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Transforming Your Practice Through EHR The Adolescent Obesity A Physicians & Inactivity Project Perspective on Healthcare Disparities

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summer 2005 PUBLISHED BY THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS The North Carolina Family Physician is published quarterly by the NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS P.O. Box 10278 Raleigh, NC 27605 919.833.2110 • fax 919.833.1801 www.ncafp.com 2005 NCAFP Board of Directors NCAFP Executive Officers President Karen L. Smith, MD President-Elect J. Carson Rounds, MD Vice President Michelle F. Jones, MD Secretary/Treasurer Christopher S. Snyder, III, MD Board Chair Conrad L. Flick, MD Executive Vice President Sue L. Makey, CAE Past President (w/voting privileges) Mott P. Blair, IV, MD The District Directors District 1 Donald Keith Clarke, MD District 2 Robert Lee Rich, Jr., MD District 3 Kevin B. Yow, MD District 4 William A. Dennis, MD District 5 Thomas H. Woollen, Jr., MD District 6 Thomas J. Zuber, MD District 7 R.W. Watkins, MD, MPH At Large Elizabeth B. Gibbons, MD At Large Richard Lord, MD IMG Physicians Constituency Ofelia N. Melley, MD Minority Physicians Constituency Claudia E. Gonzalez, MD New Physicians Constituency Jessica J. Burkett, MD Resident Director David C. Luoma, MD Resident Director-Elect Jennifer L. Mullendore, MD Student Director Kimberly W. Bennett Student Director-Elect Aye Otubu AAFP Delegates and Alternates AAFP Delegate L. Allen Dobson, MD AAFP Delegate Conrad L. Flick, MD AAFP Alternate George H. Moore, Jr., MD AAFP Alternate Mott P. Blair, IV, MD FP Department Chairs and Alternates Chair (UNC) Warren P. Newton, MD Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) (Interim) Mark Darrow, MD Alternate (WFU) Michael L. Coates, MD NCAFP Council Chairs Child & Maternal Health Shannon B. Dowler, MD Governmental Affairs Advisory J. Carson Rounds, MD Health Promotion & Disease Prev. Mott P. Blair, IV, MD Mental Health Robert E. Gwyther, MD Professional Services Karen L. Smith, MD NCAFP Editorial Committee William A. Dennis, MD Chair Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard Lord, MD David C. Luoma, MD

CREATED BY: Virginia Robertson, President vrobertson@pcipublishing.com Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION: Adrienne Freeman adrienne@pcipublishing.com 501.221.9986 • 800.561.4686 edition


Ta b l e o f C o n t e n t s

Vol 1 • No 3



A Physicians Perspective on Healthcare Disparities


Transforming Your Practice Through EHR


Into the Mouths of Babes Program = Fewer Cavities!

12 Academy Announces New Professional Services Director 12 Membership News 13 CME Greetings


NC Tar Wars News

14 The Adolescent Obesity & Inactivity Project


Legislative Update

14 The ABCD Project

10 New Academy Members 11

NCAFP Foundation News

12 Student News

14 Advanced Life Support in Obstertrics 15 NCAFP President Opens State-of-The-Art Practice Facility in Raeford

NCAFP Strategic Plan Vision Statement The vision of the North Carolina Academy of Family Physicians is to be the leader in transforming healthcare in NC to achieve optimal health for all people of NC. Mission Statement The mission of the North Carolina Academy of Family Physicians is to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity. Strategic Objectives 1. Health Promotion & Disease Prevention (Health of the Public): Assume a leadership role in improving the health of North Carolina’s citizens by becoming proactive in health promotion, disease prevention, chronic disease management and collaborating in other public health strategies. 2.Advocacy: Shape healthcare policy through interactions with government, the public, business, and the healthcare industry. 3. Workforce: Ensure a workforce of Family Physicians which is sufficient to meet the needs of patients and communities in NC. 4. Education: Assure high-quality, innovative education for family physicians, residents, and medical students that embodies the art, science, and socioeconomics of family medicine. 5. Technology & Practice Enhancement: Strengthen members’ abilities to manage their practices, maintain satisfying careers, and balance personal and professional responsibilities. 6. Research: Develop and promote new medical knowledge and innovative practice strategies through information technology, primary care research and assessment of the practice environment. 7. Communications: Promote the unique role and value of family medicine, family physicians and the NCAFP to the public, business, government, the healthcare industry and NCAFP members.

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A PHYSICIANS PERSPECTIVE on Healthcare Disparities Dr. Karen L. Smith, 2004-05 NCAFP President Healthcare disparities is a relatively popular phrase which attempts to describe a recognized difference in disease management leading to a suboptimal outcome for specific populations. This is a cognitively loaded phrase which has stimulated discussion in multiple arenas. The impact of disparities in care crosses multiple socioeconomic levels. The burden of less than optimal disease management affects not only the individual, but the entire community. Individuals directly affected by disparities in care have long recognized that a problem existed. Providers of care recognized this difference as noted in the poor control of several chronic disorders. Despite attempts to provide the best management possible, the desired outcome still remains unrealized. Healthcare disparities are frustrating for both providers and consumers of care. I can recall my first encounter with this issue as a new practicing physician just after completing my family medicine residency. This experience was an eye-opener due to the “obvious� difference in management. These three encounters will establish a platform for further review. The medical office I was associated with treated all patient populations represented in this rural community. We encountered Caucasian, African American, Native American Indian, and Hispanic, male, female, newborn, geriatric, poor, wealthy, insured, underinsured, uninsured, employed, and unemployed. Basically, as a rural health clinic, care was provided to most of the patients who presented. During one busy fall day a Caucasian male in his latefifties employed as an electrical lineman presented with subtle symptoms suggestive of coronary ischemia. Physicians recognize this as possible heart attack. Due to his complaint of intermittent chest discomfort and supporting information of a strong family history, high cholesterol, and as a ciga4

rette smoker, he was advised to accept transfer to the hospital in the neighboring town. He and his family realized this would require a twenty-five mile ambulance transport, probable notification of the insurance company for verification of coverage, time away from work; all but necessary for proper treatment. Clearly this option was desired and readily accepted. Upon arrival to the emergency room the consulting cardiologist confirmed the existence of coronary artery disease and provided several therapeutic options, including surgical intervention. The patient elected to have open-heart surgery with medication to control high cholesterol, smoking cessation, and other life style modifications. After completing a three-month course of cardiac rehabilitation, he returned to full time work duties with no subsequent episodes of chest pain. In the same week, a Native American Indian male in his late fifties presented with classical symptoms of acute myocardial infarction. He was profusely sweating, with shortness of breath, and complaining of chest pain which had been present for six hours. His diagnosis was further supported

His refusal for transfer was based on past experience, as well as the need to return to his construction site for work. Both he and his wife worked to support their family and absence from work would cause significant strain on his income. Subsequent discussion ensued, which included the risk of death if he did not receive further treatment. He reluctantly authorized transport for further care. Upon arrival to the neighboring town hospital, emergent catheterization with angioplasty was done. After discharge, he returned to work prior to starting cardiac rehabilitation. One month later he presented with similar symptoms which resulted in a coronary artery bypass graft procedure. This time he participated in the cardiac rehab program, made several changes in his diet, quit smoking, and maintained contact with the office in an effort to keep followup appointments. He returned to work eight weeks later, but despite this effort, his family was forced to apply for public assistance as they attempted to make ends meet. The third person who presented was an African American male in his fifties. He presented to the office with worsening

"DESPITE ADVANCES IN TECHNOLOGY AND ENHANCEMENTS IN CLINICAL EDUCATION, THE MORTALITY RATE FOR MINORITIES IN THE UNITED STATES REMAINS SUBSTANTIALLY HIGHER THAN THE CAUCASIAN POPULATION." by EKG changes done in the office upon presentation. As we prepared for emergent ambulance transport, this gentleman made direct eye contact with me and requested that we not send him to the hospital. He only desired medication from the office to relieve his pain which he felt was tolerable. Upon further review, this was not his first episode and prior attacks resolved with rest.

fatigue and some shortness of breath. He did not complain of chest pain upon presentation. His symptoms were vague but he definitely noted his problem was steadily becoming worse over the course of seven days. This problem actually started four months ago and he was seen by another physician who started treatment for high blood pressure. He was advised to have

North Carolina Academy of Family Physicians

further cardiac testing done due to his family risk factor of sudden death prior to age fifty. In an effort to follow instructions, he purchased the prescribed medications and took them as ordered on a daily basis. Due to difficulty with obtaining health insurance, further cardiac testing was deferred. His progressive weakness made it difficult for him to function as a self-employed auto mechanic. His once thriving business was headed into bankruptcy. The health insurance premiums were too high for his budget in light of this change in his income. In addition, the out of pocket expense for medications was creating a strain on the household budget. His deteriorating condition forced him to seek care at our facility which offered a sliding scale for payment of services provided. After assessment, it was

These three cases demonstrate multiple factors which result in different management for the same disease with similar levels of severity. The influence of the individual patient, cultural background with associated belief system, the socioeconomic situation, the role of family’s thoughts, and past encounters with healthcare providers have an impact on outcome. The perception of treating physicians and clinical staff, administrative staff at the physician office and hospital, and EMS personnel has an impact on the patient’s sense of trust with the healthcare system. Other factors which are not readily identified include physical barriers to care, language differences, availability of physicians, community leaders’ understanding the role of healthcare, hospital support of practicing physicians, physician

determined that he required immediate intervention at the neighboring town coronary care unit. He was evaluated and discharged with a recommendation for medical management. He returned to the office four weeks later with similar clinical presentation. His second hospital admission resulted in open heart surgery for coronary artery disease. Upon discharge, he participated in cardiac rehabilitation and lifestyle modifications. He did discontinue smoking cigars as advised. Due to his financial situation, he applied for full disability. He worked very hard to maintain compliance, with marked improvement noted in his overall condition. His business reopened six months later after receiving a release to full time work.

access to finances for practice enhancement, financial support for medical education institutions, and students who desire to become doctors. The three patients reviewed presented to the outpatient practice in 1994. Unfortunately, disparities in care continue to plague our delivery system in 2005. Despite advances in technology and enhancements in clinical education, the mortality rate for minorities in the United States remains substantially higher than the Caucasian population. As we struggle with ways to decrease the healthcare percentage noted in the gross national product, it is imperative to correct this difference in disease management. The health of the individual is key to maintaining a strong workforce with less dependence on public assis-

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tance for support of the family unit. The family physician is the liaison between the patient and services available in the medical community. The family medicine curriculum as presented in the residency education programs prepares the physician to recognize and address many of the factors identified as a barrier to accessing equitable care. The family doctor develops lifelong relationships with most patients encountered in the practice. A sense of trust is established and strengthened with repeat visits to the office. The physicians reach a point of understanding the needs as well as the desires of the patient. The bond created can be described as a “professional friendship.” I suspect that this may be a reason why many physicians are disheartened when confronted by the reality of less-than-optimal care for a patient in their panel. Family physicians are in the process of implementing changes in the discipline in response to the desires of patients we care for, as well as to enhance professional gratification. The timing is perfect for us to recognize disparities in care and add this to our list of challenges to be addressed. The modifications in progress will inherently deal with some of the factors previously identified. The recognition of the family physician as an advocate for the individual patient must be communicated to the public and our specialty colleagues. The North Carolina Academy of Family Physicians has created a council on Healthcare Disparities which reviews this problem in depth. The Healthcare Disparities Council is open to every member who would like to express ideas or present situations similar to the ones reviewed in this discussion. We seek your ideas since the solution will most likely be found in our conglomeration of thoughts. It is hoped that the efforts of this council will lead to the development of strategies which the NCAFP can implement throughout the state as part of service to assist practicing family physicians. The problem of healthcare disparities will not be solved by the solo physician. It is the desire of the NCAFP to recognize this problem and continue with initiatives which will serve family physicians who care for the citizens of North Carolina. We look forward to being a part of the solution as other leaders throughout the state address this very important issue. 5

Transforming Your Practice Through

EHR Byline here

Electronic health records (EHR) could transform your practice. But success takes time, planning and strategy. Medical Review of North Carolina (MRNC) can help. MRNC is recruiting adult primary care (Family Medicine, General Practice and Internal Medicine) practice sites to participate in the Doctor’s Office Quality – Information Technology (DOQ-IT) project to assist in making a smooth transition from paper-based medical records to an EHR.

Benefits of EHR to Your Patients – to Your Practice As a physician today, you are challenged to provide better care for your patients while attempting to save time and money. EHRs can enhance access to patient information, decision support and reference data, as well as decrease the likelihood of errors and improve patientclinician communications. EHRs can be major tools in addressing quality of care and cost/time issues in clinical practice. Recent studies have highlighted the potential for information technology (IT) to improve the quality, safety, and efficiency of healthcare. Systems that enhance patient-clinician communication and provide access to patient information, as well as decision support and reference data, hold the promise of improving the efficiency and effectiveness of healthcare delivery. Additionally, enhanced IT infrastructure allows the implementation of improved tracking and surveillance applications on an individual provider level as well as for comparative state and national data.

Advantages of implementing EHR:

• Increased efficiency • Improve health care providers access to patient information • Create a more efficient physician practice • Improved care • Provide decision support tools and current reference material at the point of care

• Reduce the risk of error and improve quality of care • Fiscal improvement • Improve billing accuracy • Address concerns of liability and fraud through improved documentation • Reduce transcription costs and reclaim space now occupied by paper charts


The Integration of IT in Healthcare Systems In 2002, the leadership of seven national family medicine organizations initiated the Future of Family Medicine (FFM) project. The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and healthcare of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. There is great interest in the integration of IT in healthcare systems by patients, payers and health policy leaders alike. A report entitled, “Fostering Rapid Advances in Health” from the Institute of Medicine (IOM) called for significant reforms in the practice and organization of medicine and recommended that the U.S. Department of Health and Human Services (DHHS) undertake a number of demonstration projects to stimulate innovation in the adoption of IT systems in healthcare. The report stated further that the health care sector has languished behind almost all other industries in adopting information technology. Gail Warden, president and chief executive officer of the Henry Ford Health System, Detroit, and chair of the committee that wrote the IOM report stated, "If these projects are implemented as a set, we believe that within five years they could go a long way toward transforming healthcare in America." Given that the bulk of patient care is provided in ambulatory settings, the lack of IT integration precludes potentially significant improvements in quality and efficiency in the delivery of healthcare. Through its roles as a major payer of healthcare services and sponsor of both the largest national quality improvement program and national innovative disease management demonstrations, CMS is in a position to provide leadership in the area of IT integration in the physician office environment.

The Role of the QIO with DOQ-IT In an effort to address the integration of the information technology in the small to medium sized physician office setting, CMS has asked the Quality Improvement Organizations (QIOs) in partnership with the American Academy of Family Physicians (AAFP) to North Carolina Academy of Family Physicians

participate in the Doctor’s Office Quality – Information Technology (DOQ-IT) project. The DOQ-IT project is designed to improve outcomes for patients with chronic illnesses by promoting the adoption of Electronic Health Record (EHR) systems. MRNC is now recruiting primary care practices that serve a Medicare population and have decided that they are ready to move to an electronic health record within the next 18 months. Priority will be given to those sites with eight or fewer physicians.

Benefits of Participation:

• Support for efficient practice processes (practice performance improvement) • Assistance with EHR vendor selection and implementation • Improve chronic care and preventative clinical outcomes • Increase patient safety • Access to free tools, resources and assistance design to help individual practices implement EHR

DOQ-IT Participants:

• Share progress through monthly reports and/or participate in regular teleconferences. • Share openly with other DOQ-IT teams in the project, including changes made to improve care and performance rates. Share electronic health record experiences and lessons-learned with appropriate physician practices in the project as needed. • Maintain the confidentiality of information shared within the project and not disclose it without the approval of the facility that shared the information. Complete an office assessment and develop a work plan. • Ensure appropriate staff is available to meet with DOQ-IT team members at times of mutually scheduled on-site visits. The project focuses on the three phases of converting a paper-based office to an electronic system: pre-implementation, implementation and post-implementation. During this time, the QIO is able to provide free resources and tools to assist the physician office with readiness assessments, implementation work plans, vendor evaluation and selection, contracting checklists, return on investment calculators, internal quality measures and, much more. If you are interested in learning more about the DOQ-IT project, please contact Ann Lefebvre, Senior Associate, Project Management, MRNC, at alefebvre@ncqio.sdps.org or via telephone at 1-800-682-2650 x. 2102.

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Into the Mouths of Babes Program = Fewer Cavities! by Kelly Haupt, for NCFP and NCPS

Preliminary analysis of Into the Mouths of Babes (IMB) program data through the UNC School of Public Health shows that Medicaid-covered children receiving the oral screening and fluoride varnish procedure have fewer caries-related treatments in dental offices than enrolled children not having these IMB preventive services. Those children having 4, 5, or 6 IMB visits before their third birthday had the most benefit, with some benefit seen in children having fewer visits. The overall reduction in caries-related treatments and a dose-related response were observed using regression analysis. This important preliminary finding provides the first outcomes data on effectiveness of IMB services and is an exciting finding with far reaching implications for very young children at risk for tooth decay. You are to be congratulated for your ongoing participation in the IMB program! Without you and the information you provided, we would not have the opportunity to demonstrate that oral preventive services can be successfully rendered in primary care medical settings. But most importantly, you have improved the oral health of NC’s most vulnerable children. The IMB program will continue to provide training for physicians in North Carolina indefinitely beyond the end of the five-year, federally-funded demonstration that ends September 30, 2005. The program will continue as a collaborative effort of the NC Oral Health Section, NC Academy of Family Physicians and NC Pediatric Society. NC Medicaid and Health Choice will continue reimbursing for the IMB visits. NC remains the national model for oral preventive services rendered by medical providers. Keep up the good work!

NC TAR WARS NEWS Addie McNeely, of Flat Rock, Henderson County won first place in the North Carolina Statewide Tar Wars Poster contest. Her poster, entitled “Throw Away Cigarettes” represented artistry, creativity, originality, and communicated a positive message about remaining tobacco-free. As a result, she has won a trip to the National Tar Wars Poster contest that was held July 18-19 in Washington, DC. Final results of the national contest were not available at press time. Two other students were runners-up in the state contest, including Kayla Lanning of Hendersonville, Henderson County and Alyssa Bonge of Mooresville in Iredell County. Each student received a plaque, monetary award, and special Tar Wars shirt. Tar Wars is an educational program and poster contest that discourages tobacco use among the country’s youth. It focuses on attitudes about tobacco use, the effects of tobacco on the body, and how different messages in tobacco advertising influence people. The program has been implemented in all 50 states and some territories and internationally, and it has reached more than 2.5 million children. To date, Tar Wars has reached over 22,000 North Carolina fourth- and fifth-graders and has been implemented in nearly 500 elementary schools across North Carolina since the program began in 1999.


North Carolina Academy of Family Physicians

Legislative UPDATE By Peyton Maynard, Governmental Affairs Consultant ummer has arrived and the Legislature is in full swing. Both the House and the Senate have completed their respective budget proposals. The bills that will be seriously considered during the session have been passed from one house to the other. The major issues have been defined. The legislature prepares to move into its most sustentative time of the session.


The new ECU Family Medicine Center is soon to be a reality. Baring some unforeseen turn of events, it appears that the enabling legislation providing the funding for the new facility will be included in the budget and that the University and the Brody School of Medicine will be given permission to proceed with the construction. Dr. Allen Dobson has been named the Assistant Secretary for Health Policy for the Department of Health and Human Services. Dr. Dobson is a family physician from Cabarrus County and a past president of the Academy who has been involved with the development of the Community Care Program. Community Care is a provider-driven care management program that is widely perceived as a model for how quality care management and cost savings should be achieved in the Medicaid program. The Legislature has continued to struggle with the rising cost of the Medicaid program. As the government health insurance program for mothers, children and the disabled, Medicaid is faced with rising health care costs similar to those in the private sector. Although when all factors are considered, costs in the Medicaid program are not rising as fast as the commercial market. This is an indicator that the management models are working.

The Legislature has also given the OK to expand the Community Care Model to a category of eligibility known as the “Aged Blind and Disabled”. This is a very significant step for the Community Care program. Community Care has accomplished substantial savings with the eligibility category of “Mothers and Children”, which is actually the least expensive category to treat. The “Aged Blind and Disabled” arguably is the most difficult to manage and the most expensive category in the Medicaid program. The prospects for this expansion of the Community Care program are extremely exciting. The Academy Leadership has actively turned its attention to the Mental Health Reform effort. The NCAFP has joined with the leadership from the Psychiatric Association to develop a care model for persons who are mentally ill or experiencing mental health problems. If mental health reform is to succeed, then community physicians must step forward and develop the clinical methods and support systems such that families will receive mental health care treatment in the same fashion as they would receive any other heath care. This will involve collaboration with community mental health professionals and psychiatrists. A team of interested physicians will be developing a proposed model over the summer and will make presentation on the model at the Academy fall meeting. Academy members are always invited to attend the Governmental Affairs Advisory Council. The council meets on the third Monday of the month and is open to anyone who wants to attend. The council providers members the opportunity to exchange ideas and give advice on the most current issues facing family medicine.

Medical Home for Children to Focus on physicians who have child patient populations with special health Complex Patients careFamily needs (CSHCN) will have an opportunity to participate in a learning collaborative beginning in the fall of 2005. The Medical Home Initiative for Children with Special Needs is being sponsored by the Center for Children's Health Care Improvement and will feature local and national experts assisting up to 20 practice teams. The teams will implement strategies for the CSHCN population and assist providers in establishing effective care processes. These include pre-visit planning, coding, reimbursement and referral strategies, communications and parental partnering. If interested, contact Sandy Fuller, Project Executive at (919) 966-0024. P. O . B o x 10 278 • R a l e i g h , N o r t h C a r o l i n a 276 0 5 – 919 . 8 33 . 2110


We l c o m e To N e w A c a d e m y M e m b e r s The Academy wishes to extend a warm welcome to all new members. If you have any questions regarding membership, please contact Tish Singletary at (919) 833-2110 or via email at tsingletary@ncafp.com Active Members Victor M. Alvarez, MD (Charlotte) Stacey A. Blyth (Tarboro) Beth Lynn Carlson, MD (Charlotte) Staci Anne Chamberlain (West Jefferson) Paul D. Collins, MD (Wilmington) Jason Douglas Creel, DO (Franklin) Dawod A. Dawod, MD (Raleigh) Stacey E. Devine, MD (Charlotte) Steven P. Dziabis, MD (Almond) Lilian Qushair Evans, MD (Charlotte) Dane R. Floberg, MD (Charlotte) James E. France, MD (Clemmons) Everlyn Hall-Baker, MD (Charlotte) Brian H. Halstater, MD (Durham) Clark Hanmer, MD (Laurinburg) Jonathan Head, MD (Gastonia) John M. Hemmersmeier, MD (Durham) Victoria Gwynn Johnson, MD (Hurdle Mills) Raghu R. Katuru, MD (Jacksonville) Daniel G. Koch, MD (Lincolnton) Ronald Krull (Goldsboro) David N. LaMond, DO (Hendersonville) Susan M. S. Lester, MD (Waxhaw) William M. Lester, MD (Waxhaw) Lisa M. Lorelli, DO (Morganton) Kenneth M. MacKinnon, MD (Fletcher)

Charlita Rose Mangrum, MD (Hamlet) Thomas Marlowe, MD (Gastonia) Matthew Mathias, MD (Durham) Kenneth R. McElynn, MD (Morehead City) Matthew Scott McGlothlin, MD (Oxford) James A. Mitchell, MD (Fayetteville) Stephen L. Moore, MD (Charlotte) Kenneth T. Patterson, MD (Charlotte) Lisa Petri, MD (Mt. Airy) Susan R. Pittman, MD (Locust) John E. Reaves, Jr., MD (Mount Holly) Lara Setti, MD (Arden) Sarita Sharma, MD (Cary) James Harrison Shepherd, MD (Mooresville) David M. B. Smith, MD (Franklin) Mark K. Stephens, MD (Charleston, WV) Vyvyan Y. Sun, MD (Greensboro) Grace Tang, MD (Raleigh) Michael E. Toedt, MD (Whittier) Paige Tomcho, DO (Waxhaw) Joseph Jack Umesi, MD (Raleigh) Gloria Vreeland, MD (Leland) Kira L. Vurlicer, MD (Goldsboro) Michael Wang, MD (Wendell) Inactive Members Hilary L. Canipe, MD (Murfreesboro) Michael M. McLeod, Jr., DO (Greenville)

Resident Members Pamela M. Binns, MD (Charlotte) Genevieve N. Brauning, MD (Charlotte) Charles H. Davis, MD (Charlotte) Sarah C. Graff, MD (Durham) Stephen J. Hartsock, MD (Greensboro) Alexander E. Osowa, MD (Greenville) Katherine M. Walker, MD (Greensboro) Student Members Mr. Omar Canaday (Winston-Salem) Ms. Tarsha Darden (Chapel Hill) Mr. Mario Paul DeMarco (Winston-Salem) Mr. Adam J. Froyum Roise (Raleigh) Ms. Jocelyn Wilson Hanna (Chapel Hill) Ms. Natalie Hatcher (Greenville) Ms. Anne Lachiewicz (Chapel Hill) Ms. Lauren Snyder Livingston (Chapel Hill) Ms. Heather Michelle Manos (Chapel Hill) Mr. Kyle Mills (Chapel Hill) Mr. Christian Bradford Moretz (Greenville) Ms. Cystal M. Pressley (Carrboro) Ms. Sarah Rogers (Chapel Hill) Ms. Kristen Ann Samuhel (Chapel Hill) Ms. Danielle Underkoffler (Durham) Mr. James G. Wallace, Jr., MPH (Chapel Hill)

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North Carolina Academy of Family Physicians

N C A F P Fo u n d a t i o n N e w s THE NCAFP FOUNDATION’S ANNUAL SILENT AUCTION CELEBRATES ITS 10TH ANNIVERSARY!! Way back in 1995 the NCAFP Foundation held its First Annual Silent Auction at the Winter Family Physicians Weekend in Asheville. Here it is 10 years later and this popular fundraiser is still going strong. Won’t you join us as we celebrate this special milestone? The Winter Family Physicians Weekend will be held December 1 – 4, 2005 at The Grove Park Inn Resort & Spa, and we’ve got some extra-special festivities planned. As in the past few years, the auction will be held in the Exhibit Hall over a period of a few days. This is your special invitation to be part of our 10-year anniversary. Please consider donating an item(s) to the auction. What are we looking for? Pieces of artwork (paintings, prints, pottery), sports and college memorabilia, weekend getaways, children’s toys, Christmas items and collectibles…and MEET OUR 2005 more! Don’t be shy – get in on the anniversary SILENT AUCTION fun! And remember – SPONSORS! all donated auction (As of 06/15/05) items are tax deductible. Look for more publicity PLATINUM SPONSOR on this year’s Silent Onslow Memorial Hospital Auction in the coming SILVER SPONSORS months. If you’re interLenoir Memorial Hospital ested in how you can be a participant, contact Union Regional Medical Marlene Rosol, Center Development Coordinator, at (919) THANK YOU FOR YOUR SUPPORT 833-2110, (800) 872OF THE NCAFP FOUNDATION 9482 [NC only], or mrosol@ncafp.com. Thank you.

YOUR CONTRIBUTION CAN CHANGE A LIFE … By making a contribution to the NCAFP Foundation, you can help the Foundation continue its mission of providing quality healthcare to the people of North Carolina. Your contribution can change the life of a child… your contribution can encourage a medical stu-

MAKE A SPECIAL GIFT You can honor or memorialize a colleague, friend or family member with a gift to the NCAFP Foundation. By making a special designation, the Foundation will send a card to the family of the deceased, individual or organization being honored. The card will show your name as the donor, but not the amount of the contribution. To make your special, tax-deductible gift, contact Marlene Rosol, Development Coordinator, NCAFP Foundation, (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com. Thank you!

dent to choose the specialty of family medicine. Help us continue to improve the lives of our citizens. For more information on how you can make a donation to the NCAFP Foundation, contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 8729482 [NC only], or mrosol@ncafp.com. Thank you for your concern and your support! HELP THE FUTURE OF FAMILY MEDICINE – JOIN THE NCAFP LEGACY LEAGUE! The North Carolina Academy of Family Physicians Legacy League is established to recognize those who make provisions through their estate for the North Carolina Academy of Family Physicians Foundation, Inc. By making such a planned gift, members of the Legacy League help ensure that the Foundation will have the financial resources to provide vital programs and services to future generations. The NCAFP Foundation relies primarily on annual financial support to implement its programs. We also encourage consideration of gifts that can endow one of our existing programs or endow a new program. The financial needs of the Foundation increase as the need for more programs arise, and the Foundation must keep pace by continually increasing its annual program funds. A planned gift can help the Foundation make a significant difference for the future of Family Medicine. Planned giving enables donors to create a living memorial that will continue their support, even after their lifetime. For information on how you can become a member of the Legacy League, please contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com. THE FOUNDATION VALUES ITS CORPORATE MEMBERS! The NCAFP Foundation’s Corporate Members are important to us! Their participation and support are crucial to what we do, and we are proud to include them as part of our Foundation family. Thank you to our 2005 Corporate Members – we couldn’t do it without you!! Thank you to our 2004 Corporate Members! We couldn’t do it without you! Grand Patrons: NC Academy of Family Physicians, Raleigh, NC* Supporters: ECR Pharmaceuticals, Richmond, VA** MedCost, LLC, Winston-Salem, NC* Moses Cone Health System, Greensboro, NC* Rudy L. & Joyce B. Snow, pharmaceuticals & Sales marketing Consultants, Stanfield, NC* *Corporate Members - Unrestricted

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**Corporate Members - Restricted


student news 2005 FMIG Dinners Present Varied Talks and Topics Each year, the Family Medicine Interest Groups (FMIG) at each of the medical schools holds a dinner towards the end of the school year. The purpose of these FMIG Dinner meetings is to bring students, residents, and family physicians together on an informal basis to discuss issues pertinent to the field of family medicine. Interaction between family physicians, residents and students can strongly influence consideration of family medicine as a career. Over 130 medical students, family medicine residents, faculty and community physicians attended this year’s dinners. Brody School of Medicine at East Carolina University (April 12) Speakers: Graduating Fourth-Year Medical Students, Faculty – Why I Chose My Residency Program, Faculty Pearls of Wisdom University of North Carolina (April 26) Speakers: Drs. Martha Carlough, Dana Iglesias, and Christy Page – International Health and Opportunities Wake Forest University (May 12) Speaker: William Dennis, MD – Hippocrates is Dead, And I Don’t Feel So Good Myself Duke University (May 19) Speaker: Karen L. Smith, MD, FAAFP – Future of Family Medicine

Academy Announces New Professional Services Director The NCAFP is pleased to announce that Greg Griggs has joined the staff as Director of Professional Services. Greg recently served as Executive Director of the Association Executives of North Carolina and brings with him over 16 years of association management experience, including 4 years of work with the Department of Community and Family Medicine at Duke University Medical Center. He is a graduate of the U. S. Chamber's Institute for Organization Management, has a B.A. in Journalism and Political Science from the University of North Carolina - Chapel Hill, and a master's degree from N.C. State University in public administration concentrating in association management. He earned his Certified Association Executive (CAE) designation in January 2005.

MEMBERSHIP News REELECTION NEWS Congratulations to the over 500 Academy members who fulfilled their CME requirements for the period ending December 2004! For our members who were last reelected in 2003, you have until the end of 2005 to report 150 hours of CME in order to maintain your Academy membership. Requirements include at least 75 AAFP prescribed credit hours, a minimum of 25 group learning activities, no more than 25 from enrichment activities, plus caps on other activities. Hours reported should be obtained between January 1, 2003 through December 31, 2005. For further details, review the AAFP CME Requirements for Members reprint 101 or visit www. ncafp.com or www.aafp.org. You can also call the AAFP at 800-274-2237 or the NCAFP at 919-833-2110 or 800-872-9482 [NC only].


MEMBERSHIP UPDATE We’re proud to announce that for the first time ever, the NC Academy was recognized by the American Academy of Family Physicians for having 100% resident membership! Our total Academy membership is currently 2,599 members, with 252 of these being residents. Resident membership in the Academy is an important stepping-stone, affording networking, career planning, practice management, and advocacy benefits. Thank you to our residents and NC residency programs!

North Carolina Academy of Family Physicians

CME MEETINGS NEWS Promoting Adolescent Health Through Immunization Online CME Program Available in August The NCAFP CME Committee has developed an online CME program for NCAFP members and primary care physicians that will be available in mid-August. The program focuses on adolescent health and immunization practices – a growing topic of interest among family physicians and primary care providers. NCAFP President-Elect Dr. J. Carson Rounds of Wake Forest, NC is the program’s presenter and guides participants through a one-hour interactive session. Immunization is becoming increasingly important within patient care. As immunity from certain diseases is now known to wear off from childhood vaccinations, adolescent and adult patients can be at risk for certain diseases. For example, the CDC logged an estimated 19,000 cases of pertussis in 2004 – an increase of 63% since 2003. In particular, adolescents and adults experienced a five-fold increase. The US FDA recently approved licensure of a new vaccine to be used for protection against tetanus, diphtheria and pertussis from adolescence through adulthood. This vaccine is the first booster to address pertussis – or whooping cough – protection across a range of ages (11 through 64 years), and the first and only such booster licensed for adults in the U.S

E.H.R. Roadshow Comes to Wilmington The third stop of the EHR Roadshow will be at the Coastline Convention Center in Wilmington, NC on September 17, 2005. The series has been designed to educate family and primary care physicians and practice managers on issues related to the adoption and utilization of electronic health records technology and is chaired by Dr. Karen Smith, NCAFP President. Attendees will have the opportunity to visit system vendors in the Roadshow’s exhibit hall, learn about key issues surrounding implementation and purchase, and to exchange perspectives with fellow physicians and professionals in a relaxed setting. Breakfast, lunch and breaks will be provided, along with a complete syllabus. To complete information including online registration, please visit the Academy’s website at http://www.ncafp.com/ehr.

2005 Annual Meeting: A Celebration in The Mountains It’s almost that time again! The NCAFP is already preparing for our annual meeting at the Grove Park Inn in Asheville. Program Chair Dr. Robert Gwyther, MBA, has gathered a fantastic group of speakers that will present information on a wide range of topics. These currently include congestive heart failure, low-carb diets for managing weight loss, and peripheral arterial disease. Physicians are urged to take advantage of early-bird registration by October 17, 2005 (savings of $30). The official meeting website, along with online registration, is available at http://www.ncafp.com/wfpw. Look for additional information on the meeting in the coming months.

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COMEDY STORIES The next hit television series to emerge from Hollywood could well be based on true events from the life of a solo FP. Carolyn Jourdan, author, documentary filmmaker, NPR commentator, and daughter of an FP, recently sold a comic literary memoir about her father that has attracted worldwide attention. The book, Heart in the Right Place, will be published in the Spring of 2006. For a sequel, Jourdan hopes to collect wacky memorable moments from other FP’s. “I’m dedicated to preserving a humane and loving portrait of community-based doctors. FP’s funny stories are unique and charming. They deserve to be preserved and told by someone who will treat them with respect.” Jourdan would love to hear as many stories as you’re willing to share and will give you credit or anonymity, as you prefer. Contact her at: Carolyn Jourdan, 8505 Carter Mill Road, Knoxville, TN 37924, (865) 933-8233, CarolynJourdan@att.net.


The Adolescent Obesity & Inactivity Project Resources Abound for Physicians and Project Participants Are you looking for resources to share with your patients regarding inactivity and overweight? Physicians participating in the Adolescent Obesity and Inactivity project have been the recipients of a physician resource kit that provides them with a wealth of useful information and tools. Included in the kit is extensive information related to program logistics, a series of BMI Growth Charts, patient interaction forms, resources regarding community

ABCD project SHARES FP'S INSIGHTS FOR CHILD DEVELOPMENT GUIDE The NC Assuring Better Child Health and Development (ABCD) is a comprehensive and coordinated system to improve the delivery and financing of child development services, especially for Medicaid children in the 0-5 age group. North Carolina is one of four states to be awarded a grant from the Commonwealth Fund for the purpose of implementing the program. Recently the group announced that it will be using a recent article by Dr. Jessica Schorr Saxe within its "SettingThe Stage for Success" Office Resource Guide. The guide was developed by practices participating in the project and includes research behind development issues, as well as the 'how tos' of getting started.


relations and the media, as well as several supporting articles related to adolescent obesity. Additionally, the project is also publishing a growing series resources that can be downloaded from the project’s website at http://www.ncafp.com/aoi. All of these resources are geared to assisting project participants with program implementation. A great source for information can be found at www.ncafp.com/aoi. From the

site you can find links to other entities including www.eatsmartmovemorenc.com and www.fittogether.org. In addition, colleagues from across the state have been generous in sharing some of the actions and tools used in their daily practice to help patients of all ages. If you have some information you would like to share, please feel free to contact us at 919-833-2110, 919-833-1801 (fax), or tsingletary@ncafp.com.

Advanced Life Support in Obstetrics American Academy of Family Physicians August 25 & 26, 2005 Chapel Hill, NC University of North Carolina At Chapel Hill Department of Family Medicine COURSE OBJECTIVES: • Discuss ways of improving the management of obstetrical urgencies and emergencies which may help standardize the skills of practicing maternity care providers. • Discuss the importance of utilizing regional maternity care services and identify possible barriers which might limit access. • Successfully complete the course written test and megadelivery testing station. Detailed educational objectives are listed at the beginning of each ALSOÆ Course Syllabus chapter. FOR Complete registration form, schedule and information visit the NCAFP website at: http://www.ncafp.com/also2005 North Carolina Academy of Family Physicians

NCAFP President Opens State-of-TheArt Practice Facility in Raeford


CAFP President Dr. Karen Smith recently opened a new practice facility in Raeford, North Carolina. An office dedication ceremony was held on April 30th that brought together numerous community leaders, family, friends and professional colleagues. The facility features eleven examing rooms, complete laboratory area and was designed from the ground up to embrace several key recommendations of the AAFP's Future of Family Medicine Project and the new model of care. Consistent with the concept of embracing technology in the practice setting, each patient examing room features a desktop computer terminal. While Dr. Smith conducts routine visits, she is constantly recording and notating key information about

The practice gets new patients involved and comfortable with using computer technology. New patients are directed to enter necessary pre-registration information from a waitingroom kiosk. Instead of relying on traditional paper forms, the kiosk helps familiarize and orient the patient with the practice's modernized care process almost immediately. the patient in the practice's electronic health records system (EHR). As a result, the practice maintains hardly any hardcopy patient records and relies exclusively on its EHR system to track and store all pertinent clinical data. This has enabled the practice to reduce administrative costs. save time, reduce errors and fostering better communication between Dr. Smith, the patient and the practice's support personnel. A unique feature of the practice's patient care workflow is how the practice gets new patients involved and comfortable

with using computer technology. New patients are directed to enter necessary pre-registration information from a waitingroom kiosk. Instead of relying on traditional paper forms, the kiosk helps familiarize and orient the patient with the practice's modernized care process almost immediately. This data is subsequently checked by staff personnel for completeness during initial interactions. Smith's waiting room also features a working fireplace that promotes the concept of family and relaxation; a first of its kind for a family medicine practice in North Carolina. Dr. Smith's facility represents the modern family medicine practice in ways that could not of been foreseen until recently. It dovetails with several core FoFM recommendations and is allowing the practice implement the new patient care model more effectively and efficiently. The NCAFP would like to congratulate her on such a remarkable achievement.

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The North Carolina Academy of Family Physicians, Inc. P.O. Box 10278 Raleigh, NC 27605


That’s healthy advice for many of your African-American patients. † • A new report by the National Medical Association recommends African Americans consume 3-4 servings of low-fat dairy foods daily to reduce the risk of chronic diseases, such as obesity and hypertension.1 1 • Nearly half of all African Americans consume less than one dairy serving daily which may lead to inadequate intake of important nutrients.

• The newly released Dietary Guidelines for Americans recommend people consume 3 servings of fat-free or low-fat milk or milk products every day as part of a healthy diet, and lactose-free milk or yogurt for individuals who are lactose intolerant.2 People who are sensitive to lactose can still enjoy dairy foods’ great taste and health benefits. Here are a few tips to consider.


rink lactose-free milk, such as LACTAID® Milk, which offers all the nutrients of regular milk, but is easier to digest and tastes great.

Aged cheeses like Cheddar and Swiss are naturally low in lactose. Introduce milk and other dairy foods into the diet slowly. Start with small portions with meals or snacks and gradually work up to 3 servings a day.


emember LACTAID® Fast Act Dietary Supplements with the first bite or sip of dairy to help break down lactose so patients can enjoy milk and other dairy foods.

Yogurt is good. Cultured dairy foods like yogurt

contain friendly bacteria that help digest lactose.

Visit www.nationaldairycouncil.org for more information about dairy’s role in weight loss and to download a free African-American health education kit, including patient education materials. For information on LACTAID® Products and lactose-free recipes visit www.lactaid.com or call 1-800-LACTAID. * Research indicates that including 3 servings of dairy each day in a reduced-calorie diet may help support healthy weight loss. † The National Medical Association is the leading national organization representing African-American physicians and health professionals. References: 1. Wooten, W.J. and Price, W. Consensus Report of the National Medical Association: The Role of Dairy and Dairy Nutrients in the Diet of African Americans. Journal of the National Medical Association. 2004;96(12):1S-31S. 2. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: US Government Printing Office;2005.

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