Focus on Research and Evaluation
Family Medicine is proliferating worldwide. These sessions profile the growth, development, and lessons learned in the expansion of family medicine and primary care globally.
Workshop sessions that focus on clinical issues are denoted with an asterisk (*).
Thursday, September 8, 2016, 10:15–11:15 a.m.
Room Location: Roswell
Jessica Evert, MD; and William Cherniak, MD, MPH, BS, CCFP
Global health competencies and learning objectives for pre-professional and lifelong learners are emerging as an important construct for teaching global health. Many of these competencies sets originate in the global north. This study represents the effort of researchers from nine countries to begin to characterize host community perspectives of how learners should develop during and prepare for global health opportunities. Over 150 respondents from 20-plus countries participated in the study that sheds light on competency-based global health education.
Thursday, September 8, 2016, 11:20 a.m.–12 p.m.
Room Location: Techwood
Mark Shaffer, MD; Heather Brown, MD; Chloé McCoy; and Prosper Bashaka, MD
Trauma is a leading cause of morbidity and mortality throughout the world and identifying individuals with visceral injury early can be critical to survival. Point-of-care ultrasound is one solution to identifying such injuries. In September 2015, ultrasound-trained family medicine and emergency physicians from the U.S. and Dar es Salaam, Tanzania, joined to perform a five-day emergency ultrasound course for eight physicians in the remote area of Mbeya, Tanzania. The course blended didactic sessions with practical training incorporated into the physicians’ normal workflow. Impact on ultrasound knowledge was assessed using pre- and post-test evaluation; provider skill was evaluated using a standardized patient encounter; and attitudes towards ultrasound were assessed using a post-training questionnaire. All physicians successfully passed their practical examination and, on average, doubled their written ultrasound test scores. Despite emphasis on hands-on training, the dominate course feedback was to include even more time practicing under supervision.
Thursday, September 8, 2016, 2:15–3 p.m.
Room Location: Roswell
Mark Ryan, MD, FAAFP; Lipi Gupta; and Wendy Sun
Asthma is a significant public health issue in developing nations, and appropriate preventive and rescue treatment is often difficult to obtain. Many patients who present to short-term medical trips in developing nations have a chief complaint of “gripe,” a constellation of cough, congestion, and other respiratory symptoms. Given the episodic nature of short-term medical trips, accurate identification of asthma among those patients presenting with “gripe” is challenging, but would provide an opportunity to provide patient education, preventive care (including controller medications for asthma), and appropriate recommendations for follow-up care. This session will describe an efficient and accurate approach to screening for asthma among pediatric patients presenting to a high-volume, short-term medical trip, as well as a physical exam-based approach to increasing the probability of asthma, which may help direct care. This approach may be applicable to short-term medical trips in other locations.
Friday, September 9, 2016, 9–10 a.m.
Room Location: Kennesaw
Creating Practice-Based Research Networks: Considerations for Family Medicine Led Global Health Research
Jessica Evert, MD; and Kim Kimminau
Practice-based research networks have been very important in the ability to leverage the strengths of family medicine to capture impacts and evaluation of clinical care. This session will be a workshop to discuss the logistics of setting up a practice-based research network and a brainstorm to consider how this could be done for international family medicine practices.
Friday, September 9, 2016, 10:15–11:15 a.m.
Room Location: Inman
Roger Huijon, MD; Heena Panchal, MD; Mark Meyer, MD; and Lindsay Nakaishi, MD
This is an update of work presented last year. At a rural clinic in Honduras, a screening intervention using general anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) instruments revealed a high prevalence of anxiety and depression among the clinic population. In consultation with the village health committee, a two-pronged approach was devised. We collaboratively designed and implemented a brief educational curriculum for our Honduran provider colleagues. We also formed a focus group from interested members of the community to assess local attitudes toward and understanding of mental health issues. We will discuss the conceptualization and implementation of our educational intervention, address gaps, and consider options going forward. We will also present themes emerging from the focus group and discuss plans for continued community engagement. Finally, we will present potential future directions.
Patrick Jenkins, III, MD; Lauren Jenkins, MD; Ije Okereke, MD; Kelli Savia, DO; and Mark Humphrey, MD MPH
As may be expected in a country considered one of the poorest in the Americas, Nicaragua's health care system leaves an estimated 40 percent without access to adequate care. Since 2008, OneWorld Health (OWH) has been tackling this disparity. In February 2016, an interdisciplinary team set out to survey Tola's population to help OWH determine its health care needs. A two-stage cluster sampling technique was implemented where eight of the 47 Tola neighborhoods were surveyed. Questions included household size; number, location, and reasons for health care visits; satisfaction; unmet needs; and perception of services needed. We found this population was similar to population data regarding health care needs going unmet compared to Pan American Health Organization (PAHO) data. The population was similar to a OWH's previous rural town survey in terms of chronic diseases such as hypertension, diabetes mellitus, and chronic kidney disease, but different compared to World Health Organization (WHO)/PAHO data.
Friday, September 9, 2016, 11:20 a.m.–12 p.m.
Room Location: Roswell
Where do Generalist Doctors in Cambodia Work? An Employment Profile of Working Physicians who Graduated from the University of Health Sciences from 1999 to 2012
Laura Goldman, MD and Jeff Markuns, EdM, MD, FAAFP
Two decades of war in the 1960s and 1970s resulted in decimation of the health care workforce in Cambodia. As a result, the health care system is underdeveloped and little is known about the provision of primary care. Medical schools lack well-trained teachers, and in particular, hospital-based teachers with no incentive to teach end up hampering primary care training. To shed light on the employment patterns of physicians and the quality of training, the University of Health Sciences, in collaboration with Boston University, surveyed 428 alumnae, 79 who were physicians. Information gathered include type of practice, hours worked, income, and satisfaction. Many physicians reported working two jobs. Data is broken down by gender and specialty. Quality ratings of the university were assessed, and reveal poor ratings in the areas of technology, library resources, facilities, and administrative support. Challenges to conducting international research will be discussed in relation to flaws in the methodology.
Friday, September 9, 2016, 2:30–3:15 p.m.
Room Location: Inman
Childhood Illness in an Underserved Neighborhood in Beirut: Health Practices and Barriers Faced by Lebanese Residents and Syrian Refugees*
Lara Jirmanus, MD; Jinan Usta, MD, MPH; and Micheline Ziadee
The Syrian refugee crisis has been described as the worst of our time. Neighboring countries struggle to serve their own populations in addition to 4.6 million Syrian refugees. We explored causes of childhood illness, management practices, and barriers to care among Syrian refugees, Lebanese, and Dom (Middle Eastern Roma) residents of an urban slum in Beirut, Lebanon. Six focus groups (n=49) and ten interviews were conducted in Arabic, and transcripts were coded by three independent coders using Dedoose software. Participants emphasized social determinants as the primary cause of disease. All participants highlighted cost as the primary barrier to care, and described poor or humiliating treatment by health care providers. We describe health beliefs and practices, which may supplement the knowledge of providers caring for Syrian refugees and asylum seekers. This study demonstrates the similar challenges faced by the Syrians and host communities, emphasizing the importance of addressing their needs together.
Saturday, September 10, 2016, 10:15–11:15 a.m.
Room Location: Roswell
Jeff Markuns, EdM, MD, FAAFP; Nguyen Hoa, PhD; Nguyen Minh Tam; Wim Peersman; and Anselme Derese, MD
The need to measure the quality of primary care systems is becoming increasingly important with new efforts to promote improvement in comprehensive health outcomes, such as the United Nations sustainable development goals in health and the Primary Health Care Performance Initiative (PHCPI). The Primary Care Assessment Tool (PCAT), initially developed by Barbara Starfield, has been one important tool to try to measure the quality of primary care, and since adapted to a variety of countries around the world. In this session, we will share our experiences in trying to apply the PCAT to Vietnam, the approach used, challenges faced, and the validation process used to establish a useful tool for measuring primary care quality in Vietnam. The session will begin with a brief review of the tool and existing literature, followed by examples and issues identified in Vietnam, as well as how these might be applied elsewhere.