2016’s Top 5 Advances in Primary Care

Opioid crisis and what to do about it tops list

MedPage Today asked specialists in primary care around the country to tell us what they thought were the most important clinical developments in 2016. These were the five most commonly mentioned.

1. The CDC, Opioids, and Chronic Pain

Primary care physicians are the frontline of pain management, so it not surprising that a majority of those contacted by MedPage Today cited chronic pain treatment and use of opioids as a major development in 2016.
In March, the CDC released its final guidance on opioid prescribing, urging clinicians not to use the painkillers as first-line therapy for chronic pain and suggesting limits on dose and duration when they do have to be prescribed.

“Given the limitations of the evidence, I think this guideline is more consequential for highlighting the growing problem of opioid misuse and overdose than in providing specific recommendations for primary care physicians,” said Kenneth Lin, MD, of Georgetown University in Washington.

2. SPRINT Trial ‘Discussion’

The NIH-funded SPRINT trial concluded that lower is definitely better for blood pressure, and suggested that aggressive treatment to achieve lower goals was in order — a conclusion that has not been universally accepted among hypertension specialists.

But Chris Lillis, MD, of the University of California Davis, said this is a finding that is really stirring his primary care colleagues. “I think one of the most significant clinical developments … was the discussion generated by the SPRINT trial, leading many to refine different blood pressure treatment targets for different patient populations. This effects how primary care doctors treat millions of Americans in an effort to protect them from poor cardiovascular outcomes and reduce morbidity and mortality.”

3. The ‘Annual’ Physical

Several primary care physicians told us that in 2016 access to outcomes-based research on screenings during annual preventive health visits, and guidelines to put those findings into practice, had a direct impact on their clinical practices.

“For example, screening for cervical cancer in women, or pap smears, used to be performed every year, and now is only recommended every 3-5 years depending on risk factors,” explained Candida Suffridge, MD, PhD, from Scott & White Clinic in Georgetown, Texas.

Another example is routine prostate cancer screening, Suffridge noted. Now, testing is decided upon on a case by case basis with the patient and physician, she said, adding that “the reason for this is large studies that demonstrated that it is possible to over-screen for things, resulting in unnecessary treatments that can bring with them unintended side effects.”

4. The ‘Testosterone Trials’

Thomas L. Schwenk, MD, of the University of Nevada Medical School in Reno, singled out new data on testosterone therapy as one of his top picks, and one that he thinks should have an effect on clinical care.
“The results of the ‘Testosterone Trials,’ published in 2016, showed that there was a statistically significant, but clinically modest, average improvement in sexual function scores and minimal improvement in fatigue and physical function. These results challenge the belief that benefits justify the known risks of testosterone therapy in aging men,” he said.

5. The Election of Donald Trump

Several primary care physicians alluded to the impact of various policy initiatives, such as the end of sustainable growth rate (SGR) and the coming of Medicare Access and CHIP Reauthorization Act (MACRA), as well as changes that were incorporated into daily practice as the result of the Affordable Care Act (ACA), often musing about what will happen next.

Joshua Septimus, MD, of Houston Methodist Primary Care Group singled out the election of Trump as the most significant event in medicine. “While it’s not strictly clinical, it is impossible to overstate the impact of the election. Whether an opponent or supporter of the ACA, it’s undeniable that the electoral swing will have a huge impact on patient access to care. Just what that impact will be is not clear.”

– Peggy Peck, Editor-in-Chief – MedPage Today