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«Annual Report 2004-2005 Mary Jo Welker, MD, Chair Department of Family Medicine 2231 North High Street Columbus, Ohio 43201 Letter from the Chair The ...»

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Drs. Gabel and Welker Lead Podogeriatrics Curriculum Initiative - The Aging Foot: An Interdisciplinary Perspective resulted from a collaborative effort between The Ohio State University College of Medicine and Public Health, Ohio College of Podiatric Medicine, Ohio University College of Osteopathic Medicine, and Western Reserve Geriatric Education Center.

Funded in October 2001 by HRSA for $485,966, Drs. Gabel and Welker were the Principal and Co-Principal Investigators of the three-year project. The project team of allopathic, osteopathic, and podiatric physician educators, plus a number of other collaborators, created a comprehensive graduate physician-training program to teach podiatry, family medicine, and internal medicine residents about foot care for older patients. The Aging Foot: An Interdisciplinary Perspective contains 15 chapters

that address issues relevant to foot problems encountered in the primary care of patients:

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Included with The Aging Foot are two informative CD-ROMs. The Interactive Guide to Physical Examination is a multimedia program designed to assist trainees in learning whole-body physical assessment through the use of audio and video clips and interactive modules. The Podiatric Procedural Video Library contains video demonstrations of treatments discussed in the book, as well as the answer keys for the pretest and post-test from the appendices.

Dr. Knutson Heads Innovative Predoctoral Programs - Dr. Doug Knutson completed a major grant project, Ohio State’s Four-Year Family Medicine Curriculum: C.A.S.E. (Comprehensive Active Student Education) and is about to undertake a similar large-scale grant project, Teaching to the CORE: Using Core Competencies Without Losing Core Values. Both are federal initiatives, the first one funded for the past three years for $604,465 and the second one funded for the next three years for $707,768.

The first project, Ohio State’s Four-year Family Medicine Curriculum: C.A.S.E. (Comprehensive Active Student Education), had as its purpose to further enhance the Department’s leadership role within The Ohio State University College of Medicine Department of Family Medicine Annual Report 2004-2005 and Public Health in the development and implementation of innovative, technology-driven, case-based, primary care educational models. Dr. Knutson and his project team developed cutting-edge educational initiatives emphasizing a patientcentered focus regarding disease management and disease prevention in response to national goals and health priorities.

This work was based on a very successful preceding project that focused on designing, developing, and creating an interactive CD-based means to teach physical examination to medical students as well as other health professional students. The patient centered medicine curriculum was restructured, and Web-based patient interaction videos allow students to more fully understand basic and more complex clinical encounters. Much attention, national and international, has been directed toward the Department as a result of this work.

Teaching to the CORE: Using Core Competencies Without Losing Core Values has as its purpose to enhance current medical school curriculum at Ohio State, focusing on the core competencies identified by the ACGME, while creating a medical school environment that allows students to retrain the values of altruism and service  values drawing students to primary care. This project includes initiatives that will enhance curriculum throughout all four years of medical school.

Drs. Miser and McDougle Train Health Educators in Bioterrorism Preparedness – The Department led an OSU Medical Center consortium effort to establish and maintain The Ohio Center of Excellence in Education for Bioterrorism Preparedness and Response under a 2-year, $1.25 million grant from the U.S. Department of Health and Human Services.

Drs. W. Fred Miser, Principal Investigator, and Leon McDougle, Co-Principal Investigator, were assisted by Department faculty members, Drs. Larry Gabel and Doug Knutson, and Ms. Donna Knisley, Project Administrative Associate. The consortium consists of The OSU Medical Center, Ohio University, the University of Cincinnati, NEOUCOM, and the Ohio Department of Health. The Center and its bioterrorism education program have received excellent coverage in local media.

Products of this project, including a PowerPoint presentation titled, An Introduction to the Threat of Bioterrorism – What Every Health Care Provider Should Know, and small group cases dealing with anthrax, smallpox, and non-nuclear explosions, have been integrated into the curriculum for medical, nursing, and allied health students. As they were putting the final touches on this two-year curriculum development project, Drs. Miser and McDougle submitted a $ 4.7 million application, Preparing Ohio Health Care Providers for All Hazards. This three-year project proposes to establish a statewide collaborative, interdisciplinary and multi-institutional effort to provide coordinated, continuing education to Ohio’s healthcare professionals to prepare them to address the health consequences of and response to terrorist acts and other public health emergencies such as natural disasters and accidents. Targeted professions include physicians, nurses, allied health professionals, dentists, mental health professionals, optometrists, pharmacists, and veterinarians.

Resident Research Projects

Completing a quality scholarly project is a requirement of all graduating Family Medicine residents. Drs. Larry Gabel, W.

Fred Miser, and Randy Wexler, and Ms. Jennifer Lehman developed and organized a research curriculum to assist the residents in achieving that requirement. The third-year Family Medicine residents presented their research projects at the 6th Annual Department of Family Medicine Resident Research Symposium on April 28, 2005. A summary of these projects follows.

1. Dr. Omar Awale, assisted by Drs. Larry Gabel, W. Fred Miser and Kent Schwirian, previously of the Department of Sociology, presented his project, Prevalence of Diabetes Mellitus in Somali Immigrants Living in the Columbus Metropolitan Area. Dr. Awale developed a community-based epidemiological study to determine the evidence of the rising prevalence of Type 2 diabetes in the Somali community living in Franklin County, Ohio. Anthropometrics (height, weight, BMI, waist-to-hip ratio), fasting blood samples, blood pressure, and behavior risk factors will be assessed to identify the most common aspects leading to diabetes prevalence in this population. Working with the Minnesota Department of Public Health, these investigators are pursuing funding for this project.

2. Dr. Matia Mulumba, mentored by Dr. Rob Crane, shared his literature review entitled, The Impact of Excise Taxes and Counter-Advertising on Youth Smoking. They evaluated the impact of excise taxes and counter-advertising on the rate of teen smoking in various states. Their study revealed that when adequately funded, comprehensive state tobacco prevention programs quickly and substantially reduce tobacco use. They also concluded that raising cigarette taxes is one of the most effective ways to prevent and reduce smoking, especially among children and adolescents.

3. Dr. Anita Ndife, with the assistance of Dr. W. Fred Miser and Ms. Jennifer Lehman, presented The Skinny on LowCarbohydrate and High-Protein Diets: Knowledge, Attitudes, and Practices of Family Physicians. They surveyed family physicians within the OSU Primary Care Network about their attitudes, knowledge, and practices toward low carbohydrate dieting. This survey revealed that most physicians were knowledgeable about low carb dieting and were likely to recommend low carb dieting to obese patients with or without co-morbidities.

4. Dr. Olusegun Osinbowale, with the assistance of Dr. W. Fred Miser, presented their project entitled, How Do the Attitudes of Family Physicians Toward Cancer Screening Prevention Affect the Practice of Screening for Cancer in Patients Age 55-69 Years? The Ohio Academy of Family Physicians Foundation and the American Cancer Society Department of Family Medicine Annual Report 2004-2005 funded this pilot project. By performing a chart review and survey of family physicians of the OSU Primary Care Network, they assessed the knowledge, attitudes, and self-perceived skills of physicians toward breast, prostate, and colon cancer prevention; determined the rate of screening for breast, colon, and prostate cancer in those age 50-69 years of age who receive their care from these physicians; and evaluated whether health care disparities existed in cancer screening in regards to gender, race, and insurance status. Breast more than colorectal and colorectal more than prostate cancer screening practices were deemed effective. Less than 50% of patients are being screened. No racial disparities were identified in screening practices.

Dr. Rupal Oza, in conjunction with Drs. Randy Wexler, Doug Knutson, and W. Fred Miser and Drs. Bill Abraham and 5.

Srinivas Iyengar from the Division of Cardiology, presented her project, Using B-Type Natriuretic Peptide as a Screen for Asymptomatic Heart Failure in Hypertensive Patients with Either Ischemic Heart Disease and/or Diabetes.

This project is described in more detail above.

6. Dr. Antonio Phillips, with the assistance of Drs. Glen Aukerman and W. Fred Miser, and Ms. Jennifer Lehman, presented Family Physicians’ Attitudes Towards Complementary and Alternative Medicine. Their survey of family physicians from The OSU Primary Care Network found that family physicians, as a group, are knowledgeable about and have a favorable attitude towards CAM. However, there is a difference based on the age of the physician, with those “younger” physicians having a more favorable attitude than their “older” colleagues.

7. Dr. Mounir Sanhaji, in conjunction with Drs. W. Fred Miser and Larry Gabel, and Ms. Jennifer Lehman, presented The Management of Chronic Low Back Pain with Controlled Substances: Practice Compliance with State Medical Board Rules. Using guidelines established by the Ohio State Medical Board, their medical record review of patients with chronic low back pain found that documentation of the use of controlled substances was good, but not perfect.

Recommendations were made as to how family physicians can be compliant with the regulations yet adequately treat their patients with chronic non-cancer pain.

Summative Listing of Research Efforts by Department of Family Medicine Faculty The summative delineation on subsequent pages provides details of research efforts undertaken by departmental faculty and demonstrates not only the efficacy of our faulty members’ collaborative efforts but the richness of those efforts. Department faculty names are highlighted for each citation. From this summary it is evident that faculty in the Ohio State Department of Family Medicine regarding the research and scholarship element of our departmental mission is making much progress.

Research in Development

1. Coyle JD, Miser WF, Brackett C: Prevalence and Management of Chronic Kidney Disease in an Adult Primary Care Patient Population. This will entail a retrospective chart review to assess prevalence and current management of chronic kidney disease in the adult patient population at Rardin Family Practice Center. The results will serve as preliminary data for related grant applications.

2. Coyle JD, Brackett C, Miser WF, et al: Enhancing Medication Adherence in Patients with Type 2 Diabetes Mellitus. The investigators are developing a comprehensive strategy for improving medication adherence in patients with type 2 diabetes mellitus. The strategy is based on health behavior theory, including a stages of change model, and incorporates motivational interviewing approaches.

3. Fahey P, Miser WF, Melwani G, Smith V, et al: Management of Hypertension and Dyslipidemia in Individuals Who Receive Their Care at the Columbus Neighborhood Health Centers. The purposes of this proposed project will be to 1) update the existing CNHC 2001 database, to allow further analysis of this group, 2) establish a new linkage between the patient care data and lab data, thus creating a more powerful database, and 3) perform a proof-of-concept study regarding the care of those with hypertension and dyslipidemia.

4. Bell H, Gabel LL, et al: Creating HOPE: Reforming Medical School Curriculum Around Behavioral and Social Sciences.

This effort resulted in a collaborative $1,278,610 application submitted to the NIH in January 2005.

5. McDougle L, et al: Investigation of the Relationship Between Pre-Admissions Variables and Medical School Performance as Measured by USMLE Step 1 Examination for Underrepresented Minority and Economically Disadvantaged Students Who Have Completed a Post-Baccalaureate Training Program Through Ohio State University College of Medicine and Public Health. This IRB-approved project started in April 2004, with data collection ongoing.

5. McDougle L, et al: M.D. Camp for Underrepresented in Medicine and Disadvantaged Scholar Students. This longitudinal six-year project is expected to begin in April 2006.

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7. Schwirian K, Schwirian P, Miser WF, Gabel LL, et al: Prevalence of Type 2 Diabetes Mellitus in Somali Immigrants Living in the Columbus Metropolitan Area. This project will explore the prevalence of this chronic disease in a group not previously known to commonly be afflicted with diabetes.

8. Wexler R, Feldman D, et al: Hypertension Guidelines and Treatment: Physician Attitudes and Beliefs. This project will evaluate physician understanding and use of hypertension guidelines in their everyday practice.

Research Applications Submitted for Funding - Pending

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2. Gabel LL: The Ohio Telemedicine, Education and Linkage Program (Ohio TeleHELP). $100,000, submitted to the Medicaid Administrative Claiming Project.

3. Gabel LL: The Ohio Telemedicine, Education and Linkage Program (Ohio TeleHELP): A Proof-of-Concept Study.

$150,000, submitted to the President’s Initiative.

4. Miser WF, McDougle L: Preparing Ohio Health Care Providers for All Hazards. $4,382,532, submitted to the Department of Health and Human Services, Health Resources and Services Administration, Bioterrorism Training and Curriculum Development Program.

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