Policy & Practice


Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists also were queried. Only 11% of women said they thought it was safe to take a depression therapy during pregnancy, compared with 68% of physicians. Less educated and lower-income women and black women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

Maryland Ready to Expand Medicaid

Maryland has approved legislation that, if fully implemented over its 5-year time frame, would provide Medicaid coverage to more than 100,000 state residents who currently lack health insurance. The bill, which also would subsidize up to 37,000 small businesses to help offset the cost of offering health insurance, is tied in part to slot machine gambling legislation. Part of the Medicaid expansion will occur only if voters approve slot machine gambling, which will appear as a state constitutional amendment on the November 2008 ballot. The health care legislation also will be funded in part by a separate doubling of the state tobacco tax to $2 per pack. The new law also includes language that allows the state to cap enrollment or limit benefits for childless adults if funding isn't available. About 14% of Maryland residents lack health insurance, according to the state.

Cord Blood Guidelines Adopted

The American Medical Association has approved new ethical guidelines for physicians who discuss fetal umbilical cord blood banking with their patients. According to the new guidelines, adopted at the AMA's interim House of Delegates meeting in November, physicians should encourage donation to public cord blood banks when a patient wishes to donate. They also should obtain consent before labor begins, if possible, disclose any ties they might have to a cord blood bank, and accept no fees or incentives for referral to a cord blood bank. “Umbilical cord blood stem cells are useful for some therapeutic purposes and as a potential source of stem cells, and physicians should be prepared to discuss cord blood banking options with their patients during pregnancy,” said AMA board member Dr. William Dolan in a statement. However, collection procedures must not interfere with standard delivery practices and the safety of a newborn or the mother, according to the new guidelines.

Routine HIV Testing Recommended

Also at its interim meeting, the AMA updated its policy on HIV testing to include guidelines in support of routine HIV testing. The guidelines state that physicians should continue to seek patients' informed consent prior to HIV testing but that the consent does not need to be documented in writing. Testing patients without prior consent is justified only “in limited cases” in which “the harms to individual autonomy are offset by significant benefits to known third parties,” including occupationally exposed health professionals or patients. “AMA's new policy calls on physicians to routinely test consenting adult patients for HIV and reflects the reality that, if HIV is detected early, infected patients can lead full and productive lives,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. In a 2006 policy revision, the Centers for Disease Control and Prevention urged physicians to make HIV testing “a routine part of care in health care settings for all patients ages 13 through 64,” regardless of whether the patient has specific behavioral risk factors.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so.

Next Article: