The 21st National Conference on Primary Health Care Access met in six breakout sessions on Monday, April 12, 2010. The following question was posed to each of five teams:
From your experience, describe models of community-based medical education that have had a positive impact in a geographical area’s primary care workforce and community health. Identify sites for training physicians whose accomplishments you believe deserve national recognition?
Table 1. Frey (Lead), Lee, Osborn, Palafox, Vega
Group Health (Washington)
Critical Access Hospital
Song-Brown grants (California)
What effect of ALOS/Integrated Care Models? Leadership Training
Public perception i s8important
Community-based —-> primary care workforce
University programs – scholarly activism
2. Kasovac (Lead), Casey, Coleman, Hara, Kimball
Kentucky – Skycap, Lay health visitors –> Kentucky Homeplace; C entering Pregnancy Project; ___ visits for ____ dental cleaning and flouride –> postnatal bonding, breastfeeding education
Latino Health Access – promontores in Orange County, California; UCLA Mobile Clinic; Venice Family Clinic; White Memorial Family Medicine Residency; Kaiser Community Medicine fellowships; Albert Schweitzer Fellowship for health professional students; X-rays read by Kaiser for Skid Row Los Angeles
Home exercise programs in areas where the neighborhood is dangerous
Omaha: all professional schools provide a day of health screening
Phoenix – high school physicals continued by Phoenix Sun’s team physician – 2000 physicals by medical students and residents
Louisville – self management program
3. Troy (Lead), Erickson, Fernandez, Freeman, Webster
Define positive impact. What are the incentives? How do we know there has been positive impact? Methods for evaluating behavior change are okay. But how do we define outcomes?
–> one measure: where do they end s p practicing (in those communities?)
[Freenan] one model: open up a four year campus in a ___ area. Selina (Lake Wichita) —> Problem Based Learning (PBL) model with teleconferencing —> Family medicine residency that meets the LCME mrequirement for resident presence —> first class = 2011?
[Webster] MSU: for two years students go to community campuses. Using outcomes measure of where grads practice indicates that a significant proportion go to rural sites.
Discussed student lead/driven instructive and volunteer efforts.
Primary care workforce – easier to measure the impact on this, but no s o easy to extrapolate its impact on community health. There is data, but it’s less generalizable.
4. Fowkes (Lead), Baird, Fort, Hines, Hixon
A. Community-based educational program deserving national recognition:
Rural Primary Associate Program (RPAP) —> Kathleen Brooks, MD, University of Minnesota
The WWAMI Program of the University of Washington
University of Western Ontario
B. Worries that current budget crises – state by state – will undermine the efforts to engage “voluntar” community-based teachers.
5. Maudlin (Lead), Bejinez-Eastman, Flinders, Hansen, North
Sonoma County, California:
Santa Rosa Family Medicine Residency program works in underserved areas; graduates woften will go to underserved areas to practice, both long-term and short-term.
Anchorage Native Health Center, Alaska:
Nurse case manager —> teamlets.
Routine care going on all the time; care is being provided by everyone on the health care tea, all of the time. There is a consortium of native tribes. The health services are owned by its customers with open access to care.
The family medicine residency in Anchorage, not necessarily in the same clinic.
Most all residency programs have a positive impact on the community in which they are located.
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The following conference participants were engaged elsewhere:
Boardroom: Pugno (Lead), Babitz, Clover, Herman, Ross, Wilke, W.H. Burnett (Executive Board Meeting, Coastal Research Group)