Welcome to the FMCH Tuesday Talk. Please continue to send us your announcements, celebrations, and accomplishments to FMCHtuesdaytalk@umassmed.edu.
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Table of Contents
Upcoming Events
Focus of the Week - Research
Announcements
Frankly Speaking Podcast
Faculty Presentations/Publications
Clinical Services Spotlight
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Upcoming Events
Lean White Belt - Part 2
Tuesday, January 25th, 12:00 - 1:00 pm, Lynne Lombardi, MBA, Senior Lean Consultant in OPD, UMMS
Meeting ID: 191 986 273 Passcode: FMCH
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Focus of the Week - Research
Retirement of our dear colleague, Dr. Robin Clark on January 28, 2022
After 20 years serving as a leader in Research and Evaluation for the University of Mass Medical School and Commonwealth Medicine, Dr. Robin Clark will be retiring in January 2022. Dr. Clark completed undergraduate studies at Appalachian State University and received his PhD in Social Policy from Brandeis University. He specializes in the economic evaluation of health care policies and interventions, with a special focus on substance abuse, mental health and primary care. His work has been funded by the National Institute on Drug Abuse, the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Blue Cross and Blue Shield Foundation of Massachusetts and by health and human services agencies in several states. Recently, Dr. Clark’s work focused on implementation of treatment for individuals with addiction in real world settings and the impact of Medicaid policies on the accessibility, effectiveness and cost of treatment for opioid addiction. Dr. Clark also studied policies and practices that support individuals with persistently high health care costs and multiple chronic conditions. We owe Robin much for his many contributions. We thank you, Robin, from our hearts, for your many years of service, teaching, mentoring and leadership. You will be missed and we wish you the very best moving forward.
Research Collaboration Opportunity – The YogaMAT study
Family Medicine research colleagues at Boston Medical Center and Brown University are seeking clinician collaborators to support the NIH funded YogaMAT study. The study is examining how Yoga assists patients with substance use disorders on medication assisted therapy (MAT) cope with the chall enges of recovery and experiences of chronic pain. The team is seeking a clinical champion at UMass to help recruit patients over the next 24 months. The expected recruitment target is two patients per month. There will be opportunities for co-authorship in publication. Patients will be compensated for their participation and provided with a smartphone to support participation in yoga classes. There is no available funding for the clinician champion, however, a follow-up study is being planned and future funding is possible. If you are interested, please contact Suzanne Mitchell@ Suzanne.mitchell2@umassmed.edu.
Annals of Family Medicine
An important message from our clinician community is published in this month’s Annals of Family Medicine…A Special Message to the Primary Care Workforce (from Annals of Family Medicine Vol. 19, Issue 6, 1 Nov 2021) As we mark near the end of our second year living with the COVID-19 pandemic, the crisis is far from over. Despite the development of effective vaccinations, new waves of infection continue to overwhelm health care systems around the world. This pandemic is not something that happens to others. Many health care workers have been infected and died on the front lines. Those who recovered or have managed to avoid infection have watched as patients, team members, friends, and family members succumb to the disease.
There has been a great deal of focus on the supply of vaccinations, protective equipment, oxygen and ventilators, but those of us who work every day in the health care system know that it is the shortage of skilled health care team members that is crippling our pandemic response. The stress and chaos have made it more difficult for many of us to continue to show up for work every day. In a recent reflection in our journal, a longtime family physician, David Loxtercamp, wrote a moving piece recalling the importance of continuity of care suggesting that continuity is an expression of the value we place on human relationships. Such relationships are not lightly discarded, for they serve us best when our own sense of identity and purpose is tested and worn.
He writes:
By standing by our patients through their various illnesses and over a lifetime, we are given the opportunity—often many opportunities—to discover the rest of the story, learn from our mistakes, repair a misunderstanding, hear the unsaid, witness a change, and repay a debt. We know this to be true, not because of any randomized trial, but because we have known the joy and comfort of old friends, familiar landmarks, life partners and the children we raised together. And despite the toil and worry, our continuing investment in them has grown its dividend over the years.
While the news and social media highlight those health care team members whom we have lost, here at the Annals of Family Medicine we are thinking of those who are still working every day on the front lines of the pandemic. They face a triple burden: workloads have increased with departing colleagues, COVID-19 infections on the rise, and we are only just seeing the aftershocks of missed diagnosis of other diseases and conditions. Continuing to show up every day for our patients and colleagues brings purpose and meaning in some of our darkest moments.
Annals of Family Medicine strives to provide a voice for our Family Medicine community and to provide critical and timely information as we continue to work together to limit pandemic losses and to forge a new path forward for Family Medicine in the future.
In this month's online issue of Annals of Family Medicine, you can read more about how researchers are modernizing methods for studying racism and health equity.
Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research
Elle Lett, Emmanuella Asabor, Sourik Beltrán, Ashley Michelle Cannon and Onyebuchi A. Arah. The Annals of Family Medicine January 2022, 2792; DOI: https://doi.org/10.1370/afm.2792
Abstract
Differences in health outcomes across racial groups are among the most commonly reported findings in health disparities research. Often, these studies do not explicitly connect observed disparities to mechanisms of systemic racism that drive adverse health outcomes among racialized and other marginalized groups in the United States. Without this connection, investigators inadvertently support harmful narratives of biologic essentialism or cultural inferiority that pathologize racial identities and inhibit health equity. This paper outlines pitfalls in the conceptualization, contextualization, and operationalization of race in quantitative population health research and provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but rather as a proxy for exposure to systemic racism. Future studies should go beyond this proxy use and directly measure racism and its health impacts.
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Announcements
The UMass Chan Office of Communications has released a podcast about the Scribe Fellowship: UMass Chan Scribe Fellowship Podcast 1-2022 The Fellowship is under the leadership of Steve Earls and Linda Cragin in collaboration with the Office of Admissions. Drs. Elizabeth Erban, Dennis Dimitri, Fred Baker and Christina Kim are precepting the fellows. Plans to expand in the coming year are underway with Scribe America.
100 Million Mouths Campaign as part of the work of the Center for Integration of Primary Care and Oral Health, a joint venture between Harvard Medical/Dental School and our UMMS Department of Family Medicine and Community Health.
We have selected nine new state oral health education champions to add to our current five state champions in year 2. Work will be ongoing this year to assess the efficacy of Champions engaging health schools in these 14 states to produce graduates of primary care residencies and medical and nursing schools who have improved their knowledge, skill, and attitude around oral health.
The Worcester FM Residency has four new residency leadership roles open: Children’s Health Education Director, Advocacy Director and two Associate Program Director (APD) roles. In addition to being posted internally, the APD roles are also being posted externally. Please find the job descriptions attached. Email Ginny Van Duyne to express your interest and please include your CV (virginia.vanduyne@umassmemorial.org).
Suzanne Mitchell is leading the search for a mid-career, tenure track, Community Health Investigator dedicated to the conduct of research aligned with our mission emphasizing the relationship between clinical practice and community health with a focus on serving vulnerable populations and promoting health equity across the lifespan. Please see the application requirements at AcademicJobsOnline position 20374, https://academicjobsonline.org/ajo/jobs/20374. Please refer inquiries to Suzanne.Mitchell2@umassmed.edu.
Hepatitis C and General Hepatology
Project ECHO (Extension for Community Healthcare Outcomes)
You are invited to join an exciting virtual collaborative learning opportunity!
What? Hepatitis C ECHO, a virtual case-based tele-mentoring educational model
Who? Primary care interdisciplinary team members (providers, nurses, social workers, community health workers, patient navigators, etc.)
Why? Tele-mentoring model that links specialists to primary care providers (PCPs) via video conferencing from any computer; Case based, iterative learning facilitated by specialists and related experts; through guided practice, PCPs become proficient in specialty care
When? A new cohort begins Friday, February 11th, 2022, 12:30 - 1:30pm ~ with 10 sessions held bi-monthly.
Curriculum content includes:
- HCV screening
- Acute HCV
- Chronic HCV: Workup
- Treatment of non-cirrhotic patients
- Treatment of cirrhotic patients
- Monitoring during treatment
- Monitoring post treatment
- "Topic by request"
- Other hepatitides in the context of HCV/Hepatitis A&B
- Treatment of special populations
Volunteers needed for WFCC
Worcester Free Care Collaborative is always in need of volunteer family physicians and family nurse practitioners to support its mission to address needs of the uninsured and underinsured of our community. We also need help with pediatric vaccine program management. You fill find it fulfilling to address needs for vulnerable patients and work with highly motivated student volunteers. Contact student leader Tyler Healy (tyler.healy@umassmed.edu) for needs across the 6 programs or Danielle Heims-Waldron (danielle.heimswaldron@umassmed.edu) for Monday night’s Epworth program.
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Frankly Speaking Podcast
A weekly Podcast series covering newsworthy topics in primary care medicine.
Please join us for an overview: We will review the current USPSTF recommendations regarding aspirin use to reduce the risk of CVD and colorectal cancer. Additionally, we will discuss as well as the findings of the ASPREE (ASPirin in reducing events in the elderly) randomized clinical trial. Guest: Jillian Joseph, MSPAS, PA-C, presents: "Avoiding Aspiring in the Elderly: More Than Increased Bleeding Risk". - Frankly Speaking Ep 260.
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Faculty Presentations/Publications
Alexandra Boland, research coordinator working with Kate Pivovarova, published on The Mental Health and Social Media Use of Young Australians during the COVID-19 Pandemic in the International Journal of Environmental Research and Public Health. https://www.mdpi.com/1660-4601/19/3/1077/htm.
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Clinical Services Spotlight: |
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COVID-19 UPDATES
Public Health State of Emergency
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The Biden Administration extended the public health State of Emergency on January 14th for at least an additional 90 days, to be reassessed in April. HHS will provide states with a 60 days notice prior to termination of the Public Health Emergency.
- This State of Emergency has been renewed eight times since the pandemic.
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Massachusetts nurses' union is asking Governor Baker to call a State of Emergency for MA due to ongoing crises in State Healthcare facilities.
COVID Update UMMMC
- As of Monday am, there were 170 confirmed COVID cases currently hospitalized at the medical center.
- Of the 170 cases, 96 are in acute care and 36 in the ICU. Of the 170, 104 are fully vaccinated.
- COVID 7-day positivity rate is 23.0 percent.
- The test positivity for symptomatic patients is 42.8%, and 11% for asymptomatic patients (both down slightly).
Massachusetts COVID Update
- There are 13,935 new cases of COVID.
- The state 7-day average of percent positivity is 13.7%.
- There are 3,105 hospitalized patients with 446 in the ICU and 269 intubated.
UMMMC COVID Visitor Policy
Per DPH guidance, ambulatory visits are required to allow one visitor to attend an ambulatory visit with the patient. Our current guidance follows this DPH directive.
If a visitor is symptomatic per our COVID screening guidelines, a clinic may deny the visitor entrance to the visit. What most clinics are doing during these situations is asking the visitor to leave the clinical area and they are brought into the visit through phone or doximity/video means so that they can participate in the visit. In some instances, a provider may deem that the symptoms do not warrant the visitor to leave and the visitor may stay – but this is a provider decision (example – visitor was cleared of COVID infection 4 days ago but still has a cough).
We may not – under any circumstances – deny a patient a visitor based off the vaccination status of the patient or the visitor. This issue has been discussed with ambulatory and medical center leadership. This guidance aligns with DPH guidance, all the major medical centers in our area, as well as Reliant Medical Group.
COVID Treatment Center
- The COVID treatment center is working out the details for ambulatory IV remdesivir. It is currently not available for outpatients. They will announce when it is an option, and the details will be provided at that time.
- To date the center has provided oral anti-viral treatment to 42 patients. Supplies are expected to increase in the coming weeks but are still limited.
How to refer:
UMass Memorial Health Primary Care Physicians can refer patients for treatment (IV Sotrovimab and oral PaxlovidTM) in Epic by placing a referral order for Ambulatory Referral to COVID Treatment Center (previously Ambulatory Referral to Monoclonal Antibody Clinic) and entering:
- COVID diagnosis date
- Symptom onset date
- Vaccination status
- Does the patient have a recent comprehensive metabolic panel? (at least within 1 year except those with underlying renal impairment and greater than 65 years of age at least within 3 months) (to assess for Paxlovid eligibility)
- High-risk medical conditions (please add under the additional order details tab)
- Height
- Weight
PCPs are also requested to update the patient’s medication list in Epic to screen for potential drug-drug interactions with PaxlovidTM. In case any patient with a confirmed SARS-CoV-2 infection requires a comprehensive metabolic panel drawn, please call the extensions below to make an appointment with the phlebotomy draw station.
- 774-441-7797 at Benedict Clinic
- 508-334-6486 at Memorial Campus
Free home COVID tests
Masks
- The US government will soon make 400 million N95 masks available for free.
- The N95 offers a more secure fit and is thought to provide better protection; current CDC recommendation is to wear the most protective mask available.
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Wellness Resources
The Caring for the Caregiver Program provides resources such as the Caregiver Support Line (508-334-HELP) and The Employee Assistance Program (EAP) which offers a variety of services and supports (including virtual peer support and wellness tips. EAP can be accessed at 866-263-3525, or www.LiveandWorkWell.com, [company code UmassMemorial]. More information is available on the Caring for the Caregiver page.
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Yoga Classes with Dr. Liz Erban
New Yoga Link!
Our Yoga class hit the 1 year anniversary - which in zoomland means we need a new link. Happy anniversary yogis and much gratitude to our fearless leader, Liz!
Also, a great time to join, new members always welcome. Start your mid week with some relaxing yoga!
Please join department members for early morning gentle yoga, Wednesday mornings 6:30am via Zoom.
Join Zoom Meeting ID: 923 9393 3653 Passcode: 764113
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Zumba with Dr. Anna Zheng
Thursdays 6:15pm: In-person or ZOOM
Please join department members Thursday evenings at 6:15pm**(30 Anna Street: tall ceilings & spacious indoor location) and get moving with Zumba. Please note details and any changes via webpage: http://annazheng.zumba.com/. ZOOM still possible for all classes.
Much appreciation to Dr. Anna Zheng for hosting these outstanding classes. New to the class? Please email Dr. Zheng at ZumbawithAnnaZheng@gmail.com to register and complete brief health screen if it's your first class and the ZOOM link.
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