 December 2002 • Volume 8 • Number 12 |
 David Satcher, M.D., Ph.D., left; Louis Sullivan, M.D., center; and Warren Jones, M.D., exchange views after their panel presentation at the Nov. 1 opening of the National Center for Primary Care. |
The nation now has a federally funded home for primary care research, training and policy analysis -- focusing especially on minority and poor populations. The Academy helped celebrate the opening of the National Center for Primary Care at Morehouse School of Medicine, Atlanta, on Nov. 1.
"The research and training going on here are invaluable," said AAFP Board Chair Warren Jones, M.D., of Ridgeland, Miss. "Your future is bright. Your work will help illuminate the path for all of us."
Former Surgeon General David Satcher, M.D., Ph.D., a family physician, directs the center. "The gap between what we know and what we do in public health is lethal to Americans, if not the world," said Satcher. "We only spend 2 percent of our budget for population-based preventive care -- that's an example of a major gap between what we know and what we do. We don't have parity of access to mental health services. We discriminate in the funding of mental health services in most states -- that's a gap between what we know and what we do."
Satcher insisted, "In a nation as prosperous as ours, there must be a way to bridge the chasm between minority and majority, rich and poor."
That's what the center is all about. It's the brainchild of former HHS Secretary Louis Sullivan, M.D., president emeritus of Morehouse School of Medicine. He convinced Congress to fund the center's creation through the Public Health Service's Office of Minority Health to the tune of $15 million. The school found donors to ante up another $5 million; the 106,000-square-foot building is paid for.
Ongoing projects
The center inherits several projects the school has nurtured. For example:
Clinical research network. Some 146 community health centers in eight southeastern states already collaborate with the new center in health disparities research. In one aspect of the work, physicians are using guidelines for treating asthma and are evaluating the guidelines' impact on patients' outcomes. "In time, we'll develop a national network for primary care research, including rural areas," said Satcher.
Minority faculty development. In 1992, the nation had 52 African-American teachers in its medical schools. Since then, Morehouse School of Medicine, a historically black institution, has trained more than 100 African-American physicians for faculty roles, said FP George Rust, M.D. He started the faculty development program, then based in the family medicine department and now located in the center.
Cultural competency. "Patient populations are changing for many family physicians," said Rust. The center offers training programs in cultural competency for practicing physicians and physician administrators. "Learning to show respect for other cultures -- seeing diversity as a strength instead of a challenge -- is useful in one-on-one doctor-patient relationships and in managing teams of professionals from different cultures," said Rust.
Mental health care
"Something I wrote about when I was surgeon general -- mental health -- is very important here at the center," said Satcher, the first surgeon general to issue reports on mental health.
"We know African-Americans are more likely to turn to their church than their doctor to deal with a mental health problem. There's a very high level of depression in African-Americans, especially in women, but the diagnosis is often missed. It has a lot to do with the difference in culture of the physician and patient," said Satcher. "Asian-Americans are more likely to completely deny the problem because in their community, it's not acceptable to have a mental health problem. So they're least likely to seek outpatient treatment."
The center will build on recent studies of relationships between mental health problems and diseases such as heart disease, cancer and HIV/AIDS.
"Until primary care physicians are more involved in early diagnosis of mental health problems and management of mental health care, we're not going to get a handle on the mental health care problem in the country," said Satcher. "There aren't enough psychiatrists. Also, psychiatrists don't get people into systems of care -- primary care physicians do that. They're the ones out there who see people who are complaining of headaches and backaches, but who are depressed."
Center-AAFP interface
The National Center for Primary Care and the Robert Graham Center (established by the AAFP in Washington) are exploring ways they might study Medicaid data sets on maternity care, focusing on care delivered by FPs and GPs. "We'll propose looking at cost, birth outcomes and prenatal care," said Ed Fryer, Ph.D., analyst at the Robert Graham Center.
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"We want to have input into laws and acts and
budgets." |
"Medicaid covers one-third of the births in this country," said Rust. "We're talking with the Graham Center about how to write articles that will make sense of high rates of low birth weight and infant mortality, as well as access to prenatal care."
Addressing similar aspirations of the National Center for Primary Care and the Academy, Jones said the new center's mission -- promoting excellence in community-oriented primary care and optimal health outcomes for all Americans -- is "a worthy and noble goal we share."
He accented AAFP's commitment to seeking access to care for all Americans: "More than 41 million Americans do not have health insurance. That's 41 million people who live in fear of a catastrophic accident that could leave their family bankrupt, 41 million who regard preventive health care as a luxury."
Policy impact
"We want to be part of the national dialogue on health policy, especially as it relates to primary care and to disparities in health," said Satcher. "We're going to write papers about it; have conferences; impact discussions at the local, state and federal level. We want to have input into laws and acts and budgets. We want to be viewed as the public health scientists that are providing input based on our experience. We want to make life better for primary care physicians whether it has to do with malpractice insurance or with being adequately reimbursed for what you do."
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Copyright © 2002 by
American Academy of Family Physicians.