News Release 

ACP issues policy recommendations aimed at mitigating the rising costs of prescription drugs

Embargoed news from Annals of Internal Medicine

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. ACP issues policy recommendations aimed at mitigating the rising costs of prescription drugs

ACP calls for increased transparency, lower out-of-pocket costs for patients, and improved access to affordable medications

Note: HD video soundbites of the authors discussing the paper are available to download at http://www.dssimon.com/MM/ACP-prescription-drug-pricing.

Abstract PBMs: http://annals.org/aim/article/doi/10.7326/M19-0035

Abstract Public Health Plans: http://annals.org/aim/article/doi/10.7326/M19-0013

Editorial: http://annals.org/aim/article/doi/10.7326/M19-2895

URLs go live when the embargo lifts

In two new policy papers, the American College of Physicians (ACP) calls for changes aimed at mitigating the rising cost of prescription drugs. The papers provide recommendations to improve transparency in industry and government, examine the role of the Pharmacy Benefit Manager (PBM), and address issues in public health plans that create barriers to care. Both papers are published in Annals of Internal Medicine.

The new recommendations expand on ACP's 2016 policy paper, Stemming the Escalating Cost of Prescription Drugs, and focus on the need for increased transparency in how drugs are priced, lowering the out-of-pocket costs for patients, enhancing the government's purchasing power, and take a closer look at the roles PBMs and public health plans play in the industry and how to help stem the rising cost of prescription drugs.

To address the complex factors at play, ACP's paper offers a series of recommendations aimed at improving transparency surrounding PBMs and underscores the need for reliable and timely information on prescription drug pricing for physicians and patients. ACP's paper also addresses issues in public health plans, including the Medicare and Medicaid programs, which can add costs to the health care system and increase expenses for patients.

The author of an accompanying editorial from discusses four of ACP's recommendations in detail and notes that many of ACP's policy recommendations are currently being debated by members of Congress. The author suggests that having clear support from physician groups on reforms that focus on drug pricing, out-of-pocket spending, and access are encouraging.

Notes and media contacts: For an embargoed PDF or to speak with someone from ACP, please contact Julie Hirschhorn at JHirschhorn@acponline.org.

2. 3 Wishes Project proves transferrable, affordable, and sustainable for providing valuable care at end of life

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2438

URLs go live when the embargo lifts

The 3 Wishes Project, an end-of-life program designed to honor the dignity of dying patients, has proven to be transferrable, affordable, and sustainable for providing value at end of life. The program, which was pioneered at St. Joseph's Healthcare in Hamilton, Ontario, was analyzed at four additional sites to determine if it could be successfully implemented at other locations. The findings are published in Annals of Internal Medicine.

The 3 Wishes Project was created to enrich the relationships among patients, family members, and clinicians that are foundational to empathetic end-of-life care. By eliciting and implementing wishes from the dying patient, the project gives caregivers and clinicians "something" to do when the goals of care have shifted from curative to palliative. While the program was started at St. Joseph's Healthcare, word of its success spread, and ICU clinicians from all over the world wondered if they, too, could implement the program in their own hospitals.

Researchers from McMaster University set up the 3 Wishes Project in three new North American ICUs to determine whether it could be successfully implemented (defined as demonstrating value, transferability, affordability, and sustainability) beyond the ICU in which it was created. A total of 730 patients were enrolled, and 3,407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital managers. The researchers measured characteristics and processes of care; the number, type, and cost of each wish; and feedback from family and the care teams. They found that the cost was affordable and family members, clinicians, hospital managers, and administrators spoke at length about the value they experienced from the program. In fact, the 3 Wishes Project was continued at all four sites after the research project had concluded. According to the researchers, these findings suggest that the 3 Wishes Program may be successfully implemented at other ICUs.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Deborah J. Cook, MD, MSc, please contact Veronica McGuire at vmcguir@mcmaster.ca.

3. Online coaching coupled with EHR-based tracking tools may help to maintain weight loss better than using EHR-based tracking tools alone

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3337

Editorial: http://annals.org/aim/article/doi/10.7326/M19-2988

Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P19-0014

URLs go live when the embargo lifts

Use of electronic health record (EHR) tracking tools plus online coaching helped adults maintain intentional weight loss better than using EHR tools alone. Findings from a randomized trial are published in Annals of Internal Medicine.

Weight regain after intentional loss is common, yet few randomized clinical trials to date have focused on weight maintenance. Weight maintenance interventions can be integrated into routine primary care by using the EHR to identify potentially eligible patients, establish ongoing contact with those patients, and engage the primary care provider. It was hypothesized that incorporating personalized coaching and primary care physician support into the intervention would help to maintain recent weight loss.

Researchers from the University of Utah and University of Pittsburgh randomly assigned 194 participants who had lost at least 5 percent of their body weight in the previous 2 years to a weight maintenance intervention consisting of either EHR-based tracking tools alone or the tracking tools plus online coaching to evaluate their benefit in helping to maintain weight loss. The EHR tools included weight, diet, and physical activity tracking flow sheets; standardized surveys; and reminders. Participants in the coaching group received 24 months of personalized coaching through the EHR patient portal, with 24 scheduled contacts. The researchers found that, on average, the participants in the tools-only group regained about twice as much weight as those in the tools plus coaching group. At 24 months, 65 percent of participants in the coaching group and 50 percent in the tracking group maintained weight loss of at least 5 percent.

According to the author of an accompanying editorial from Kaiser Permanente Colorado, the study represents an important step forward in the integration of obesity treatment into routine medical care because it utilizes the electronic health record. However, there were some limitations to the study. Participants were socioeconomically advantaged and had mild to moderate obesity. Also, despite the relatively low burden of participation, 60 percent of the persons who qualified for the study declined to participate, suggesting that not all patients want formal assistance with behavior change.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Molly B. Conroy, MD, MPH, please contact Julie. Kiefer at julie.kiefer@hsc.utah.edu.

Also new in this issue:

The Hamman Sign: A Case Report With Audio Recording

Gabby Reijnders, MD

Case Report

Abstract: http://annals.org/aim/article/doi/10.7326/L19-0428

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Embargoed for release until 5:00 p.m. ET on Monday November 11 2019

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