Government and Regulations

As lawmakers grapple with how best to combat the nation’s prescription painkiller abuse crisis, a recent survey is shedding light on how patients who get these medications  — drugs such as OxyContin, methadone or Vicodin — sometimes share or mishandle them.

According to findings detailed in a research letter published Monday in JAMA Internal Medicine, about one in five people who were prescribed the highly addictive drugs reported having shared their meds with a friend, often to help the other person manage pain. Most people with a prescription either had or expected to have extra pills left after finishing treatment. And almost 50 percent didn’t know how to safely get rid of the drugs left over after their treatment was complete, or how to store them while going through treatment.

The study’s authors suggested that the results point to changes doctors could make in prescribing practices and counseling to help alleviate the problems.

“We’ve all been saying leftover medications are an issue,” said Wilson Compton, deputy director of the federal National Institute on Drug Abuse, who wasn’t involved with the study. “Now I have a number that is concerning.”

The survey was sent to a random sample of almost 5,000 people in 2015. Of the recipients, about 1,000 had used prescription painkillers in the past year. Almost all of the people in this group responded to the survey.

Public concerns about painkiller abuse are growing louder. About 2 million people were addicted to prescription opioids in 2014, the most recent year for which data is available, according to the Centers for Disease Control and Prevention. Overdoses kill 44 people per day, the U.S. Department of Health and Human Services estimates. Researchers say deaths in 2014 were almost four times as common as they were in 2000.

“There’s a growing awareness among medical advisers, policymakers and even members of the general public that these are medications that can do serious harm,” said Colleen Barry, one of the study’s authors. She is a professor of health policy at Johns Hopkins University and co-director of the university’s Center for Mental Health and Addiction Policy Research.

And it is not news that most people who use prescription painkillers for nonmedical reasons often get them through social channels rather than a physician. In 2013 — the most recent year for which this data is available — the National Survey on Drug Use and Health estimated that number to be more than 80 percent.

But this paper’s findings illustrate some of the forces behind drug-sharing, Barry said, and in turn indicate how to stop it. For instance, the authors recommend that doctors prescribe smaller amounts of drugs, to minimize leftovers that could be shared or stolen. That tracks with new opioid prescribing guidelines issued by the Centers for Disease Control and Prevention.

“We probably prescribe a little bit more than we need to, and it’s not like people throw these away afterward. The leftovers are something we’re not thinking about,” said Jonathan Chen, an instructor at Stanford University School of Medicine, who has researched opioid abuse. Chen, who was not involved in the study, is also a practicing physician.

Meanwhile, it’s still tough for people to get rid of the drugs when they finish with them, and few say they know about safe storage practices. That’s another avenue for prevention.

Most respondents, for instance, didn’t lock up the pills when storing them. That makes it easier for someone else to take them.

And the prevalence of sharing medications suggests consumers need to be better educated about how addictive prescription opioids are, Barry said.

Doctors, added NIDA’s Compton, also need to understand the risk that, when they prescribe pills, they could end up used by someone else.

“One out of five people that I write a prescription to for opioids may share those with someone else. That’s a lot of people,” he said.

Physicians, meanwhile, haven’t historically been trained to counsel patients on safe drug disposal, meaning patients are often left unaware. Just under a quarter of respondents reported they remembered learning from the doctor or nurse about how to get rid of their meds safely. Chen said he couldn’t recall ever going over disposal practices with a patient. Even if he did, he said, it’s hard to know if patients would remember that information.

And when they are informed, it’s still difficult for consumers to easily get rid of pills they no longer need. The federal Drug Enforcement Administration sponsors “drug take-back days” twice a year. Some local law enforcement agencies hold similar events. But such events are often sporadic enough that it’s hard to make them a real habit, Barry noted.

Making those practices easier is essential, Barry said. And changing the culture around those drugs is key, so people understand the risk.

“Just the realization on the part of the public as well as physicians that these medications are not like Tylenol — these are highly addictive meds,” she said. “That message is starting to get out there.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

As lawmakers grapple with how best to combat the nation’s prescription painkiller abuse crisis, a recent survey is shedding light on how patients who get these medications  — drugs such as OxyContin, methadone or Vicodin — sometimes share or mishandle them.

According to findings detailed in a research letter published Monday in JAMA Internal Medicine, about one in five people who were prescribed the highly addictive drugs reported having shared their meds with a friend, often to help the other person manage pain. Most people with a prescription either had or expected to have extra pills left after finishing treatment. And almost 50 percent didn’t know how to safely get rid of the drugs left over after their treatment was complete, or how to store them while going through treatment.

The study’s authors suggested that the results point to changes doctors could make in prescribing practices and counseling to help alleviate the problems.

“We’ve all been saying leftover medications are an issue,” said Wilson Compton, deputy director of the federal National Institute on Drug Abuse, who wasn’t involved with the study. “Now I have a number that is concerning.”

The survey was sent to a random sample of almost 5,000 people in 2015. Of the recipients, about 1,000 had used prescription painkillers in the past year. Almost all of the people in this group responded to the survey.

Public concerns about painkiller abuse are growing louder. About 2 million people were addicted to prescription opioids in 2014, the most recent year for which data is available, according to the Centers for Disease Control and Prevention. Overdoses kill 44 people per day, the U.S. Department of Health and Human Services estimates. Researchers say deaths in 2014 were almost four times as common as they were in 2000.

“There’s a growing awareness among medical advisers, policymakers and even members of the general public that these are medications that can do serious harm,” said Colleen Barry, one of the study’s authors. She is a professor of health policy at Johns Hopkins University and co-director of the university’s Center for Mental Health and Addiction Policy Research.

And it is not news that most people who use prescription painkillers for nonmedical reasons often get them through social channels rather than a physician. In 2013 — the most recent year for which this data is available — the National Survey on Drug Use and Health estimated that number to be more than 80 percent.

But this paper’s findings illustrate some of the forces behind drug-sharing, Barry said, and in turn indicate how to stop it. For instance, the authors recommend that doctors prescribe smaller amounts of drugs, to minimize leftovers that could be shared or stolen. That tracks with new opioid prescribing guidelines issued by the Centers for Disease Control and Prevention.

“We probably prescribe a little bit more than we need to, and it’s not like people throw these away afterward. The leftovers are something we’re not thinking about,” said Jonathan Chen, an instructor at Stanford University School of Medicine, who has researched opioid abuse. Chen, who was not involved in the study, is also a practicing physician.

Meanwhile, it’s still tough for people to get rid of the drugs when they finish with them, and few say they know about safe storage practices. That’s another avenue for prevention.

Most respondents, for instance, didn’t lock up the pills when storing them. That makes it easier for someone else to take them.

And the prevalence of sharing medications suggests consumers need to be better educated about how addictive prescription opioids are, Barry said.

Doctors, added NIDA’s Compton, also need to understand the risk that, when they prescribe pills, they could end up used by someone else.

“One out of five people that I write a prescription to for opioids may share those with someone else. That’s a lot of people,” he said.

Physicians, meanwhile, haven’t historically been trained to counsel patients on safe drug disposal, meaning patients are often left unaware. Just under a quarter of respondents reported they remembered learning from the doctor or nurse about how to get rid of their meds safely. Chen said he couldn’t recall ever going over disposal practices with a patient. Even if he did, he said, it’s hard to know if patients would remember that information.

And when they are informed, it’s still difficult for consumers to easily get rid of pills they no longer need. The federal Drug Enforcement Administration sponsors “drug take-back days” twice a year. Some local law enforcement agencies hold similar events. But such events are often sporadic enough that it’s hard to make them a real habit, Barry noted.

Making those practices easier is essential, Barry said. And changing the culture around those drugs is key, so people understand the risk.

“Just the realization on the part of the public as well as physicians that these medications are not like Tylenol — these are highly addictive meds,” she said. “That message is starting to get out there.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

As lawmakers grapple with how best to combat the nation’s prescription painkiller abuse crisis, a recent survey is shedding light on how patients who get these medications  — drugs such as OxyContin, methadone or Vicodin — sometimes share or mishandle them.

According to findings detailed in a research letter published Monday in JAMA Internal Medicine, about one in five people who were prescribed the highly addictive drugs reported having shared their meds with a friend, often to help the other person manage pain. Most people with a prescription either had or expected to have extra pills left after finishing treatment. And almost 50 percent didn’t know how to safely get rid of the drugs left over after their treatment was complete, or how to store them while going through treatment.

The study’s authors suggested that the results point to changes doctors could make in prescribing practices and counseling to help alleviate the problems.

“We’ve all been saying leftover medications are an issue,” said Wilson Compton, deputy director of the federal National Institute on Drug Abuse, who wasn’t involved with the study. “Now I have a number that is concerning.”

The survey was sent to a random sample of almost 5,000 people in 2015. Of the recipients, about 1,000 had used prescription painkillers in the past year. Almost all of the people in this group responded to the survey.

Public concerns about painkiller abuse are growing louder. About 2 million people were addicted to prescription opioids in 2014, the most recent year for which data is available, according to the Centers for Disease Control and Prevention. Overdoses kill 44 people per day, the U.S. Department of Health and Human Services estimates. Researchers say deaths in 2014 were almost four times as common as they were in 2000.

“There’s a growing awareness among medical advisers, policymakers and even members of the general public that these are medications that can do serious harm,” said Colleen Barry, one of the study’s authors. She is a professor of health policy at Johns Hopkins University and co-director of the university’s Center for Mental Health and Addiction Policy Research.

And it is not news that most people who use prescription painkillers for nonmedical reasons often get them through social channels rather than a physician. In 2013 — the most recent year for which this data is available — the National Survey on Drug Use and Health estimated that number to be more than 80 percent.

But this paper’s findings illustrate some of the forces behind drug-sharing, Barry said, and in turn indicate how to stop it. For instance, the authors recommend that doctors prescribe smaller amounts of drugs, to minimize leftovers that could be shared or stolen. That tracks with new opioid prescribing guidelines issued by the Centers for Disease Control and Prevention.

“We probably prescribe a little bit more than we need to, and it’s not like people throw these away afterward. The leftovers are something we’re not thinking about,” said Jonathan Chen, an instructor at Stanford University School of Medicine, who has researched opioid abuse. Chen, who was not involved in the study, is also a practicing physician.

Meanwhile, it’s still tough for people to get rid of the drugs when they finish with them, and few say they know about safe storage practices. That’s another avenue for prevention.

Most respondents, for instance, didn’t lock up the pills when storing them. That makes it easier for someone else to take them.

And the prevalence of sharing medications suggests consumers need to be better educated about how addictive prescription opioids are, Barry said.

Doctors, added NIDA’s Compton, also need to understand the risk that, when they prescribe pills, they could end up used by someone else.

“One out of five people that I write a prescription to for opioids may share those with someone else. That’s a lot of people,” he said.

Physicians, meanwhile, haven’t historically been trained to counsel patients on safe drug disposal, meaning patients are often left unaware. Just under a quarter of respondents reported they remembered learning from the doctor or nurse about how to get rid of their meds safely. Chen said he couldn’t recall ever going over disposal practices with a patient. Even if he did, he said, it’s hard to know if patients would remember that information.

And when they are informed, it’s still difficult for consumers to easily get rid of pills they no longer need. The federal Drug Enforcement Administration sponsors “drug take-back days” twice a year. Some local law enforcement agencies hold similar events. But such events are often sporadic enough that it’s hard to make them a real habit, Barry noted.

Making those practices easier is essential, Barry said. And changing the culture around those drugs is key, so people understand the risk.

“Just the realization on the part of the public as well as physicians that these medications are not like Tylenol — these are highly addictive meds,” she said. “That message is starting to get out there.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for immunocompromised adults at risk for invasive pneumococcal diseases. But booster doses reportedly can cause “hyporesponsiveness,” which make PPSV23 less suitable for some HIV-infected patients, according to researchers at University Division of Infectious Diseases, Siena,  University of Siena, San Gerardo Hospital, University of Milano-Bicocca, Monza, and Institute of Clinical Infectious Diseases, Rome, all in Italy. These researchers cite studies that have found that the humoral response to PPSV23 is weaker in HIV-infected adults and that patients with AIDS are not protected.

Related: New Developments in Adult Vaccination: Challenges and Opportunities to Protect Vulnerable Veterans From Pneumococcal Disease

Protein-conjugated pneumococcal vaccines (PCVs), both 7-valent and 13-valent, may prime the immune system for better, faster responses to booster doses, the researchers say, and could be an optimal primary prophylaxis strategy for HIV-infected patients. But to the best of their knowledge, they note, data regarding the effectiveness of PCV13 in HIV-positive adults are “scant,” and no studies have directly compared the immunogenicity of PCV13 with PPSV23 in those patients.

The researchers conducted 2 parallel studies of 100 HIV-infected adult outpatients who had never been vaccinated with any pneumococcal vaccine. In the first, 50 patients were given PCV13 in 2 doses 8 weeks apart; in the second, patients were given their first routine vaccination with PPSV23. A third group of 100 HIV-negative adults who received no vaccination was used for comparison.

Related: Intervals between Pneumococcal Vaccines

After immunization, IgG titers significantly increased in both study groups at each time point compared with baseline, although response to serotype 3 was blunted in the first group. Antibody titers for each antigen did not differ between the groups at week 48. Seroprotection and seroconversion to all serotypes were comparable.

Over time, the researchers observed a “marked decrease” in IgG levels with both vaccines.

Related: Hunting Down a C difficile Vaccine

Both vaccines were safe and well tolerated; no relevant adverse reactions were seen in either group. No HIV-infected patients developed Streptococcus pneumoniae infection during the follow-up.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for immunocompromised adults at risk for invasive pneumococcal diseases. But booster doses reportedly can cause “hyporesponsiveness,” which make PPSV23 less suitable for some HIV-infected patients, according to researchers at University Division of Infectious Diseases, Siena,  University of Siena, San Gerardo Hospital, University of Milano-Bicocca, Monza, and Institute of Clinical Infectious Diseases, Rome, all in Italy. These researchers cite studies that have found that the humoral response to PPSV23 is weaker in HIV-infected adults and that patients with AIDS are not protected.

Related: New Developments in Adult Vaccination: Challenges and Opportunities to Protect Vulnerable Veterans From Pneumococcal Disease

Protein-conjugated pneumococcal vaccines (PCVs), both 7-valent and 13-valent, may prime the immune system for better, faster responses to booster doses, the researchers say, and could be an optimal primary prophylaxis strategy for HIV-infected patients. But to the best of their knowledge, they note, data regarding the effectiveness of PCV13 in HIV-positive adults are “scant,” and no studies have directly compared the immunogenicity of PCV13 with PPSV23 in those patients.

The researchers conducted 2 parallel studies of 100 HIV-infected adult outpatients who had never been vaccinated with any pneumococcal vaccine. In the first, 50 patients were given PCV13 in 2 doses 8 weeks apart; in the second, patients were given their first routine vaccination with PPSV23. A third group of 100 HIV-negative adults who received no vaccination was used for comparison.

Related: Intervals between Pneumococcal Vaccines

After immunization, IgG titers significantly increased in both study groups at each time point compared with baseline, although response to serotype 3 was blunted in the first group. Antibody titers for each antigen did not differ between the groups at week 48. Seroprotection and seroconversion to all serotypes were comparable.

Over time, the researchers observed a “marked decrease” in IgG levels with both vaccines.

Related: Hunting Down a C difficile Vaccine

Both vaccines were safe and well tolerated; no relevant adverse reactions were seen in either group. No HIV-infected patients developed Streptococcus pneumoniae infection during the follow-up.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for immunocompromised adults at risk for invasive pneumococcal diseases. But booster doses reportedly can cause “hyporesponsiveness,” which make PPSV23 less suitable for some HIV-infected patients, according to researchers at University Division of Infectious Diseases, Siena,  University of Siena, San Gerardo Hospital, University of Milano-Bicocca, Monza, and Institute of Clinical Infectious Diseases, Rome, all in Italy. These researchers cite studies that have found that the humoral response to PPSV23 is weaker in HIV-infected adults and that patients with AIDS are not protected.

Related: New Developments in Adult Vaccination: Challenges and Opportunities to Protect Vulnerable Veterans From Pneumococcal Disease

Protein-conjugated pneumococcal vaccines (PCVs), both 7-valent and 13-valent, may prime the immune system for better, faster responses to booster doses, the researchers say, and could be an optimal primary prophylaxis strategy for HIV-infected patients. But to the best of their knowledge, they note, data regarding the effectiveness of PCV13 in HIV-positive adults are “scant,” and no studies have directly compared the immunogenicity of PCV13 with PPSV23 in those patients.

The researchers conducted 2 parallel studies of 100 HIV-infected adult outpatients who had never been vaccinated with any pneumococcal vaccine. In the first, 50 patients were given PCV13 in 2 doses 8 weeks apart; in the second, patients were given their first routine vaccination with PPSV23. A third group of 100 HIV-negative adults who received no vaccination was used for comparison.

Related: Intervals between Pneumococcal Vaccines

After immunization, IgG titers significantly increased in both study groups at each time point compared with baseline, although response to serotype 3 was blunted in the first group. Antibody titers for each antigen did not differ between the groups at week 48. Seroprotection and seroconversion to all serotypes were comparable.

Over time, the researchers observed a “marked decrease” in IgG levels with both vaccines.

Related: Hunting Down a C difficile Vaccine

Both vaccines were safe and well tolerated; no relevant adverse reactions were seen in either group. No HIV-infected patients developed Streptococcus pneumoniae infection during the follow-up.

One of the nation’s Centers for Innovation in Advanced Development and Manufacturing, led by the Texas A&M University System, is beginning development and manufacturing on a second-generation anthrax vaccine. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response is supporting this research with an 18-month, $10.49 million task order.

NasoShield, a nose spray, will require only a single dose to protect against infections caused by inhaling anthrax. The spray uses technology known as the Adenovirus 5 viral vectored delivery system that modifies a non-infectious virus to include the genetic material needed to produce an immune response against anthrax. The researchers also will focus on improving the shelf life of the anthrax vaccine.

This project is the first time the HHS’s Biomedical Advanced Research and Development Authority (BARDA) has supported development of an anthrax vaccine using this delivery system. “Anthrax remains a material threat to our national health security,” said Dr. Richard Hatchett, acting BARDA director. “To help combat the health impacts of an anthrax attack, BARDA partnered with several biotechnology firms in accelerating development of promising next-generation treatments against anthrax infection. Engaging one of our Centers for Innovation in Advanced Development and Manufacturing represents a unique approach to this development.”

One of the nation’s Centers for Innovation in Advanced Development and Manufacturing, led by the Texas A&M University System, is beginning development and manufacturing on a second-generation anthrax vaccine. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response is supporting this research with an 18-month, $10.49 million task order.

NasoShield, a nose spray, will require only a single dose to protect against infections caused by inhaling anthrax. The spray uses technology known as the Adenovirus 5 viral vectored delivery system that modifies a non-infectious virus to include the genetic material needed to produce an immune response against anthrax. The researchers also will focus on improving the shelf life of the anthrax vaccine.

This project is the first time the HHS’s Biomedical Advanced Research and Development Authority (BARDA) has supported development of an anthrax vaccine using this delivery system. “Anthrax remains a material threat to our national health security,” said Dr. Richard Hatchett, acting BARDA director. “To help combat the health impacts of an anthrax attack, BARDA partnered with several biotechnology firms in accelerating development of promising next-generation treatments against anthrax infection. Engaging one of our Centers for Innovation in Advanced Development and Manufacturing represents a unique approach to this development.”

One of the nation’s Centers for Innovation in Advanced Development and Manufacturing, led by the Texas A&M University System, is beginning development and manufacturing on a second-generation anthrax vaccine. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response is supporting this research with an 18-month, $10.49 million task order.

NasoShield, a nose spray, will require only a single dose to protect against infections caused by inhaling anthrax. The spray uses technology known as the Adenovirus 5 viral vectored delivery system that modifies a non-infectious virus to include the genetic material needed to produce an immune response against anthrax. The researchers also will focus on improving the shelf life of the anthrax vaccine.

This project is the first time the HHS’s Biomedical Advanced Research and Development Authority (BARDA) has supported development of an anthrax vaccine using this delivery system. “Anthrax remains a material threat to our national health security,” said Dr. Richard Hatchett, acting BARDA director. “To help combat the health impacts of an anthrax attack, BARDA partnered with several biotechnology firms in accelerating development of promising next-generation treatments against anthrax infection. Engaging one of our Centers for Innovation in Advanced Development and Manufacturing represents a unique approach to this development.”

The VA has proposed a significant rule change that would grant full practice authority to advanced practice registered nurses (APRNs). According to the VA, this stated goal will “increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services.” The change permits APRNs, nurse practitioners who have completed at least a master’s degree in nursing, to assess and diagnose patients, prescribe medications, and interpret diagnostic tests.

“This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing,” Under Secretary of Health David J. Shulkin, said in a statement.

The proposed role of APRNs is not unique in federal health care systems. The Army, Navy, Air Force, and Indian Health Service already give APRNs full practice authority.

The rule is open for comment through July 25, 2016, and has already received nearly 20,000 comments. Physician organizations have been particularly critical of the proposed change. “We believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans. We feel this proposal will significantly undermine the delivery of care within the VA,” the American Medical Association noted in a statement.

Many of the most critical comments concerned the role of certified nurse anesthetists (CRNAs). The American Society of Anesthesiologists strongly criticized the rule, and of the comments to date, 15,906 specifically reference anesthesia.

Dr. Shulkin suggested that much of the criticism was misinformed. “I do not believe they [physicians] understand what our intent in going into this rule-making is,” he told The Washington Post. “We have embraced team-based health care. We believe in the model. We are not looking to destroy that. We are looking to add to our ability to deliver heath care to veterans in places that don’t frankly have health care for them right now.”

Echoing Dr. Shulkin’s comments, the Nurses Organization of Veteran Affairs (NOVA) and other nursing organizations fully support the rule. “The recognition of APRNs as full practice providers will continue to support the current VA team model of care,” Teresa Morris, NOVA director of advocacy & government relations explained. “In this model, each team member is working at the top of his or her education, training and expertise.”

According to Morris, the expanded role for APRNs also may help address disparities in care within the VA system. “There has been a lack of uniformity between VA networks, which can lead to confusion throughout the system and can contribute to issues in relationship to access,” she said. “We believe that this proposed change is resource driven and will help to decrease the variability in care provided by APRNs throughout the VA system.”

The VA has proposed a significant rule change that would grant full practice authority to advanced practice registered nurses (APRNs). According to the VA, this stated goal will “increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services.” The change permits APRNs, nurse practitioners who have completed at least a master’s degree in nursing, to assess and diagnose patients, prescribe medications, and interpret diagnostic tests.

“This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing,” Under Secretary of Health David J. Shulkin, said in a statement.

The proposed role of APRNs is not unique in federal health care systems. The Army, Navy, Air Force, and Indian Health Service already give APRNs full practice authority.

The rule is open for comment through July 25, 2016, and has already received nearly 20,000 comments. Physician organizations have been particularly critical of the proposed change. “We believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans. We feel this proposal will significantly undermine the delivery of care within the VA,” the American Medical Association noted in a statement.

Many of the most critical comments concerned the role of certified nurse anesthetists (CRNAs). The American Society of Anesthesiologists strongly criticized the rule, and of the comments to date, 15,906 specifically reference anesthesia.

Dr. Shulkin suggested that much of the criticism was misinformed. “I do not believe they [physicians] understand what our intent in going into this rule-making is,” he told The Washington Post. “We have embraced team-based health care. We believe in the model. We are not looking to destroy that. We are looking to add to our ability to deliver heath care to veterans in places that don’t frankly have health care for them right now.”

Echoing Dr. Shulkin’s comments, the Nurses Organization of Veteran Affairs (NOVA) and other nursing organizations fully support the rule. “The recognition of APRNs as full practice providers will continue to support the current VA team model of care,” Teresa Morris, NOVA director of advocacy & government relations explained. “In this model, each team member is working at the top of his or her education, training and expertise.”

According to Morris, the expanded role for APRNs also may help address disparities in care within the VA system. “There has been a lack of uniformity between VA networks, which can lead to confusion throughout the system and can contribute to issues in relationship to access,” she said. “We believe that this proposed change is resource driven and will help to decrease the variability in care provided by APRNs throughout the VA system.”

The VA has proposed a significant rule change that would grant full practice authority to advanced practice registered nurses (APRNs). According to the VA, this stated goal will “increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services.” The change permits APRNs, nurse practitioners who have completed at least a master’s degree in nursing, to assess and diagnose patients, prescribe medications, and interpret diagnostic tests.

“This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing,” Under Secretary of Health David J. Shulkin, said in a statement.

The proposed role of APRNs is not unique in federal health care systems. The Army, Navy, Air Force, and Indian Health Service already give APRNs full practice authority.

The rule is open for comment through July 25, 2016, and has already received nearly 20,000 comments. Physician organizations have been particularly critical of the proposed change. “We believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans. We feel this proposal will significantly undermine the delivery of care within the VA,” the American Medical Association noted in a statement.

Many of the most critical comments concerned the role of certified nurse anesthetists (CRNAs). The American Society of Anesthesiologists strongly criticized the rule, and of the comments to date, 15,906 specifically reference anesthesia.

Dr. Shulkin suggested that much of the criticism was misinformed. “I do not believe they [physicians] understand what our intent in going into this rule-making is,” he told The Washington Post. “We have embraced team-based health care. We believe in the model. We are not looking to destroy that. We are looking to add to our ability to deliver heath care to veterans in places that don’t frankly have health care for them right now.”

Echoing Dr. Shulkin’s comments, the Nurses Organization of Veteran Affairs (NOVA) and other nursing organizations fully support the rule. “The recognition of APRNs as full practice providers will continue to support the current VA team model of care,” Teresa Morris, NOVA director of advocacy & government relations explained. “In this model, each team member is working at the top of his or her education, training and expertise.”

According to Morris, the expanded role for APRNs also may help address disparities in care within the VA system. “There has been a lack of uniformity between VA networks, which can lead to confusion throughout the system and can contribute to issues in relationship to access,” she said. “We believe that this proposed change is resource driven and will help to decrease the variability in care provided by APRNs throughout the VA system.”

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.