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Needle exchange users take fewer HIV risks
Last Updated: 2004-09-28 10:45:45 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Illicit injection drug users who take part in needle exchange programs are less likely than other injection drug users to engage in drug-related behaviors that increase the risk of HIV transmission, researchers report in the Journal of Acquired Immunodeficiency Syndromes.
Dr. Lawrence Ouellet and colleagues at the University of Illinois at Chicago note that there have been mixed results from studies that have evaluated needle exchange programs and their impact on bloodborne infections.
To investigate further, the researchers studied Chicago area drug users. Five hundred fifty-eight subjects received at least half of their needles from a needle exchange program and 175 did not use a needle exchange program.
Compared with nonusers, needle exchange program users were about one third as likely to share needles and less than half as likely to lend used needles, share cookers or water. They were also 85 percent less likely to use a needle for more than one injection.
Even among those who shared needles, needle exchange program users were more likely to do so for significantly fewer injections overall, and to always use bleach to clean used needles.
Thus, the researchers conclude that "regular needle exchange program use is associated with less frequent and lower risk HIV injection risk practices."
SOURCE: Journal of Acquired Immune Deficiency Syndromes, September 1, 2004.
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Drugstores May Charge for Consultations
By MARC LEVY
Associated Press Writer
CAMP HILL, Pa. (AP) -- Jaime White helps her diabetes patients understand how to manage their blood sugar, checks their blood pressure, and sometimes even examines their feet for loss of sensation from nerve damage common to diabetes sufferers.
Her patients are West Virginia state employees participating in a program offered by Camp Hill-based Rite Aid Corp., the nation's third-largest drugstore chain. They meet with White at one of two drugstores, and their insurer pays the bills: $80 for initial visits, $20 for follow-ups.
Pharmacists like White have long been called on by customers to do more than just fill prescriptions. But drugstores, from giants like Rite Aid to smaller regional chains, are looking to expand their counseling programs and boost revenue - a trend that could be bolstered by the prescription-drug benefit that will become available to Medicare enrollees in 2006.
"Many of (the chains) have started to look at how they can transform a pharmacy from a place where one can obtain drugs into a place where you deliver health care," said John M. Coster, vice president of policy and programs for the National Association of Chain Drug Stores.
The chains say that regular patient consultations help patients stay healthier because many patients don't take their medication correctly. As a result, they say, both patients and insurers will save money.
But to provide a pharmacists' time and private rooms for the consultations, stores need to be reimbursed by insurers, as in White's program, the companies say.
The hurdle is getting insurers to agree to the reimbursements. Such reimbursement is common for pharmacists who work in nursing homes, but nowhere else, those in the industry say.
Under the law President Bush signed in December, insurers providing Medicare drug plans must provide a medication consulting service for patients whose illnesses and prescription use meet certain thresholds.
The federal government has not finalized how the consulting programs will work, and there are conflicting ideas over the shape of final regulations.
Drugstores and pharmacist groups want retail pharmacies to play a significant role. Insurers generally support the idea of pharmacist checkups, but want more flexibility.
For instance, some insurers already have in-house systems in which enrollees can consult by telephone with a pharmacist, which they would like the regulations to accommodate, said Mohit Ghose, a spokesman for America's Health Insurance Plans, a group that represents insurers.
The services tend to target people with one or more long-term illnesses.
JoAnn McCleaf, a 70-year-old cancer survivor who takes medication for cardiovascular disease and high cholesterol, said she does not see the need for pharmacist checkups: She finds free information on the Internet and aggressively questions her doctor about medications he prescribes.
"I can't see that a pharmacist can give me a better explanation than my doctor does," said McCleaf, who lives near Newberrytown, Pa. "It's going to be a terrible financial drain on Medicare."
The American Medical Association hasn't developed a stand on the issue. But a board member, Dr. Edward Langston, of Lafayette, Ind., cautioned that Medicare is a "zero sum game" and that any new program that is reimbursed will draw money from other programs.
He also said consultations should be subject to oversight and evaluation.
Bill Wilmer, 68, a retired city worker in Asheville, N.C., said his physician takes care of him when he has a problem, but his pharmacist is like a coach who works to keep him healthy.
Wilmer, who takes medication for diabetes, high cholesterol and congestive heart failure, has seen a Kerr Drug pharmacist a few times a year since the late 1990s through his insurer.
"I think I am far better off in the program with the pharmacist than on my own, trying to learn, hit or miss," Wilmer said. "I wouldn't feel uncomfortable asking my doctor any question, but what I'm saying is that the coach is there."
Daniel Stokley, 69, of Wendell, N.C., last week began a counseling program with a Kerr Drug pharmacist that is paid for by a pharmaceutical company grant. His physician recommended it, he said.
For the drugstores, the consulting revenue could help them compete with online pharmacies and restore some profit margins on prescriptions that HMOs and pharmacy benefits managers have squeezed in recent years.
Coster said he doesn't expect consultation revenue to amount to a "big windfall," and industry analysts said it's too early to tell how important this niche will be to the drugstores.
But, said Mark Miller, of the Chicago-based investment firm, William Blair & Co. LLC, he expects drugstores to continue looking for new ways that pharmacists can bring in revenue.
Drugstores and pharmacist groups say the goal is to make the consultation programs available to everyone who takes medication, at least as a companion to traditional, over-the-counter advice.
"There will always be some advice that's provided with the dispensing and then there's the in-depth medication review, like, 'We really need to sit down and talk about your diabetes,'" said Susan C. Winckler, staff counsel and vice president for policy and communications for the American Pharmacists Association.
Eager to expand the programs, drug chains are retrofitting stores with private consultation rooms and trying to persuade insurers, one by one, to reimburse them for the service, even if on a trial basis.
The 102-store Kerr Drug chain, based in Raleigh, N.C., has installed consultation rooms in 10 stores, and its pharmacists take part in a dozen different counseling programs, said Rebecca Chater, Kerr Drug's group manager for clinical services.
Rite Aid has pilot programs for Washington state's Medicaid program and West Virginia's state employees.
Walgreen Co., the nation's largest drugstore chain, has a handful of pilot programs in states including Wisconsin, New Mexico and Texas.
"We're looking at the potential there to expand services," Walgreen spokesman Michael Polzin said. "Certainly, the new Medicare program could help move these along. ... But a lot of that depends on how the final regulations look."
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On the Net:
Walgreen Co.: http://www.walgreen.com
Rite Aid Corp.: http://www.riteaid.com
Kerr Drug Inc.: http://www.kerrdrug.com
National Association of Chain Drug Stores: http://www.nacds.org
American Pharmacists Association: http://www.aphanet.org
© 2004 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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