Resident News

Family Physicians Leading in Advocacy

On February 28th over 200 physicians and medical students stormed the State Capitol to bring the Georgia Academy’s legislative priorities to the Georgia General Assembly.  Governor Brian Kemp made welcoming remarks and Medicaid Chief Blake Fulenwider gave the group an update on current state health policy initiatives.

GAFP’s current legislative priorities are listed below:

House Bill 287 (Sponsor Rep. Matt Dubnik – Gainesville)

Workforce – Preceptor Tax Credit – Support tax credits for community-based physician faculty to precept Georgia medical students, physician assistants and advanced practice registered nurses.  (Pending House Ways and Means Committee – as of February 27)

Senate Bill 106 (Sponsor Senator Blake Tillery – Augusta)

Medicaid – Support Medicaid innovations (state waivers) to provide affordable access to health insurance for low income Georgians and stabilize the current insurance market for individuals and small businesses.  (Passed the Senate on February 26!!  Now heads to the House.)

House Bill 63 (Sponsor Rep. Sharon Cooper – Marietta)

Insurance – Step Therapy – Support legislation to require insurance (non-ERISA) and State Health Benefit Plans to have a process for step therapy exception protocols.  (Passed the House and now pending in the Senate Insurance Committee)

House Bill 409 (Sponsor Rep. Alan Powell – Hartwell/Senate Bill 109 (Sponsor Sen. Larry Walker – Perry)

Patient Safety – Oppose legislation that would allow APRN’s to order imaging without supervision of a physician and would also allow physicians to increase supervision from four to eight advance practice nurses at the same time in active practice.  The Georgia Academy has concerns about additional abundance of over-imaging of patients by allowing non-physicians to order screenings.  The GAFP also believes that increasing the number of active APRN’s working concurrently under a physician’s supervision diminishes the ability to provide accurate review of patient care. (Pending in the House Special Committee on Access to Quality Health Care / Passed in Senate Health Committee)

House Bill 416 (Sponsor State Rep. Rick Williams – Milledgeville

Child Safety – Oppose legislation that would create a state vaccine board to allow easing of mandatory childhood vaccines.  This legislation would reduce Georgia’s child immunization rates.  It would also be duplicative of the federal National Vaccine Injury Compensation Program.  Vaccines save lives by preventing disease. (Pending in the House Health & Human Services Committee.)

Thank you GAFP leaders who made the time to support our advocacy by connecting with our legislators.  Save the date for the 2020 Day at the Capitol – Thursday, March 5.

Sponsor of HB 287 (Tax Credit for Preceptor) State Rep Matt Dubnik – Gainesville joins Drs Monica Newton and Amy Bailey

Medical students at Capitol with past presidents’ Drs Mitch Cook and Mitzi Rubin

Georgia Academy Board-chair, Loy “Chip” Cowart, MD and President, Donald L. Fordham, MD pictured with State Representative Terry Bruce

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!