WASHINGTON – The American Academy of Family Physicians voiced its support for ending of tobacco sales at pharmacies and for developing end-of-life registries.

Resolutions from the Reference Committee on Health of the Public & Science were adopted by consent without debate Oct. 21 during a session of the full Congress of Delegates, with a number being referred back to the board of directors for further investigation.

Family doctors support efforts to get tobacco products out of pharmacies.

During an Oct. 20 session to present the resolutions, all testimony provided by delegates was in support of a resolution introduced by the New York State, Pennsylvania, and Rhode Island chapters directing AAFP to “support ending the sale of tobacco products in all pharmacies and stores that contain a pharmacy department,” and to work with various pharmacy and pharmacist associations to push for the prohibition of sale of tobacco products at pharmacies.

The move comes in the wake of CVS/Caremark announcing that it will charge higher copays at pharmacies that also sell tobacco products, a move that could be designed to drive business to CVS/pharmacies, which no longer sells tobacco products in the retail portion of its stores.

An end-of-life planning resolution offered by the Michigan chapter also received support, though specific concerns were voiced during the Oct. 20 reference committee session.

The resolution directs AAFP to support the implementation of centralized registries, similar to Michigan’s “Peace of Mind Registry” that offers a central repository housing a patient’s end-of-life care preferences. It also calls for support of mechanisms that encourage the uploading of durable powers of attorney, physician order scope of treatment forms, and do-not-resuscitate orders into the registry, advocates for the development of centralized HIPAA registries of an individual’s preferences for end-of-life care, and supports mechanisms that allow for the registries to be readily accessible and routinely used by medical professionals.

Delegates generally supported the resolution during the Oct. 20 session, though some concerns regarding its implementation were raised, including wording that was eventually dropped regarding how public the information would be.

Other concerns included understanding how the registries would be updated as patient preferences changed.

Dr. Dale Ragle, president of the Texas delegation, offered his support of the spirit of the resolution, asked for wording to be included specifically on who could access such registries, similar to wording that is used to determine access to prescription drug–monitoring programs, including patients and their families as well as physicians.

“What happens if the wishes or the conditions of the patient changes?” Dr. Ragle asked. “Perhaps there should be some sort of mechanism in place or some sort of assurances that would be ... reviewed and updated periodically as the conditions may change. Also maybe put wording in there that a physician could override the database ... at the wishes of the patients that they verbally express them ... or if the physician has reliable information that perhaps the patient’s wishes have changed or the condition has changed.”

Florida delegate Dr. Dennis Saver also noted that access when a patient travels outside of his home state also need to be addressed.

Integrating information into electronic health records also was raised as a need from multiple delegates voicing support for the resolution.

Other resolutions adopted relate to addressing disparities and discrimination in immigrant populations and support for the Center for the Study of Tobacco and Society.

One resolution that received strong support from delegates at the reference committee meeting but ultimately was referred to the board for further study was the development of educational materials regarding the recreational use of marijuana, particularly as states begin to legalize it for that purpose.

Dr Elizabeth Snyder, the Oregon delegate, noted that family physicians are “going to have a different kind of counseling that we need to do and even without it becoming legal, we find ourselves with a paucity of useful, valid scientific information that we can use to educate our patients, both young and older, about marijuana use and its risks. We would therefore encourage the academy to help develop high-quality educational materials as it has done for many other substances that people use or medical conditions that we can reliably use in our practices.”

Other resolutions referred back to the board for further investigation addressed a vaccination personal belief exemption policy, support of the One Health Initiative, expansion of venues for peer-reviewed family medicine research, support of the prohibition of sale/distribution of raw or unpasteurized milk or milk products and support of the ban on nontherapeutic antibiotic use in farm animals.

gtwachtman@frontlinemedcom.com

AAFP Congress to push for ending of tobacco sales at pharmacies