Drug shortages cause scrambles in primary care

Physicians are prescribing drugs and dosages they normally wouldn't to fill the gaps in drug manufacturing shortages. Learn more about what the federal government is doing about shortages and what internists can expect in the near future.

Drug shortages have made headlines recently mainly because of their impact on hospital practice, but they are also affecting primary care. Physicians may find themselves struggling to obtain enough of a previously plentiful drug to treat a patient, or substituting a different drug they normally wouldn't have chosen. Such substitutions may require closer monitoring for side effects and may have negative effects on adherence, among other potential consequences. In our story, Charlotte Huff talks to practicing physicians and other experts to discover the current state of drug shortages in the U.S., what's being done to address them, and what can be expected in the future.

It's not always easy to attract medical professionals to practice in rural areas, so incentive programs, such as loan forgiveness, are relatively commonplace. However, research has shown that the people most likely to take on the challenges of rural practice are those who grew up there. Stacey Butterfield looks at a few programs across the country that are trying to attract students to rural medicine right out of the gate, in high school.

This issue also examines a novel program run by the National Institutes of Health, the Undiagnosed Diseases Program, which focuses on identifying disorders that have eluded the traditional path to diagnosis. Patients whose cases are accepted undergo a rigorous examination by a panel of physicians who try to determine what's ailing them. Our story gives an overview of the program through the eyes of internists and others who work there.

Before referring a patient with a baffling rash to the NIH, though, you may want to consider a more prosaic cause: bed bugs. The pests, which have made a big comeback in recent years, aren't thought to transmit diseases but can cause itching, skin problems, and psychological trauma. To learn how to spot a possible bed bug victim in your practice—and to gain tips on how to avoid becoming a victim yourself—don't miss our article.

Next month's issue of ACP Internist will feature a wrapup of our coverage from Internal Medicine 2012, held in April in New Orleans. If you attended the meeting, we'd like to hear what you thought about it. What sessions were most and least valuable? What would you change if you could? Let us know.


Jennifer Kearney-Strouse