Published 12/1/2015

Second Look—Advocacy

FDA panel: Labeling for fluoroquinolones
A joint panel convened by the U.S. Food and Drug Administration (FDA) Antimicrobial Drugs Advisory and the FDA Drug Safety and Risk Management Advisory Committees has recommended that fluoroquinolone antibiotics have stronger warnings on the risk for serious adverse events, including tendinitis and tendon rupture, prolongation of the QT interval, and peripheral neuropathy. Fluoroquinolones currently carry warnings about risks for tendonitis, tendon rupture, central nervous system effects, peripheral neuropathy, myasthenia gravis exacerbation, QT prolongation and Torsades de Pointes, phototoxicity, and hypersensitivity.

Drug prescribing patterns
A multistate report released by the U.S. Centers for Disease Control and Prevention (CDC) and the FDA-funded Prescription Behavior Surveillance System (PBSS) finds wide variation in prescribing patterns by state for opioids, stimulants, and benzodiazepines. Based on at state-level data from eight states, representing about a quarter of the U.S. population. Prescribing rates between states were found to vary twofold for opioids, fourfold for stimulants, and nearly twofold for benzodiazepines.

Impact of financial integration
Data from JAMA Internal Medicine (Oct. 19) suggest that financial integration between physicians and hospitals may be associated with increased spending for outpatient care. Over a 5-year study period, physician-hospital integration increased by a mean of 3.3 percent and was linked to a mean increase of $75 in annual outpatient spending per enrollee. Associated changes in utilization were minimal, leading the research team to conclude that the increase in outpatient spending was driven almost entirely by price increases.

Healthgrades Report to Nation
The Healthgrades 2016 Report to the Nation notes significant variation in health outcomes, with patients treated at 5-star hospitals having, on average, a 71 percent lower risk of dying and a 65 percent lower risk of experiencing a complication during their hospital stay than those treated at 1-star hospitals.

Perioperative medication error rates
Findings from a study in Anesthesiology (online) suggest that the rate of perioperative medication errors (MEs) may be higher than previously reported. The prospective, observational study of 277 surgical procedures covering 3,671 medication administrations at a single institution found 193 MEs or adverse drug events (ADEs). Of those, 79.3 percent were preventable, "markedly higher than those reported by retrospective surveys."

Prescription drug use
A study in The Journal of the American Medical Association (Nov. 3) finds a significant increase in overall use of prescription drugs among U.S. adults between 19992000 and 2011-2012. During 1999-2000, an estimated 51 percent of adults reported use of any prescription drugs, compared to 59 percent during 2011-2012. The prevalence of polypharmacy (use of 5 or more prescription drugs) increased from an estimated 8.2 percent in 1999-2000 to 15 percent in 2011-2012.

Defensive medicine
According to a study in The BMJ (online), increased resource use by physicians may be associated with fewer medical liability claims. Based on hospital admissions data from Florida (2000 to 2009), 4,342 medical liability claims were made against physicians (2.8 percent per physician year). In six of seven specialties reviewed, greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents. Information on illness severity was lacking, and it cannot be conclusively determined that higher spending was defensively motivated.

Physician-owned hospitals
Based on the U.S. Centers for Medicare & Medicaid Services (CMS) Percentage Payment Summary Reports to hospitals for the FY 2016 Hospital Value-Based Purchasing (VBP) program, physician-owned hospitals accounted for seven of the top 10 performers in the program.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information.