Archive for November, 2019

Georgia Academy of Family Physicians elects, Jeff Stone, MD, MBA, MHA, FAAFP as president at the 2019 Annual Meeting

Georgia Academy of Family Physicians elects, Jeff Stone, MD, MBA, MHA, FAAFP as president at the 2019 Annual Meeting

The Georgia Academy of Family Physicians inaugurated Jeff Stone MD, MBA, MHA, FAAFP during their 51st Congress of Delegates, in conjunction with the Annual CME Meeting on Saturday, November 16th.  The 2019 Annual Meeting was held at the Atlanta Evergreen Marriott Conference Resort, November 14th through November 16th. Dr. Stone joins other physician leaders who inspire and mount initiatives, education, resources, and advocacy efforts in service to fellow family physicians and Georgia families.  Dr. Stone is a native of Latham, New York but now resides in Canton, Georgia.

Dr. Jeff Stone received his bachelor’s degree in Biology and Russian from Bucknell University in Pennsylvania. He obtained his medical degree from St. George’s University School of Medicine in Grenada, W. I. and completed his residency program in family medicine at the Albany Medical Center Affiliated Hospitals in New York. In 2014, Dr. Stone obtained his Master of Business Administration (MBA) and Master of Healthcare Administration (MHA) from Georgia State University. Dr. Stone is certified by the American Board of Family Medicine and is a Fellow of the American Academy of Family Physicians.

Dr. Stone is currently a family physician at WellStar Health Systems in Marietta, Georgia. Prior to joining WellStar Medical Group, Dr. Stone was a managing partner with Latham Medical Group in New York. He has more than thirty years of experience treating patients for a wide variety of “cradle to grave” conditions. Dr. Stone is passionate about providing cost effective, value and evidenced based medicine.

In addition to his clinical background, Dr. Stone is heavily committed to community and professional leadership. He is a graduate of the 2017 Georgia Physician Leadership Academy. He served as the Treasurer of the GAFP Board of Directors for three years, and he previously served as the Speaker of Congress of Delegates. Prior to that, he was the Finance and Practice Management Committee Chairman for the GAFP. In 2017, Dr. Stone was awarded the Preceptor of the Year Award at Mercer University School of Medicine and Georgia Regents University (MCG).

“I look forward to a year supporting our members and advancing our strategic initiatives,” said Dr. Stone.

Dr. Stone will serve as the GAFP President 2019-2020 and will subsequently become Board Chair in 2021.

 

MCG at Augusta University Family Medicine Residents Present Tar Wars to Laney High School Students

MCG at Augusta University Family Medicine Residents Present Tar Wars to Laney High School Students

Family Medicine Residents from MCG at Augusta University recently presented the Tar Wars tobacco and vaping prevention program to Laney High School students in Augusta, GA. In addition to learning about the dangers of tobacco and e-cigarettes/vaping use, the students also received information on hookahs and secondhand smoke.

Pictured (L-R) are Laney H.S. Coach William Wallace, Dr. Sara Myers, Dr. Mark Beckman, Dr. Christian Bramwell and Dr. Bilal Fiaz. To learn how you can present the Tar Wars program in your community contact Kara Sinkule at ksinkule@gafp.org.

 

Support for Tar Wars in Georgia provided by the W.G. Raoul Foundation

Kathleen E. Toomey, M.D., M.P.H.

Commissioner, Georgia Department of Public Health

November 19, 2019

The Georgia Department of Public Health (DPH) has confirmed 11 cases of measles in the past 10 days. That brings the total number of confirmed measles cases in Georgia to 18 so far this year – more than in the previous decade combined.

As physicians and health care providers, we must be ever vigilant for patients presenting with febrile rash illness and clinically compatible measles symptoms. If you suspect measles in a patient, notify Public Health immediately at 404-657-2588 (during business hours), or 1-866-PUB-HLTH after hours or weekends.

Please follow the guidance below in assessing patients for measles.

  • Healthcare providers should consider measles in the initial differential diagnosis of patients presenting with the following symptoms, particularly those who have a history of recent international or domestic travel, exposure to international travelers, or exposure to a possible measles case:
    • Fever ≥101˚F (38.3˚C) AND
    • Generalized maculopapular rash lasting > three days AND
    • Cough, runny nose or conjunctivitis
  • Isolate persons with suspect measles immediately (negative pressure room, if available). Patients should be managed in a manner that prevents disease spread in the healthcare setting https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf.
  • Report suspect cases of measles immediately by calling either the District Health Office or Georgia DPH at 404-657-2588 (during business hours), or 1-866-PUB-HLTH after hours or weekends. Do not wait on laboratory results before reporting.
  • Obtain appropriate clinical specimens. Laboratory testing for measles is required for confirmation. This includes two throat swabs and urine for measles PCR and culture, and blood for serology testing. Detailed specimen collection and shipping guidelines are available at the DPH measles website. DPH will assist in coordinating measles testing at the Georgia Public Health Laboratory.
  • Ensure patients are up-to-date on their vaccinations according to CDC’s recommended schedules for children and adults.

The number of measles cases in the U.S. continues to increase almost daily. Just a few weeks ago, the country was very close to losing its measles elimination status – a very sobering thought in this day and age.

The current measles outbreak in Georgia is small compared to other outbreaks documented around the country. However, the toll even a single case of measles takes goes well beyond physical illness – impacting economies, work forces, education, health care systems, and creating a public health burden to protect vulnerable populations. As such, our role becomes even more critical in identifying every case of measles and preventing transmission and strengthening vaccine confidence among parents and patients.

Thank you for all that you do to keep Georgians safe and healthy.

Sincerely,

Kathleen E. Toomey, M.D., M.P.H.
Commissioner

Get Involved in Committees! GAFP seeking member participation in its committees

Committee Recruitment 2020

The GAFP is now soliciting new members to our 2020 Committees! We are looking for GAFP members to join various committees in support of the GAFP’s mission to promote the health of the citizens of Georgia by advancing the specialty of Family Medicine through education, advocacy and service to family physicians in the State of Georgia.

The GAFP has implemented several successful initiatives in past years, all because of the dedication and commitment of our volunteer committee members.

All Committee members are appointed by our president, Dr. Jeff Stone.  He will evaluate each person’s volunteer application and make every attempt to have you serve on the Committee of your choice.

Committee membership will be held to no more than 15 members. For most committees, this will include one slot for a resident and a medical student. The expectation is that each member selected for a committee will have the ability to 1) attend the three committee conclave meetings, 2) respond to emails, and 3) review committee materials and be ready to offer advice and guidance.

We ask that you only volunteer to serve on a Committee if you can attend either in person or by phone all three meetings in 2020.  Although several committees meet more than 3 times a year, here are the dates for the 2020 Committee Conclaves:

  • Saturday, February 29                    Atlanta, GA (Le Meridian Atlanta Perimeter)
  • Thursday, June 4                              Sandestin Golf & Beach Resort (Miramar, FL, in conjunction with the GAFP Summer CME Meeting)
  • Saturday, August 1                         Pine Mountain, GA (Callaway Resort & Gardens)

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Following is a list of the opportunities for service. You will find a more detailed list of Committee descriptions and Committee Recruitment Application by clicking here.

  • Bylaws Committee
  • Education and Research Committee
  • Finance Committee
  • Legislative Committee
  • State Legislative Session Working Group (unlimited # of members and has a shorter time commitment):
  • Membership Services Committee
  • Practice Management Committee
  • Public Health Committee
  • Student and Resident Recruitment

We encourage your interest and participation as this is certainly an important and pivotal time for family medicine. We are only as strong as the commitment and involvement of our members.

Registration Now Open – Day at the State Capitol – Thursday, March 5, 2020

Registration Now Open – Day at the State Capitol – Thursday, March 5, 2020

Registration is now open for GAFP members to join your colleagues to advocate for our profession and our patients at our Legislative Day at the Capitol. This year’s Day at the Capitol will be held at the Freight Depot (next to the State Capitol) on Thursday, March 5, 2020.  You will receive important legislative updates and have the opportunity to visit with Georgia legislators at the Capitol prior to returning to the Freight Depot for lunch. Both your state representative and state senator will be invited to sit with you during the lunch program.  Small travel stipends available for GAFP medical students and family medicine residents.

Registration is free – but you must register before February 24th to be included.  Click here to register or complete the PDF version of the registration and email/scan to ffulton@gafp.org.

Day at the Capitol Registration Form

Agenda

8:30 am – 9:15 am          Breakfast/Legislative Priorities

9:15 am – 10:15 am        Policy Briefing

10:15 am – Noon             Legislative Visits at the Capitol

12:15 pm – 2:00 pm       Lunch with Legislators/Wrap Up

Questions?  Contact Fay Fulton at ffulton@gafp.org.

 

Marietta-Based Adult Disability Medical Healthcare (ADMH) Awarded Community Health Grant to Support “Get Fit and Be Healthy” Program for Disabled Adults

GHFA Deputy Director Kara Sinkule recently presented a $5,000 grant award to ADMH Director and Georgia Family Physician Dr. Andrea Videlefsky (L) with ADMH Clinic Director Janice Nodvin (R) and Get Fit & Be Healthy graduates who lost a total of 51 pounds during the project!

The Georgia Healthy Family Alliance (GHFA) recently awarded Marietta -based Adult Disability Medical Healthcare (ADMH) $5,000 from the Community Health Grant Program for their “Get Fit and Be Healthy” project which provides nutritional guidance, exercise instruction and health education to adults with disabilities.

The Adult Disability Medical Healthcare (ADMH), which operates inside Urban Family Practice Associates in Marietta provides all-encompassing healthcare and social service needs for teens and adults with developmental disabilities including Down Syndrome, Autism, Fragile X, Microcephaly, and Cerebral Palsy.

Six members of the 2019 “Get Fit & Be Healthy” graduating class are pictured above. Through hands on healthy cooking instruction, grocery store tours and group exercise coaching, the group lost a total of 51 pounds during the yearlong project.

GHFA is the philanthropic arm of the Georgia Academy of Family Physicians (GAFP). Our nationally recognized Community Health Grant Program exists to support and create momentum in an area of need and provide vital funds for family physician sponsored healthcare projects across Georgia.

Since launching the program in 2012, the Alliance has awarded 62 charitable organizations more than $326,000. Grant awards are made to GAFP member affiliated community organizations supporting underserved populations and community programs that promote healthy practices. For more information visit www.georgiahealthyfamilyalliance.org.

GLP-1 Receptor Agonists: Where do these non-insulin injectables, and newly approved oral option, fit in for the treatment of Type 2 Diabetes Mellitus?

GLP-1 Receptor Agonists:

Where do these non-insulin injectables, and newly approved oral option, fit in for the treatment of Type 2 Diabetes Mellitus?

By: Cedrice Davis, MD

Advances in treatment options for Diabetes have expanded over the last decade. While first-line therapy for the treatment of Diabetes has remained Metformin and comprehensive lifestyle modifications, several professional organizations, including the American Diabetes Association1, American College of Cardiology2, American Heart Association3, and American College of Clinical Endocrinologists4, have updated their guidelines to reflect a wider playing field for 2nd line options. Glucagon Like Peptide – 1 Receptor Agonists (GCP-1 RA) is one of those options.

Despite guideline updates, utilization of GLP-1 RA in the primary care setting remains relatively low.5 As an outpatient family physician with an office that participates in diabetes clinical research trials, I think it is important that we take a look at why this class of medicines should be part of the primary care physician’s armamentarium in the fight to control this disease.

GLP-1 is a member of the incretin family of glucoregulatory hormones.  It is secreted in response to food ingestion. GLP-1 RA therapies attempt to correct the dysregulation/dysfunction of normal physiology that contributes to the diabetes disease state.  GLP-1 RAs impact several core defects present in type 2 diabetes.6Background:

How do GLP-1 RA work?6

  1. Glucose-dependent increase in insulin secretion from pancreas. It does so by stimulating the beta cells of the pancreas in the setting of a glucose load.
  2. Glucose-dependent decrease of glucagon secretion from the liver. In Diabetes, the hormone glucagon is oversecreted causing an unwanted release of glucose from the liver. The suppression of the glucagon results in a welcomed decrease of glucose from the liver.
  3. Increased satiety resulting in a suppressed appetite. This occurs via receptors in the central nervous system.
  4. Delayed gastric emptying. This results in lower postprandial glucose levels.
  5. Protection of ?-cell mass (demonstrated in animal models).

GLP-1 RA Products Available:

There is currently one newly approved oral GLP-1 RA and six injectable GLP-1 RAs available in the U.S. Dulaglutide (Trulicity), exenatide (Bydureon), exenatide (Byetta), liraglutide (Victoza), lixisenatide (Adlyxin), and semaglutide injectable (Ozempic) and now semaglutide oral (Rybelsus). (Click on brand name for link to product information)

Expected Clinical Outcomes:6,7,8

A1C reduction: 0.8-1.8%

Body weight reduction: 2-14 lbs

Efficacy and safety between GLP-1RAs vary. All have demonstrated cardiovascular safety, but liraglutide has an FDA approved indication to prevent CVD in high risk patients. Other GLP1 RAs are currently under FDA review for a CVD prevention indication (e.g., dulaglutide, semaglutide).

Cost:

Out of pocket expense for the patient will vary depending on insurance coverage.  Most manufacturers offer copay assistance for commercially insured patients and financial assistance for low income patients.

Tolerability: 6,7,9

GLP-1 RAs are generally well tolerated, with nausea and vomiting being the most common adverse event.  It is important to inform patients initiating GLP-1 RA therapy that this may occur initially, but it is usually transient and is typically mild to moderate in nature. If nausea is bothersome, the patient may be advised to eat smaller meals and avoid spicy or high-fat meals.  For patients already on the GLP-1 RA that experience nausea and vomiting with dose titration, consider decreasing back to the last tolerated dose for 1 week before repeating the incremental dosing steps.  The ADA standards of care note that renal dosing adjustments are required for exenatide and lixisenatide.1   Injection site reactions have also been reported.

What about GLP-1 RA and risk of pancreatitis? 9,10

Type 2 diabetes is a risk factor for development of acute pancreatitis, and studies of patients treated with GLP-1 RAs have reported that pancreatitis may occur more frequently with these medications, but results have been mixed. According to the PIs of all GLP-1 RAs, if pancreatitis is suspected, these drugs should be discontinued, and if acute pancreatitis is confirmed, they should not be restarted. The FDA and the European Medicines Agency (EMA) have agreed that assertions concerning a causal association between incretin-based drugs and pancreatitis or pancreatic cancer, as expressed in some scientific literature and in the media, are inconsistent with current data; however, the FDA and the EMA have not reached a final conclusion regarding such a causal relationship.

What about GLP-1 RA and risk of thyroid tumors? 6,7

In rodent models, GLP-1RAs have been linked to the release of calcitonin, and the potential formation of thyroid tumors, but there is no evidence of a causal relationship between GLP-1 RAs and thyroid tumors in humans. Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome is contraindicated according to the FDA PI for the long acting GLP-1 RAs dulaglutide, liraglutide, semaglutide and exenatide once weekly.

COMING SOON: 11

Different delivery systems for GLP-1 RAs are being investigated. Oral Semaglutide (Rybelsus) was approved by the FDA on September 20, 2019 and is now available in pharmacies. Other oral options are also being investigated as well as an implantable osmotic pump…. stay tuned!

References:

  1. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42(Suppl. 1): S1-S193. https://doi.org/10.2337/dc19-S009
  2. Das SR, et al. 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on expert consensus decision pathways [published online November 26, 2018]. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2018.09.020
  3. Arnett DK, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2019 Mar 17; [e-pub]. https://doi.org/10.1016/j.jacc.2019.03.010
  4. Alan J. Garber, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2019 Executive Summary. Endocrine Practice: January 2019, Vol. 25, No. 1, pp. 69-100. https://doi.org/10.4158/EP151126.CS
  5. Raval, A. D., et al. National Trends in Diabetes Medication Use in the United States: 2008 to 2015. Journal of Pharmacy Practice.2018. https://doi.org/10.1177/0897190018815048
  6. Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metab.2018 Apr 3;27(4):740-756. https://doi.org/10.1016/j.cmet.2018.03.001
  7. Hinnen, D., et al. Glucagon-like peptide 1 receptor agonists for type 2 diabetes. Diabetes Spectr, 30 (3) 2017;202-210. https://doi.org/10.2337/ds16-0026
  8. Pratley RE, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol 2018;6:275–86. https://doi.org/10.1016/S2213-8587(18)30024-X
  9. Thomsen RW, et al. Incretin-based therapy and risk of acute pancreatitis: a nationwide population-based case-control study. Diabetes Care 2015;38:1089–1098. https://doi.org/10.2337/dc13-2983
  10. Egan AG, et al. Pancreatic safety of incretin-based drugs—FDA and EMA assessment.New England Journal of Medicine. 2014;370(9):794-797. https://doi.org/1056/NEJMp1314078
  11. Meier, J.J., et al. Incretin-based therapies: where will we be 50 years from now? Diabetologia. 2015;58: 1745. https://doi.org/10.1007/s00125-015-3608-6

Georgia Healthy Family Alliance Announces Northeast Georgia Health System as Presenting Sponsor of Tar Wars Vaping Prevention Program for Gainesville Area Elementary Schools

 Gainesville, Ga. – The Georgia Healthy Family Alliance (GHFA), the philanthropic arm of the Georgia Academy of Family Physicians, today announced Northeast Georgia Health System (NGHS) as presenting sponsor of Tar Wars, a program developed by the American Academy of Family Physicians (AAFP) focused on educating students as early as 4th grade about the dangers of tobacco use and vaping.

In response to the epidemic of youth vaping and e-cigarette use, Georgia family physicians are partnering with the health system to present the Tar Wars program in Hall County Schools, Gainesville City Schools and surrounding counties.

From a community prevention effort, NGHS was eager to partner with GHFA.  “This initiative aligns with our community health improvement plan in terms of preventing lung disease and is an educational effort targeted directly at the kids in our community.  We felt very strongly about supporting this program,” says Christy Moore, Community Health Improvement Manager at NGHS.

According to the Georgia Student Health Survey administered by the Georgia Department of Education, the incidence of students who report having used a vape has increased over 100 percent in just the past two years in Hall County Schools.

“The trend is alarming and clearly dangerous for our community,” says Dr. Monica Newton, a family medicine physician at Northeast Georgia Physician’s Group and leader of the Northeast Georgia Strike Force effort.  “Not only are we seeing more illness as a direct result of vaping, we don’t always know what is contained in the vape, which is scary. I am grateful to NGHS for taking the lead to educate our children about how dangerous vaping is.”

GHFA has set a goal of raising $250,000 so that students can have access to the program for multiple years starting in the 2020 school year.

The Alliance is the philanthropic arm of the Georgia Academy of Family Physicians (GAFP).  Established in 1947, the GAFP is a member chapter of the American Academy of Family Physicians. GAFP strives to promote the health of the citizens of Georgia by advancing the specialty of Family Medicine through education, advocacy and service to family physicians in the State of Georgia. Boasting a membership of 3,200 family physicians, family medicine residents, and medical students, the organization supports those who aspire to achieve excellence and who are committed to delivering it. For more information about Tar Wars, visit www.georgiahealthyfamilyalliance.org or call us at 404-321-7445.

 

Members in the News

Altelisha Taylor, MD, MPH appointed to the AAFP Commission on Continuing Professional Development (COCPD)

The American Academy of Family Physicians Board of Directors has appointed Altelisha Taylor, MD, MPH, to the AAFP Commission on Continuing Professional Development (COCPD) for 2019-2020. Dr. Taylor’s term begins December 15, 2019.

Dr. Taylor is a PGY-1 resident at Emory University Family Medicine Residency Program in Atlanta, GA.

Congratulations Dr. Taylor!

Georgia Academy of Family Physicians Awards Dolapo Babalola, MD, FAAFP, its 2019 Family Medicine Educator of the Year Award

The Georgia Academy of Family Physicians (GAFP) awarded Dolapo Babalola, MD, FAAFP its 2019 Family Medicine Educator of the Year, for her exceptional influence on medical students and residents as faculty at Morehouse School of Medicine.

Dr. Babalola is an Associate Professor of Family Medicine and the Director of Medical Education and Rural Health at Morehouse School of Medicine in Atlanta.

Dr. Babalola has led many innovative efforts, including the Family Medicine Sub-Internship Selective Curriculum both structurally and educationally for the fourth-year medical students to promote primary care. She volunteers in the free student run clinic where she supervises and teaches students as they provide medical care for underserved and uninsured populations. She continues to develop new curricula and initiatives for medical students which includes; mid-clerkship evaluation meetings, group clinical skill sessions and National Board of Medical Examiners Subject examination prep review.

Dr. Babalola received her Doctor of Medicine from the University of Guyana School of Medicine, in Guyana. She completed Postgraduate Training at Morehouse School of Medicine and a fellowship in the Department of Family Medicine Faculty Development and Family Medicine Residency. Dr. Babalola has received the following awards; Grady Community Teacher’s Award, Outstanding Family Medicine Educator by the Morehouse Student Government Association. She was the 2nd place recipient for the Morehouse Faculty Teaching Competition and she was the 2018 GAFP Research Poster Award winner in the Practicing physician category at Georgia Academy of Family Physicians Annual Meeting.

Dr. Babalola embodies the true definition of an effective educator in Family Medicine. She is an emerging leader and we look forward to supporting her in her pursuit of being a lifelong educator.

Dr. Babalola will be among a group of four individuals honored by GAFP at the Annual Fall CME meeting in November.