Resident News

GAFP Annual Research Poster Competition Winners Announced at the GAFP Annual Meeting, November 9th in Stone Mountain

The Georgia Academy Annual Research Poster Competition was held during the Annual Meeting and Scientific Assembly November 7-10 in Atlanta. Posters were displayed outside of Salon E-G of the Evergreen Marriott Conference Resort in Stone Mountain for all attendees to view, and were evaluated by Dr. Rhonda Walton, Dr. Catherine James Peters, and AAFP Representative Dr. Leonard Reeves.  Pre-med, medical students, residents and practicing physicians from throughout the state participated in the competition.

Results were as follows:

Pre-Med Category Winner:

1st Place – “Say What?” Patient Health Literacy as a Determinant of Effective Physician-Patient

Communication in a Community Clinic

Author/Presenter: Taylor Bennett, Clark Hall, Kathryn McGraw

Advisor/Coordinator/Contributor: Catherine Apaloo, MD, FACP; Zahraa Rabeeah, MD

 

Abstract:

Effective communication is a key element in patient care. Health literacy can affect understanding and subsequent adherence to the treatment plan.  Miscommunication is thought to be the root cause of medical errors and malpractice cases.  In this study, we evaluated patient health literacy and physician communication style to protect patient safety using a descriptive cross-sectional at Piedmont Athens Regional Community Care Clinic (PARMC).  Questionnaires were given to patients and doctors to evaluate health literacy, communication style, autonomy, and shared decision capacity before and after the visit.  Analysis was done using IBM SPSS Statistics. Study population consisted of 51 percent male and 49 percent female.  83 percent of surveyed patients stated that they asked a lot of questions, yet only 50 percent were unable to read labels or follow hand out instructions.  Patients older than 50 years old asked more questions than younger patients [p=0.02].  Females were more likely to understand labels [p =0.03]. 66 percent of participants had difficulty navigating insurance plans.  Our studies show that low health literacy is a major contributor to non-adherence and loss of follow-up.  Future plans to improve physician-patient communication will include a score sheet for each physician implemented every 3 months designating patient feedback and advice for areas of improvement.  Communication workshops targeted towards health literacy will be conducted every 6 months in order to improve physicians’ attention to health literacy and to provide safer care.

Medical Student Category Winner
Reducing Non-Essential Emergency Department Visits Among Mercy Health Center Patients

Authors/Presenters: Jakob Feeney, Silki Modi, Nzota Nsona, E’Lexus Okafor, Kyle Royalty,

Harini Vakamudi, Eden Woubshet

Advisor/Coordinator/Contributor:

 

Abstract

Purpose. Approximately 20 percent of U.S. adults seek emergency department (ED) care each year, and at least 30% of these visits are non-urgent. Inappropriate ED use leads to unnecessary testing, treatment, and larger downstream healthcare costs for patients/providers. Interviews with patients/providers suggest a knowledge gap pertaining to proper ED use. This study aims to use patient education on appropriate ED use to decrease financial burdens on hospitals and improve long-term patient care.

Methods. Bilingual informative television slides and posters were displayed highlighting appropriate ED use and Mercy Health Center’s services. Surveys were administered eliciting patient comprehension of the posters. Mock phone calls to Mercy tested ability to schedule acute care appointments. Viability of a triage hotline was assessed for afterhours care recommendations.

Results. Surveys were completed by 40 patients. About 78 percent of patients reported increased willingness to call Mercy for an acute appointment, and 40 percent learned new information from the poster. Phone calls to Mercy highlighted barriers for making acute appointments, including scheduling unavailability during evenings and inconsistent callbacks. The initiation/use of triage hotlines was not currently a feasible option.

Conclusions. This study identified several factors to increase patient utilization of Mercy. Mercy’s scheduling can be improved by modifying voicemail protocol. Patient receptiveness to informational posters warrants converting them into brochures for distribution. This study reinforces using an educational, lifestyle medicine approach to increase patient understanding of symptoms and availability of medical resources which decreases inappropriate ED use, hospital financial burdens, and poor patient care.

 

Resident Category Winner
Implementation of Multi-Disciplinary Teams to Provide Comprehensive Care for Type 2 Diabetes Population in a Primary Care Clinic Setting

Author/Presenter: Afua Akhi-Gbade, MD

Advisor/Coordinator/Contributor: Miranda Moore, PhD; Susana A. Alfonso, MD, MHCM; Yawen Wang, MPH

Practicing Physician/Fellow Category Winner
Evaluate the Effectiveness of the American Heart Association (AHA) Check. Change. Control Hypertension Management Program in patients with uncontrolled Hypertension at Grady East Point Health Center.

Author(s): Dolapo Babalola, MD

Advisor/Coordinator/Contributor: Denise Bell-Carter, MD, Esther Iwotor, DNP, Carli Barbo, MS, Mark Mooney, MPH, Unique Waker, MPH, Nike Agbe, PharmD

 

Abstract

Evaluate the Effectiveness of the American Heart Association (AHA) Check. Change. Control Hypertension Management Program in patients with uncontrolled Hypertension at Grady East Point  Health Center.

Background

It is well documented the cardiovascular risk doubles with uncontrolled blood pressure for systolic and diastolic greater than baseline of 120/80. Data analysis reveals 60 percent of patients at Grady East Point Clinic (GEP) have uncontrolled Hypertension. This leads to macrovascular disorders complications from longstanding hypertension to include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. These patient outcomes lead to increased healthcare bill and overall poor health.

Hypothesis

The Hypothesis is will the Evidence based American Heart Association (AHA) Check. Change. Control Hypertension Management Program reveal at least 70 percent of the patients seen at Grady East Point recruited with uncontrolled blood pressure of greater than 140/90 will have a BP of less than 140/90 or a 10 mmHg decrease in systolic blood pressure by the proposed four months multidisciplinary intervention involving physicians, community personnel, nutritionist and pharmacist.

Method

Setting:

  • The study will be conducted at Grady East Point (GEP) ambulatory clinic in the East Point Community. GEP is a Grady’s Neighborhood Health Centers which offers primary care and more for men and women of all ages. Providers offer complete care for all parts of your body and for most diseases. Referrals are made if there is a need to see a specialist.
  • The population density in East Point is 1319 percent higher than Georgia. The median age in East Point is 4 percent lower than Georgia. In East Point 15.43 percent of the population is Caucasian. In East Point 75.64 percent of the population is African American.

Design study

The procedure for the study is as follows;

  • There will be a Retrospective chart review of patients with uncontrolled Hypertension seen at Grady East Point Health Center between January to November 2017
  • 50 Adult patients’ ages 18-75 seen and treated at Grady East Point Health Center with uncontrolled hypertension greater than 140/90 will be recruited and consented by the physician champions to voluntarily participate in the study to monitor their blood pressure by using the AHA Check. Change. Control Hypertension Management Program.
  • The Intervention period will run for 4 months with patients participating in the following activities;
  1. Twice a month blood pressure check measured at either Grady East Point Health Center or the YMCA facility. This will take 15 – 30 minutes each time.
  2. Once a month blood pressure check via remote monitoring using the free blood pressure cuff monitor provided to patients to record their blood pressure on a log sheet which will be submitted to the physician champions to review the blood pressure and make treatment plan.
  3. Once a month nutritional seminar held at either Grady East Point Health Center or the YMCA facility to discuss the impact of nutrition, low sodium, low fat, and portion control on hypertension goals. The sessions will be one hour long.
  • Post-Intervention retrospective chart review will be done in July 2018 and results will be compared to patients’ baseline blood pressure.

Results/Discussion

 Table 1: Bivariate association between Final BP Meet Goal and covariates

Variable Final BP Meet Goal
Yes No
N (%) N (%) P-value*
Class Taken 1 or 2 6 (85.7) 1 (14.3) 0.585
3 or 4 6 (66.7) 3 (33.3)
Age < 60 6 (85.7) 1 (14.3) 0.585
>=60 6 (66.7) 3 (33.3)
Gender Male 2 (100) 0 (0) 1
Female 10 (71.4) 4 (28.6)
Smoking Status Yes 1 (50.0) 1 (50.0) 0.45
No 11 (78.6) 3 (21.4)
Alcohol Consumption Yes 2 (100) 0 (0) 1
No 10 (71.4) 4 (28.6)
*Fisher’s exact tests were used to calculate p-values.

 

Table 2: Association between Final BP Meet Goal and Number of Class Taken adjusted

for Age using logisitc regression model

Variable  aOR (95%CI) P-value
Class Taken 1 or 2 ref
3 or 4 0.399 (0.016, 4.734) 0.488
Age < 60 2.509 (0.211, 61.279) 0.488
>=60 ref
aOR=adjusted odds ratio, 95 percent CI= 95% confidence interval

The aOR for ‘Class Taken 3 or 4’ is 0.399, which means patients who attended 3 or 4 classes were about 60% less likely to meet the BP control goal compared to those who had 1 or 2 classes, but the result was not statistically significant (p=0.488). Intuitively, people who had more classes were supposed to be more likely to meet the goal. Two major explanations are;

(1) The sample size is too small to represent the true situation. Table 1 reveals 4 patients whose blood pressure didn’t meet the goal, but three of them actually attended all the four classes.

(2) Some confounding factors may play a part in the relationship between ‘Number of Class Taken’ and ‘Whether BP meet goal’. For example, baseline severity of hypertension may confound the association. People with severe hypertension or worse baseline health condition might be more interested and adhering to these classes, but it is also more difficult for them to meet the goal compared to people with much better health condition.

Conclusion

The purpose of this research is for GEP patients to improve and maintain a healthy heart as well as creating a Healthier Community by overcoming barriers by using a multidisciplinary approach with involves the following;

  • Checking their blood pressure with routine self-monitor and clinic appointments
  • Changing their blood pressure with healthy lifestyle habits: exercise and food
  • Controlling their blood pressure with the YMCA Community programs

 

Congratulations to the GAFP 2018 Research Poster Winners!  We wish them continued success in their research efforts!

Register Now for the October 3rd Webinar on Georgia’s Preceptor Tax Incentive Program

Host: Healthcare Georgia Foundation

Date:  Wednesday, October 3rd

Time: 10:30 AM – 11:30 AM EST

Speaker: Erin Mundy, MPA, Director of Community Based Training Programs and Cindy Peloquin, PTIP Program Manager

Program Description:

Georgia faces a critical shortage of health care professionals, particularly in primary care. Georgia Area Health Education Centers coordinate community-based training for health professional students in primary care specifically rural/underserved areas. The Preceptor Tax Incentive Program was created to entice physicians who are not compensated to train health professional students.

Learning Objectives:

At the end of the presentation, attendees should be able to:

  • Examine the process Georgia followed in creating the Preceptor Tax Incentive Program including developing a greater understanding of legislative processes in creating the bill and the challenges encountered during the process.
  • Examine the mechanisms utilized to certify the eligible rotations and eligible practitioners for tax purposes.
  • Recognize the critical role of the Georgia Statewide AHEC in collaborating partnerships with legislators, university leaders and state departments in creating a workable framework for reporting, managing, and auditing incentive dollars impacting the state’s revenue

Register Here

2018 Annual Research Poster Competition

The Georgia Academy of Family Physicians is seeking submissions for the Annual Research Poster Competition to be held Friday, November 9, 2018, during the GAFP’s Annual Scientific Assembly.

Submissions from Pathway to Medical School Pre-med students, and GAFP members who are medical students, residents and practicing physicians/fellows are welcome.

Posters presented may be research results, case reports, summer projects, or educational projects.  Posters may address any topic relevant to family medicine.  Submissions must be of original work not yet published or presented at regional or national meetings.  However, concurrent (2018) submissions to other conferences such as NAPCRG and STFM are encouraged.  Medical student projects previously presented at medical schools or on student “Research Days” are accepted.

How to Submit Your Poster Information:

Please visit the GAFP website at www.gafp.org and access the Poster Competition information by clicking on the Education tab, then selecting the 2018 Research Poster Competition link.  Complete the entry form and submit it back to Megan Neuffer at mneuffer@gafp.org by Monday, October 1st with a copy of your project abstract and an electronic copy of your poster.

Poster Acceptance Notification:

Competition finalists will be notified via email no later than Friday, October 15th.

During the Competition:

Posters will be judged at the time of presentation at the Annual Meeting on Friday, November 9th from 9:30am – 12:30pm.  Review will focus on the Significance of findings for practicing family physicians; Quality of presentation of findings; and, Quality of methods used to generate findings.

Winners will be announced immediately after the competition in the Social and Information Hub.

After the Competition:

Awards up to $500 will be awarded to the winning outstanding pre-med student(s), medical student(s),

and resident(s). The winning practicing physician/fellow will receive a recognition award.

Monetary and recognition awards will be sent to the winners within two weeks after the meeting.  Please note, if there are multiple presenters for a winning poster, they will share the award equally.

For more information, please contact Megan Neuffer (800) 392-3841 or mneuffer@gafp.org

Family Medicine Leads provides scholarships for GAFP Students and Residents

The winners of the 2018 Family Medicine Leads Scholarships for National Conference have been determined. Here is a list of scholarship recipients from Georgia.

  • Saira Bari (student)– Cairo
  • Deema Elchoufi (student) – Atlanta
  • Shilpa Jhol (student) – Marietta
  • Michael McCullagh (resident) – Augusta
  • Keisha Parker (student) – Atlanta
  • Setu Patel (student)– Valdosta
  • Vijay Venkatesan (student) – Alpharetta
  • Maria Westerfield (student) – Macon

This program provides $600 scholarships to help cover out-of-pocket travel and registration expenses for students and residents to attend National Conference, August 2–4 in Kansas City, MO. These scholarships are made possible because of donations from family physicians across the country. Nearly 600 scholarship applications were received, and 220 Family Medicine Leads Scholarships were awarded.

Family Medicine Leads Scholarships for National Conference are comprised of the following categories: Early Career Student, Student or Resident Primary Care Champion, and Family Medicine Interest Group (FMIG) Leaders.

Congratulations to all the Georgia recipients. See you in Kansas City!

Initiative Creates Efficiencies and Incentives for Preceptors; An Interview with Preceptor Expansion Initiative Chair, Annie Rutter, MD

Initiative Creates Efficiencies and Incentives for Preceptors; An Interview with Preceptor Expansion Initiative Chair, Annie Rutter, MD

By Mary Theobald, MBA, Vice President, Society of Teachers of Family Medicine

Mary: Tell us a little about yourself.

Annie: My name is Annie Rutter and I’m a family doc and I work in upstate New York where I’m the clerkship director for family medicine. That’s what I do as my day job. I’ve also been working with STFM on a couple of different initiatives — most recently with the Preceptor Expansion Initiative.

What’s the Preceptor Expansion Initiative?

So, this is an interdisciplinary approach to increase the pool of community-based preceptors. When we look at where most physicians practice after they graduate from residency, it’s in community settings. Right now, most of our medical education takes place in tertiary medical centers. We don’t have enough sites for students to train in community settings. So, this initiative was taken on by multiple organizations, with the Society of Teachers of Family Medicine as the leader, to gain insight and to increase the number of physicians, nurse practitioners, and physician assistants in the community providing ambulatory education.

Why is there a shortage of community-based preceptors?

There are a lot of demands put on community physician’s day to day. Sometimes, they’re not able to — or they don’t feel like they’re able to — take on students. This initiative will help them get rewarded for their work and also help them realize that this is work they can do. There are also more medical schools — both MD and DO — in the United States and in the Caribbean and other parts of the world that are using the United States physicians as community faculty. And then certainly the demand increases when you add in other health professions who rely on community-based preceptors to teach the skills they need in an ambulatory setting.

What about the fact that an increasing number of community physicians are employed rather than solo practitioners?

Yeah, I mean that’s part of the hypothesis. There’s certainly a trend across the United States for more and more community-based and private practices to be part of bigger hospital or health care systems — to be employed. That comes with competing demands, created by systems or just the health care system more broadly. Where solo practitioners were making the decisions about whether or not they could or wanted to take a student, that decision is now sometimes taken out of their hands and raised up to the systems level. And when compensation is based on productivity, and there’s a perception that a student slows you down, then it’s certainly viewed as a burden to teach. That can be a huge barrier to getting students into community settings.

You’ve noted that clinical practices have a lot on their plates. Isn’t taking on a student going to add more to that already full plate?

If we train our students well before they get into the clinical setting, they can be a huge asset to a practice. Students can do a lot more than what many think they can do. Students can help with quality improvement projects and other practice-based initiatives. With the new CMS documentation changes, students can document patient visits. The preceptor, who of course has to see the patient and repeat the pertinent parts of the physical and the history, can confirm what the student wrote. The tedious task of re-typing doesn’t have to take place any more.

I think many of us, because of how we were trained, think students need to work one-on-one with a doctor and that students need to see every patient that comes in the door. If a student only sees several patients in a day and does the full visit from start to finish, including all the follow-up — the documentation, all of those pieces— they’ll learn what it’s like to take care of patients. Students aren’t as efficient as trained attending faculty physicians, so they’re not expected to do that same workload.

The reality is that students get a lot out of varied experiences in a practice — spending time with different types of providers, like pharmacists, medical assistants, case managers, nurse practitioners, physician assistants, all sorts of folks who are part of the care team. There’s value in learning from all health care team members.

Will the Preceptor Expansion Initiative help students be better prepared for clinical rotations?

Yeah, so there are a couple of things that this project is specifically focusing on. One of them is standardized onboarding of students, and this takes on a couple of facets. One is the logistics of onboarding: Does the student have a login to your EMR? Does the student have all of the proper HIPAA and other training and paperwork, so he can contribute and begin learning right away?

The second piece of that onboarding is making sure the preceptor knows what the student has already learned, such as documentation skills, physical exam skills, history taking, and maybe even specific procedures. So, again, when student comes in on day one, the preceptor can utilize the student’s skills for improved and efficient patient care. And so those two pieces, the logistics and the clinical preparation, will help ease the transition of students into clinical settings.

I would say the other thing the Preceptor Expansion Initiative is working on is figuring out efficient workflows for when there are multiple learners in an environment. So, for example, if a practice was able to host a medical student and a pharmacy student, the practice could use the workflow models to get ideas on how to incorporate both types of students — who have different skill sets — into one clinical practice setting to provide value for the patients, the preceptor, and the students.

What are some of the positive things you hear from preceptors?

Some of the most positive feedback I get is related to giving back to the profession. A lot of preceptors say, “You know, I take students because someone took me and taught me how to do this.” They enjoy getting to know the students and sharing their wisdom –, not just clinical wisdom, which is important, but also mentorship. Things like how to decide where to go for residency, work life balance, etcetera. Preceptors can share what it’s like working in private practice or working for a hospital system or doing procedures in the office. I think sharing this knowledge is one of the things preceptors really enjoy. The other thing so many preceptors tell me is that students teach them a lot.

What if a physician wants to precept, but no one has ever asked?

So, there’s a lot of different ways to get involved. One of the first ways is to talk to your state chapter. Many of the Academy chapters can connect preceptors with medical schools. Or, if you have a medical school in your community, reach out directly to the Department of Family Medicine or to their office of medical education.

What if someone wants to precept and there are policies within their practice or system that won’t allow them to do that? Any suggestions for advocating for change?

I think one way is to have a good relationship with your administration, whether that’s your practice manager or a larger hospital systems director, and to talk to them directly. Systems need physicians, so hopefully they’ll want to keep you happy. Another avenue is to connect with other providers who might be interested in teaching. Band together and talk to your administration. And still another way might be go ahead and contact a medical school, because some of the folks there may be able to build a bridge with the administration at your health system to negotiate how this might work and to dispel myths.

Some people think a commitment means they need to take a medical student every day for the entire academic year. Many schools are able to negotiate it so a preceptor works with students part of the time — maybe at certain times of the year or when the demand is great. There are a lot of different models out there. It’s important to explore those options before closing the door.

Is there anything else you think we should talk about?

I sometimes hear that family docs don’t teach because they’re not sure they’d be a good teacher. Faculty development is a requirement for medical schools, and that includes community-based faculty. Schools work with community-based faculty to get them prepared to have students in their offices by teaching them what is expected and also providing tips on effective teaching. Community based physicians are extremely smart. They’re taking care of patients, they’re working hard every day, and they have a lot of wisdom to share with students about the day-to-day clinical presentations of patients.

For more information about precepting in Georgia and receiving a state tax incentive – click here:  https://www.augusta.edu/ahec/ptip/