Delegates Adopt Measures to Improve Patient Care, Communication With Colleagues

Continuity of care, education resources, vaccines, blood donation and connecting with colleagues: All were topics discussed by delegates during various reference committee meetings and business sessions at the 2011 National Conference of Special Constituencies here on May 5-7.

During hearings of the Reference Committee on Education, the Reference Committee on Health of the Public and Science, and the Reference Committee on Organization and Finance on May 6, representatives from the gay, lesbian, bisexual and transgender, or GLBT; international medical graduate, or IMG; minority; new physician; and women's constituencies were outspoken about issues they want the AAFP to address during the coming year.

Although delegates discussed a variety of issues -- from modeling healthy lifestyles, to recognition for mentors and residency programs, to more business management education opportunities -- during the Reference Committee on Education hearing, the most spirited discussion was sparked by a resolution addressing health care for seasonal and migrant workers.

The resolution called on the AAFP to provide education to members to make them aware that many seasonal and migrant workers may only have insurance coverage during certain times of the year and asking that such workers be flagged in electronic health records to ensure they receive continuity of care in terms of managing chronic diseases.

Resolution co-author Elene Brandt, M.D., a GLBT delegate from Salinas, Calif., noted that most of her patients who are seasonal workers have insurance from May to December, but the rest of the year, they tend to stop taking their medications for chronic diseases.

Based on limited testimony, reference committee members recommended that the resolution not be adopted. They pointed to the AAFP's annual national and regional CME assessments that inform decisions about what CME the AAFP offers. "Migrant health and chronic disease management are included in the national and regional surveys," the committee noted in its report, adding that if these topics become priorities for members, the AAFP will offer relevant CME.

But the resolution's co-authors brought the measure up again during the May 7 business session. Theresa "Tess" Garcia, M.D., a minority delegate from Grain Valley, Mo., said she considered the reference committee's statement on the topic not being a priority for members "disingenuous."

"The issue has just arisen as a priority," said Garcia.

Brandt agreed, pointing out that lack of awareness was part of the problem. Other delegates noted that although headlines on the migrant population might be localized to a few states, problems with health care for these individuals exist in other places, as well, but it is more of a hidden problem.

Rachel Franklin, M.D., a women's delegate from Oklahoma City, said she disagreed with some of the assumptions of the reference committee. "Patients who live in the shadows often will not come to the attention of a typical physician," she said. If the AAFP waits until a needs assessment tells them education is needed, there will be a delay in providing action.

Marguerite Duane, M.D., M.H.A., a women's delegate from Washington, D.C., suggested adding the words "transient populations, e.g., seasonal and migrant workers," to the resolution to cover all transient populations, including retirees, truck drivers and other groups who often move around the country seasonally. The amendment to the resolution was adopted, as was the resolution itself.

Other resolutions adopted by delegates included a substitute resolution that asks the AAFP to provide evidence-based CME on alternative forms of pain control, such as acupuncture, yoga, pain psychology and compound medications.

"Our education is mostly pharma-based," said resolution co-author Lori Carnsew, M.D., a women's delegate from Liberty, S.C. "We haven't had training in areas that are not drug-related, and we need resources for that kind of training."

Delegates also adopted a resolution asking the AAFP to create a "toolkit for FPs to provide age-appropriate, evidence-based sexual health education in their communities." Such a toolkit could be modeled on the AAFP's Tar Wars program, the education reference committee noted in its report.

Resolution co-author Joanna Bisgrove, M.D., a new physician delegate from Fitchburg, Wis., said she was concerned about the lack of standardized, age-appropriate sexual education for children in individual communities. In its report, the reference committee agreed, noting, "Promoting community involvement is important for the AAFP."

Among resolutions considered during the Reference Committee on Health of the Public and Science hearing, one that generated a good deal of discussion called on the AAFP to educate physicians about the use of quadrivalent human papillomavirus, or HPV, vaccine in men who have sex with men. It also called on the Academy to work with organizations, such as the CDC's Advisory Committee on Immunization Practices, to increase vaccination rates of men who have sex with men and to advocate for insurance coverage for HPV for all populations in which it is indicated.

Laura Jordhen, M.D., a GLBT delegate from Portland, Ore., and co-author of the resolution, testified that men who have sex with men have a 36 percent higher prevalence of HPV infection than do heterosexual men. The AAFP should educate members to help raise vaccination rates, said Jordhen. "To make it happen, advocating for insurance for HPV vaccine is an important part because that will be a barrier for many of our patients."

In the end, delegates adopted a substitute resolution that emphasizes that any Academy advocacy efforts regarding increasing vaccination rates in men who have sex with men or seeking insurance coverage for HPV vaccination for all indicated populations should be "based on clinical evidence."

NCSC delegates also adopted another substitute resolution introduced during the same reference committee hearing that calls on the Academy to request that the FDA's Blood Products Advisory Committee and HHS' Advisory Committee on Blood Safety and Availability eliminate barriers to blood donation that are not evidence-based by changing their current lifetime deferral for men who have sex with men to a period of only 12 months.

The Reference Committee on Organization and Finance addressed a number of resolutions that dealt with reaching out to colleagues via the AAFP's new online, members-only community, AAFP Connection.

AAFP Connection currently has five established AAFP member communities: rural medicine, clinical procedures, EHR and health IT, emergency medicine/urgent care, and marketing research. Individuals signed up for these communities have an opportunity to exchange information, establish relationships and discuss various issues with like-minded colleagues.

In recognition of this new opportunity, delegates adopted three resolutions that call on the AAFP to establish a women's community, a community for business management, and a community for leadership and advocacy.