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PCNA Supports New Medicare Preventive Benefits for Better Senior Health
As of January 1, 2005, people with Medicare can take advantage of 3 important new Medicare benefits: a one-time "Welcome to Medicare" physical exam, cardiovascular screening, and diabetes screening.
New Medicare beneficiaries now have the "Welcome to Medicare" physical exam, coupled with an increasingly broad set of preventive benefits that will include prescription drug coverage next year. These provide people with Medicare greater access to more prevention-focused benefits than ever before. The services are key features of the Medicare Modernization Act, signed into law by President George W. Bush in December 2003.
The physical exam is aimed at providing education and counseling about the preventive services that may be needed. In addition to the physical, Medicare's comprehensive set of preventive benefits includes screening services for heart disease and diabetes; osteoporosis and glaucoma; and cancers of the colon, breast, cervix, and prostate.
Medicare also recently announced its intention to cover smoking cessation counseling for beneficiaries who have smoking-related diseases. This decision expands Medicare's focus to not only cover the treatment of smoking-related illness, but also the prevention of further illness by helping seniors quit smoking. The new counseling services cover Medicare beneficiaries who have a smoking-related illness, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots, and cataracts. It also applies to patients on medications that can be made less effective by smoking, such as insulins and medicines for high blood pressure, seizures, blood clots, and depression.
PCNA is pleased to see a new emphasis on prevention for seniors and encourages all nurses to help maximize attention to Medicare's new preventive benefits and to help seniors understand them better.
FDA Advisory Ruling
The FDA Advisory Panel recommended against over-the-counter sales of Mevacor, saying that patients need medical guidance in treating a condition that has no symptoms and may require drugs for life to stay healthy. The panel also voiced concern that women who do not know they are pregnant will take Mevacor and possibly damage the developing fetus. The vote was 20-3.
Advisers expressed concern that in studies, most of the people who opted to take Mevacor with a doctor's guidance did not meet the requirements of the label. For instance, some people were not at high enough risk for heart disease to need the drug because they were too young or their cholesterol levels were not high enough. In other cases, their risk for heart disease was so high that they should have been seeing a doctor and possibly receiving a stronger drug.
Reference
http://www.hhs.gov/news.
PCNA Testifies at FDA Hearing Regarding Over-the-Counter Statins
Board member and former president of PCNA, Suzanne Hughes, testified at the FDA Advisory Committee hearing in Washington, DC, on January 14, 2005. On behalf of the PCNA Board she presented the following statement:
The Preventive Cardiovascular Nurses Association is a national organization of 2000 professional nurses dedicated to the prevention of primary and secondary coronary heart disease, vascular disease, and stroke. Our mission is achieved through professional and public education, through increasing consumer awareness of the importance of reducing cardiovascular risk, and through advocacy regarding nursing's role in the care of persons and families at risk for coronary heart disease and stroke.
Most of us on the board have worked in the field for more than 30 years, and we remember when care of the acute cardiovascular patient was reactive rather than proactive, and when available strategies for the treatment of dyslipidemia included agents (often poorly tolerated) that were given 3 times daily and that only modestly reduced cholesterol levels and cardiovascular-event rates. All of us in this room know that the approval of Mevacor, the first HMG CoA reductase inhibitor, or statin, in 1987, and the agents in the class that followed, has effectively revolutionized pharmacologic treatment of dyslipidemia.
In numerous well-designed clinical trials over the past 10 years, involving hundreds of thousands of adults, cholesterol lowering through the use of statins has been found to be remarkably safe and effective. The results of these trials have demonstrated substantial reductions in morbidity as well as mortality. However, of the millions of Americans eligible for treatment with cholesterol-lowering medications, only a fraction receives these evidence-based therapies. Many who begin taking these medications fail to continue therapy over time. Barriers to the initiation of, and persistence with, treatment are complex and multifactorial. Making a statin available without a prescription is one strategy being explored to close the undertreatment gap. This is an option that may be appropriate for those at moderate risk.
As nurses, we work on the frontlines in this field, and have a vantage point, allowing us to see the gap between the evidence-based treatments that are available to lower the risk of both first and subsequent cardiovascular events and what actually happens day to day in clinical practice. Today we are discussing the possibility of a new mode of access to statin therapy, one that may provide part of the solution to the current problem of undertreatment.
The Board of Directors of PCNA acknowledges the potential public health benefit of over-the-counter (OTC) availability of low-dose statins. We support the concept of the switch to OTC status on the basis of satisfaction of the following criteria:
* The research must demonstrate that the population who chooses to use this product is composed of appropriate candidates for OTC lipid-lowering therapy with regard to age, level of risk, medical history, and baseline lipid levels.
* The research must show that those who elect to use the product follow the instructions on the label with regard to dosage and frequency.
* The research must demonstrate that those who elect to use the product appropriately consult with their healthcare providers for clinical follow-up.
* The promotion of this product must be accompanied by a responsible marketing campaign targeted to the appropriate population. A comprehensive education program that includes continued emphasis on therapeutic lifestyle change should be in place, and interaction with the healthcare system should be encouraged. We believe that potential misuse of the proposed OTC product can be greatly obviated through public education, education in the clinical setting, and responsible promotional strategies.
In closing, we believe that the OTC availability of a statin is likely to be associated with other important public health benefits. More than simply "a box on a shelf," this new option would allow Americans to take a more active role in their own health and well-being. The associated marketing effort and media response will raise awareness of the importance of treating dyslipidemia as a strategy to reduce overall cardiovascular risk. We believe that this increased awareness will stimulate important dialogue between the public and the healthcare community. This presents a challenge and an opportunity for all of us. In response, we should embrace the opportunity to educate our patients and the public, not only with regard to the use of pharmacologic lipid-lowering agents, but about the central role of nutrition and physical activity on cardiovascular health. The PCNA is committed to participating in this important campaign that clearly has the potential to save lives.
PCNA to Release National Guidelines and Tools for Cardiovascular Risk Reduction: A Pocket Guide
The Preventive Cardiovascular Nurses Association is pleased to announce the development of its newest publication, National Guidelines and Tools for Cardiovascular Risk Reduction: A Pocket Guide. This resource provides information on the multiple national guidelines and recommended treatment goals that pertain to both primary and secondary cardiovascular disease prevention and risk management. This unique compilation of guidelines and tools will facilitate the healthcare provider's ability to initiate global risk factor assessment and optimal treatment.
As a special benefit for PCNA members, the revised pocket guide will be packaged with the most current Tarascon Pocket Pharmacopoeia Classic. The addition of the Pharmacopoeia will ensure that the most up-to-date prescription information is readily available to all PCNA members. These two practical tools are intentionally designed to fit in a lab coat pocket and literally be at the practitioner's fingertips, filling the need for a quick, reliable, and comprehensive reference.
In the early 1990s, PCNA released the first edition of the Pocket Guide. According to the comments received, PCNA found this piece to be one of its most beneficial tools offered to members. The latest release of the Pocket Guide will be an updated and more comprehensive version of the first. As national guidelines are continually updated and national organizations assemble a variety of formats, implementation is often a daunting task. The intentions of the editors of this publication are to organize the major national guidelines into one convenient pocket-size booklet. PCNA's members are uniquely positioned to address and implement global risk reduction; this publication will assist in that mission. The editors of this pocket guide hope that it will inspire providers to become even more familiar with treatment goals and optimize their treatment plans accordingly.
National Guidelines and Tools for Cardiovascular Risk Reduction: A Pocket Guide will be mailed to PCNA members in late spring of 2005 and available for purchase to nonmembers at that time. PCNA will provide continuing education for this publication. For additional information, visit the PCNA Web site at http://www.pcna.net.
Prevention in Youth: Turning Guidelines Into Interventions
Healthcare professionals recognize that cardiovascular (CV) disease is the leading cause of death in both men and women in the United States. To address this problem, the American Heart Association and related professional organizations have developed guidelines for primary and secondary prevention of CV disease and stroke in adults. While most nurses and their healthcare colleagues are diligently trying to implement these recommendations, we are now being challenged to expand our efforts across the whole lifespan-from childhood to geriatric years.
It is clear that the atherosclerotic process leading to CV disease begins early in life. While genetics plays an important role in its development, so does the role of established, potentially modifiable risk factors now prevalent in the pediatric and adolescent populations. Smoking, being viewed as a pediatric disease, and the current epidemics of obesity and physical inactivity in our youth demonstrate this point. Unfortunately, the presence of these risk factors gives youth a "head start" in developing atherosclerosis. We cannot begin to imagine the health burden this will place on our society as they age.
It is beyond the scope of this article to highlight all the data that argues for the initiation of primary prevention efforts early in life. Instead the reader is referred to several important articles and statements that provide background and guidance in this area. Hayman and Reineke (2003) provide an excellent description of evidence-based individual-, family-, and school-based strategies successful in promoting CV health in children and adolescents. Several American Heart Association documents provide further background information. The "Cardiovascular Health in Children" statement (2003) describes methods of assessment appropriate for this age group, and interventions for both children and their parents. The risk factors addressed include physical activity, obesity, insulin resistance and type 2 diabetes mellitus, hypertension, high blood cholesterol level, hypertension, and cigarette smoking. Another statement focuses on CV health promotion in the schools (2004), recognizing the important role schools and school health programs play in promoting behavior change.
The call to action is clear. PCNA already can provide one example of how their members are answering this call. One of our newest chapters in Montreal, boasting over 40 members from a variety of healthcare sites, decided early on that they wanted to make a difference in the community, and chose elementary schools as their target. Currently they are designing a program to assist CV nurses in going into the elementary classrooms to teach CV disease prevention. They have already secured educational resources and a school site, and hope to initiate the program in 2005. Hopefully more nurses will follow suit in offering health-promoting interventions to reduce this formidable disease.
References
1. Hayman L, Reineke P. Preventing coronary heart disease. The implementation of healthy lifestyle strategies for children and adolescents. J Cardiovasc Nurs. 2003;18(4):294-301.
2. Hayman L, Williams C, Daniels S, Steinberger J, Paridon S, Dennison B, McCrindle B. Cardiovascular health promotion in the schools. Circulation. 2004;110:2266-2275.
3. Kavey RE, Daniels S, Lauer R, Atkins D, Hayman L, Taubert K. AHA guidelines for primary prevention of atherosclerotic cardiovascular disease in childhood. Circulation. 2003;107:1562-1566.
4. National Cholesterol Education Program of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Bethesda, MD: National Heart Lung and Blood Institute Information Center; 1991.
5. Williams C, Hayman L, Daniels S, Robinson T, Steinberger J, Paridon S, Bazzare T. Cardiovascular health in childhood. Circulation. 2002;106:143-160.
Section Description
The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.