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T H E 2 0 07 I N A U G U R A L A D D R E S S

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TILTING AT WINDMILLS? BY DR. J. CARSON ROUNDS, NCAFP PRESIDENT

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THE SHELL GAME AND YOUR PRACTICE RETIREMENT PLAN

SCREENING FOR VISUAL IMPAIRME NT

HAVING A PLACE AT THE TABLE

Thank You to our advertisers for their support!

If you would like to advertise in the North Carolina Family Physician, please contact Kristen Hudson at 1-800-561-4686 or

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NCFP

Vol 3 • No 1

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

Winter 2007 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

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

Mott P. Blair, IV Named 2006 Family Physician of the Year; UNC’s Dr. Robert Gwyther, MBA, Honored with Lifetime Service Award

Resources Now Available for Families with Special Needs Children

2006 Prostate Screening Guidelines

“Be Smart” about North Carolina’s Medicaid Family Planning Waiver Program

Adolescent Obesity & Inactivity Project: 2006 YearIn-Review

2007 CME Calendar of Events

2006 Awards

Foundation News

Academy Briefs

The 2007 Inaugural Address

Contribute to the Community Practitioner Program

2007 NCAFP Board of Directors NCAFP Executive Officers President Michelle F. Jones, MD President-Elect Christopher S. Snyder, III, MD Vice President Robert Lee Rich, Jr., MD Secretary/Treasurer Elizabeth B. Gibbons, MD Board Chair J. Carson Rounds, MD Executive Vice President Sue L. Makey, CAE Past President (w/voting privileges) Karen L. Smith, MD, FAAFP The District Directors District 1 Donald Keith Clarke, MD District 2 Christopher B. Isenhour, MD District 3 Victoria S. Kaprielian, MD District 4 William A. Dennis, MD District 5 Sara O. Beyer, MD District 6 Thomas J. Zuber, MD District 7 Shannon B. Dowler, MD At Large R.W. Watkins, MD, MPH At Large Richard Lord, MD IMG Physicians Constituency Rafael G. Torres, MD Minority Physicians Constituency Suzanne E. Eaton Jones, MD New Physicians Constituency Jana C. Watts, MD FM Department Constituency Michael L. Coates, MD FM Residency Director Stephen Hulkower, MD Resident Director Parker McConville, MD, (GAHEC) Resident Director-Elect Tamieka Howell, MD, (GAHEC) Student Director Mary Jean Deason, (UNC) Student Director-Elect Carrie Hamby, (UNC) AAFP Delegates and Alternates AAFP Delegate L. Allen Dobson, MD AAFP Delegate Conrad L. Flick, MD AAFP Alternate Mott P. Blair, IV, MD AAFP Alternate Karen L. Smith, MD FP Department Chairs and Alternates Chair (WFU) Michael L. Coates, MD Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Valerie J. Gilchrist, MD Alternate (UNC) Warren P. Newton, MD, MPH NCAFP Council Chairs Child & Maternal Health Shannon B. Dowler, MD Governmental Affairs Advisory Robert Lee Rich, Jr., MD Health Promotion & Disease Prev. Mott P. Blair, IV, MD Mental Health Michelle F. Jones, MD Professional Services Brian Forrest, MD Health Disparities Karen L. Smith, MD NCAFP Editorial Committee Chair William A. Dennis, MD Shannon B. Dowler, MD Elizabeth B. Gibbons, MD Richard Lord, MD David C. Luoma, MD

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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The 2007 Inaugural Address Delivered by Dr. Michelle F. Jones, 2006-07 NCAFP President Bernard of Chartres once said, “We are like dwarves upon the shoulders of giants, and so able to see more and farther than the ancients.” The specialty of Family Medicine was merely a vision some sixty years ago as medicine was becoming increasingly specialized and some saw the need for a specialist to care for the whole patient. It is upon those visions and dreams we sit today as the largest single specialty physician organization in the United States. It is my privilege to stand on those shoulders and share with you my vision for Family Medicine in North Carolina in 2007. As this is a historic occasion for husband and wife to be president of the same state Academy I thought I would look back to the presidency of the first Dr. Jones and see how far we have come. In 1972 – a kinder, gentler time when there were only 2 antibiotics and no prior approvals - Dr. James Jones was elected by a membership of 766. The current North Carolina Academy has twentysix hundred-members. The 1973 Academy supported its revenue of just over 100,000 dollars with annual dues of seventy-five dollars. This means 55% of the budget was from dues income. In 2006, our revenue was one point two million dollars with less than half of that supported by dues. Notable events from 1973 include the purchase of a new headquarters building for the exorbitant cost of twenty-five thousand dollars. Board minutes reflected that postage was increasing to ten cents for first class mail and this would create a strain on the budget. President Jones persuaded the Academy to join the political battle to establish a medical school at East Carolina University with a mission to train more family physicians. The family medicine residency programs at Duke and Chapel Hill were just getting started and the well established program at Moses Cone in Greensboro was already sending residency trained family physician specialists out into the community. Today North Carolina has 14 residencies graduating over 90 family physicians each year. Every county has at least one practicing Family Physician, and North Carolina has one of the highest retention rates for residency graduates in the country. When Duke announced earlier this year they were closing their residency, many of you wrote letters in support of training our future family physicians. Our immediate past president Carson Rounds met with the Duke residents and with Dr. Lloyd Michener, Chair of the Department of Community and Family Medicine. As a result

Duke asked the Academy leaders to meet with the Chancellor of Health Affairs and Dean of the School of Medicine. The outcome of those meetings was the formation of a Chancellor’s Advisory Committee for Family Medicine with representation from state and national leaders in the discipline. Our goal is to reinstate a new Family Medicine Residency Program and prepare young physicians to practice in new models of care like those described in the Future of Family Medicine Report. Thank you for your support as we continue this effort. It was Family Physician leaders of 1973, like Jim Jones, George Wolff, Hervy Kornegay, Wally Brown, Bill Hedrick, and others who saw a vision for this specialty and worked to create training programs and establish policies to help make North Carolina’s citizens healthier. As we enter the 21st century with a well established foundation

annual AAFP meeting in Washington, DC, more that 40 of your colleagues from North Carolina rallied on Capitol Hill for just these reforms. They visited in nearly all of the offices of our North Carolina legislators and spoke with senators, representatives and staffers about these very issues. Now, I challenge each of your to contact your local, state and national legislators while they are home for the holidays and discuss with them your concerns about healthcare and the future of family medicine. Another way to send our message is by giving to the state FAMPAC and national FAMMEDPAC. In fact if every family physician gave just $100 to the PAC we would have the largest PAC in the country and boy would they listen to us then…… We are fortunate in North Carolina to have many great leaders who are Family Physicians. One such exceptional leader is Dr. Allen Dobson.

“Let this be a year that the people of North Carolina realize that the North Carolina Academy of Family Physicians is alive and well and prepared to meet the healthcare needs of our state.”

we stand on the shoulders of these men and women. Do we, each one of us, see the vision of North Carolina where every citizen man, woman, elder or infant has a medical home and that medical home is the office of a family physician? Are we, you and I, committed to ensuring that we continue to train these physicians? And that those currently practicing are paid enough to keep their doors open? The 1970s were difficult times as Family Medicine was struggling for validity as a specialty in the midst of much more powerful specialists. Today, we have proof in Barbara Starfield’s data that communities cared for by primary care physicians are healthier and utilize fewer healthcare dollars than those without such care. But we struggle against an insurance industry which refuses to pay us what we are worth and a government who believes that decreasing reimbursement to primary care physicians will curb the spiraling cost of healthcare. I am proud to say that in September during the

Dr. Dobson is the current Assistant Secretary for Health Policy and Medical Assistance in the Department of Health and Human Services. He oversees the Medicaid program – a budgetary item with ever increasing need but a very limited resource base. Dr. Dobson has been a motivator in the implementation of the community care networks which were developed to help control the costs of Medicaid Early success has sparked national attention to this physician dominated health care delivery system. You can thank Dr. Dobson that there have been no cuts in the Medicaid payments this year like those planned for Medicare. There is not adequate time to mention all of his contributions to the people of this great state, but Allen – THANK YOU. If you are not already participating in one of the networks of CCNC I urge you to do so. It is a unique opportunity for us to control our own destiny while improving access. In its short life CCNC has improved the quality of care we provide, not

North Carolina Academy of Family Physicians

according to Blue Cross or United Healthcare’s criteria, but according to criteria established by you – the patient’s personal physician. Over a year ago as I was considering a presidential project I had a luncheon meeting with the Secretary of Health and Human Services, Carmen Hooker Odom. We discussed many of the healthcare issues in the state but kept coming back to Mental Health. As you know the legislature has abolished the traditional mental health centers and replaced them with LMEs or Local Management Entities. The private sector was expected to absorb the patients from mental health centers and several of the state’s mental hospitals were closed. Unfortunately, the private sector was not able to take in the numbers of ill patients many of whom had no insurance or other resources for care. Many of these are ending up in our offices and as one physician told me, “whether I am comfortable managing this patient or not I have to – there are no psychiatrists available.” As you all know, mental health care is not delivered in the same way as the care of other organ systems. If a patient presents to the office at 4 pm on a Friday afternoon with acute cardiac pain a cardiologist is merely a phone call away. He will consult over the phone, meet the patient at the hospital and facilitate the assembly of a team for the catheterization lab. He calls when a stent is placed and reports on the condition of the patient. If this patient did not have an emergent cardiac problem, but an emergent mental health problem such as severe depression with suicidal ideations and is in the office on Friday afternoon; there may be no one to call and very few options. If the patient has insurance, there may be a panel of psychiatrists who have contracted with the insurance company, but the patient must make the appointment and it may be several months before he can be seen. If he or she has no insurance then the patient may be sent to the emergency room – a very expensive option. For these reasons, it became obvious to me that my presidential project needed to be one of helping to improve access and coordination of mental health services in this state. Subsequently, I became involved in the iCARE partnership. This acronym stands for Integrated, Collaborative, Accessible, Respectful and Evidence-Based. Its goals are to increase collaboration and communication between primary care and mental health, developmentally disabled, and substance abuse

service providers. We also aspire to increase the ability of primary care providers to provide appropriate evidence based behavioral health services to patients and increase the capacity of mental health providers to screen and refer physical illness. The project design is three parts over three years. The first is provider training and this has already begun at this meeting with a talk by Dr. Bradley Gaynes on Crisis Assessment on Thursday. This Academy will continue to provide educational assistance at these meetings, in smaller more local venues and even in office seminars similar to the training for the Dental Varnish program. We are also piloting models of integrated care and co-location of mental health providers with family physician and primary care offices. Screening tools and guidelines for outpatient use are being developed and disseminated. Finally, we are developing a website which will act not only as a CME reference, but as a referral source such that when a patient presents to your office in need of psychological or substance abuse counseling you can in a few clicks access resources in your community. We realize that integration of mental health into the mainstream of medicine will take years and a change in the way providers and patients think about mental health. But this is a collaborative with participants including pediatricians, psychiatrists, family physicians, counselors, and social workers among others, and I believe that we can influence the future only by being committed to this change. Change is never easy but those who seem to adjust best are our medical students. We have long taken an interest in students and residents as leaders in this academy. I stand before you a former Student to the Board of Directors of this Academy. Medical students are our future and one of the objectives of the Future of Family Medicine Project is to identify and promote young family physicians as leaders in their communities, in government, and in other influential groups. As we heard from Dr. Rounds yesterday, the numbers of US medical students seeking Family Medicine residencies have significantly decreased in recent years. As the population in our state increases we will be faced with serious physician workforce shortages unless we hold our medical schools accountable for who they admit and how many primary care physicians they graduate. East Carolina had been a leader in training

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family physicians, but now we are seeing a deviation from their mission and an emphasis no longer on primary care. But they need only look to the leadership of students like Jessica Triche, a senior medical student from ECU who took advantage of the Academy’s Administrative Clerkship. Jessica spent four weeks last summer researching obstetrics in family medicine and will use this data to ask the North Carolina legislature to reinstate the ROCI funds to assist family physicians in rural areas who want to deliver babies. Jessica, you are a mentor to me and your fellow students. I am proud of your work. I began by reviewing the Academy’s year in 1973. There was one other event of significance that year. The executive vice president Jack Knowles resigned. Several years ago our Executive Sue Makey announced her retirement in December 2007. I won’t make any comparisons because in the North Carolina Academy’s history there has never been one like her. On a personal note Sue has been my mother in this specialty. From the first time I called her about the Externship program as a student in 1993 to my years as student director and resident representative to the AAFP committees and now as President, she has been my advisor, my advocate and a trusted friend. It now falls on my shift to find her successor. Our Task Force has been meeting for over a year and will soon launch a national search. While the successor will not be Sue Makey, I assure you the Task Force is committed to finding an individual as dedicated to Family Medicine and its ideals as Sue has been. Sue has always had a passion for students and has issued a challenge to us to establish an endowed student fund of 500,000 dollars by the time of her retirement. I challenge each of you to show your appreciation to Sue by making her dream a reality and ensuring the interest of students in Family Medicine. Where there is no vision the people perish. In the last few minutes, I hope I have shared with you my vision for the next year. But it cannot be accomplished alone. Let this be a year that the people of North Carolina from East Carolina to Duke realize that the North Carolina Academy of Family Physicians is alive and well and prepared to meet the healthcare needs of our state. I pledge my total energy to work toward that goal. I hope you will join me. Thank you for the confidence in allowing me to serve as your president.

Contribute to the Community Practitioner Program By Charles F. Wilson, MD, Past President, North Carolina Medical Society

If I were to tell you that I had an idea about how we could help place outstanding family physicians and other primary care providers in rural and underserved areas of North Carolina, would you be skeptical that it could be done? If I were to ask you for a letter of support for a grant for this program, would you write one? Well, there is no reason to be skeptical and

The Foundation’s mission is to improve access to quality health care for all North Carolinians and the CPP is the flagship project of the Foundation. every reason to join in support of the North Carolina Medical Society Foundation’s Community Practitioner Program (CPP). Over the past 15 years, our CPP has helped place more than 125 family physicians in more than a hundred communities across North Carolina. As President of the North Carolina Medical Society, I am writing to ask for you to support our Community Practitioner Program as we strengthen and expand its scope. Instead of a

letter, I ask for a check, a contribution for the future of primary care in our state. Created in 1989, CPP has a longstanding close collaborative and successful relationship with the North Carolina Office of Rural Health & Community Care, the North Carolina Area Health Education Centers (AHEC), and other state agencies. CPP partners with these agencies to assist in the recruitment of providers, and has become a proven, low-cost method of increasing access to quality health care for an at-risk and medically underserved population in rural, economically distressed and medically underserved areas of the state CPP provides assistance to physicians, physician assistants, and family nurse practitioners in return for five years of service in a target community. By offering partial help with education loan repayments, as well as practice management assistance and other incentives, CPP enables health care professionals to serve in the areas of North Carolina that need them most. Since inception, CPP has been remarkably successful. Its greater flexibility results in a higher long-term retention rate than similar state and federal programs. Sixty-four percent of all participants remain in their communities beyond their initial five-year commitments; seventy-three percent remain in practice in a

R ESOU RCES NOW AVAI L AB LE

with

Special

Have you ever wondered how your patients with spe-

FA M I L I E S

Needs

Children

children who have special needs through: parent-to-par-

cial needs children can find resources to help deal with

ent support; information and referral including the NC

the specific issues regarding their child’s need or disabil-

Early Intervention Mentor Program; education and out-

ity?

reach; and research and evaluation.

If so, then you will want to know about the Central

The Network was highlighted at a recent meeting of

Directory of Resources, a program of the Family Support

the North Carolina ABCD (Assuring Better Child Health

Network of North Carolina. The directory and the

and Development) Advisory Committee. Greg Griggs,

Network can be reached by referring your patients to

MPA, CAE, NCAFP’s Director of Professional Services,

800-852-0042 or www.fsnnc.org.

represents the Academy on the State ABCD Advisory

The network helps provide support for families with

FOR

rural or underserved community; eighty-five percent remain in North Carolina. To date, hundreds of medical providers and practices have been supported in more than 128 communities in 76 North Carolina counties. An estimated $226 million in direct health services to the uninsured have been provided by CPP participants. The Foundation’s mission is to improve access to quality health care for all North Carolinians and the CPP is the flagship project of the Foundation. As a 501(c) 3 organization, the Foundation does not receive funding from society dues, but is dependent upon voluntary contributions and grants to achieve its mission of improving access to quality health care for all North Carolinians. In 2006, the Blue Cross and Blue Shield of North Carolina Foundation approved a $10 million matching grant, in the form of an endowment, to support the CPP. This endowment will ensure the future of the program and your financial support will help us meet the $5 million match. For further information about how you can help meet the primary health care needs in your community, please contact the Foundation at 919-833-3836 or go to www.ncmsfoundation.org. With your support we can help our colleagues, our profession and the patients we serve.

Group.

North Carolina Academy of Family Physicians

Increased Vaccination Coverage May Counteract Rising Reports of Pertussis Did you know that reports of pertussis, commonly called whooping cough, have been rising in the United States (US) for years,1 reaching a 45-year high of more than 25,000 reported cases in 2004?2 These statistics show that, although pertussis is a vaccine-preventable disease, it remains a highly contagious health threat—one that poses serious consequences for infants who are too young to be fully immunized.2 Until recently, there were only pertussis vaccines for infants and young children. Fortunately, in 2005 the Food and Drug Administration licensed 2 combination tetanus/diphtheria/acellular pertussis (Tdap) booster vaccines to provide adolescents and adults with protection against pertussis.3 Only one of these, ADACEL® (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine), is licensed for both adolescents and adults. To provide further protection against pertussis, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has voted to recommend that adolescents 11-18 years of age and adults 19-64 years of age receive a single dose of Tdap vaccine in place of a single dose of tetanus/diphtheria (Td) booster vaccine.3 When there are multiple cases of pertussis in a household, older persons are often found to have the initial case; ADACEL vaccine provides adolescents and adults with protection against pertussis, which may help reduce the spread of the disease to vulnerable infants. Physicians like knowing that ADACEL vaccine can be used concomitantly with hepatitis B and influenza vaccines and that it has a safety profile comparable to Td vaccine in both adolescents and adults. ACIP also has voted to recommend that health-care personnel (HCP) who have direct patient contact should receive a single dose of Tdap booster (if they have not previously done so) as soon as feasible, especially those who have direct contact with infants less than 12 months of age. Pertussis infection has a greater impact on infants than other age groups. Most young infants with pertussis still must be hospitalized, and some cases can be fatal.4 From 2001-2003, 91% of the reported deaths in the US from pertussis were among infants younger than 6 months of age and 75% were among infants younger than 2 months of age.2 Why are reports of pertussis increasing? There are a few factors contributing to the increase in reported pertussis cases: • Immunity to pertussis “wears off” over time, approximately 5-10 years after completing the childhood vaccination series, so adolescents and adults who think they have immunity can still be susceptible to pertussis and may transmit pertussis to infants1 • Adolescents and adults tend to have milder forms of pertussis, or even be asymptomatic; but those who develop even mild pertussis disease may still transmit the organism to unimmunized or underimmunized infants One study to determine the source of infant pertussis found that, among 264 cases of infant pertussis infection with a known or suspected source, 75% of the sources were family members and 32% were mothers.*4 These results demonstrate the need to reduce infant pertussis infection by emphasizing immunization of adolescents and adults.

ADACEL recommendations for adolescents, adults, and HCP ACIP has voted to recommend ADACEL vaccine for new mothers and those adolescents and adults who are in close contact with infants less than 12 months of age.3 Specific finalized or provisional recommendations for immunization beyond the completed diphtheria/ tetanus/pertussis (DTP) or diphtheria/tetanus/acellular pertussis (DTaP) childhood vaccination series include: • A single dose of Tdap vaccine for adolescents 11-18 years of age instead of Td for those who have yet to receive a Td booster1 • A single dose of Tdap vaccine for adults 19-64 years of age instead of a Td booster; the Tdap dose is recommended if it has been more than 10 years since the last Td booster, but shorter intervals after Td vaccine are acceptable3 ACIP also recommends that HCP make sure that their own vaccinations are up-to-date, as are those of any family members in contact with infants (especially new mothers) and that all infants have completed their childhood vaccination series. Remember to immunize not only the child but all close contacts as well. To help reduce the spread of pertussis to vulnerable infants, HCP and their organizations should develop campaigns to raise awareness among new mothers and their families about the importance of Tdap vaccine. Through the commitment of HCP, plus the availability of Tdap vaccines, the standard of care for providing protection against pertussis in the US is being redefined. ADACEL Safety Information ADACEL vaccine is indicated for active booster immunization for the prevention of tetanus, diphtheria, and pertussis as a single dose in persons 11 through 64 years of age. As with any vaccine, ADACEL vaccine may not protect 100% of vaccinated individuals. There are risks associated with all vaccines. The most common local adverse events include injection site pain, erythema, and injection site swelling. The most common systemic adverse events include headache, body ache, tiredness, and fever. ADACEL vaccine is contraindicated in persons with known systemic hypersensitivity to any component of the vaccine or a life-threatening reaction after previous administration of the vaccine or a vaccine containing the same substances. Because of uncertainty as to which component of the vaccine may be responsible, no further vaccination with the diphtheria, tetanus, or pertussis components found in ADACEL vaccine should be carried out. Because intramuscular injection can cause injection site hematoma, ADACEL vaccine should not be given to persons with any bleeding disorder, such as hemophilia or thrombocytopenia, or to persons on anticoagulant therapy unless the potential benefits clearly outweigh the risk of administration. If the decision is made to administer ADACEL vaccine to such persons, it should be given with caution, with steps taken to avoid the risk of hematoma formation following injection. Before administering ADACEL vaccine, please see accompanying full Prescribing Information.

*It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants. References: 1. Centers for Disease Control and Prevention (CDC). Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2006;55(RR-3):1-44. 2. CDC. Pertussis. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe C, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. 9th ed. Washington, DC: Public Health Foundation; 2006:79-96. 3. CDC. National Immunization Program. ACIP votes to recommend use of combined tetanus, diphtheria and pertussis (Tdap) vaccine for adults (Advisory Committee on Immunization Practices): March 2, 2006. Available at: http://www.cdc.gov/nip/vaccine/tdap/tdap_adult_recs.pdf. Accessed August 23, 2006. 4. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J. 2004;23:985-989.

Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Adsorbed ™ ADACEL Brief Summary: Please see package insert for full prescribing information

$ only

INDICATIONS AND USAGE ADACEL vaccine is indicated for active booster immunization for the prevention of tetanus, diphtheria and pertussis as a single dose in persons 11 through 64 years of age. The use of ADACEL vaccine as a primary series, or to complete the primary series, has not been studied. See DOSAGE AND ADMINISTRATION for use in tetanus prophylaxis in wound management. ADACEL vaccine is not indicated for the treatment of B pertussis, C diphtheriae or C tetani infections. As with any vaccine, ADACEL vaccine may not protect 100% of vaccinated individuals. CONTRAINDICATIONS Known systemic hypersensitivity to any component of ADACEL vaccine or a life-threatening reaction after previous administration of the vaccine or a vaccine containing the same substances are contraindications to vaccination with ADACEL vaccine. Because of uncertainty as to which component of the vaccine may be responsible, additional vaccinations with the diphtheria, tetanus or pertussis components should not be administered. Alternatively, such individuals may be referred to an allergist for evaluation if further immunizations are to be considered. The following events are contraindications to administration of any pertussis containing vaccine: (1) • Encephalopathy not attributable to another identifiable cause within 7 days of administration of a previous dose. • Progressive neurological disorder, uncontrolled epilepsy, or progressive encephalopathy. Pertussis vaccine should not be administered to individuals with these conditions until a treatment regimen has been established, the condition has stabilized, and the benefit clearly outweighs the risk. ADACEL vaccine is not contraindicated for use in individuals with HIV infection. (1) WARNINGS Because intramuscular injection can cause injection site hematoma, ADACEL vaccine should not be given to persons with any bleeding disorder, such as hemophilia or thrombocytopenia, or to persons on anticoagulant therapy unless the potential benefits clearly outweigh the risk of administration. If the decision is made to administer ADACEL vaccine in such persons, it should be given with caution, with steps taken to avoid the risk of hematoma formation following injection. (1) If any of the following events occurred in temporal relation to previous receipt of a vaccine containing a whole-cell pertussis (eg. DTP) or an acellular pertussis component, the decision to give ADACEL vaccine should be based on careful consideration of the potential benefits and possible risks: (2) (3) • Temperature of *40.5°C (105°F) within 48 hours not due to another identifiable cause; • Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours; • Persistent, inconsolable crying lasting *3 hours, occurring within 48 hours; • Seizures with or without fever occurring within 3 days. When a decision is made to withhold pertussis vaccine, Td vaccine should be given. Persons who experienced Arthus-type hypersensitivity reactions (eg., severe local reactions associated with systemic symptoms) (4) following a prior dose of tetanus toxoid usually have high serum tetanus antitoxin levels and should not be given emergency doses of tetanus toxoid-containing vaccines more frequently than every 10 years, even if the wound is neither clean nor minor. (4) (5) If Guillain-Barré Syndrome occurred within 6 weeks of receipt of prior vaccine containing tetanus toxoid, the decision to give subsequent doses of ADACEL vaccine or any vaccine containing tetanus toxoid should be based on careful consideration of the potential benefits and possible risks. (1) The decision to administer a pertussiscontaining vaccine to individuals with stable central nervous system (CNS) disorders must be made by the health-care provider on an individual basis, with consideration of all relevant factors and assessment of potential risks and benefits for that individual. The ACIP has issued guidelines for immunizing such individuals. (2) A family history of seizures or other CNS disorders is not a contraindication to pertussis vaccine. (2) The ACIP has published guidelines for vaccination of persons with recent or acute illness. (1) PRECAUTIONS General Do not administer by intravascular injection: ensure that the needle does not penetrate a blood vessel. ADACEL vaccine should not be administered into the buttocks nor by the intradermal route, since these methods of administration have not been studied; a weaker immune response has been observed when these routes of administration have been used with other vaccines. (1) The possibility of allergic reactions in persons sensitive to components of the vaccine should be evaluated. Epinephrine Hydrochloride Solution (1:1,000) and other appropriate agents and equipment should be available for immediate use in case an anaphylactic or acute hypersensitivity reaction occurs. Prior to administration of any dose of ADACEL vaccine, the vaccine recipient and/or the parent or guardian must be asked about personal health history, including immunization history, current health status and any adverse event after previous immunizations. In persons who have a history of serious or severe reaction within 48 hours of a previous injection with a vaccine containing similar components, administration of ADACEL vaccine must be carefully considered. The ACIP has published guidelines for the immunization of immunocompromised individuals. (6) Immune responses to inactivated vaccines and toxoids when given to immunocompromised persons may be suboptimal. (1) The immune response to ADACEL vaccine administered to immunocompromised persons (whether from disease or treatment) has not been studied. A separate, sterile syringe and needle, or a sterile disposable unit, must be used for each person to prevent transmission of blood borne infectious agents. Needles should not be recapped but should be disposed of according to biohazard waste guidelines. Information for Vaccine Recipients and/or Parent or Guardian Before administration of ADACEL vaccine, health-care providers should inform the vaccine recipient and/or parent or guardian of the benefits and risks. The health-care provider should inform the vaccine recipient and/or parent or guardian about the potential for adverse reactions that have been temporally associated with ADACEL vaccine or other vaccines containing similar components. The vaccine recipient and/or parent or guardian should be instructed to report any serious adverse reactions to their health-care provider. Females of childbearing potential should be informed that Aventis Pasteur Inc. maintains a pregnancy registry to monitor fetal outcomes of pregnant women exposed to ADACEL vaccine. If they are pregnant or become aware they were pregnant at the time of ADACEL vaccine immunization, they should contact their health-care professional or Aventis Pasteur Inc. at 1-800-822-2463 (1-800-VACCINE). The health-care provider should provide the Vaccine Information Statements (VISs) that are required by the National Childhood Vaccine Injury Act of 1986 to be given with each immunization. The US Department of Health and Human Services has established a Vaccine Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events after the administration of any vaccine, including but not limited to the reporting of events required by the National Childhood Vaccine Injury Act of 1986. (7) The toll-free number for VAERS forms and information is 1-800822-7967 or visit the VAERS website at http://www.fda.gov/cber/vaers/vaers.htm. Drug Interactions Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to vaccines. (See PRECAUTIONS, General.) For information regarding simultaneous administration with other vaccines refer to the ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION sections. Carcinogenesis, Mutagenesis, Impairment of Fertility No studies have been performed with ADACEL vaccine to evaluate carcinogenicity, mutagenic potential, or impairment of fertility. Pregnancy Category C Animal reproduction studies have not been conducted with ADACEL vaccine. It is also not known whether ADACEL vaccine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. ADACEL vaccine should be given to a pregnant woman only if clearly needed. Animal fertility studies have not been conducted with ADACEL vaccine. The effect of ADACEL vaccine on embryo-fetal and pre-weaning development was evaluated in two developmental toxicity studies using pregnant rabbits. Animals were administered ADACEL vaccine twice prior to gestation, during the period of organogenesis (gestation day 6) and later during pregnancy on gestation day 29, 0.5 mL/rabbit/occasion (a 17-fold increase compared to the human dose of ADACEL vaccine on a body weight basis), by intramuscular injection. No adverse effects on pregnancy, parturition, lactation, embryo-fetal or pre-weaning development were observed. There were no vaccine related fetal malformations or other evidence of teratogenesis noted in this study. (8) Pregnancy Registry Health-care providers are encouraged to register pregnant women who receive ADACEL vaccine in Aventis Pasteur Inc.’s vaccination pregnancy registry by calling 1-800-822-2463 (1-800-VACCINE). Nursing Mothers It is not known whether ADACEL vaccine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when ADACEL vaccine is given to a nursing woman. Pediatric Use ADACEL vaccine is not indicated for individuals less than 11 years of age. (See INDICATIONS AND USAGE.) For immunization of persons 6 weeks through 6 years of age against diphtheria, tetanus and pertussis, a Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed (DTaP) may be used, unless otherwise contraindicated. Geriatric Use ADACEL vaccine is not indicated for individuals 65 years of age and older. No data are available regarding the safety and effectiveness of ADACEL vaccine in individuals 65 years of age and older as clinical studies of ADACEL vaccine did not include subjects in the geriatric population. ADVERSE REACTIONS The safety of ADACEL vaccine was evaluated in 4 clinical studies. A total of 5,841 individuals 11-64 years of age inclusive (3,393 adolescents 11-17 years of age and 2,448 adults 18-64 years) received a single booster dose of ADACEL vaccine. The principal safety study was a randomized, observer blind, active controlled trial that enrolled participants 11-17 years of age (ADACEL vaccine N = 1,184; Td vaccine N = 792) and 18-64 years of age (ADACEL vaccine N = 1,752; Td vaccine N = 573). Study Product information as of June 2005 MKT10383

Manufactured by: Aventis Pasteur Limited Toronto Ontario Canada

participants had not received tetanus or diphtheria containing vaccines within the previous 5 years. Observer blind design, ie, study personnel collecting the safety data differed from personnel administering the vaccines, was used due to different vaccine packaging (ADACEL vaccine supplied in single dose vials; Td vaccine supplied in multi-dose vials). Solicited local and systemic reactions were monitored daily for 14 days post-vaccination using a diary card. Participants were monitored for 28 days for adverse events which were not specifically queried on the diary card, ie, unsolicited adverse events, and for 6 months post-vaccination for visits to an emergency room, unexpected visits to an office physician, hospitalization and serious adverse events. Unsolicited adverse event information was obtained either by telephone interview or at an interim clinic visit. Information regarding adverse events that occurred in the 6 month post-vaccination time period was obtained via a scripted telephone interview. Approximately 96% of participants completed the 6-month follow-up evaluation. In the concomitant vaccination study with ADACEL and Hepatitis B vaccines, local and systemic adverse events were monitored daily for 14 days post vaccination using a diary card. Local adverse events were only monitored at site/arm of ADACEL vaccine administration. Unsolicited reactions (including immediate reactions, serious adverse events and events that elicited seeking medical attention) were collected at a clinic visit or via telephone interview for the duration of the trial, ie, up to six months post-vaccination. In the concomitant vaccination study with ADACEL vaccine and trivalent inactivated influenza vaccines (see Clinical Studies for description of study design and number of participants), local and systemic adverse events were monitored for 14 days post vaccination using a diary card. All unsolicited reactions occurring through day 14 were collected. From day 14 to the end of the trial, ie, up to 84 days, only events that elicited seeking medical attention were collected. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to vaccine use and for approximating rates of those events. Serious Adverse Events in All Safety Studies Throughout the 6-month follow-up period in the principal safety study, serious adverse events were reported in 1.5% of ADACEL vaccine recipients and 1.4% in Td vaccine recipients. Two serious adverse events in adults were neuropathic events that occurred within 28 days of ADACEL vaccine administration; one severe migraine with unilateral facial paralysis and one diagnosis of nerve compression in neck and left arm. Similar or lower rates of serious adverse events were reported in the other trials and there were no additional neuropathic events reported. Solicited Adverse Events in the Principal Safety Study The frequency of selected solicited adverse events (erythema, swelling, pain and fever) occurring during Days 0-14 following one dose of ADACEL vaccine or Td vaccine were reported at a similar frequency in both groups. Few participants (<1%) sought medical attention for these reactions. Pain at the injection site was the most common adverse reaction occurring in 62-78% of all vaccines. In addition, overall rates of pain were higher in adolescent recipients of ADACEL vaccine compared to Td vaccine recipients. Rates of moderate and severe pain in adolescents did not significantly differ between the two groups. Rates of pain did not significantly differ for adults. Fever of 38°C and higher was uncommon, although in the adolescent age group, it occurred significantly more frequently in ADACEL vaccine recipients than Td vaccine recipients. (8) The rates of other local and systemic solicited reactions occurred at similar rates in ADACEL vaccine and Td vaccine recipients in the 3 day postvaccination period. Most local reactions occurred within the first 3 days after vaccination (with a mean duration of less than 3 days). Headache was the most frequent systemic reaction and was usually of mild to moderate intensity. Adverse Events in the Concomitant Vaccine Studies Local and Systemic Reactions when Given with Hepatitis B Vaccine The rates reported for fever and injection site pain (at the ADACEL vaccine administration site) were similar when ADACEL and Hep B vaccines were given concurrently or separately. However, the rates of injection site erythema (23.4% for concomitant vaccination and 21.4% for separate administration) and swelling (23.9% for concomitant vaccination and 17.9% for separate administration) at the ADACEL vaccine administration site were increased when coadministered. Swollen and/or sore joints were reported by 22.5% for concomitant vaccination and 17.9% for separate administration. The rates of generalized body aches in the individuals who reported swollen and/or sore joints were 86.7% for concomitant vaccination and 72.2% for separate administration. Most joint complaints were mild in intensity with a mean duration of 1.8 days. The incidence of other solicited and unsolicited adverse events were not different between the 2 study groups. (8) Local and Systemic Reactions when Given with Trivalent Inactivated Influenza Vaccine The rates of fever and injection site erythema and swelling were similar for recipients of concurrent and separate administration of ADACEL vaccine and TIV. However, pain at the ADACEL vaccine injection site occurred at statistically higher rates following concurrent administration (66.6%) versus separate administration (60.8%). The rates of sore and/or swollen joints were 13% for concurrent administration and 9% for separate administration. Most joint complaints were mild in intensity with a mean duration of 2.0 days. The incidence of other solicited and unsolicited adverse events were similar between the 2 study groups. (8) Additional Studies An additional 1,806 adolescents received ADACEL vaccine as part of the lot consistency study used to support ADACEL vaccine licensure. This study was a randomized, double-blind, multi-center trial designed to assess lot consistency as measured by the safety and immunogenicity of 3 lots of ADACEL vaccine when given as a booster dose to adolescents 11-17 years of age inclusive. Local and systemic adverse events were monitored for 14 days post vaccination using a diary card. Unsolicited adverse events and serious adverse events were collected for 28 days post vaccination. Pain was the most frequently reported local adverse event occurring in approximately 80% of all subjects. Headache was the most frequently reported systemic event occurring in approximately 44% of all subjects. Sore and/or swollen joints were reported by approximately 14% of participants. Most joint complaints were mild in intensity with a mean duration of 2.0 days. (8) An additional 962 adolescents and adults received ADACEL vaccine in three supportive Canadian studies used as the basis for licensure in other countries. Within these clinical trials, the rates of local and systemic reactions following ADACEL vaccine were similar to those reported in the four principal trials in the US with the exception of a higher rate (86%) of adults experiencing ‘any’ local injection site pain. The rate of severe pain (0.8%), however, was comparable to the rates reported in the four principal trials. (8) Postmarketing Reports In addition to the data from clinical trials, the following adverse events have spontaneously been reported during the commercial use of ADACEL vaccine in other countries. These adverse events have been very rarely reported (<0.01%), however, incidence rates cannot precisely be calculated. The reported rate is based on the number of adverse event reports per estimated number of vaccinated patients. General disorders and administration site conditions: injection site bruising, sterile abscess; skin and subcutaneous tissue disorders: pruritus, urticaria. Reporting of Adverse Events The National Vaccine Injury Compensation Program, established by the National Childhood Vaccine Injury Act of 1986, requires physicians and other health-care providers who administer vaccines to maintain permanent vaccination records of the manufacturer and lot number of the vaccine administered in the vaccine recipient’s permanent medical record along with the date of administration of the vaccine and the name, address and title of the person administering the vaccine. The Act further requires the health-care professional to report to the US Department of Health and Human Services the occurrence following immunization of any event set forth in the Vaccine Injury Table. These include anaphylaxis or anaphylactic shock within 7 days; brachial neuritis within 28 days; an acute complication or sequelae (including death) of an illness, disability, injury, or condition referred to above, or any events that would contraindicate further doses of vaccine, according to this ADACEL vaccine package insert. (7) (9) (10) The US Department of Health and Human Services has established the Vaccine Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events after the administration of any vaccine. Reporting of all adverse events occurring after vaccine administration is encouraged from vaccine recipients, parents/guardians and the health-care provider. Adverse events following immunization should be reported to VAERS. Reporting forms and information about reporting requirements or completion of the form can be obtained from VAERS through a toll-free number 1-800-822-7967 or visit the VAERS website at http://www.fda.gov/cber/vaers/vaers.htm. (7) (9) (10) Health-care providers should also report these events to Pharmacovigilance Department, Aventis Pasteur Inc., Discovery Drive, Swiftwater, PA 18370 or call 1-800-822-2463 (1-800-VACCINE). DOSAGE AND ADMINISTRATION ADACEL vaccine should be administered as a single injection of one dose (0.5 mL) by the intramuscular route. SHAKE THE VIAL WELL to distribute the suspension uniformly before withdrawing the 0.5 mL dose for administration. Five years should have elapsed since the recipient’s last dose of tetanus toxoid, diphtheria toxoid and/or pertussis containing vaccine. For individuals planning to travel to developing countries, a one-time booster dose of ADACEL vaccine may be considered if more than 5 years has lapsed since receipt of the previous dose of diphtheria toxoids, tetanus toxoids or pertussis-containing vaccine. Do NOT administer this product intravenously or subcutaneously. STORAGE Store between 2° - 8°C (35° - 46°F). DO NOT FREEZE. Discard product if exposed to freezing. Do not use after expiration date. REFERENCES 1. CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR 2002;51(RR-2):1-35. 2. CDC. Pertussis vaccination: Use of acellular pertussis vaccines among infants and young children. Recommendations of the ACIP. MMWR 1997;46(RR7):1-25. 3. CDC Update. Vaccine side effects, adverse reactions, contraindications and precautions - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(RR-12):1-35. 4. CDC. Update on adult immunization recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1991;40(RR-12):1-52. 5. CDC. Diphtheria, tetanus and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(RR-10):1-28. 6. CDC. Use of vaccines and immune globulins in persons with altered immunocompetence. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1993;42(RR-4):1-18. 7. CDC. Current trends - Vaccine Adverse Event Reporting System (VAERS) United States. MMWR 1990;39(41):730-3. 8. Data on file at Aventis Pasteur Limited. 9. CDC. Current trends - national vaccine injury act: requirements for permanent vaccination records and for reporting of selected events after vaccination. MMWR 1988;37(13):197-200. 10. FDA. New reporting requirements for vaccine adverse events. FDA Drug Bull 1988;18(2):16-8. Printed in USA Distributed by: Aventis Pasteur Inc. Swiftwater PA 18370 USA 2021114/2021543

“Be Smart” about North Carolina’s M e d i c a i d Fa m i l y P l a n n i n g Wa i v e r P r o g r a m by Jenni Mullendore MD, member of NCAFP Committee on Maternal and Child Health A 32 year old uninsured female comes into your office to discuss her options for contraception. She has 3 children; her youngest is 9 months old. She qualified for Medicaid during her pregnancy, but its coverage has since lapsed. She does not desire any more children and wants to have her tubes tied, but can’t afford it. What are her options? As of October 2005, she can apply for “Be Smart,” North Carolina’s family planning waiver program. North Carolina and several other states have developed these programs to help low-income persons, who are not covered by Medicaid, afford family planning services. Who qualifies? • Women age 19 through 55 • Men age 19 through 60 • Income at or below 185% of the federal poverty level • U.S. citizens or qualified aliens • Residents of North Carolina • Not incarcerated • Not pregnant • Not permanently sterilized What services are provided FREE to participants? • Annual and periodic family planning visits (includes counseling, education, & treatment) • Pap smears

2006 2

2006 Outstanding Family Medicine Residents Fourteen third-year family medicine residents were recognized as Outstanding Residents by their respective programs. Each were recognized for delivering compassionate patient care, their maturity in interpersonal relationships and their strong commitment to the specialty. MAHEC – Asheville Ryan Truxillo, MD MAHEC – Hendersonville Travis Johnson, MD UNC Chapel Hill Mark Lloyd, DO CMC-Charlotte Rachel Banks, MD CMC-Union Erin Mullins, DO Duke University Erik Butler, DO Southern Regional AHEC Seth Garber, MD Moses Cone Amy Bedsole, MD New Hanover Phillip Moye, MD East Carolina University Lisa Doherty, MD Wake Forest University Elizabeth Placek, DO Cabarrus Jennifer Thill, MD WOMACK Steven Lynch, MD Camp Lejeune Leah Soley, MD 2006 Community Teaching Award Winners Each medical school annually confers recognitions on family physicians who help advance the principles of family medicine by dedicating themselves to the teaching and mentoring of medical students.

• Medicaid-covered birth control methods/devices (NOT diaphragms or condoms) • Pregnancy testing • Screening for and treatment of sexually transmitted infections • Screening for HIV • Voluntary sterilization (tubal ligations and vasectomies) Where can participants obtain services? • Any participating family planning provider enrolled with Medicaid How do interested person sign up for “Be Smart”? • Applications are available at local health departments, Departments of Social Services (DSS), or online at http://www.dhhs.state.nc.us/dma and should be returned to the applicant’s local DSS. • Applications are available in Spanish. • Applications are usually processed within 45 days of receipt. How long will “Be Smart” be available? States must obtain approval of these waiver programs from the Centers for Medicare and Medicaid Services. Programs are approved for a five year period initially, but states can apply for an extension. North Carolina’s “Be Smart” program will expire on October 1, 2010 unless extended. For more information on North Carolina’s family planning waiver program, “Be Smart,” visit http://www.dhhs.state.nc.us/dma/bulletin/FamilyPlanningTraining.pdf.

W Duke University East Carolina University UNC – Chapel Hill Wake Forest University

Dr. Katherine Bliss Lenoir Family Medicine (Drs. Agsten, Crisp, Weatherdon and Crain) Dr. Anupama Ha Dr. Terry Hess

2006 Research Poster Contest This year, the Academy’s annual poster contest consisted of ten high-quality presentations. In the student category the competition was fierce, and the NCAFP Foundation awarded two runners-up. Physician Category Dr. David Price Effect of a waiting room video on patients' understanding of the specialty of family medicine: a pilot study Resident Category Dr. Lisa Doherty Impact of Point of Care HBA1c Testing on Diabetes Management in a University-based Family Medicine Setting Student Category Julie Thibodeaux Impact of Medicare Part D on Haywood County Medicare Recipients Displace from the Good Samaritan Medication Assistance Program Cara Davidson, UNC-Chapel Hill Chronic Disease, Willingness to Change and Physician Prevention Advice Allan D. Nanney, III, UNC- Chapel Hill Proecto Puentes de Salud: An Exploration of Cardiovascular Health and Risk Factors in Rural Mexico

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MOTT P. BLAIR, IV NAMED 2006 FAMILY PHYSICIAN OF THE YEAR UNC’s Dr. Robert Gwyther, Honored with Lifetime Service Award

The Academy presented its 2006 Family Physician of the Year award to Dr. Mott P. Blair of Wallace during the annual Winter Meeting in Asheville on Dec 1st. Dr. Blair has been active with the Academy since medical school and his career has been marked by excellence in clinical care, tireless efforts on part of his local community and a leader’s vision in advancing the practice of medicine. Caring for North Carolinians has always been sort of a family tradition for Dr. Mott Blair and his family. This heritage began in the mid-19th century in western North Carolina and continues today, with Dr. Blair and his brother, Dr. Seaborn Blair of Oriental, NC, and their sister, Dr. Elizabeth Blair of Greenville, all practicing medicine. Dr. Blair and his brother are family physicians, while their sister is a pediatrician. Dr. Mott Blair realized early on that he was called to practice medicine. As a teenager he would often volunteer in his father’s practice, the late Dr. Seaborn Blair, Sr., and assist where he could while getting to know the many patients and their families. After graduating from medical school and completing his family medicine residency at East Carolina University in 1990, Blair returned home to Wallace and began practice alongside his father. Dr. Blair has always considered small-town, rural Wallace the perfect place to live, raise a family and develop his career. He loves the quality of life and takes pride in the hundreds of close relationships he and his family have formed over the years. One key aspect that sets Dr. Blair apart from many physicians is the strength of the relationships he’s formed with his patients. Many patients consider Dr. Blair to be ‘part of the family’ and have established close relationships with

him and his practice staff. Testimonials describe his care process as one that combines clear communication, compassion and empathy with expert clinical skills. Through these lasting relationships that in some cases span generations, Dr. Blair is able to apply a unique knowledge that enhances his care and outcomes. Community Minded and Dedicated to Advancing Medicine In addition to managing the demands of his independent practice, Dr. Blair also finds the time to advocate for Wallace and the greater Duplin County community where he lives. He has served his community in a number of capacities over the years, including being elected to the Duplin County Board of Education, serving on the Wallace Chamber of Commerce, in leadership on the Duplin County Parks and Recreation Board and the Don-Lee Center Local Board of Directors, and volunteering as the team physician for the Wallace-Rose Hill High School football team. In pursuing these activities, colleagues noted Blair’s willingness to listen and an innate talent at building consensus. Dr. Blair also finds the time to be involved in many efforts that are improving and advancing the practice of medicine. Within North Carolina’s organized medical community, Blair has assumed a number of leadership roles. He has served as President of the North Carolina Academy of Family Physicians (2003), chairman of NCAFP’s statewide Adolescent Obesity and Inactivity Project (2004-06), represented North Carolina within the AAFP Congress of Delegates, served on the national American Academy of Family Physicians (AAFP) Committee on Rural Health and has also been a board member of Protect Healthcare Now (200405) and the Medical Mutual Community Advisory Board (2004-05). Most recently, he was named Chair of the AAFP Commission on The Health of the Public. Much like his work in other areas, Dr. Blair has received several recognitions on behalf of his physician colleagues. These include the ‘Young Physicians Community Service Award’ by the North Carolina Medical Society (1998), the 2001 George T. Wolff Award by the Whitehead Society at the UNC School of Medicine and several awards by the NCAFP including the NCAFP Community Teaching

Award (1999) and an honor for Distinguished Service (2004). Away from medicine and community, Dr. Blair is an master sailor and readily shares his knowledge and skills with younger sailors. Blair volunteers as a ‘Sailing Master’ at Camp Don Lee, a Methodist summer camp in Arapahoe, NC that his family helped found in the early 1950s. The camp works to instill faith and values in young people and Blair has been known to use his knowledge and expertise in sailing as a metaphor to touch countless lives of young people. Dr. Blair completed his undergraduate studies in Biology at UNC-Wilmington in 1982. He later attended ECU’s Brody School of Medicine and finished his residency training in 1990. His wife Jennifer (Tyndall) is a native Grifton, NC and the Blairs of have three children, Cece (15), Ivey (13) and Parks (12). Dr. Robert Gwyther Recognized for a Lifetime of Service to Family Medicine The Academy honored UNC’s Dr. Robert Gwyther with our annual Lifetime Service Award. Dr. Gwyther is an integral part of UNC’s family medicine department and is a recognized expert in the area of substance abuse education. Since arriving at the school in 1978, Gwyther has excelled in the area of medical student teaching and mentoring. He has been recognized by his peers with numerous teaching awards, including Excellence in Family Medicine Education (2005), UNC Hospital’s H. Fuller Fleming Award (2003), and was the recipient of the Outstanding Faculty Teaching Award in 1994. In addition to his academic service, he has also been active with the Academy, the Society of Teachers of Family Medicine and is a charter member of North Carolina’s Society of Addiction Medicine. In NCAFP affairs, Dr. Gwyther has served innumerous capacities, culminating with his Presidential term in 2002-03. He continues to volunteer with the chapter as an active participant in many councils and committees, and most recently served as Mental Health Council Chair. Dr. Gwyther completed his undergraduate education at Adelbert College in Cleveland and later obtained his medical degree from the Medical College of Ohio. After completing his family medicine residency at Akron City Hospital, Akron, Ohio, he arrived at UNC in 1978.

North Carolina Academy of Family Physicians

Notice to Readers: Improved Supply of Meningococcal Conjugate Vaccine, Recommendation to Resume Vaccination of Children Aged 11--12 Years In January 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine (MCV4) (Menactra™, Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11--55 years. The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with MCV4 for children aged 11--12 years at their regular health-care visit and, if not previously vaccinated with MCV4, of adolescents at high-school entry (at approximately age 15 years), of college freshmen living in dormitories, and of other persons at increased risk for meningococcal disease (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, persons with anatomic or functional asplenia, and persons with terminal complement deficiency) (1). In May 2006, CDC, in consultation with ACIP, the American Academy of Pediatrics, American Academy of Family Physicians, American College Health Association, and Society for Adolescent Medicine, recommended deferral of MCV4 vaccination of children aged 11--12 years in response to vaccine supply limitations (2). Currently, Sanofi Pasteur reports that limitations in the MCV4 supply have resolved. Therefore, CDC recommends resuming routine vaccination for all recommended groups according to ACIP recommendations, including children aged 11--12 years and, if not previously vaccinated with MCV4, of adolescents at high-school entry (at approximately age 15 years), of college freshmen living in dormitories, and of other persons at increased risk for meningococcal disease. Where possible, providers who deferred vaccination of children aged 11--12 years should recall those patients for vaccination. Providers who have questions about ordering vaccine may contact Sanofi Pasteur at 1-800-VACCINE or at http://www.vaccineshoppe.com/. References 1. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2005;54(No. RR-7):1--21. 2. CDC. Limited supply of meningococcal conjugate vaccine, recommendation to defer vaccination of persons aged 11--12 years. MMWR 2006;55;567--8.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

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Adolescent Obesity & Inactivity Project: 2006 Year-in-Review The Academy's Adolescent Obesity Initiative has now completed its third year. In 2006, the project sought to determine key variables for success when establishing relationships with community referral sources. Efforts were driven to better understand barriers to successful partnerships in order to establish outlines for overcoming such obstacles. During the past year, the project focused on counties where a physician and cooperative extension agent partnership was already in place. These 15 counties were Alleghany, Duplin, Guilford, Hertford, Hoke, Mitchell, Sampson, Vance, Wake, Durham, Buncombe, New Hanover, Nash, Cabarrus and Craven. Jenni Fisher, the project coor-

2007

dinator, traveled to these counties and met with each team to identify their barriers and successes in their county. In 2006, new patient education materials were developed. The first were prescription pads with cooperative extension county-specific contact information and generic prescription pads with healthy eating and physical activity goals. Two new tear-off pads for physician waiting areas and patient rooms were also created. One is called “Moving More, Watching Less,” and the other is called “Fast Food Survival Guide.” They both have simple tips and have been created through the Families Eating Smart Moving More program. All of these materials are still available and will be available throughout the course of the grant.

CME Calendar

Mark your calendars for the Academy’s 2007 CME Meetings! More events are in the works; STAY TUNED.

Final Cohort Data Collection The third and final cohort data collection is due on January 15th. The study consists of height and weight measurements and a survey to assess physical activity, eating behaviors, and self-efficacy. The data from all of the Fit Together grantees will be compiled and analyzed by an evaluation team at East Carolina University. The Health and Wellness Trust Fund is allowing grantees to carry over unexpended funds into a fourth year. As a result, the NCAFP initiative will continue into 2007. Project staff will concentrate on documenting key success factors and barriers as well as translating existing materials into a digital format so that portions of the project can be self-sustaining into the future.

Events

2007 Spring Family Physicians Weekend Charleston, SC April 19-22, 2007 Embassy Suites – North Charleston 2007 Mid-Summer Family Medicine Digest Myrtle Beach, SC July 1-6, 2007 Kingston Plantation 2007 Winter Family Physicians Weekend Asheville, NC Nov. 29 – Dec. 2, 2007 Grove Park Inn

North Carolina Academy of Family Physicians

Increasing Immunization Coverage May Reverse Rising Reports of Pertussis Many people are unaware that reports of pertussis, commonly called whooping cough, have been rising in the United States (US)1 and pose serious consequences for infants who are too young to be fully immunized.2 Fortunately, in 2005 the Food and Drug Administration licensed 2 combination tetanus/diphtheria/acellular pertussis (Tdap) vaccines, one for adolescents and one for adolescents and adults3; until that time, pertussis immunization was limited to infants and young children. With the availability of Tdap vaccines, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has voted to recommend that adolescents and adults 11-64 years of age receive a single dose of Tdap in place of a single dose of tetanus/diphtheria (Td) booster vaccine. Tdap vaccine provides adolescents and adults with protection against pertussis, and may help reduce the spread of the disease to vulnerable infants. ACIP also has voted to recommend that health-care personnel (HCP) who have direct patient contact receive Tdap (if they have not previously done so), especially those who have direct contact with infants less than 12 months of age.

Reports of pertussis on the rise The number of reported pertussis cases in the US has steadily increased, reaching 25,827 in 2004, the largest number since 1959.2 Because of underreporting and misdiagnosis, the true number of pertussis cases is most likely even higher, estimated at 600,000 adults annually.3 In recent years, pertussis has had a significant impact on particular age groups. For example, between 2003 and 2004 reported pertussis cases increased 122% overall and 73% in children 4 years of age or younger.4,5 Adolescents 10-19 years of age and adults over 20 years of age still accounted for a clear majority (approximately 66%) of the reported cases.5

Nearly 50% of Pertussis Sources Are Parents6 In a CDC study of 774 reported cases Unknown source of infant pertussis, interviews were 57% (n=352) conducted in 616 of the families to determine the source of the disease A source was defined as a person with an Known or acute cough illness who had contact with the suspected source case-infant 7 to 20 days before the infant’s 43% (n=264) onset of cough The source was identified for 43% (264) Of the 264 with known of the infants with pertussis. Within this or suspected source, the source was: subgroup of infants, the known or Grandparents 8% suspected source of pertussis was*: Siblings 20% • The mother in 32% • A parent in nearly 50% Others 25% (Child-care workers, • A family member in 75% friends, etc.) Fathers 15% *It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants. Mothers 32%

Tdap recommended for adolescents, adults, and HCP ACIP has voted to recommend Tdap vaccination for new mothers and those adolescents and adults who are in close contact with infants, especially younger than 12 months of age. Specific finalized or provisional recommendations for immunization beyond the completed diphtheria/tetanus/pertussis (DTP) or diphtheria/tetanus/acellular pertussis (DTaP) childhood vaccination series include: • A single dose of Tdap for adolescents 11-18 years of age instead of Td for those who have yet to receive a Td booster1 • A single dose of Tdap for adults 19-64 years of age instead of a Td booster; the Tdap dose is recommended if it has been more than 10 years since the last Td booster, but shorter intervals after Td vaccine are acceptable.3

The implications of rising numbers of reported pertussis cases are alarming. Most young infants with pertussis still must be hospitalized, and some cases can be fatal.6 From 2001-2003, 91% of the deaths from pertussis were among infants younger than 6 months of age and 75% were among infants younger than 2 months of age.2

The role of HCP

Why are reports of pertussis on the rise?

HCP can help reduce the increasing rates of pertussis infection by first making sure that, if they work in hospitals or ambulatory-care settings, they have received Tdap immunization to protect themselves, their patients, and family members. This is especially important for those in direct contact with infants less than 12 months of age.

One reason for the increase in pertussis cases may be that immunity to pertussis “wears off” over time—approximately 5-10 years after completing the childhood vaccination series1—which means adolescents and adults who think they have immunity can be susceptible to pertussis and may transmit the disease to infants. Adolescents and adults also tend to have milder forms of pertussis, or even be asymptomatic; but those who develop even mild pertussis disease may still transmit the organism to unimmunized or underimmunized infants. In families, this is often the case. In a study to determine the source of infant pertussis, family members, especially new mothers, have been found to be an important source. The study found that, among 264 cases of infant pertussis infection with a known or suspected source, 75% of the sources were family members and 32% were mothers.6 Tdap immunization for parents and family members may help reduce the spread of pertussis to infants.

With the availability of Tdap vaccine for adolescents and adults, HCP need to redefine the standard of care for infant pertussis by immunizing not only the child but also those who come in close contact with the child. HCP will play a major role in increasing Tdap immunization.

HCP also need to make sure that family members in contact with infants are up-to-date with their pertussis vaccinations and that infants and young children have completed their DTaP childhood vaccination series.

Raising awareness among new mothers and their families To help reduce the spread of pertussis to vulnerable infants, HCP and their organizations should develop campaigns to raise awareness among new mothers and their families about the importance of Tdap immunization. Providers can use existing office visits as an opportunity to increase the use of Tdap immunizations among adolescents and adults. Through the commitment of HCP, plus the availability of Tdap vaccines, the standard of care for providing protection against pertussis in the US is being redefined.

References: 1. Centers for Disease Control and Prevention (CDC). Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2006;55(RR-3):1-44. 2. CDC. Pertussis. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe C, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. 9th ed. Washington, DC: Public Health Foundation; 2006:79-96. 3. CDC. National Immunization Program. ACIP votes to recommend use of combined tetanus, diphtheria and pertussis (Tdap) vaccine for adults (Advisory Committee on Immunization Practices): March 2, 2006. Available at: http://www.cdc.gov/nip/vaccine/tdap/tdap_adult_recs.pdf. Accessed March 10, 2006. 4. CDC. Summary of notifiable diseases—United States, 2003. MMWR. 2003;52:1-85. 5. CDC. Pertussis Surveillance Report—8/12/05. MKT11970. 6. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J. 2004;23:985-989.

FOUNDATION NEWS 2006 SILENT AUCTION A SMASH HIT! Eleven years ago the NCAFP Foundation began a tradition – our annual Silent Auction. The 2006 auction was held during the Winter Family Physicians Weekend at The Grove Park Inn in the beautiful mountains of Asheville, and it proved to be a smash hit. With over 150 items, there was something for everyone – sports memorabilia and tickets, weekend getaways, artwork, jewelry, gift baskets, electronic equipment, furniture, and more. Our Academy and Foundation boards, as well as members and exhibitors, contributed items to the auction, bringing the Foundation a grand total of $8,180.36! We’d like to extend a special “thank you” to our Silent Auction Sponsors – Onslow Memorial Hospital, Presbyterian Healthcare, “UHS” – University Health Systems of Eastern Carolina and UNC Hospitals (Platinum), Scotland Health Care System (Gold), Gaston Memorial Hospital, Lenoir Memorial Hospital and Mission Health & Hospitals (Silver). Thank you for your sponsorship of the auction and your support of Family Medicine! We’d also like to extend a heartfelt “thank you” to Martini Print Media, Inc., who donated their services to produce the Silent Auction booklets. Marlene Rosol, Development Coordinator, did a wonderful job of organizing the auction. A special thank you to Silent Auction CoChairs Dr. James G. Jones and Rudy L. Snow for their leadership. We also want to thank Jenni Fisher, Peter Graber, and Kelly Haupt for their invaluable assistance. The Silent Auction continues to support the Foundation’s programs and projects, and we greatly appreciate our members’ involvement!

RING IN THE NEW YEAR! Ring in the new year with the NCAFP Foundation! We extend our thanks and wishes for a Happy New Year go to all our members who made individual contributions in 2006! With your generosity our programs and projects continue to flourish. Through your support, we continue to make a difference in the lives of the people of North Carolina. Tar Wars and the Adolescent Obesity and Inactivity Project, our preventive medicine initiatives, continue to be successful in educating and bringing quality healthcare to the citizens of our state. Our student programs, such as the Student Scholarship Program, Student Activities Endowment Fund, Family Medicine Interest Groups

and Student Elective Rotation, give our medical students firsthand insight into the specialty of Family Medicine. Did you know that you can make your contribution in honor or memory of a colleague or loved one? Look for the special designation on our 2007 appeals. Help us keep our programs alive – ring in the new year with a Foundation donation! For more information on any of the Foundation’s projects, please contact Marlene Rosol, Development Coordinator, at (919) 833-2110, (800) 872-9482 [NC only], or mrosol@ncafp.com. Thank you – Happy New Year!!

MEDICAL STUDENT ENDOWMENT FUND CHALLENGE

and our medical students – thank you!

FOUNDATION SCHOLARSHIP PROGRAM North Carolina medical students are eligible to apply for one of four scholarships in 2007. Applications are available through the four FMIG programs or you can download them on the NCAFP website (www.ncafp.com). For more information on student scholarships, or how you can make a donation to the Scholarship Program, please contact Peter Graber at (800) 872-9482 [NC only], (919) 833-2110, or pgraber@ncafp.com.

GIVING TO THE FOUNDATION IS JUST A “CLICK” AWAY!

In 1997, the NCAFP Foundation created the Medical Student Endowment Fund to support student activities at the four North Carolina medical schools. Using only the interest earned on the endowment’s funds, our goal is to grow the endowment to the point where the annual interest is large enough to support all of our student activities and programs. At the 2005 Winter Family Physicians Weekend, Sue Makey, our Executive Vice President, isused a challenge to reach $500,000 for the Medical Student Endowment Fund prior to her retirement on December 31, 2007. That’s only one year away! As of December 31, 2006, the fund has grown to $307,869.41. Through our members’ generous contributions, $8,599.00 was raised for the fund in 2006 – thank you! But we still have a way to go – let’s all help Sue reach her goal in 2007! Your tax-deductible charitable gift will be in perpetuity – only the interest will be used. You can send your contributions to: NCAFP Foundation, P.O. Box 10278, Raleigh, NC 27605. On behalf of the NCAFP Foundation

With just a “click” you can make a donation to the Foundation. And it’s safe and secure! The NCAFP Foundation’s on-line donation page is up and running on our website. Access the NCAFP web site at www.ncafp.com and click on “Foundation” and then “Contributions.” Your donation will be automatically transmitted to the Foundation and processed immediately. Contact Marlene Rosol, Development Coordinator, at (800) 872-9482 [NC only], (919) 833-2110, or mrosol@ncafp.com if you have any questions or concerns.

THE FOUNDATION VALUES ITS CORPORATE MEMBERS! We extend a heartfelt “thank you” to our 2006 Foundation Corporate Members! Their participation and support are a big part of what we do, and we’re proud to include them as part of our Foundation family. We look forward to their partnership again in 2007. Thank you!!

THANK YOU TO OUR 2006 CORPORATE MEMBERS!! WE COULDN’T DO IT WITHOUT YOU! Grand Patrons: NC Academy of Family Physicians, Raleigh, NC* Patrons: First Citizens Bank, Raleigh, NC*

Supporters: MAG Mutual Insurance Company, Atlanta, GA* MedCost, LLC, Winston-Salem, NC* Medical Mutual, Raleigh, NC* Rudy L. Snow, Menzies-Med, Granite Falls, NC*

*Corporate Members - Unrestricted **Corporate Members - Restricted

North Carolina Academy of Family Physicians

ACADEMY BRIEFS FOUNDATION INITIATIVES HOLD INITIAL EDUCATIONAL PROGRAMS AT ANNUAL MEETING Two new Foundation initiatives held initial educational sessions during the Academy’s 2006 Annual Meeting in December. The ICARE Partnership, a collaboration of several organizations led by the N.C. Foundation for Advanced Health Programs, sponsored a lecture on managing mental health crises in the primary care setting. Dr. Bradley Gaynes, a psychiatrist from UNC, discussed common crises, as well as assessing and managing them in the office setting. The Academy, through a sub-contract from the N.C. Foundation for Advanced Health Programs, is responsible for the provider training and technical assistance portion of the ICARE Partnership. The next trainings will take place in conjunction with a N.C. Pediatric Society Meeting in February, as well as regional frontline programs in March and May. The regional training programs will provide primary care and behavioral health specialists the opportunity to interact and develop referral relationships. The ICARE Partnership hopes to improve the care of mental health patients in North Carolina by 1) increasing collaboration and communication between primary care and mental health/development disability/substance abuse providers; and 2) increasing the capacity of primary care physicians to provide appropriate, evidence-based behavioral health services to their patients and the capacity of MH/DD/SAS provider to screen and refer for physical illness. A second grant funded project, the Academy’s Health Disparities Initiative, also held initial educational sessions at the 2006 Annual Meeting. Funded by the N.C. Health and Wellness Trust Fund, the Academy’s Disparities Initiative hopes to provide family physicians with the tools and knowledge needed to provide culturally appropriate care and therefore help eliminate health disparities in North Carolina. The initial training included a general session focused on the federal CLAS (Culturally and Linguistically Appropriate Services) Standards and a more indepth workshop utilizing video vignettes to illustrate culturally appropriate care. Zori Rodriguez, MHA, AAFP’s Manager of Health Disparities, presented the general session and served as a panelist for the workshop, which was attended by approximately 25 Academy members. Other panelists included Karen L. Smith, MD, a past president of the Academy, and two representatives of the Carolinas Center for Medical Excellence. The Health Disparities Initiative will now enter a new phase with pilot practice-based initiatives. Members wishing to receive additional information about either of these projects should contact Greg Griggs, MPA, CAE, Director of Professional Services, at 919-833-2110 or ggriggs@ncafp.com.

ACADEMY LEADERS PARTICIPATE IN WORKFORCE SUMMIT Representatives of the Academy’s leadership, including NCAFP President Michelle F. Jones, MD, recently participated in a day-long summit on the primary care and specialty health care workforce in North Carolina. Current research indicates that physician growth is no longer keeping pace with population growth in our state. As a result, the N.C. Institute of Medicine has conducted a year-long effort to study future supply needs for health care professionals in North Carolina. The effort, including the summit that released preliminary recommendations, is funded by the Kate B. Reynolds Charitable Trust. The overall study sought to identify potential provider shortages by both specialty and geography with the intent of ultimately developing a plan of action before the shortage becomes a statewide crisis. The study examined

past and current efforts to recruit and retain healthcare professionals in North Carolina, including in-state academic training and residency programs. Some of the preliminary recommendations released at the summit include: • Increasing the supply of medical students by developing a new medical school and/or increasing the class size in existing medical schools; • Increasing the number of residents trained in North Carolina; • Developing new efforts to retain physicians who train or move to North Carolina; • Increasing the availability of non-physician providers including nurse practitioners and Physician Assistants; • Recruiting healthcare professionals from outside of North Carolina to practice in North Carolina; • And developing new models of care that increase the effectiveness and efficiency of the healthcare system in the state. For a complete copy of the report and background materials that the study group has considered over the last year, visit the Institute of Medicine’s website at www.nciom.org/projects/supply/primary_specialty.html. Additional comments will be forwarded to the Institute of Medicine in the coming months.

ACADEMY COUNCILS HOLD PRODUCTIVE MEETINGS DURING WINTER FAMILY PHYSICIANS WEEKEND Each of the Academy’s seven standing Councils held meetings during the Winter Family Physicians Weekend at the Grove Park Inn in early December. A sampling of the actions taken by the Councils and ultimately acted upon by the Academy Board is included below: • The CME Council approved utilizing an audience response system at the 2007 Spring Family Physicians Weekend to give participants a more interactive experience during educational sessions. In addition, the Council will begin asking speakers to address coding issues during their presentations to make the information as practical as possible to all attendees. • The Child and Maternal Health Council asked the Academy to pursue reinstatement of funding for the Rural Obstetrical Care Initiative as part of its government affairs efforts in 2007. The ROCI program provided incentives to help reduce the cost of malpractice insurance for physicians providing OB care in rural areas. • The Government Affairs Advisory Council discussed ways to increase payment for services to family physicians, as well as the state of family medicine education in North Carolina, particularly efforts to help reinstate the residency program at Duke University. • The Health Disparities Council reported that a representative of the Academy had been asked to present to students at ECU’s Brody School of Medicine as part of the 2007 Diversity Week. The group also discussed ongoing efforts to educate member physicians about the Culturally and Linguistically Appropriate Services (CLAS) Standards. • The Health Promotion and Disease Prevention Council recommended supporting the N.C. Division of Public Health’s efforts to obtain $4 million in new funding from the General Assembly to fund a fulltime health promotion coordinator in each county. • The Mental Health Council discussed resources that could be added to the ICARE Partnership’s website to assist primary care physicians with referrals to mental health/behavioral health professionals. The Council recommended that the resources include information on billing and coding for mental health services. • Finally, the Professional Services Council recommended writing a letter to Blue Cross Blue Shield of North Carolina asking that the insurer withdraw implementation of a new Diagnostic Imaging Management Program.

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