WAFP February 2020 Newsletter
Health of the Public
The Latest on the 2019 Novel Coronavirus
Officials across the globe scrambled to contain the outbreak of novel coronavirus, as cases multiplied in China. The first American case occurred in Snohomish County, with 10 additional confirmed cases in Boston, Chicago, Phoenix and California.
The Centers for Disease Control and Prevention released updated clinical guidance on Feb. 1. If patients have traveled to China or have had close contact with someone known to have 2019-nCoV illness and present with a fever or symptoms of lower respiratory illness, they should be given a surgical mask and be isolated in a private room or separate area. The CDC also advises that clinicians should immediately notify the facility’s infection control personnel as well as the local health department, which will determine if the patient should be tested for 2019-nCoV.
A look at the latest developments:
In Washington and Regionally
Members of the Snohomish Health District, Providence Regional Medical Center, the Washington State Department of Health, and the CDC published their observations and treatment plan in the New England Journal of Medicine. Upon testing positive for 2019-nCoV, the patient — a 35-year old male who had recently visited family in Wuhan, China, the epicenter of the outbreak — was moved to an airborne-isolation unit at PRMC in Everett.
By the ninth day of illness, pneumonia was detected and continued to worsen. Given those parameters, clinicians opted for compassionate use of remdesivir, which had been developed to combat Ebola and the Marburg virus. By the 12th day of illness, the patient’s condition had improved.
As of Feb. 4, DOH reported pending tests for three other persons under investigation and 17 close contacts who are subject to monitoring (a drop from seven pending tests and 56 close contacts a few days prior). DOH has established a 2019-nCoV webpage for health care providers.
Both domestic and international airlines suspended direct air service to mainland China. For SeaTac, Delta has suspended flights to Beijing and Shanghai through at least April 30; Hainan Airlines has likewise canceled flights to those destinations from SeaTac. Scheduled service to Hong Kong on Cathay Pacific continues.
SeaTac is also one of 11 U.S. airports that will receive all inbound passengers from mainland China, where they will undergo screening for potential illness. Those who have recently traveled to Wuhan and cannot quarantine themselves will be house at the state’s Fire Training Academy near North Bend.
British Columbia is home to two of Canada’s five confirmed cases: a male in his 40s who lives in Metro Vancouver and, announced on Feb. 4, a Vancouver-area woman in her 50s. Like the American carriers, Air Canada also suspended nonstop flights to Beijing and Shanghai.
Around the U.S.
The federal government has enacted mandatory, 14-day quarantines for citizens who have traveled to Wuhan and anywhere else in Hubei province. Travelers to other parts of mainland China will be screened upon re-entry and may be subject to self-quarantine, also for 14 days. Noncitizens who traveled to China within the previous 14 days will not be granted entry to the U.S.
The CDC is recommending that Americans avoid all nonessential travel to China.
Americans who have been evacuated from Wuhan are being housed at military bases in California (including March Air Reserve Base in Riverside, Travis Air Force in Northern California, and Marine Corps Air Station Miramar in San Diego) until their quarantine period is over.
Outside of China, no other country has more than 35 cases; Hong Kong and the Philippines have reported one death each. Within China, there are more than 24,000 cases (as of Feb. 5) with 490 deaths.
Family Medicine Advocacy Day’s 80 Attendees Garner Support for Key Issues
The 2020 Family Medicine Advocacy Day brought a record number of WAFP members to Olympia and put Academy issues in front of legislators whose districts stretched from the Idaho border to the Pacific Ocean.
On Jan. 27, the first time in recent memory that the event was held on a Monday, the numbers of attendees nearly overwhelmed Senate Hearing Room 3. That room was the site for the morning portion of FMAD, which featured discussion of WAFP priorities and presentations from leaders in the executive and legislative branch. The guests included Judy Zerzan, MD, chief medical officer of the Washington State Health Care Authority; Rep. Eileen Cody (D-West Seattle), chair of the House Health Care & Wellness Committee; and Sean Graham, director of government affairs for the Washington State Medical Association.
The afternoon was dedicated to meetings with individual legislators. WAFP members met with key party leaders of the legislature, including Sen. Andy Billig (D-Spokane), Sen. Sharon Brown (R-Kennewick), Rep. Jenny Graham (R-Spokane), Speaker Laurie Jinkins (D-Tacoma), Rep. Joel Kretz (R-Wauconda), Sen. Marko Liias (D-Lynnwood), Sen. John McCoy (D-Tulalip), Rep. Jared Mead (D-Mill Creek), Rep. Gina Mosbrucker (R-Goldendale) and Sen. Shelly Short (R-Addy).
Donate to the 2020 WAFP Foundation Auction!
The WAFP Foundation grows family medicine in Washington state by supporting learning and development opportunities, with a special focus on opportunities for physicians in training.
Its main fundraiser is the banquet and auction at WAFP’s annual meeting — but there’s no reason to wait until May to donate your item! Our online form is live; download and fill it out today!
Any money raised from your donation will be used to support the Foundation’s mission to foster the advancement of family medicine in Washington State through support for workforce development, advocacy, leadership development and other special projects.
WAFP Board Opts to Split HOD, ASA Beginning in 2022
At its Jan. 25 meeting, the WAFP Board of Directors voted to split the House of Delegates and Annual Scientific Assembly events starting in 2022.
The move had its origins in a 2018 resolution to the House of Delegates, asking WAFP to avoid scheduling its annual meeting at the same time as Primary Care Update, a CME event hosted by WAFP’s Inland Northwest chapter. The resolution was ultimately referred to the Board, which opted to look at the larger purpose of the annual meeting and whether it was effectively serving membership.
A task force was formed, and it recommended splitting the two events. The Board acknowledged the task force’s work at its September meeting but felt it needed more information before a final decision.
Just before the vote, the Board discussed the known unknowns, as well as the unknown unknowns. After a wide-ranging discussion, the Board voted to split the two events, though the vote was not unanimous.
Residents, Medical Students Attend Annual Retreat
Nearly 100 residents and medical students from across the state descended on Olympia for WAFP’s annual Medical Student and Resident Retreat.
The keynote speakers each day focused on advocacy, both in terms of family medicine priorities and in the community at large. Other workshops included point-of-care ultrasound; dermatologic procedures; partnering with American Indian communities; vaccine hesitancy; short counseling interventions; trauma-informed care; suboxone; vaginal deliveries and repairs; paracenteses, thoracenteses and lumbar punctures; and wilderness medicine.
Resident workshops included dermoscopy, gender-affirming care, POEMS and vasectomy.
A new feature for 2020 was a social hour with tables for hot topics. Each table had a practicing physician with an interest or training in that area. Among the topics were self-care, crisis standards of care and identifying as an LGBTQ provider.
As in the past, funding from the WAFP Foundation made the retreat possible.
Members in the News
- Laura Fox, DO, was featured in a Medium post by Gov. Jay Inslee. Fox is one of 71 health care providers in the state to participate in ParkRx, which Inslee and his staff called attention to in the post.
- Lucinda Grande, MD, was part of a feature by the Associated Press looking at the impact — and lingering distrust of — buprenorphine. Though buprenorphine has proven effective in numerous circumstances, the story cites treatment programs in Missouri and the Skagit County prosecuting attorney as skeptics.
- Walt Hollow, MD, was quoted in a Seattle Times story about the closure of the city’s Thunderbird Treatment Center. Hollow, a founding member of the Seattle Indian Health Board, told the paper that the center’s closure exacerbates an already dire situation for Native Americans who need inpatient treatment.
- Paul James, MD, was the lead author for one of the 10 JAMA editor’s picks from 2010 to 2020. Then on the faculty at the University of Iowa (and now chair of the Department of Family Medicine at the University of Washington), James served as the lead author for “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults.”
- Russell Maier, MD, FAAFP, WAFP’s president, co-authored an op-ed in the Yakima Herald with former Yakima City Council member Carmen Mendez. The piece praised the success of the Access to Baby and Child Dentistry Program, particularly in Yakima County, and advocated for further state funding to expand the program’s reach even further.
- Molly Parker, MD, was an honorable mention 2019 Community Star as chosen by the National Organization of State Offices of Rural Health. Parker is a family physician with Jefferson Healthcare in Port Townsend.
- P.Z. Pearce, MD (pictured above), was featured in the Spokesman-Review upon his retirement from a long and successful career in sports medicine. Over the years, Pearce has worked with the Spokane Indians, the Spokane Chiefs, Eastern Washington University and the Seattle Seahawks. “It’s kind of hard to retire, but there is a time you have to decide enough is enough,” Pearce told the newspaper. “You want to enjoy life when you’re still healthy enough to do it.”
- Peter Rabinowitz, MD, MPH, was featured in a Veterinary Information Network story about the weekly One Health Clinic in Seattle. The clinic provides health care for homeless populations — and their pets. Rabinowitz serves as the director of the University of Washington Center for One Health Research, which administers the clinic along with Washington State University’s College of Veterinary Medicine.
- Kevin Walsh, MD, wrote a letter to the editor of The Seattle Times in response to an opinion piece by former Rep. Brian Baird. Baird posited that health care options that would eliminate private insurance are not politically viable. Walsh agreed with Baird’s premise, particularly Baird’s assertion that loss aversion would prevent large numbers of Americans from parting with their private insurance.
Primary Care Collaborative Bill Advances in Legislature
Legislation championed by WAFP, which would create a multi-stakeholder collaborative to investigate ways to increase primary care spending in Washington, has begun making its way through both chambers of the Washington State Legislature.
The Senate version, S.B. 6413, is the first mover. With five sponsors — three Democrats and two Republicans — the bill has already had a public hearing before the Health & Long Term Care Committee. During the public hearing, WAFP members Russell Maier, MD, FAAFP; Tony Butruille, MD; and Annika LaVoie, OMS-2 all testified in support of the legislation.
After amendments in executive session, the bill passed unanimously and was referred to the Ways & Means Committee.
A companion version in the House, H.B. 2615, was scheduled for a public hearing on Feb. 5. Like the Senate version, the House bill also has bipartisan sponsorship with eight Democrats and two Republicans.
WAFP Board Approves 2020 Legislative Priorities
At its Jan. 25 meeting, the WAFP Board of Directors formally approved the Academy’s 2020 legislative priorities.
The document gives Academy leaders and staff guidelines for legislation that deserves WAFP’s support. Among the key topics are reinforcing the importance of primary care in the health of Washington residents; improving access to high-quality primary care services; addressing social determinants of health and strengthening the public health system; and opposing efforts to lessen access to a family physician or making it more difficult to practice as a family physician.
Flu Activity is Elevated in Washington
As of mid-January, the most recent timeframe for which statistics are available, 52 people (including five children) have died from influenza this season in Washington. The Washington State Department of Health classifies the current level of activity as elevated.
Influenza type A has overtaken type B as the more common strain.
Nearly half of the deaths related to the flu have been in King, Pierce and Snohomish counties. Seven other counties — Benton, Grant, Kitsap, Spokane, Thurston, Whatcom and Yakima — have had at least two deaths each.
AAFP Seeks Help in Investigating Health Equity in Washington State
The American Academy of Family Physicians and the Washington Academy of Family Physicians need your help to improve health equity in your state.
By completing this short survey, you will help us better understand how to address health inequity in your communities. Our goal is to identify passionate family physicians and other “health equity champions” with whom we can develop an effective health equity plan. This short survey will ask you about you and your work, as well as your interests and expertise related to health equity.
We appreciate your time and look forward to reviewing your response.
DOH Releases Data on Drug Overdoses
The Washington State Department of Health has analyzed information from the State Unintentional Drug Overdose Reporting System (SUDORS). Between July 2017 and June 2018, the most recent period for which data was available, there were 531 unintentional overdoses in 13 counties:
- Nearly a fifth (19 percent) had previously been treated for substance use disorder; 14 percent had undergone a recent opioid use relapse; 13 percent were currently being treated for pain; 12 percent were currently being treated for substance use; eight percent had a previous overdose; and two percent had recently been released from jail.
- The majority of the 124 deaths involving fentanyl or fentanyl analogs were illicitly manufactured. Further, fentanyl was present in 35 percent of deaths involving cocaine; 11 percent of deaths involving methamphetamine; and six percent of deaths involving heroin.
- Three-quarters (76 percent) of overdose deaths occurred in a house or apartment, and emergency medical services responded to 79 percent. Forty-one percent of deaths had a bystander, but most happened alone. And only 21 percent of bystanders witnessed the drug use, and less than one quarter of those administered naloxone.
ESFCOM Seeks Faculty Preceptors Across the State
As the Elson S. Floyd College of Medicine prepares to welcome its fourth class of medical students, its mission of providing clinical experiences across the state continues — but it needs your help.
Below are five different roles the college is seeking to fill:
- Year 1 and 2 Pre-clerkship preceptor: Pre-clerkship students spend three separate weeks (Clinical Campus Weeks) each year on their distributed campuses across the state. The weeks include shadowing in the initial week with progressive independent activity (garnering a history and physical, etc.) as the students gain more knowledge and exposure. The goal is to have the student return to the same preceptor(s) each time they are sent for an experience.
- Year 3 Clerkship Preceptor (Longitudinal): Third-year Longitudinal Integrated Clerkship (LIC) preceptors spend one half to one full day a week with the same medical student over a 10-month period, starting in late June and ending in early May. The idea is that weekly exposure to a family medicine preceptor and the preceptor’s team will provide them a deeper relationship with the team and a unique understanding of family medicine as a means to improve the health of individuals and communities.
- Year 4 Family Medicine Sub-Internship, Advanced Elective in Ambulatory Family Medicine or other Family Medicine adjacent electives: Students participate in four-week immersion experiences with our community faculty partners. The Sub-I is geared for students who wish to have focused exposure to family medicine. Electives engage students in family medicine-adjacent fields (e.g. palliative care, sports medicine, addiction, advanced PCMH models) to prepare for future training. It is expected that their entrustability would be that of what is expected of a PGY-1 (intern).
- Year 4 Rural/Underserved Rotation: Every ESFCOM student is required to complete a rural/underserved rotation as part of the graduation requirements. The rotation engages students in the navigation of environments with limited resources, the courage to provide care in such environments, and the partnership necessary to work in parallel with communities to improve health for the broader population.
- Scholarly Project Supervision: ESFCOM’s MD-program students are required to complete a scholarly project as part of their graduation requirement. The project is founded on the principle that investigative experiences promote problem-solving and sharpen critical reasoning. Students have three years to contribute a minimum of 320 hours of work towards their chosen project. Supervisors will play two important roles as part of these scholarly projects: 1) guidance/content expertise and 2) feedback which will inform assessment.
If you have questions, curiosity or interest, please contact Jeff Haney, MD, director, clinical education – family medicine at email@example.com or by phone at 509-368-6860.
Majority of FM Residencies Use Telehealth, Though Not Comprehensively
Researchers at the Robert Graham Center and Emory University School of Medicine found that while a majority of family medicine residencies employ telehealth services, they do so in a limited fashion and infrequently.
“Family physicians have identified lack of training on how to use telehealth as a barrier to providing telehealth services,” Megan Coffman, administrator of the Graham Center’s health policy research, told AAFP News. “If family physicians are not provided opportunities to deliver telehealth in residency, it may prevent them from offering telehealth services to their patients once in practice.”
The research was published in the online journal Telemedicine and e-Health.
Registration is Open for 2020 Northwest Rural Health Conference
Registration is now available for the 2020 Northwest Rural Health Conference, which will be held March 23-25 at the Davenport Grand Hotel in Spokane.
The conference is the product of a collaboration between the Washington State Department of Health’s State Office of Rural Health; the WWAMI AHEC Programs; the Washington Rural Health Association; and the Rural Health Clinic Association of Washington.
AHIP Begins Testing System to Speed Prior Authorizations
By marrying available technology, America’s Health Insurance Plans is testing a system that it says will “accelerate the exchange of prior authorization requests, responses and information exchange,” according to Health Data Management.
The program — dubbed the Fast Prior Authorization Technology Highway, or Fast PATH — will try to employ electronic channels to receive, discuss and transmit prior authorization requests.
Anthem, Cambia and Cigna are among the insurance companies participating in all or part of the Fast PATH program.
VA May Have the Key for Better Medication Adherence
Research published in Health Affairs points to the Department of Veterans Affairs’ Veterans Health Administration as providing a good model to improve medication adherence.
According to Patient Engagement HIT, which reviewed the article prior to publication, the VA’s drug coverage plan has made necessary medications more affordable, among other pricing strategies. The researchers’ analysis of the data found that even the most vulnerable patients covered by the VA improved in medication adherence because of the program.