Thursday, December 11, 2003

Higher Drug Copayments May Halt Use by Some Patients
Medscape Medical News story - "To control the costs of employee drug benefit programs, many large employers have adopted three-tier formularies in recent years. Under this approach, enrollees typically select from a range of copayments for drugs, with the lowest fee for a generic drug (tier 1), the next highest for a brand-name drug preferred by the employer (tier 2), and the highest copayment for a brand-name drug not on the preferred list (tier 3). While these "incentive-based" formularies slow the rate of drug spending for employers, they also, depending on their design, lead some employees to discontinue purchasing drugs to manage chronic illnesses, according to a study in the Dec. 4 issue of the New England Journal of Medicine." "med" See also the NEJM abstract of the article.  
  

Psychologists persevere in the states
Article in the latest APA Monitor - "With bleak budget situations in the states, psychologists faced uphill advocacy battles this year. But in many states--even those in economic hard times--advocates trudged on to legislative victories. 'This was a very tough year financially,' says Michael Sullivan, PhD, assistant executive director for state advocacy in APA's Practice Directorate. 'State legislatures didn't have money to spend. So it's been a mixed picture for psychology.' Psychology leaders say a great deal of credit for the legislative victories goes to state psychological associations."  
  

Measuring cognitive decline
Article in the latest APA Monitor - "Many of the tests used in research to demonstrate age-related decline in executive functioning--processes thought to control other cognitive operations--may not go far enough in differentiating these control functions from other processes, say psychologist Timothy Salthouse, PhD, and colleagues at the University of Virginia, in a study published in this month's Journal of Experimental Psychology: General (Vol. 132, No. 4)."  
  

'Capitolizing' on member advocacy efforts
A year end summary in the latest APA Monitor of 2003 psychology-related legislative action, compiled by the APA's Public Policy Office.  
  

Medical privacy lands in court
Philadelphia Inquirer story on a legal challenge to HIPAA focusing on its privacy stipulations - "The privacy rule created by U.S. Health and Human Services Secretary Tommy G. Thompson gives patients power to approve release of medical information to employers and life insurers. But patients have no say about how the information is used or shared by health plans, billing companies, and some groups doing business with medical providers, such as consultants, lawyers or drug companies. That's why patients are now asked to sign the HIPAA consent forms. While patients may refuse to sign the HIPAA form, their likely option is finding another doctor. Since the rule took effect, privacy advocates say, most doctors or medical providers refuse to assume civil and criminal liability for wrongly disclosed patient information and require patients to sign."  
  

British Warning on Antidepressant Use for Youth
New York Times story - "British drug regulators yesterday recommended against the use of all but one of a new generation of antidepressants in the treatment of depressed children under 18. In a letter sent to doctors and other health professionals, the government regulators said a review of data on the safety and effectiveness of the drugs, known as S.S.R.I.'s, indicated that their benefits did not outweigh their potential risks. Their effectiveness in treating depression in children, they said, has not been sufficiently demonstrated, and some drugs have been linked with suicidal thoughts and self-harm in children and adolescents." [Viewing New York Times resources requires registration, which is free]. See also the related item posted here yesterday and the Medicines and Healthcare Regulatory Agency web site, where you'll find links to a number of related articles, including the message sent to health professionals and a leaflet for patients (Adobe Acrobat format) and the full Overview of regulatory status and CSM advice relating to MDD in children and adolescents.  
  

New Studies Claim Ritalin Used For ADHD Causes Permanent Brain Alterations
Story at SciScoop on three new studies conducted in animals, published in the December issue of the journal Biological Psychiatry which "provide evidence that misuse of the stimulant methylphenidate (Ritalin) may have long-term effects on the brain and behavior. While methylphenidate and other stimulant medications are the recommended treatments for Attention Deficit Hyperactivity Disorder (ADHD), based on the more than 150 controlled studies demonstrating their safety and efficacy when used as prescribed, these three studies showed changes in the brains of young (adolescent or pre-adolescent) animals that persisted into adulthood."  
  

County continues its good government awards winning streak (Michigan)
Macomb Daily story - "After 21 years as the top county in Michigan to earn national "good government" awards, Macomb County this year finished in a tie with Oakland County for the most National Association of Counties citations. ... The annual awards single out innovative program that enhance services, improve county management or promote intergovernmental coordination." Among the programs cited in the award were "a Community Mental Health Department program that purchases prescription drugs in bulk from pharmaceutical companies and distributes them to the mentally ill. In cooperation with the United Way, the program helped clients find prescription drug coverage through Medicaid and other programs or offered them low-cost medicines. Last year, 10,000 prescriptions were filled for approximately 600 clients."  
  

Mental wards fight drug problem
BBC story - "Hospitals for the mentally ill could face legal action from patients because of the growing use of illegal drugs on the wards. Mental health groups are calling for government guidelines to help staff tackle the problem. They fear hospitals could be sued by patients who accuse them of failing in their 'duty of care'. "  
  

Attempt made to streamline mental health services (Iowa)
Story in The Hawkeye - "State and county officials say a plan to redesign and coordinate mental health and disability programs will streamline a broken system, though local mental health officials argue it creates an unnecessary bureaucracy and could cause a loss of state funding. The plan, outlined in a 20–page report by the Iowa State Association of Counties, will allow for more uniform decisions to be made by officials in the state's 99 counties by ensuring certain "core services," officials say. It would also nix a decades–old Iowa program called "legal settlement," which allows non–county residents to collect mental health benefits from county offices. A change in the way state funding is doled out to Iowa counties could have an effect on local mental health budgets."