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Georgia Family Docs Work with DPH to Address Public Health

January 27, 2014

For the past 10 years, the Georgia Academy of Family Physicians (GAFP) has had a significant head start on a renewed national push in health care that calls for greater collaboration between public health and primary care.

Both the Institute of Medicine (IOM) and the Trust for America's Heath released reports on the topic in recent years. Although the IOM report acknowledged that family medicine is firmly grounded in integrated, community-oriented primary care, it also noted how few communities have successfully established long-term relationships between public health and primary care.

"In Georgia, we're lucky that the (state) department of public health has seen the value of having outside contracts with us," GAFP Executive Vice President Fay Fulton Brown told AAFP News Now.

Armed with data from the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care that show family physicians conduct more child visits than pediatricians in certain areas, including rural and medically underserved areas, the GAFP made a case for its involvement with public health initiatives that were funded by the Title V Maternal and Child Health Services Block Grant program, said Brown. Enacted as part of the Social Security Act in 1935, the Title V Maternal and Child Health program is the nation's oldest federal-state partnership.

"Because of the work the Graham Center did 10 years ago, we were able to initiate a small project that has grown to this nine- to 10-year working relationship," said Brown.

The first project was related to developmental screening, she recalled, and, since then, the chapter has had numerous contracts with the department.

Currently, the GAFP is helping launch a transition care plan for children with special health care needs who are aging into adult medical care. Working in concert with Children's Medical Services (CMS) -- Georgia's specialty health care program for low-income children with chronic medical conditions -- the GAFP is helping ensure children who previously weren't expected to live into adulthood receive the care they need to thrive, Brown said.

Project partners are creating a transition care guide for physicians to help patients, including those with cystic fibrosis and sickle cell disease, switch to an adult medical home while still accessing subspecialists as needed to manage complex chronic conditions.

The chapter already has created an online CME activity based on a lecture -- "Sickle Cell Disease: New Insights into Management" -- that was presented during the 2012 GAFP Annual Assembly. This spring, the chapter will be conducting so-called CMS Grand Rounds with family medicine residents at three Georgia medical schools. Using cystic fibrosis as the model, the Grand Rounds will include a presentation about the transition guide by a pediatric pulmonologist alongside a presentation by a parent of a youth with special health care needs.

"What we've found in the past," said Deanna Kauten, who is a public health consultant for the GAFP, "is it's good to involve residents who are just going out into practice ... catch them at the get-go."

In addition to learning about the transitional care needs of these patients, the Grand Rounds also provide an opportunity for physicians to meet the public health and CMS staff who attend. Throughout all of the GAFP's collaborative efforts with the state department of public health, a nice benefit has been the strengthened relationship between community physicians and public health officials, said Kauten.

"You know how it is once you've seen a face and a name. You're more likely to reach out and contact them," she said. "Making that introduction opens the door and makes things accessible for everybody."

Building relationships was also one of the tenets when the GAFP participated in the state's Grade Level Reading Campaign in 2012, Kauten said.

This campaign reviewed the literacy rates of third-graders throughout Georgia. What public health officials and educators wanted to know, Brown explained, was how children get to the third grade without having learned to read. It's a critical tipping point in education, said Kauten. "Up until third grade, it's all about learning to read. In fourth grade, it's reading to learn."

Only 29 percent of Georgia's fourth-graders were reading at a proficient level or better, according to 2009 National Assessment of Educational Progress statistics.

The Georgia chapter was asked to organize lunch-and-learns with family physicians in four public health districts that saw the lowest reading scores. Kauten and other GAFP nurses acting as public health consultants, often with the assistance of district public health coordinators, made 37 presentations to family physicians and their staff to discuss early identification of hearing and vision problems and developmental delays, all medical conditions that can be barriers to reading. Educational issues in Georgia and public health programs available to help families also were discussed.

Often, physicians and their staff didn't realize public health programs were available to assist their patients, Kauten said.
"The fact that the (state) department of public health has initiated and maintained our working relationship has gone a long way to connect our work," Brown said. "It's been a fantastic way to connect our doctors with the programs they have in their community."

"We can't do the work that we do without involving our partners," said Seema Csukas, M.D., Ph.D., director of the Maternal and Child Health Section of the Georgia Department of Public Health. When everyone leverages their resources, it's easier to improve on the state's health initiatives, she said. "The benefit is to the families we serve in Georgia."

- Reprinted with permission from the Georgia Academy of Family Physicians. AAFP News Now, Dec. 4, 2013, (c) American Academy of Family Physicians, Jessica Pupillo, author