KayCee Gardner, M.D., co-author of a resolution calling for the creation of a federal drug registry, points out during her reference committee testimony on Aug. 2 the limitations inherent in separate state registries.
Family medicine residents care deeply about their patients. That message came through loud and clear recently as residents who attended the 2013 National Congress of Family Medicine Residents spent the better part of two days writing -- and then discussing -- a myriad of resolutions that pertain to their specialty and their patients.
The congress, part of the larger National Conference of Family Medicine Residents and Medical Students, was held here Aug. 1-3.
Resolutions that were adopted will proceed along the AAFP's policymaking highway for review, referral and, when called for, further action by AAFP leaders and the AAFP Congress of Delegates.
Keeping Patients Safe
Residents took seriously their role as patient advocates, and many resolutions focused on keeping patients healthy and safe.
- Family medicine residents met recently in Kansas City, Mo., to elect resident leaders and write resolutions that could help guide AAFP policy decisions.
- Many resolutions adopted were aimed at enhancing patient health and safety.
- Residents also asked the Academy to, among other things, develop relationships with other organizations and advocate system changes to advance family medicine.
For example, Elizabeth Lynn, M.D., of the South Nassau Communities Family Medicine Residency Program in Oceanside, N.Y., co-authored a resolution regarding the dangers of a new method of alcohol consumption that involves inhaling alcohol vapors through a device known as a "hookah."
"No research is available on this topic because it's so new," said Lynn in reference committee testimony on Aug. 2. "Young girls are doing this because the method bypasses the (gastrointestinal) tract" and, therefore, also bypasses the body's natural defenses against alcohol overconsumption, such as vomiting, she added.
Lynn noted that online videos posted on a popular social media website about the topic of "smoking alcohol" had garnered tens of thousands of views.
During the business session, delegates adopted a substitute resolution that asks the AAFP to develop public education programs and an expanded policy on substance and alcohol abuse addiction to "raise awareness of the dangers of alternate methods of alcohol use, including inhalation and mucosal absorption." Residents also asked the AAFP to encourage health care professionals to facilitate research on the adverse effects of those alternate methods.
A resolution regarding OTC availability of oral contraceptive pills (OCPs) generated much debate. Resolution author Anita Ravi, M.D., M.P.H., of the Beth Israel Residency in Urban Family Medicine in New York, said she wanted OCPs to be readily available OTC to her medically underserved and younger patients. "A lot of our teen patients are not going to feel comfortable going to their physician to discuss contraceptives," she told the reference committee.
However, Megan Janson, M.D., of the Bayfront Medical Center Family Medicine Residency in St. Petersburg, Fla., expressed concern that certain groups of patients, particularly adolescents and those with low health literacy levels, could misuse OCPs obtained without a prescription. She said an office visit opens up the opportunity for patient education. For example, said Janson, during an office visit, she can tell a patient that even if she prescribes oral contraceptives, the patient still needs to use a condom.
"I'm not sure how effective the pharmacist is in providing that kind of counseling," she added.
Nikolay Teleten, M.D., of the North Shore University Glen Cove (N.Y.) Hospital Family Medicine Residency, also was concerned about patient education. "It is important to provide initial education material before the patient starts taking the medication," said Teleten, but perhaps the patient wouldn't need to continue to see the physician for medication refills, he added.
Ultimately, the residents adopted a substitute resolution asking the AAFP to develop a specific policy on access to OCPs without a prescription.
Nicholas Cohen, M.D., of the University Hospitals Case Medical Center Family Medicine Residency Program in Cleveland, testified during the reference committee hearing in favor of a resolution that would define competencies for providing obstetric ultrasound screening by family physicians.
"Is delivering babies important to family physicians?" asked Cohen. "That is the question. If we are not able to provide prenatal ultrasound, then our ability to deliver babies is at risk." Cohen argued that hospital radiology and obstetrics departments increasingly are challenging family physicians regarding their ultrasound training.
Before the start of the Aug. 3 business session, resident members of the New York AFP huddle to discuss candidates and resolutions on the consent calendar.
In the end, residents adopted a substitute resolution asking the AAFP to explore the development of specific guidelines for FP training in prenatal ultrasonography.
Another resolution asked the AAFP to advocate that a federal drug registry for controlled substances be created.
Co-author KayCee Gardner, M.D., of the Montana Family Medicine Residency-RiverStone Health in Billings, testified that even though her state maintained its own drug registry, "There is no access to other state's registries" or to information from the Indian Health Service or the Department of Veterans Affairs because of limited state funding.
Delegates ultimately adopted a substitute resolution that asks the AAFP to advocate that a federal registry that can be accessed by all licensed health care providers and pharmacists be established.
Addressing System Changes
Alexis Reedy, M.D., of the Lancaster General Hospital Family Medicine Residency, co-authored a resolution that addressed improving care coordination for patients who are frequent users of hospital ERs and other hospital services. She testified during the reference committee hearing that "a small proportion of people use an exorbitant amount of health care dollars."
Delegates adopted a substitute resolution that asks the AAFP to explore collaboration with other organizations to develop best practices for interventions to address this problem.
Another resolution delegates considered addressed the need to rebuild trust in -- and accountability for -- primary care workforce production reporting. Resolution co-author Kevin Bernstein, M.D., M.S., of the Naval Hospital Pensacola (Fla.) Family Medicine Residency, told the reference committee that some of the top-ranked medical schools in the country claim that 50 percent of their graduates enter primary care specialties.
"But when you compare their numbers to actual primary care production, some of those top 20 institutions are at the bottom of the list," said Bernstein. "It's very misleading to the public, and our taxpayer dollars should not be funding these (residency) slots if they can't be tied to funding for primary care doctors," he added.
Delegates adopted the resolution, which specifically asks the AAFP to advocate that such reporting be accurate and that physicians' specialty of choice be measured five years after graduation from medical school.
During the resident congress, Richard Bruno, M.D., debates the merits of a resolution he co-authored that aims to prevent gun violence; after the resolution was amended on the floor, residents overturned the reference committee's recommendation to not adopt the measure.
Using the Power of Debate
Some residents fought hard to breathe life back into resolutions that the two reference committees -- after sifting through all the background materials and testimony -- recommended residents not adopt.
Several resolutions were extracted for further consideration and, after additional testimony, were adopted with amendments to the original language. Such was the case with a resolution that asks the Academy to promote public health and access to medicines in all U.S. trade agreements.
The residents did the same for a resolution that directs the AAFP to explore the development of relationships with other national organizations to address gun violence prevention and to promote family physicians' role in counseling patients about gun safety.
Another amended resolution the resident congress adopted asks the AAFP to continue its advocacy regarding teaching health center programs and to strengthen the Academy's policy statement to reflect that support.
One extracted resolution that ultimately was adopted with the original verbiage intact asks the AAFP to invite student and resident input into the development of the Future of Family Medicine 2.0 project. Residents want the AAFP's Commission on Education subcommittee on resident and student issues to, among other things, involve residents and students in ongoing work to define family physicians' scope of practice and to identify key training elements necessary to achieve competency within that scope.
The resident congress adopted a number of other resolutions and substitute resolutions that dealt with a variety of issues. For instance, delegates asked the AAFP to
- explore the establishment of a liaison relationship with the American Medical Society for Sports Medicine,
- advocate that educational loan repayment options be made available to primary care physicians who provide care for Medicaid patients,
- create a policy on dietary sodium reduction in the U.S. food supply and encourage the AAFP journal American Family Physician to publish an updated review of evidence regarding dietary sodium and its effects on patients health,
- explore the creation of guidelines on patient use of smartphone applications and other electronic resources to improve patient-physician teamwork and achieve health management goals, and
- encourage the AAFP Foundation to support community outreach programs to communities with limited access to fresh fruits and vegetables.
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