR. STEIN

Officials at the Food and Drug Administration and the Agency for Healthcare Research and Quality are launching a large-scale study aimed at determining whether the medications used to treat attention-deficit/hyperactivity disorder expose patients to an increased risk for cardiovascular problems.

The study is a retrospective review of about 500,000 children and adults who took ADHD medications before the end of 2005. Of the 500,000 patients included in the analysis, about 80% represent pediatric use and 20% adult use, according to the FDA. The evaluation will build on preliminary work performed by the FDA that included information from large health care databases on prescription drug use, outpatient treatment, health outcomes, and death.

The federal study will include all drugs currently being marketed for the treatment of ADHD. The study is expected to be completed in about 2 years.

The launch of the study follows reports of sudden death in treated patients with underlying serious heart problems, and reports of stroke and heart attack in treated adults with certain risk factors. As a result of these reports, in 2006 the agency directed ADHD drug manufacturers to revise their product labeling for physicians to include concerns about cardiovascular problems. And earlier this year, FDA officials also directed drug manufacturers to develop patient medication guides to alert patients to possible cardiovascular risks from ADHD medications.

At that time, the FDA also recommended that physicians obtain a health history and assessment of possible cardiovascular problems before starting patients on ADHD medications.

“It's an important study to do,” said Dr. Martin T. Stein, professor of pediatrics at the University of California, San Diego. Dr. Stein is the recipient of unrestricted educational grants from Eli Lilly and Co., which makes Strattera, and is a member of the Strattera Pediatric Advisory Board.

The main question that pediatricians will be looking to have answered is whether children with an underlying structural heart disease or an arrhythmia are at increased risk for cardiovascular problems when taking these medications, Dr. Stein said. The 2006 reports of sudden death have raised public awareness, but the jury is still out on the risks of taking medications for ADHD in association with a cardiovascular disorder. The federally funded study has the potential to lay some of these concerns to rest, he said.

But for most physicians who treat a lot of ADHD, there is no doubt about the safety of these medications, said Dr. Steven R. Pliszka, chief of the division of child and adolescent psychiatry at the University of Texas at San Antonio. Despite increases in prescriptions for these drugs among children, there has been no documented increase in cardiovascular disease, he said. Dr. Pliszka has conducted research for McNeil Pediatrics, Shire, and Eli Lilly and Co., which manufacture ADHD drugs.

ADHD affects 3%–5% of school-age children and about 4% of adults in the United States, according to estimates from the National Institute of Mental Health. ADHD medications are widely prescribed to children and adolescents, according to government data. Three ADHD drugs (Concerta, Strattera, and Adderall) were among the top five drugs prescribed for children 17 years and younger in 2004, according to the AHRQ. And the agency estimates that the national price tag for those three medications was about $1.3 billion in 2004.

In addition to providing information for physicians and families, federal officials expect that the results of the study will also influence reimbursement for drugs under Medicare, Medicaid, and the State Children's Health Insurance Program.

The jury is still out on the risk of taking ADHD meds in association with cardiovascular disorders. DR. STEIN

The number of Americans without health insurance reached 47 million last year, up from 44.8 million in 2005, according to new data released by the U.S. Census Bureau.

The percentage of individuals without health insurance also rose from 15.3% in 2005 to 15.8% in 2006.

This rise includes an increase in the number of uninsured children.

The percentage and number of children under age 18 without health insurance increased from 8 million (10.9%) in 2005 to 8.7 million (11.7%) in 2006.

Much of the increase in the uninsured rate for children can be attributed to a decline in private coverage, David Johnson, chief of the division of housing and household economic statistics at the Census Bureau, said during a news conference.

Overall, the percentage of individuals covered by any type of private insurance plan dropped from 68.5% in 2005 to 67.9% in 2006.

And among children, the percentage with private coverage fell from 65.8% in 2005 to 64.6% in 2006, Mr. Johnson said.

At the same time, coverage by government insurance was also down from 27.3% in 2005 to 27% in 2006.

The data are compiled from the 2007 Current Population Survey Annual Social and Economic Supplement.

The increase in the number of uninsured individuals between 2005 and 2006 is “pretty shocking,” said Karen Davis, Ph.D., president of The Commonwealth Fund, especially in a year when states have been under less financial pressure and many have been trying to expand coverage.

The deterioration of dependent coverage among private plans is particularly disturbing and points to the importance of reauthorizing the State Children's Health Insurance Program (SCHIP) with adequate funding, she said.

The number and percentage of uninsured children had been falling consistently between 1998 and 2004 but that progress began to reverse in 2005, said Robert Greenstein, executive director of the Center on Budget and Policy Priorities.

These latest data from the Census Bureau show that the country is “losing significant ground” in insuring children, he said, and he called on President Bush to rethink his position on funding for SCHIP.

The number of Americans without health insurance reached 47 million last year, up from 44.8 million in 2005, according to new data released by the U.S. Census Bureau.

The percentage of individuals without health insurance also rose from 15.3% in 2005 to 15.8% in 2006.

This rise includes an increase in the number of uninsured children.

The percentage and number of children under age 18 without health insurance increased from 8 million (10.9%) in 2005 to 8.7 million (11.7%) in 2006.

Much of the increase in the uninsured rate for children can be attributed to a decline in private coverage, David Johnson, chief of the division of housing and household economic statistics at the Census Bureau, said during a news conference.

Overall, the percentage of individuals covered by any type of private insurance plan dropped from 68.5% in 2005 to 67.9% in 2006.

And among children, the percentage with private coverage fell from 65.8% in 2005 to 64.6% in 2006, Mr. Johnson said.

At the same time, coverage by government insurance was also down from 27.3% in 2005 to 27% in 2006.

The data are compiled from the 2007 Current Population Survey Annual Social and Economic Supplement.

The increase in the number of uninsured individuals between 2005 and 2006 is “pretty shocking,” said Karen Davis, Ph.D., president of The Commonwealth Fund, especially in a year when states have been under less financial pressure and many have been trying to expand coverage.

The deterioration of dependent coverage among private plans is particularly disturbing and points to the importance of reauthorizing the State Children's Health Insurance Program (SCHIP) with adequate funding, she said.

The number and percentage of uninsured children had been falling consistently between 1998 and 2004 but that progress began to reverse in 2005, said Robert Greenstein, executive director of the Center on Budget and Policy Priorities.

These latest data from the Census Bureau show that the country is “losing significant ground” in insuring children, he said, and he called on President Bush to rethink his position on funding for SCHIP.

The number of Americans without health insurance reached 47 million last year, up from 44.8 million in 2005, according to new data released by the U.S. Census Bureau.

The percentage of individuals without health insurance also rose from 15.3% in 2005 to 15.8% in 2006.

This rise includes an increase in the number of uninsured children.

The percentage and number of children under age 18 without health insurance increased from 8 million (10.9%) in 2005 to 8.7 million (11.7%) in 2006.

Much of the increase in the uninsured rate for children can be attributed to a decline in private coverage, David Johnson, chief of the division of housing and household economic statistics at the Census Bureau, said during a news conference.

Overall, the percentage of individuals covered by any type of private insurance plan dropped from 68.5% in 2005 to 67.9% in 2006.

And among children, the percentage with private coverage fell from 65.8% in 2005 to 64.6% in 2006, Mr. Johnson said.

At the same time, coverage by government insurance was also down from 27.3% in 2005 to 27% in 2006.

The data are compiled from the 2007 Current Population Survey Annual Social and Economic Supplement.

The increase in the number of uninsured individuals between 2005 and 2006 is “pretty shocking,” said Karen Davis, Ph.D., president of The Commonwealth Fund, especially in a year when states have been under less financial pressure and many have been trying to expand coverage.

The deterioration of dependent coverage among private plans is particularly disturbing and points to the importance of reauthorizing the State Children's Health Insurance Program (SCHIP) with adequate funding, she said.

The number and percentage of uninsured children had been falling consistently between 1998 and 2004 but that progress began to reverse in 2005, said Robert Greenstein, executive director of the Center on Budget and Policy Priorities.

These latest data from the Census Bureau show that the country is “losing significant ground” in insuring children, he said, and he called on President Bush to rethink his position on funding for SCHIP.

Influenza vaccination of children aged 6–23 months remains low, with only 21% of children in this age group being fully vaccinated against influenza during the 2005–2006 season, according to data from the Centers for Disease Control and Prevention.

The vaccination rate was similar for the 24–59 months group—recently added to groups officially recommended to receive influenza vaccine—in preliminary data from the 2006–2007 season.

Results from the 2006 National Immunization Survey found that 32% of children aged 6–23 months received at least one dose of the vaccine in the 2005–2006 season and 21% were fully vaccinated in accordance with recommendations from the CDC's Advisory Committee on Immunization Practices (ACIP).

The data reflect vaccination uptake in the second season since ACIP began recommending annual influenza immunization for children aged 6–23 months in 2004.

The results are based on a sample of 13,546 children from across the country (MMWR 2007;56:959-63).

The 2005–2006 coverage levels were similar to those reported during the previous influenza season. The national estimate for fully vaccinated children increased from 18% in 2004–2005 to 21% in 2005–2006. For children who received at least one dose of the vaccine, the rate fell from 33% in 2004–2005 to 32% in 2005–2006.

“The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health care providers and caregivers about the effectiveness of influenza vaccination among young children,” the CDC researchers wrote.

In addition to the national figures, the CDC also analyzed state vaccination rates and found significant variation.

For example, the percentage of children who received at least one dose of influenza vaccine ranged from a low of 8% in Mississippi to a high of 53% in Connecticut. No state had more than 40% of children fully vaccinated, according to the study.

CDC researchers also took an early look at influenza vaccination rates for the 2006–2007 season using data from six immunization information system sentinel sites, located in Arizona, Michigan, Minnesota, Montana, Oregon, and the District of Columbia.

Researchers used the data from the sentinel sites to gauge compliance with a June 2006 ACIP recommendation, which called for routine influenza vaccination among children aged 6–59 months. The early data revealed that at all six sites less than 30% of children aged 6–23 months had been fully vaccinated and less than 20% of children aged 24–59 months were fully vaccinated against influenza during the 2006–2007 season (MMWR 2007;56:963-5).

The low rate of vaccination among children aged 24–59 months was expected because the ACIP recommendations are so new, the researchers wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Influenza vaccination of children aged 6–23 months remains low, with only 21% of children in this age group being fully vaccinated against influenza during the 2005–2006 season, according to data from the Centers for Disease Control and Prevention.

The vaccination rate was similar for the 24–59 months group—recently added to groups officially recommended to receive influenza vaccine—in preliminary data from the 2006–2007 season.

Results from the 2006 National Immunization Survey found that 32% of children aged 6–23 months received at least one dose of the vaccine in the 2005–2006 season and 21% were fully vaccinated in accordance with recommendations from the CDC's Advisory Committee on Immunization Practices (ACIP).

The data reflect vaccination uptake in the second season since ACIP began recommending annual influenza immunization for children aged 6–23 months in 2004.

The results are based on a sample of 13,546 children from across the country (MMWR 2007;56:959-63).

The 2005–2006 coverage levels were similar to those reported during the previous influenza season. The national estimate for fully vaccinated children increased from 18% in 2004–2005 to 21% in 2005–2006. For children who received at least one dose of the vaccine, the rate fell from 33% in 2004–2005 to 32% in 2005–2006.

“The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health care providers and caregivers about the effectiveness of influenza vaccination among young children,” the CDC researchers wrote.

In addition to the national figures, the CDC also analyzed state vaccination rates and found significant variation.

For example, the percentage of children who received at least one dose of influenza vaccine ranged from a low of 8% in Mississippi to a high of 53% in Connecticut. No state had more than 40% of children fully vaccinated, according to the study.

CDC researchers also took an early look at influenza vaccination rates for the 2006–2007 season using data from six immunization information system sentinel sites, located in Arizona, Michigan, Minnesota, Montana, Oregon, and the District of Columbia.

Researchers used the data from the sentinel sites to gauge compliance with a June 2006 ACIP recommendation, which called for routine influenza vaccination among children aged 6–59 months. The early data revealed that at all six sites less than 30% of children aged 6–23 months had been fully vaccinated and less than 20% of children aged 24–59 months were fully vaccinated against influenza during the 2006–2007 season (MMWR 2007;56:963-5).

The low rate of vaccination among children aged 24–59 months was expected because the ACIP recommendations are so new, the researchers wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Influenza vaccination of children aged 6–23 months remains low, with only 21% of children in this age group being fully vaccinated against influenza during the 2005–2006 season, according to data from the Centers for Disease Control and Prevention.

The vaccination rate was similar for the 24–59 months group—recently added to groups officially recommended to receive influenza vaccine—in preliminary data from the 2006–2007 season.

Results from the 2006 National Immunization Survey found that 32% of children aged 6–23 months received at least one dose of the vaccine in the 2005–2006 season and 21% were fully vaccinated in accordance with recommendations from the CDC's Advisory Committee on Immunization Practices (ACIP).

The data reflect vaccination uptake in the second season since ACIP began recommending annual influenza immunization for children aged 6–23 months in 2004.

The results are based on a sample of 13,546 children from across the country (MMWR 2007;56:959-63).

The 2005–2006 coverage levels were similar to those reported during the previous influenza season. The national estimate for fully vaccinated children increased from 18% in 2004–2005 to 21% in 2005–2006. For children who received at least one dose of the vaccine, the rate fell from 33% in 2004–2005 to 32% in 2005–2006.

“The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health care providers and caregivers about the effectiveness of influenza vaccination among young children,” the CDC researchers wrote.

In addition to the national figures, the CDC also analyzed state vaccination rates and found significant variation.

For example, the percentage of children who received at least one dose of influenza vaccine ranged from a low of 8% in Mississippi to a high of 53% in Connecticut. No state had more than 40% of children fully vaccinated, according to the study.

CDC researchers also took an early look at influenza vaccination rates for the 2006–2007 season using data from six immunization information system sentinel sites, located in Arizona, Michigan, Minnesota, Montana, Oregon, and the District of Columbia.

Researchers used the data from the sentinel sites to gauge compliance with a June 2006 ACIP recommendation, which called for routine influenza vaccination among children aged 6–59 months. The early data revealed that at all six sites less than 30% of children aged 6–23 months had been fully vaccinated and less than 20% of children aged 24–59 months were fully vaccinated against influenza during the 2006–2007 season (MMWR 2007;56:963-5).

The low rate of vaccination among children aged 24–59 months was expected because the ACIP recommendations are so new, the researchers wrote.

ELSEVIER GLOBAL MEDICAL NEWS

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the settlement.

The company has also agreed to a 3-year process improvement plan that will run through the end of 2010. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, one of the lead parties in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators.

The District of Columbia and the following states signed on to the agreement: Alabama, Alaska, Arkansas, California, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, and Wyoming.

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the settlement.

The company has also agreed to a 3-year process improvement plan that will run through the end of 2010. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, one of the lead parties in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators.

The District of Columbia and the following states signed on to the agreement: Alabama, Alaska, Arkansas, California, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, and Wyoming.

The insurance giant UnitedHealthcare could pay up to $20 million to state regulators as part of an agreement to settle allegations that the company violated state laws in its claims processing.

Under the settlement, UnitedHealthcare has agreed to pay about $12.2 million up front to 36 states and the District of Columbia. The payout could grow to $20 million if other states join the settlement.

The company has also agreed to a 3-year process improvement plan that will run through the end of 2010. The company will be required to self-report data quarterly and annually on how it performs on a set of national performance standards. These benchmarks will focus on claims accuracy and timeliness, appeals review, and consumer complaint handling. A lack of compliance with the benchmarks could result in additional financial penalties, according to the National Association of Insurance Commissioners.

The settlement follows a multistate investigation that found errors in claims processing such as not applying correct fee schedules and deductibles. There were also frequent violations of prompt payment rules, according to the New York State Insurance Department, one of the lead parties in the settlement.

The settlement was praised by the National Association of Insurance Commissioners and the states involved. UnitedHealthcare also praised the settlement as evidence of how the industry can work with state regulators.

The District of Columbia and the following states signed on to the agreement: Alabama, Alaska, Arkansas, California, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, and Wyoming.

Adult obesity is on the rise in 31 states, and no states have experienced a drop in obesity, according to a study from Trust for America's Health.

Mississippi topped the list of the fattest states, with the highest adult obesity rates for the third year in a row. More than 30% of the adult population in the state is obese. Colorado was ranked the “leanest” state with an obesity rate of 17.6%. No state has reached the Health and Human Services department goal of reducing the prevalence of adult obesity to 15% in every state by 2010.

The report, “F as in Fat: How Obesity Policies are Failing in America 2007,” ranked states by their rate of obesity using 3-year averages of 2004–2006 data from the Centers for Disease Control and Prevention. The study compares the more recent data to 2003–2005 figures. Individuals were considered obese if their body mass index (BMI) was 30 kg/m

This is the fourth annual edition of the report, which was supported by a grant from the Robert Wood Johnson Foundation.

“Despite the increased attention that the obesity epidemic is receiving in the country, obesity is continuing to grow in America,” said Jeff Levi, Ph.D., executive director of Trust for America's Health, a nonprofit health advocacy group.

Obesity rates have climbed sharply in recent years, Dr. Levi said. For example, in 1991, no state had an obesity rate that exceeded 20%.

The report's authors also examined rates of overweight among children aged 10–17 based on the results of the 2003–2004 National Survey of Children's Health, conducted by HHS. Children were considered overweight if they were in the 95th percentile of BMI for their age.

Rates of overweight among youth ranged from a high of 22.8% in Washington, D.C., to a low of 8.5% in Utah.

The findings are a “devastating indictment,” commented Dr. James S. Marks, a pediatrician and senior vice president and director of the Health Group at the Robert Wood Johnson Foundation. “Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is,” he said.

But despite the severity of the problem, there are proven solutions, Dr. Marks said. For example, evidence shows that 60 minutes of moderate to vigorous physical activity each day helps children maintain a healthy weight.

Also, increasing access to affordable, healthy food in communities has been shown to make a difference. The government needs to provide incentives to bring supermarkets back to underserved communities so families can obtain affordable fresh fruits and vegetables, he said.

States have already begun to take some action, Dr. Levi said. For example, 17 states require that school lunches, breakfast, and snacks meet higher nutritional standards than those set by the Department of Agriculture. And two states—California and Illinois—have enacted legislation that requires screening to identify students at risk for type 2 diabetes.

“While some promising policy efforts are underway, the nation still lacks a comprehensive, effective strategy for addressing this serious health crisis,” Dr. Levi said.

In the report, Trust for America's Health calls on federal officials to develop and implement a national strategy to combat obesity along the lines of the administration's government-wide approach to preparation for pandemic flu. The plan should involve every federal agency, define clear roles for states and local governments, and engage private industry and community groups, Dr. Levi said.

For their part, physicians can help by supporting policy changes that help fight obesity, Dr. Marks said. But the report also recognizes that although the physician's role is important, there are often barriers. The report cites a lack of training in communicating delicately and effectively with patients about weight problems and a lack of reimbursement for obesity services.

'Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is.' DR. MARKS

Adult obesity is on the rise in 31 states, and no states have experienced a drop in obesity, according to a study from Trust for America's Health.

Mississippi topped the list of the fattest states, with the highest adult obesity rates for the third year in a row. More than 30% of the adult population in the state is obese. Colorado was ranked the “leanest” state with an obesity rate of 17.6%. No state has reached the Health and Human Services department goal of reducing the prevalence of adult obesity to 15% in every state by 2010.

The report, “F as in Fat: How Obesity Policies are Failing in America 2007,” ranked states by their rate of obesity using 3-year averages of 2004–2006 data from the Centers for Disease Control and Prevention. The study compares the more recent data to 2003–2005 figures. Individuals were considered obese if their body mass index (BMI) was 30 kg/m

This is the fourth annual edition of the report, which was supported by a grant from the Robert Wood Johnson Foundation.

“Despite the increased attention that the obesity epidemic is receiving in the country, obesity is continuing to grow in America,” said Jeff Levi, Ph.D., executive director of Trust for America's Health, a nonprofit health advocacy group.

Obesity rates have climbed sharply in recent years, Dr. Levi said. For example, in 1991, no state had an obesity rate that exceeded 20%.

The report's authors also examined rates of overweight among children aged 10–17 based on the results of the 2003–2004 National Survey of Children's Health, conducted by HHS. Children were considered overweight if they were in the 95th percentile of BMI for their age.

Rates of overweight among youth ranged from a high of 22.8% in Washington, D.C., to a low of 8.5% in Utah.

The findings are a “devastating indictment,” commented Dr. James S. Marks, a pediatrician and senior vice president and director of the Health Group at the Robert Wood Johnson Foundation. “Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is,” he said.

But despite the severity of the problem, there are proven solutions, Dr. Marks said. For example, evidence shows that 60 minutes of moderate to vigorous physical activity each day helps children maintain a healthy weight.

Also, increasing access to affordable, healthy food in communities has been shown to make a difference. The government needs to provide incentives to bring supermarkets back to underserved communities so families can obtain affordable fresh fruits and vegetables, he said.

States have already begun to take some action, Dr. Levi said. For example, 17 states require that school lunches, breakfast, and snacks meet higher nutritional standards than those set by the Department of Agriculture. And two states—California and Illinois—have enacted legislation that requires screening to identify students at risk for type 2 diabetes.

“While some promising policy efforts are underway, the nation still lacks a comprehensive, effective strategy for addressing this serious health crisis,” Dr. Levi said.

In the report, Trust for America's Health calls on federal officials to develop and implement a national strategy to combat obesity along the lines of the administration's government-wide approach to preparation for pandemic flu. The plan should involve every federal agency, define clear roles for states and local governments, and engage private industry and community groups, Dr. Levi said.

For their part, physicians can help by supporting policy changes that help fight obesity, Dr. Marks said. But the report also recognizes that although the physician's role is important, there are often barriers. The report cites a lack of training in communicating delicately and effectively with patients about weight problems and a lack of reimbursement for obesity services.

'Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is.' DR. MARKS

Adult obesity is on the rise in 31 states, and no states have experienced a drop in obesity, according to a study from Trust for America's Health.

Mississippi topped the list of the fattest states, with the highest adult obesity rates for the third year in a row. More than 30% of the adult population in the state is obese. Colorado was ranked the “leanest” state with an obesity rate of 17.6%. No state has reached the Health and Human Services department goal of reducing the prevalence of adult obesity to 15% in every state by 2010.

The report, “F as in Fat: How Obesity Policies are Failing in America 2007,” ranked states by their rate of obesity using 3-year averages of 2004–2006 data from the Centers for Disease Control and Prevention. The study compares the more recent data to 2003–2005 figures. Individuals were considered obese if their body mass index (BMI) was 30 kg/m

This is the fourth annual edition of the report, which was supported by a grant from the Robert Wood Johnson Foundation.

“Despite the increased attention that the obesity epidemic is receiving in the country, obesity is continuing to grow in America,” said Jeff Levi, Ph.D., executive director of Trust for America's Health, a nonprofit health advocacy group.

Obesity rates have climbed sharply in recent years, Dr. Levi said. For example, in 1991, no state had an obesity rate that exceeded 20%.

The report's authors also examined rates of overweight among children aged 10–17 based on the results of the 2003–2004 National Survey of Children's Health, conducted by HHS. Children were considered overweight if they were in the 95th percentile of BMI for their age.

Rates of overweight among youth ranged from a high of 22.8% in Washington, D.C., to a low of 8.5% in Utah.

The findings are a “devastating indictment,” commented Dr. James S. Marks, a pediatrician and senior vice president and director of the Health Group at the Robert Wood Johnson Foundation. “Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is,” he said.

But despite the severity of the problem, there are proven solutions, Dr. Marks said. For example, evidence shows that 60 minutes of moderate to vigorous physical activity each day helps children maintain a healthy weight.

Also, increasing access to affordable, healthy food in communities has been shown to make a difference. The government needs to provide incentives to bring supermarkets back to underserved communities so families can obtain affordable fresh fruits and vegetables, he said.

States have already begun to take some action, Dr. Levi said. For example, 17 states require that school lunches, breakfast, and snacks meet higher nutritional standards than those set by the Department of Agriculture. And two states—California and Illinois—have enacted legislation that requires screening to identify students at risk for type 2 diabetes.

“While some promising policy efforts are underway, the nation still lacks a comprehensive, effective strategy for addressing this serious health crisis,” Dr. Levi said.

In the report, Trust for America's Health calls on federal officials to develop and implement a national strategy to combat obesity along the lines of the administration's government-wide approach to preparation for pandemic flu. The plan should involve every federal agency, define clear roles for states and local governments, and engage private industry and community groups, Dr. Levi said.

For their part, physicians can help by supporting policy changes that help fight obesity, Dr. Marks said. But the report also recognizes that although the physician's role is important, there are often barriers. The report cites a lack of training in communicating delicately and effectively with patients about weight problems and a lack of reimbursement for obesity services.

'Unfortunately, we're treating it like a mere inconvenience instead of the emergency that it is.' DR. MARKS

A new team-based approach to care has helped physicians and their staffs in the Abington Physician Network achieve goals for blood pressure, cholesterol levels, and hemoglobin A_1c levels in their diabetic patients.

It's not that physicians in the network are working harder or longer, but that they are working with the rest of their staff as a team, said Dr. Keith Sweigard, medical director and chief of internal medicine at Abington (Pa.) Memorial Hospital.

Earlier this year, practices within the Abington network reported performance above the National Committee for Quality Assurance (NCQA) criteria for HbA_1c levels, blood pressure, LDL cholesterol levels, and yearly ophthalmology visits. But only a few years ago, Dr. Sweigard declined even to apply for NCQA recognition in diabetes because practices in the network were below criteria in all areas.

What's different now is that the practices have new tools in the form of a team-oriented care approach, he said. Several teams—comprising a physician, office manager, and a nurse or medical office assistant—from the Abington network attended a series of training sessions in team-based care that were provided by the American College of Physicians.

The “Closing the Gap” training sessions, which were held most recently in 2006, focused on elements of the chronic care model, which uses teams of providers rather than relying on individual physicians. The elements of the model include using decision support, providing patients with self-management support, redesigning systems to involve other staff members in providing care, and using clinical information systems.

Following the diabetes training, members of the Abington network returned home with a mission to set clear goals for care and to share their experiences with colleagues. Dr. Sweigard and his colleagues set two networkwide goals to begin the process: controlling both blood pressure and LDL cholesterol levels. Individual practices were then free to choose other benchmarks for their offices, such as HbA_1c values; the use of ACE inhibitors and aspirin therapy; yearly podiatric exams; and influenza and pneumonia vaccine administration.

To get to their goals, each office designed its own system and assigned roles for everyone in the practice, from the receptionist to the physician. For example, in some practices, the receptionist places a green dot on the charts of all diabetic patients. Other ideas included having the medical office assistant or nurse ask diabetic patients to remove their shoes and socks before the physician sees them, thereby prompting the physician to perform a foot exam.

The members of the Abington network achieved their goals with room to spare:

▸ NCQA criteria call for 80% of patients to have an HbA_1c less than 9%; nearly 90% of Abington patients have achieved that goal.

▸ According to NCQA criteria, at least 36% of patients should have LDL cholesterol levels less than 100 mg/dL; 65% of Abington patients do.

▸ Yearly ophthalmology visits should be completed by 60% of patients, according to NCQA; 78% of Abington patients now see their eye doctor annually.

▸ NCQA criteria require 65% of patients to have blood pressure less than 140/90 mm Hg; in the Abington network, 89% have blood pressure lower than that.

But one process does not fit all. Larger practices that have more than 10 physicians plus phone operators, managed-care coordinators, nurse practitioners, and office managers may take one approach, whereas physicians with solo practices will need a different one.

For those in solo practice, Dr. Sweigard recommended collaborating with other physicians to share what works and what does not. In the case of smaller offices, one person may have multiple roles, whereas the challenge in a large office is making sure communication is clear, he said.

One of the lessons learned by studying practices as they go through these changes is that physicians need to delegate responsibility to the rest of the staff, said Dr. Vincenza Snow, director of clinical programs and quality of care at the American College of Physicians.

Although this can be a difficult transition for physicians, the staff is usually eager to take on responsibility when it comes to improving clinical care, Dr. Sweigard said.

A new team-based approach to care has helped physicians and their staffs in the Abington Physician Network achieve goals for blood pressure, cholesterol levels, and hemoglobin A_1c levels in their diabetic patients.

It's not that physicians in the network are working harder or longer, but that they are working with the rest of their staff as a team, said Dr. Keith Sweigard, medical director and chief of internal medicine at Abington (Pa.) Memorial Hospital.

Earlier this year, practices within the Abington network reported performance above the National Committee for Quality Assurance (NCQA) criteria for HbA_1c levels, blood pressure, LDL cholesterol levels, and yearly ophthalmology visits. But only a few years ago, Dr. Sweigard declined even to apply for NCQA recognition in diabetes because practices in the network were below criteria in all areas.

What's different now is that the practices have new tools in the form of a team-oriented care approach, he said. Several teams—comprising a physician, office manager, and a nurse or medical office assistant—from the Abington network attended a series of training sessions in team-based care that were provided by the American College of Physicians.

The “Closing the Gap” training sessions, which were held most recently in 2006, focused on elements of the chronic care model, which uses teams of providers rather than relying on individual physicians. The elements of the model include using decision support, providing patients with self-management support, redesigning systems to involve other staff members in providing care, and using clinical information systems.

Following the diabetes training, members of the Abington network returned home with a mission to set clear goals for care and to share their experiences with colleagues. Dr. Sweigard and his colleagues set two networkwide goals to begin the process: controlling both blood pressure and LDL cholesterol levels. Individual practices were then free to choose other benchmarks for their offices, such as HbA_1c values; the use of ACE inhibitors and aspirin therapy; yearly podiatric exams; and influenza and pneumonia vaccine administration.

To get to their goals, each office designed its own system and assigned roles for everyone in the practice, from the receptionist to the physician. For example, in some practices, the receptionist places a green dot on the charts of all diabetic patients. Other ideas included having the medical office assistant or nurse ask diabetic patients to remove their shoes and socks before the physician sees them, thereby prompting the physician to perform a foot exam.

The members of the Abington network achieved their goals with room to spare:

▸ NCQA criteria call for 80% of patients to have an HbA_1c less than 9%; nearly 90% of Abington patients have achieved that goal.

▸ According to NCQA criteria, at least 36% of patients should have LDL cholesterol levels less than 100 mg/dL; 65% of Abington patients do.

▸ Yearly ophthalmology visits should be completed by 60% of patients, according to NCQA; 78% of Abington patients now see their eye doctor annually.

▸ NCQA criteria require 65% of patients to have blood pressure less than 140/90 mm Hg; in the Abington network, 89% have blood pressure lower than that.

But one process does not fit all. Larger practices that have more than 10 physicians plus phone operators, managed-care coordinators, nurse practitioners, and office managers may take one approach, whereas physicians with solo practices will need a different one.

For those in solo practice, Dr. Sweigard recommended collaborating with other physicians to share what works and what does not. In the case of smaller offices, one person may have multiple roles, whereas the challenge in a large office is making sure communication is clear, he said.

One of the lessons learned by studying practices as they go through these changes is that physicians need to delegate responsibility to the rest of the staff, said Dr. Vincenza Snow, director of clinical programs and quality of care at the American College of Physicians.

Although this can be a difficult transition for physicians, the staff is usually eager to take on responsibility when it comes to improving clinical care, Dr. Sweigard said.

A new team-based approach to care has helped physicians and their staffs in the Abington Physician Network achieve goals for blood pressure, cholesterol levels, and hemoglobin A_1c levels in their diabetic patients.

It's not that physicians in the network are working harder or longer, but that they are working with the rest of their staff as a team, said Dr. Keith Sweigard, medical director and chief of internal medicine at Abington (Pa.) Memorial Hospital.

Earlier this year, practices within the Abington network reported performance above the National Committee for Quality Assurance (NCQA) criteria for HbA_1c levels, blood pressure, LDL cholesterol levels, and yearly ophthalmology visits. But only a few years ago, Dr. Sweigard declined even to apply for NCQA recognition in diabetes because practices in the network were below criteria in all areas.

What's different now is that the practices have new tools in the form of a team-oriented care approach, he said. Several teams—comprising a physician, office manager, and a nurse or medical office assistant—from the Abington network attended a series of training sessions in team-based care that were provided by the American College of Physicians.

The “Closing the Gap” training sessions, which were held most recently in 2006, focused on elements of the chronic care model, which uses teams of providers rather than relying on individual physicians. The elements of the model include using decision support, providing patients with self-management support, redesigning systems to involve other staff members in providing care, and using clinical information systems.

Following the diabetes training, members of the Abington network returned home with a mission to set clear goals for care and to share their experiences with colleagues. Dr. Sweigard and his colleagues set two networkwide goals to begin the process: controlling both blood pressure and LDL cholesterol levels. Individual practices were then free to choose other benchmarks for their offices, such as HbA_1c values; the use of ACE inhibitors and aspirin therapy; yearly podiatric exams; and influenza and pneumonia vaccine administration.

To get to their goals, each office designed its own system and assigned roles for everyone in the practice, from the receptionist to the physician. For example, in some practices, the receptionist places a green dot on the charts of all diabetic patients. Other ideas included having the medical office assistant or nurse ask diabetic patients to remove their shoes and socks before the physician sees them, thereby prompting the physician to perform a foot exam.

The members of the Abington network achieved their goals with room to spare:

▸ NCQA criteria call for 80% of patients to have an HbA_1c less than 9%; nearly 90% of Abington patients have achieved that goal.

▸ According to NCQA criteria, at least 36% of patients should have LDL cholesterol levels less than 100 mg/dL; 65% of Abington patients do.

▸ Yearly ophthalmology visits should be completed by 60% of patients, according to NCQA; 78% of Abington patients now see their eye doctor annually.

▸ NCQA criteria require 65% of patients to have blood pressure less than 140/90 mm Hg; in the Abington network, 89% have blood pressure lower than that.

But one process does not fit all. Larger practices that have more than 10 physicians plus phone operators, managed-care coordinators, nurse practitioners, and office managers may take one approach, whereas physicians with solo practices will need a different one.

For those in solo practice, Dr. Sweigard recommended collaborating with other physicians to share what works and what does not. In the case of smaller offices, one person may have multiple roles, whereas the challenge in a large office is making sure communication is clear, he said.

One of the lessons learned by studying practices as they go through these changes is that physicians need to delegate responsibility to the rest of the staff, said Dr. Vincenza Snow, director of clinical programs and quality of care at the American College of Physicians.

Although this can be a difficult transition for physicians, the staff is usually eager to take on responsibility when it comes to improving clinical care, Dr. Sweigard said.