Mafp magazine jan mar 2014 for web by Missouri Academy of Family Physicians

MISSOURI

Official Publication of the Missouri Academy of Family Physicians

Family Physician

January - March 2014 Volume 33, Issue 1

66th Annual Scientific Assembly June 6-7, 2014 The Lodge of Four Seasons, Lake Ozark pg. 7

Resident Grand Rounds Renee Diamond, MD Suzanne Ozbun, MD Anne Sly, MD pg. 10

Americans Prefer Physicians for Medical Care pg. 5

MAFP Local Chapters pg. 15

Contents MAFP

Mark your Executive Commission Board Chair - Kate Lichtenberg, DO, MPH (Kirkwood) President - Bill Fish, MD (Liberty) President-elect - Daniel Purdom, MD (Kansas City) Vice President - Peter Koopman, MD (Columbia) Secretary/Treasurer - Tracy Godfrey, MD (Joplin) Board of Directors District 1 Director: Dana Granberg, MD Alternate: Jennifer Moretina, MD District 2 Director: Lisa Mayes, DO Alternate: Vacant District 3 Director: F. David Schneider, MD Director: Caroline Rudnick, MD Alternate: Sarah Cole, DO District 4 Director: Vacant Alternate: Vacant District 5 Director: James Stevermer, MD, MSPH Director: Vacant Alternate: Vacant District 6 Director: Jamie Ulbrich, MD Alternate: Vacant District 7 Director: Kathleen Eubanks-Meng, DO Director: Jeff Suzewits, DO, MPH Alternate: Vacant District 8 Director: Mark Woods, MD Director: John Paulson, DO, PhD Alternate: Charlie Rasmussen, DO District 9 Director: Vacant Alternate: Vacant District 10 Director: Mark Schabbing, MD Alternate: Steven Douglas, MD Resident Directors Imani Anwisye, MD Betsy Wan, MD (Alternate)

MAFP Annual Advocacy Day & Board Meeting February 25, 2014 Register now! State Capitol See pg.8 Jefferson City, MO AAFP Family Medicine Congressional Conference April 7-8, 2014 Renaissance Washington DC Downtown Hotel Washington, DC AAFP Annual Leadership Form and National Conference of Special Constituencies May 1-3, 2014 Sheraton KC Hotel at Crown Center Kansas City, MO

Missouri Academy of Family Physicians 722 West High Street Jefferson City, MO 65101 f (573) 635-0148 office@mo-afp.org

MAFP Missouri Reception (in conjunction with NCFMRS) August 8, 2014

Mark your calendar! Join us for the 66th Annual Scientific Assembly to be held at The Lodge of Four Seasons Lake Ozark, MO

June 6 - 7, 2014 Register online now! www.mo-afp.org

www.4seasonsresort.com

Inside this issue

MAFP Staff Education & Finance Director - Nancy Griffin Member Services/ Managing Editor - Laurie Bernskoetter

AAFP National Conference of Family Medicine Residents & Students August 7-9, 2014 Kansas City Convention Center Kansas City, MO

CME credits

AAFP Delegates Larry Rues, MD Darryl Nelson, MD Bruce Preston, MD (Alternate) Keith Ratcliff, MD (Alternate)

MAFP 66th Annual Scientific Assembly (ASA) June 6-8, 2014 Register now! Lodge of Four Seasons See pg.7 Lake Ozark, MO MAFP Board & Commission Meetings June 8, 2014

Earn up to 13.50

Student Directors Amanda Williams Sarah Williams (Alternate)

p (573) 635-0830 www.mo-afp.org

Calendar

Board Chair Update

Kate Lichtenberg, DO, MPH, FAAFP

13 Immunization Grant Opportunity

14 Nominate 2014 Family Physician of 15 the Year 16 Americans Prefer Physicians for 18 Medical Care AAFP News Release

Members in the News MAFP Local Chapters Legislative Update Annual Fall Conference Sponsors & Exhibitors Thank you

Help Desk Answers

19 Educate Students Through Tar Wars Program

Patient Hand-Offs

19 E-Cigarettes - Call For More Research

2014 Annual Scientific Assembly

2014 Advocacy Day

Resident Case Studies ProAssurance Article

Advertisements 2

Cox Health

Help Desk Answers

Missouri Health Professional Placement Services

10 Resident Grand Rounds

Family Physicians Inquiries Network

Core Content Review

Resident Case Studies Renee Diamond, MD Suzanne Ozbun, MD Anne Sly, MD

17 FP JobsOnline 20 Missouri Professionals Mutual (MPM) Missouri Family Physician January - March 2014

MAFP Board Chair Update

Kate Lichtenberg, DO, MPH, FAAFP 2013-2014 MAFP Board Chair

appy 2014! We are already off to a quick start. The Legislature is back in session and we are tracking bills. You can always look to our website for an update on what is happening. We have also had members already testify. Speaking of our website, in the next few months, you will see a new and updated website that will provide more information about the Missouri Academy’s activities. I am happy to welcome Kathleen Eubanks-Meng, DO, (Lee's Summit) as our new Co-Chair of the Member Services Commission. She will work on this publication along with the new website. Thank you to George Harris,

MD, who recently relocated from Kansas City to West Virginia to serve as Professor and Department Chair at West Virginia University. Dana Granberg, MD, Kansas City, is joining Peter Koopman, MD from Columbia as Co-Chair of the Education Commission. Dr. Granberg and Dr. Koopman will continue to work with the entire commission on our educational conferences. Many thanks to James Stevermer, MD, Fulton, who is stepping down as co-chair after many years of service to the commission. Our Executive Director Search Committee, led by President, Bill Fish,

Eubanks-Meng

Granberg

MD, has been busy reviewing resumes and interviews are beginning as we go to press. The Academy will continue to advocate for physicians and their patients across the state, and as always, please send us your suggestions.

Nominate the 2014 MAFP Family Physician of the Year Do you have an outstanding, caring colleague or physician in your community that deserves the title “Missouri Family Physician of the Year?" The Missouri Academy of Family Physicians (MAFP) supports over 1,100 active members in the work-force ~ doing extraordinary things every day. You know them, and we would like to acknowledge them. MAFP is now seeking nominations for this prestigious award. Nominate your family physician or a family physician that you know! Nominations may be made by any member of the MAFP or the public.

Visit our website at www.mo-afp.org to find everything you need: • Nomination Form • Nomination & Selection Process • Past Winners • Judging Criteria • Eligibility Requirements & Limitations You may also request information by calling MAFP at (573) 6350830 or by emailing lbernskoetter@mo-afp.org . The winner will be honored at the MAFP Annual Meeting in June 2014. (Mail, fax, e-mail or online submissions are accepted)

Nominations due by March 1, 2014 4

Missouri Family Physician January - March 2014

AAFP News Release MAFP

Americans Overwhelmingly Prefer Physicians for Their Medical Care According to AAFP News Release Topline findings: • Nearly three-quarters (72 percent) prefer physicians over non-physicians for their medical care. • Nine in 10 (90 percent) pick a physician to lead their ‘ideal medical team’ if given the choice. • By margins greater than 2-1, physicians and family physicians are seen as more knowledgeable, experienced, trusted and up-to-date on medical advances than non-physicians. LEAWOOD, Kan. — Nearly three-quarters (72 percent) of Americans and 81 percent of opinion leaders prefer to receive their medical care from a physician rather than a non-physician provider, according to a new, nationally representative survey conducted by Ipsos on health care and health care providers. This majority opinion holds true regardless of a respondent’s age, gender, race, partisan affiliation or opinion of the Affordable Care Act. “These results indicate that Americans want a physician as the leader of their health care team,” said AAFP President Reid Blackwelder, M.D. “They understand that physicians have the medical expertise necessary to know whether an apparently simple symptom signals a complication of a chronic condition, the onset of a new condition affecting multiple organs, or a short-term and easily treated problem. They want that expertise for themselves and their loved ones.” According to the survey, 9 in 10 Americans choose a physician to lead their ideal medical team. When thinking about this team, roughly the same number indicates that a physician is their top choice when they have a medical need. Given the choice of a variety of health care professionals, only 1 in 10 respondents put a nonphysician (nurse, nurse practitioner, physician assistant or chiropractor) in charge of his/her medical team. Respondents were also asked to identify the three most important characteristics they want in their medical professional. The top selections are:

• Knowledgeable (37 percent of respondents) • Up-to-date on the latest medical advances (29 percent) • Experienced (27 percent) • Someone they trust (27 percent)

most desirable health care characteristics, indicating their greater comfort with medical doctors.”

Accordingly, Americans ascribe these traits – the ones they identify as the most important for their primary medical professional to possess – to physicians by margins greater than 2-to-1 when compared to non-physicians. Respondents see physicians as the providers who are most: • Knowledgeable (77 percent) • Up-to-date on the latest medical advances (80 percent) • Experienced (77 percent) • Someone they trust (72 percent) “Americans clearly prefer that their health care be physician-led when asked to choose between physician and nurse practitioners, ” said Chris Jackson, research director at Ipsos Public Affairs in Washington, D.C. “Americans also associate the physicians more strongly with the

Commissioned by the American Academy of Family Physicians, the survey of 1,000 adults and 363 opinion leaders (see definition below) was conducted online between Nov. 8–15, 2013, and has a credibility interval of +/- 3.5 percent. To view the Ipsos survey results in more detail please visit: http://ipsos-na.com/ newspolls/pressrelease.aspx?id=6338. (http://ipsos-na.com/news-polls/pressrelease. aspx?id=6338)

Missouri Health Professional Placement Services (MHPPS) is a non-profit recruiting service dedicated to rural and underserved areas of our great state! We partner with safety-net providers and health care systems throughout Missouri to help health care professionals, like yourself, find a community that best fits your personal and professional needs. Whether it’s a scenic rural setting, dynamic urban location, or somewhere in between, we are committed to focusing on your interests and careers that count! Find Out More: Joni Adamson 573.636.4222 jadamson@mo-pca.org www.3rnet.org/locations/missouri

Family Medicine Opportunities -

Available throughout MO’s Rural & Urban Areas Loan Repayment Options Competetive Salary & Comprehensive Benefits Contact us Today!

Proud Partners:

MHPPS is located within the MO Primary Care Association

Missouri Family Physician January - March 2014

MAFP Help Desk Answers About HDAs - Resident authors work directly with a physician faculty mentor as “author teams”. Residencies meet RRC requirements, and many programs have developed their faculty into local evidence-based medicine experts!

What are the sensitivity and specificity of head CT for subarachnoid Hemorrhage? Evidence-Based Answer

Using contemporary multidetector CT scanners, the sensitivity of noncontrast CT scanning for subarachnoid hemorrhage (SAH) is 93% to 100%, and the specificity is 100%. The sensitivity and specificity are the highest within the first 5 days from onset of symptoms (SOR: B, prospective and retrospective cohort studies). In a retrospective trial conducted from 2000 to 2005 to determine the sensitivity of CT scanners in detecting subarachnoid hemorrhage (SAH), 499 patients were included who were referred to the neurosurgical unit with a diagnosis of SAH or suspicion of SAH.1 Investigators recorded clinical history, examination findings, and time from onset of symptoms (days) to CT scan. All patients had a noncontrast head CT performed using contemporary, industrystandard multidetector scanners. Patients with a positive CT scan underwent angiography. All patients with a negative CT scan underwent lumbar puncture. In 203 patients, the diagnosis of SAH was excluded by negative head CT and negative lumbar puncture. SAH was diagnosed in 296 patients based on a positive CT scan and confirmed by angiography. From day 1 of symptom onset to day 5, noncontrast CT scanning had a sensitivity of 100% and a specificity of 100%. One patient was diagnosed with SAH on day 6 by lumbar puncture, yielding an overall sensitivity of 99.7% and the specificity of 100%.1 A 2011 prospective cohort trial involving 11 tertiary care emergency departments enrolled 3,132 neurologically intact adults with nontraumatic headache to determine the sensitivity of currentgeneration CT scanners for detecting SAH.2 The time of onset of headache was recorded and all patients underwent noncontrast head CT using contemporary, industry-standard multidetector scanners. Lumbar puncture was performed at the discretion of the attending physician according to usual practice. The diagnostic “gold standards” for SAH included bleeding identified on the CT scan, xanthochromia of the cerebrospinal fluid, or spinal fluid showing red blood cells >5×106/L in the final tube plus aneurysm identified on cerebral angiography. To identify any missed SAH, investigators followed up patients with negative CT scans by phone call and records review at 1 and 6 months. Of 953 patients scanned within 6 hours of headache onset, 121 were diagnosed with SAH. All were identified by CT, so the sensitivity 6

Missouri Family Physician January - March 2014

November 2013 EBP

of CT scan in this group was 100% and the specificity was 100%. When the CT scan was performed between 8 hours and 8 days after headache onset, 17 of 119 patients with SAH were not identified on CT (sensitivity 86%). For all study patients, the sensitivity of noncontrast CT overall was 93% and the specificity was 100%.2 Jack Wells, MD, MHA Laura Morris, MD, MSPH U of MO Department of Family and Community Medicine Columbia, MO 1. Cortnum S, et al. Neurosurgery. 2010; 66(5):900–902. [LOE 2b] 2. Perry JJ, et al. BMJ. 2011; 343:d4277. [LOE 1b]

From the authors who bring you HelpDesk Answers comes a relevant, concise, and clinically useful journal to assist you in delivering the best care to your patients –all without the bias of industry support. Evidence-Based Practice is published monthly by the Family Physicians Inquiries Network. 12 issues and 48 PRA Category 1 CME CreditsTM $119 Missouri Family Physician Reader or $59 FPIN Member To subscribe, or view a sample issue, visit www.ebponline.net or call 573-256-2066.

Patient Hand-Offs MAFP

Patient Hand-Offs Submitted by ProAssurance

Patient “hand-offs” occur when the accountability and responsibility for a patient’s care are transferred from one clinician to another—a critical point in continuity of care. Hand-offs occur in all healthcare settings: a physician’s office, in noisy and chaotic emergency departments, on hospital floors, or among anesthesiologists who may be covering several surgeries at once. Ensuring accurate and thorough communication between physicians and other clinicians during hand-offs can prevent patient injury and reduce medical liability risks. Information exchanged during hand-offs should include pertinent patient information such as: patient demographics, current status, pending labs and radiology scans, medications, procedures, and the care plan. ProAssurance risk management consultants suggest the following for effective hand-offs: • if possible, communicate directly with the clinician who is assuming care of the patient; permit time for interactive communication, and questions and answers; • access appropriate medical information, including the patient’s medical record; review relevant information before and during a hand-off; • when appropriate, conduct hospital hand-offs at the patient’s bedside. This is especially important in the emer-

Earn up to 13.50

CME credits

gency department and intensive care units (permitting the oncoming physician to obtain a complete picture of the patient and allowing the patient and family to be involved in continuity of care); • ensure important patient information is exchanged in both verbal and written form; make sure the information is clear and free of confusing jargon; and • create a team environment among caregivers, to foster an environment in which opinions and observations are freely exchanged. Besides good, interactive communication, it’s important for physicians and other clinicians involved in hand-offs develop good working relationships built on trust and teamwork—not hierarchical status. This article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct. Copyright © 2013 ProAssurance Corporation ProAssurance is a national provider of medical professional liability insurance and risk management services. For more information about the company, visit ProAssurance.com.

Mark your calendar! Join us for the 66th Annual Scientific Assembly to be held at The Lodge of Four Seasons Lake Ozark, MO

June 6 - 7, 2014

www.mo-afp.org Missouri Family Physician January - March 2014

MAFP 2014 Advocacy Day

Bring a colleague & join fellow MAFP Members (Actives, Residents, Students, etc.) to promote the importance of family medicine & primary care. This is your opportunity to educate your State Senator & State Representative on issues affecting you, your profession, and your patients. MAFP Staff will schedule the appointments for you with your legislators. It's easy - all you have to do is register! Questions? Call MAFP at (573) 635-0830 or email: office@mo-afp.org. Schedule: 8:00am - 8:45am Breakfast (provided) & Briefing ~ Capitol Plaza Hotel 9:00am - 1:00pm Legislative Visits ~ State Capitol 1:00pm - 3:30pm Lunch (provided) and Board Meeting ~ Capitol Plaza Hotel

www.mo-afp.org

Missouri Family Physician January - March 2014

Advocacy Day February 25, 2014 State Capitol Jefferson City

You can make a difference

Help Desk Answers MAFP

Is therapy based on endoscopy (results) better Is therapy based on endoscopy (results) better than empiric therapy for dyspepsia? than empiric therapy for dyspepsia? Evidence-Based Answer Prompt endoscopy for dyspepsia leads to a small Evidence-Based Answer decrease in the for proportion patients who are Prompt endoscopy dyspepsiaof leads to a small symptomatic at 1 year, but it is not cost-effective (SOR: decrease in the proportion of patients who are A, meta-analysis of RCTs). A test-and-treat strategy symptomatic at 1 year, but it is not cost-effective (SOR: A, of RCTs). strategy is meta-analysis less expensive, results Aintest-and-treat fewer patients receiving isendoscopy, less expensive, results in in fewer receiving and results similarpatients long-term symptom endoscopy, andB,results control (SOR: RCTs.)in similar long-term symptom control (SOR: B, RCTs.)

A 2005 meta-analysis of 5 RCTs with 1,924 patients with dyspepsia (mean ages 34–44 years) compared A 2005 meta-analysis of 5 RCTs with 1,924 patients with dyspepsia prompt endoscopy with a Helicobacter pylori test(mean ages 34–44 years) compared prompt endoscopy with a 1 Compared the test-andand-treat Helicobacter pyloriapproach. test–and–treat approach.1with Compared with the treat strategy, endoscopy associated test–and–treat strategy,prompt prompt endoscopy waswas associated with a riskatof1 symptoms at 95% 1 year 0.95; lowerwith risk aof lower symptoms year (RR 0.95; CI,(RR 0.92–0.99). 95% a CI, However, a cost analysis However, cost 0.92–0.99). analysis showed that prompt endoscopy was moreshowed expensive trials; N=1,771; weighted meanexpensive difference that(4prompt endoscopy was more at 12 $389/case; 95% CI, 276–502). The authors (4 months trials; N=1,771; weighted mean difference at concluded that early$389/case; endoscopy was not CI, a cost–effective 12 months 95% 276–502).strategy. The A 2009 RCT (N=762) conducted in a primary care setting authors concluded that early endoscopy was assigned not a patients with dyspepsia to 4 groups: prompt endoscopy, H pylori test cost-effective strategy. and endoscopy for positive cases, H pylori test–and–treat, or empirical A 2009 RCT (N=762) conducted in a primary care therapy.2 At 2 months, patients receiving prompt endoscopy were setting assigned patients with dyspepsia to 4 groups: significantly more likely to report having no or minimal symptoms promptHowever, endoscopy, H pylori disappeared test and endoscopy for (TABLE). this difference at 12 months. positive pylori test-and-treat, or empirical Similarly, at 22 cases, months,Hthose receiving empiric therapy were most At 2 months, patients receiving prompt therapy. likely among the 4 treatment groups to report being dissatisfied with endoscopy were significantly more likely to reportat therapy, but no significant differences were noted between groups having no or minimal symptoms (TABLE ). However,

this difference disappeared at 12 months. Similarly, at 2 months, those receiving empiric therapy were most likely among the 4 treatment groups to report being November 2013 EBP dissatisfied with therapy, but no significant differences were noted between groups at 12 months. Patients randomized to the endoscopy group incurred the highestPatients health randomized services costs over 12 months, the 12 months. to the endoscopy group and incurred test-and-treat group had the lowest costs (no statistical the highest health services costs over 12 months, and the test–and– treat analysis group had the lowest costs (no statistical analysis provided). provided). A 2004 survey wassurvey completed by 363 patients after A follow–up 2004 follow-up was completed by 3 participation in a RCT for participation the treatment of Patients 363 patients after in dyspepsia. a RCT for the 3 were treatment initially randomized to an H pylori test–and–eradicate strategy Patients were initially of dyspepsia. or torandomized prompt endoscopy. At a mean of 6.7 years, the proportion to an H pylori test-and-eradicate strategy of symptom-free days was similar in both groups (0.52 in the testor to prompt endoscopy. At a mean of 6.7 years, the and-eradicate group vs 0.64 in the prompt endoscopy group; mean proportion of symptom-free days was similar in both difference 0.05; 95% CI, –0.03 to 0.14; P=.27.) However, the groups (0.52group in thereceived test-and-eradicate group 0.64 test–and–eradicate 0.88 endoscopies pervspatient, in the endoscopy group; mean difference compared withprompt 1.5 endoscopies per patient in the endoscopy group 0.05; 95% CI, –0.03 to 0.14; P=.27.) However, thea (P<.0001). The authors concluded that, on a long-term basis, test-and-eradicate group received 0.88 endoscopies test-and-eradicate strategy is as effective as prompt endoscopy for symptom of dyspepsia, andwith reduces1.5 healthcare resource per use. per control patient, compared endoscopies patient in the endoscopy group (P<.0001). The Zoberi, authors concluded that, on aKimberly long-term basis,MD a St. Louis University School of test-and-eradicate strategy is as effective asMedicine prompt St. Louis, and MO endoscopy for symptom control of dyspepsia, reduces healthcare resource use. 1. Ford AC, et al. Gastroenterology. 2005; 128(7):1838–1844. [LOE 1a] Kimberly Zoberi, MD 2. Duggan AE, et al. Aliment Pharmacol Ther. 2009; 29(1):55–68. St. Louis University School of Medicine St. Louis, MO [LOE 1b] 3. 1. Ford Lassen AT, et al. Gut. 2004; 53(12):1758–1763. [LOE 1b] AC, et al. Gastroenterology. 2005; 128(7):1838–1844. [LOE 1a] 2. Duggan AE, et al. Aliment Pharmacol Ther. 2009; 29(1):55–68. [LOE 1b] 3. Lassen AT, et al. Gut. 2004; 53(12):1758–1763. [LOE 1b]

TABLE

Outcomes in patients with dyspepsia by treatment protocol2 Endoscopy

H pylori test and endoscope

H pylori test and treat

Empiric therapy

P value (4-way comparison)

No symptoms or minimal symptoms at time = 2 months

74%

65%

68%

55%

.009

No symptoms or minimal symptoms at time = 12 months

55%

53%

52%

50%

Dissatisﬁed with treatment at time = 2 months

14%

13%

16%

29%

.007

Dissatisﬁed with treatment at time = 12 months

20%

18%

22%

20%

Cost per patient over 12 months (endoscopy cost £200)

£265

£199

£159

£174

Not given

Evidence-Based Practice / November 2013

Missouri Family Physician January - March 2014

MAFP Resident Grand Rounds

Change from Within Cooking classes cause positive shift in residents’ confidence, behaviors

and beliefs about food

Renee Diamond, MD, PGY-2 Suzanne Ozbun, MD, PGY-2 Anne Sly, MD, Faculty Research Family Medicine Residency Program Kansas City, Missouri Renee Diamond, MD

Introduction The prevalence of obesity and obesityrelated disease in America is evident. In 2009-2010 over one-third of US adults and one-sixth of US children were obese.1 The incidence of diabetes, heart disease, strokes and some cancers have paralleled this trend. For example, in 1980, there were 493,000 newly diagnosed cases of diabetes mellitus while in 2010, this number skyrocketed to 1.7 million.2 The medical community must encourage food-systems change within itself to lead to broader change in our patients.3 Previously, we have demonstrated the ability to do so by the anti-tobacco movement which started in healthcare institutions and trickled into the public arena.4 Primary care physicians are especially poised to influence nutrition literacy.5,6 Cooking classes have been proposed as one way to improve nutrient intake.7 Levy et. al demonstrated the superiority of interactive cooking classes to demonstrations alone.8 Interactive classes afford participants the opportunity to gain a sense of self-efficacy regarding newly acquired skills. The purpose of this pilot study was to determine if cooking classes paired with nutritional instruction could change physician’s and their families’ behavior, confidence, and beliefs about food.

Methods Participants Participants were volunteer family physician residents of Research Family Medicine Residency Program, administrative staff, and their family members. The intervention group (n=7) was made up of 4 residents and 3 resident spouses or significant others. The control group (n=7) was made up of 7 residents. Pre and Post Survey The survey previously validated by Barton et al9 was modified to fit the pilot study (Appendix A). It consisted of 22 questions pertaining to participants’ behavior, intentions, confidence, and beliefs in regards to cooking. Most responses were in the form of a Likert scale ranging from Strongly Agree to Strongly Disagree. The identical survey was administered to the control and intervention groups at the start of the 5 week cooking classes, and again upon conclusion of the classes. Surveys were manually distributed and collected by the co-investigators. Responses were not anonymous. All 5 interactive classes were taught at a residential kitchen and led by the resident co-investigators. At each class, a brief introduction was provided outlining goals and objectives for the session and providing the menu. The cooking curriculum was crafted to ensure a variety

10 Missouri Family Physician January - March 2014

Suzanne Ozbun, MD

Anne Sly, MD

of food preparation methods—baking, boiling, roasting, sautéing, and grilling. Each menu included one lean protein and two vegetables or vegetable-starch combinations such as chicken and vegetable stir-fry with brown rice. Under direction of the instructors, participants prepared, cooked and served the food. During dinner, targeted education (e.g. reading nutrition labels) was provided with open discussion about the prepared food and presented topic. The control groups neither attended these classes nor received supplemental nutrition education. Analysis The responses for each survey question were assigned a numerical value between -2 and +2 for the response given (Strongly Agree=+2, Agree=+1, Neutral=0, Disagree=-1, Strongly Disagree=-2). For questions 14 and 18, the responses were scored inversely as these questions were negatively phrased. Pre- and post- surveys were scored for each participant. To assess for baseline similarity between the intervention and control groups, we computed the group mean response for each item on the pre- survey, with 95% confidence intervals, and compared the means between the groups using F-Test Two Sample for Variance and Unpaired T-test using an Excel statistical package. Each person’s change in response

Resident Grand Rounds MAFP

was calculated between the preand post- survey ("delta") for each question. For each item, we computed the mean "delta" value for the intervention and control groups at a predetermined 95% confidence interval, and compared the means between the groups using the F-Test and Unpaired T-Test. Survey questions were further grouped into 4 general categories related to cooking including Behavior, Intentions, Confidence and Beliefs. We summed the "delta" scores for each participant in each of these categories, and again compared the means between the intervention and control groups for the 4 categories using the F-test and Unpaired T-test. All P-values are one-tailed. Results Participants The intervention group consisted of 4 residents and 3 spouses or significant others, while the control group was made up entirely of residents. The intervention group had 3 female participants, while the control group was entirely female. Eight of the 14 participants were under the age of 30. Analysis of the pre-intervention surveys revealed that the control and intervention groups were homogenous except on one item where the intervention group reported less comfort in cooking meals. Behavior Change Five questions were grouped in the “Behavior” section. Participants who took part in the cooking classes reported a positive change in eating fruits and vegetables, cooking at home, reading labels and making healthy restaurant choices between the pre and post-test. Of the 5 behaviors in this category, the intervention group demonstrated a statistically significant difference for reading food labels (Standardized Mean Difference 12; CI 1.97 to 2.27; p=0.04) and making healthy restaurant choices (SMD 2.98; CI 2.25 to 3.70; p=<0.01) as compared to the control group. (See Table 1) Confidence Change Six questions were grouped in the “Confidence” section. Participants in the cooking classes were more likely than those in the control group to report a positive

change in confidence related to cooking between the pre and post-test. The only statistically significance change between the intervention and control group was in “increased confidence with cooking for self and family” (SMD 2.89; CI 2.72 to 3.05; p=<0.01) with a greater positive change reported by the intervention group. (See Table 2) Beliefs Change Five questions were grouped in the “Beliefs” section. Class participants reported a greater positive change in their beliefs regarding cooking than those in the control group. The positive change was statistically significant between the two groups in one of these questions: “When I cook my own food, I eat healthier” (SMD 1.92; CI 1.69 to 2.15; p=0.04). (See Table 3) Intentions Change Three questions were grouped in the “Intentions” section. Participants in the cooking classes were less likely to report positive changes in this category as compared to the other three change categories noted above. No “intention”changes between the two groups were statistically significant. (See Table 4) Discussion The low subject number of this pilot study does not allow generalization of the results. However, even with this small subject number, statistically significant differences were reported between the intervention and control groups in the behavior, confidence and belief change areas. Specifically, participants in the cooking classes (intervention group) reported positive changes that were statistically significant differences from the control group in these areas: • Increased consideration of reading food labels when grocery shopping (behavior change) • Increased comfort level in cooking at home (confidence change) • Making more healthful restaurant food choices (behavior change) • Believing that cooking for self results in healthier eating (belief change)

Prior research has demonstrated that the personal health habits of physicians influence physician-patient counseling regarding health habits.12 Although physicians have been counseling patients on diet for years, the USPSTF’s only recommendation for dietary counseling is for adult patients with known cardiac risk factors.11 Since food preferences, behaviors and attitudes are deeply entrenched in our psychosocial background we may not be aware of our own feelings towards food.10 However, we need to become more aware of our own issues to become better patient educators and models. This pilot study suggests that participation in interactive cooking classes may be a first step towards changing physician’s concepts towards food. Limitations of the Pilot Study This pilot study was limited by the low subject number included. Although a smaller number of participants increased the amount of hands-on involvement during the cooking classes, it restricts generalizability to a larger population. Participants were also included in this study on a volunteer basis which may indicate an inclination to change in those participants who were interested and willing to take part in the cooking classes. In addition, the survey results were based on self-report. Conclusions This pilot study findings showed that participation in cooking classes resulted in statistically significant differences between intervention and control groups with positive changes in reading food labels, the belief that cooking at home is healthier, making healthful restaurant dining choices, and comfort level with cooking at home in the intervention group. Improving physician attitudes towards and interactions with food may positively influence physician-patient counseling. It is time we make a commitment to change – to change from within. Acknowledgements We would like to thank all the individuals who completed surveys and attended classes for their continued on page 12-13 participation.

Missouri Family Physician January - March 2014

MAFP Resident Grand Rounds Table 1: Behavior Questions

Group (N)

(1) How many servings of fruit do you eat each day?

(2) How many servings of vegetables do you eat each day?

Mean (Std Dev)

(12) I consider the (3) How often do you information on food cook meals at home? labels when grocery shopping. Mean (Std Dev)

(22) I make healthy choices when I eat out.

Mean (Std Dev)

Intervention (7)

0.43 (0.79)

0 (0.58)

1.14 (1.95)

0.43 (0.53)

1.57 (0.97)

Control (7)

0.43 (0.79)

0.14 (0.69)

0.28 (1.38)

0 (0)

0 (1)

p‐value

0.5

0.34

0.18

0.04

<0.01

Table 2: Confidence Questions

Group (N)

(10) I feel confident to cook using basic ingredients.

(11) I know how to interpret the information on a nutrition label.

(17) I feel confident with many different cooking techniques.

(19) I am comfortable cooking a meal for myself and my family.

(20) I know how to distinguish healthy from unhealthy fats.

(21) I feel confident in my ability to make healthy choices when I eat out.

Mean (Std Dev)

Intervention (7)

0 (0.58)

0.29 (0.95)

0.57 (0.53)

0.57 (0.79)

0.86 (1.35)

Control (7)

‐0.29 (0.49)

0.86 (0.90)

‐0.14 (0.38)

0.29 (0.76)

0.86 (0.69)

p‐value

0.17

0.09

0.24

<0.01

0.25

0.5

Table 3: Belief Questions

Group (N)

(13) When I cook my own food, I eat healthier.

(14) Cooking is hard and takes too much time*

Mean (Std Dev)

(15) I like to cook.

(16) Cooking saves me money.

(18) Cooking is expensive*

Mean (Std Dev)

Intervention (7)

0.57 (0.53)

1.14 (1.21)

0.29 (0.49)

0.57 (1.27)

0.43 (0.79)

Control (7)

0 (0.58)

0.29 (1.50)

0.43 (0.53)

0.29 (0.49)

‐0.14 (0.69)

p‐value

0.04

0.13

0.31

0.30

0.09

*Negatively phrased, inversely scored questions

Table 4: Intention Questions

Group (N)

(7) I intend to increase (8) I intend to increase (9) I intend to increase the amount of the amount of fruit I the frequency that I vegetables I eat in the eat in the next 6 cook meals at home next 6 months. months. over the next 6 months. Mean (Std Dev)

Mean (Std Dev)

Intervention (7)

0.14 (0.38)

0.14 (0.90)

‐0.14 (0.69)

Control (7)

0 (0.58)

0.14 (0.69)

0.29 (0.76)

p‐value

0.30

0.5

0.14

12 Missouri Family Physician January - March 2014

Resident Grand Rounds MAFP

Change from within continued from page 11-12 We also extend our gratitude to Dr. Anne Sly for the use of her home and generous contribution of materials to make this project come to fruition, and to Dr. Donna Calvert for her guidance in methodology and editing. Please contact the resident authors for cooking class curricular plans: renee.diamond@hcamidwest.com or suzanne.ozbun@ hcamidwest.com. Bibliography 1. US Department of Health and Human Services. “Final Review, Healthy people 2010: Nutrition and overweight.” http://www.cdc. gov/nchs/data/hpdata2010/hp2010_final_review_focus_area_19. pdf. Updated October, 2011. Accessed 28 November 2012. 2. CDC. “Diabetes data and trends.” http://www.cdc.gov/diabetes/ statistics/incidence/fig1.htm. Updated November, 2012. Accessed 28 November 2012. 3. Wrieden WL, et al. The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices – an exploratory trial. Public Health Nutrition. 2007 Feb; 10(2):203-11. 4. Lenard LI, et al. Changing eating habits for the medical profession. JAMA. 2012 Sept; 308(10): 983-984. 5. Zhu DG, Norman IJ, While AE. The relationship between doctors’ and nurses’ own weight status and their weight management practices: a systematic review. Obesity Reviews. 2011 Jun; 12(6):459-69. 6. Wells KB, et al. Do physicians preach what they practice? A study of physicians’ health habits and counseling practices. JAMA. 1984 Nov 23-30; 252(20):2846-8. 7. Archuleta M, et al. Cooking schools improve nutrient intake patterns of people with type 2 diabetes. Journal of Nutrition Education and Behavior. 2012 Jul-Aug; 44(4):319-25. 8. Levy J, Auld G. Cooking classes outperform cooking demonstrations for college sophomores. Journal of Nutrition Education and Behavior. 2004 Jul-Aug; 36(4):197-203. 9. Barton KL, Wrieden WL, Anderson AS. Validity and reliability of a short questionnaire for assessing the impact of cooking skills interventions. Journal of Human Nutrition and Dietetics. 2011 Dec; 24(6):588-95. 10. Marian M. “Diet and meal patterns: Cultural issues.” Arizona center for integrative medicine. http://integrativemedicine.arizona.edu/ program/IMR_2015/nutrition_health/diet_meal_patterns/4.html. Published 2012. Accessed 10 January 2013. 11. USPFTF. Behavioral Counseling in Primary Care to Promote a Healthy Diet in Adults at Increased Risk for Cardiovascular Disease. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiet.htm. Published January, 2003. Accessed 5 January 2013. 12. Shahar DR, et al. A controlled intervention study of changing health-providers’ attitudes toward personal lifestyle habits and healthpromotion skills. Nutrition. 2009 May; 25(5):532-9.

Because

commitment to

immunization deserves

recognition. If your Family Medicine residency program is working to improve flu and pneumococcal vaccine rates in patients 65 and older, tell us about it. The AAFP Foundation wants to recognize you. Senior Immunization Grant Awards Award winners receive: • $10,000 grant • $1,200 scholarship to attend the 2015 AAFP National Conference of Family Medicine Residents and Medical Students • Recognition and the opportunity to share best practices Apply by March 31, 2014 aafpfoundation.org/immunizationawards

Support for this program is provided by the WellPoint Foundation, Inc. and Pfizer Inc.

Missouri Family Physician January - March 2014

MAFP Members in the News

Members in the news Andrea Schuster, medical student of the University of Missouri Columbia, was appointed by the AAFP Board of Directors following a recommendation of the Resident and Student Screening Subcommittee as an FMIG Regional Coordinator. For a complete list of the 2014 elected and appointed resident and student representatives, please visit: www. aafp.org/medical-school-residency/fmig/ connect/leaders.html

The GO! Diabetes Research Poster entitled, “Guideline-Based Education and Implementation of Flowsheets into Care of Patients with Diabetes,” submitted by Rene Diamond, RD, MD and Darren Presley, MD, Research Family Medicine Residency Program in Kansas City, MO, was a winning entry at the 2013 GO! Diabetes Summit Research Poster Competition. The competition, held concurrently with the American Academy of Family Physicians (AAFP) Scientific Assembly in San Diego, CA, had an unprecedented number of research poster finalists representing 16 residency programs from 10 states. Visit: www.godiabetes.org to learn more about the program. On November 17, 2013, Darryl Zinck, MD, was presented with the annual Greater St. Louis Community Health Award at the St. Louis Academy of Family

Physicians (SLAFP) Annual Installation Banquet of Offices and Board of Directors. Dr. Zinck has spent 19 years caring for the uninsured and underinsured through the Family Care Health Center in St. Louis. For 17 years, he has been a devoted preceptor to medical students and now residents. Colleagues from Family Care Health Center (St. Louis) are pictured above with Darryl Zinck, MD, who was presented with the annual Greater St. Louis ComFor 8 years he has been involved with munity Health Award in November. Pictured (L to R): Abbe Sudvarg,MD; TinaRose Bosslet, MD; Maddie White, MD; Darryl Zinck, MD; and Christine Jacobs, MD. outreach for the homeless in St. Louis. From the Catholic Worker Program John Paulson, DO, efforts of 6 people at St. Cronin’s Parish in PhD, became a North St. Louis, this outreach has morphed Fellow of the AAFP in into 9 sites and multiple organizations. October. The Degree Dr. Zinck’s activities have ranged from of Fellow recognizes passing out blankets in the winter to giving AAFP members who flu shots or treating basic health needs. have distinguished Frequently, he involves medical students themselves among or residents in those endeavors -- truly their colleagues, as illustrating the caring and nurturing role of well as in their communities, by their service a family physician tending to the needs of to family medicine, by their advancement all people. of health care to the American people and by their professional development through F. David medical education and research. Fellows of Schneider, MD, the AAFP are recognized as Champions of was installed as Family Medicine. They are the physicians the 2013-2014 who make family medicine the premier president of the St. specialty in service to their community and Louis Academy of profession. From a personal perspective, Family Physicians being a Fellow signifies not only 'tenure' but on January one's additional work in your community, 11, 2014. Dr. within organized medicine, within teaching, Schneider hosted sixty medical students and a greater commitment to continuing along with faculty and local physicians professional development and/or research. at his home on January 17, 2014 in an For more information about becoming a effort to engage the students with family Fellow, please visit: www.aafp.org/about/ physicians in a social setting. membership/services/degree-of-fellow.html

14 Missouri Family Physician January - March 2014

Local Chapters MAFP

Kansas City Academy of Family Physicians board members are pictured above (women from L to R) Angela Barnett, MD (vp); Annette Acosta-Dickson, MD; Jennifer Kelley, MD; (men from L to R) John Stanley, MD; Mark Martin, MD; Chris Blanner, MD; Ed Kraemer, MD; Brad Chrisjohn, DO (pres); Jim Kelly, Executive Director. Not pictured are Daniel Purdom, MD, Kathleen EubanksMeng, DO, Emily Lott, MD (sec/treas), and Donald Potts, MD.

St. Louis Academy of Family Physicians board members are pictured above. Front row (L to R): Rosa Galvez-Myles, MD; Kate Lichtenberg, DO; Tonya Little, MD; Vivian Helm, Executive Director; TinaRose Bosslet, MD; and Edina Karahodzic, MD (treas). Back row (L to R): F. David Schneider, MD (pres); Walt Sumner, MD; Christine Jacobs, MD; Kara Mayes, MD; and Sarah Cole, DO (past pres).

The Kansas City Academy of Family Physicians (KCAFP) continues to promote family medicine in the Kansas City community by providing health awareness and education to their patients and to the overall Greater Kansas City area. In pursuit of this objective, KCAFP continued their tradition of providing a special section in the Kansas City Star. This eight page, full color, freestanding section inside the Kansas City Star on Sunday, October 13, 2013, provided articles around a theme of “General Health and Prevention Measures” with a lead article written by Bradley Chrisjohn, DO, President of the Kansas City Chapter. Article topics included information about the importance of exercise and healthy lifestyle, reaching and maintaining weight goals, increasing antibiotic resistance, medical guidelines and where they come from, health insurance exchanges and family medicine, the Patient Centered Family Medical Home, wellness visits, and recommendations for screening exams and preventive medicine. The section was distributed to over 225,000 households in the greater Kansas City area. In addition, KCAFP Board Members provide Tar Wars classes at several grade schools in the area, volunteer in the community at local underserved clinics, and participate in Honor Flight trips to Washington, D.C. with military veterans and volunteer their time to go on mission trips to disaster or underserved areas worldwide.

The mission of the St. Louis Academy of Family Physicians (SLAFP) is to represent our specialty in the area encompassing St. Louis City and County, as well as St. Charles County, to fellow physicians, medical students, health-related organizations and the general public. In pursuit of that goal, our Board of Directors strategically realigned into three committees (Advocacy, Education, and Member Services) that parallel with the MAFP structure. SLAFP continues its efforts to promote healthy air by monitoring the smoke-free efforts with the help of SLU student members who recruit Tar Wars presenters and retired/active physician members who present or refer schools. The Education Committee surveyed area medical students, residents and physicians to determine how best to increase studentphysician interactions. Among these efforts are the provision of FPs as speakers and panelists for FMIG activities at both medical schools. The Annual Welcome to Family Medicine Picnic brings medical students from SLU and Washington University together with practicing FPs facilitating one-on-one conversations between students from all MS years, not simply first year. A third regular student/physician event is offered to the membership by attendance at the SLU Family Medicine Pinning Ceremony held in May with Graduates who will be moving on to family medicine residencies. SLAFP schedules its May Board meeting onsite following this celebration. Membership Services is focused on community outreach and expansion of the website.

KCAFP • Jim Kelly, Chapter Executive PO Box 1240, Independence, MO 64051 Phone (913) 687-9967 • Jim.Kelly@tmcmed.org

SLAFP • Vivian Helm, Chapter Executive 8634 White Avenue, St. Louis, MO 63144 Phone (314) 963-7395 • slafpexec@sbcglobal.net • www.slafp.org Missouri Family Physician January - March 2014

MAFP 2014 Legislative Update

Legislative Update as of February 8, 2014 by Pat Strader, Legislative Consultant

Review future Legislative Updates which are included in Show Me State Updates via email This Week in Jefferson City… Legislators, staff and lobbyists struggled with extreme weather conditions in Jefferson City last week. Since most legislators made it to the Capitol before the bad weather hit, things progressed as normal but there was a slim crowd roaming the Capitol hallways. Tort Reform Repair Passes House Committee HB 1173 sponsored by Rep. Eric Burlison was voted "Do Pass" 5-3 by the House Special Committee on Emerging Issues in Health Care, basically on a party-line vote. The bill now goes to the House Rules Committee for approval before it moves to the full House for debate. The Senate version has not been voted out of the Senate Small Business, Industry and Insurance Committee as yet (SB 589). Missouri Immunization Registry The Senate companion bill to HB 1445 has been filed by Senator Scott Sifton (D-St. Louis). This legislation would require all immunization providers to submit vaccination records of adults and children to the Missouri Immunization Registry. MAFP testified in opposition to the bill in the House and we will be talking with the Senator to share our concerns about the burdensome provisions in the bill. These measures are supported by the Maternal Child and Family Health Coalition/Gateway Immunization Coalition. Tanning Bed Legislation Approved by Committee This week HB 1430, sponsored by Rep. Gary Cross, was voted “do pass” 12-0 from the House Health Care Policy Committee. This legislation requires persons less than 17 years of age using a tanning device in a tanning facility to have the parent or guardian of the minor give written consent in person to the minor's use of a tanning device. Senate Discusses Medicaid Reform and Expansion Two issues relating to Medicaid popped up this week in the Senate. SB 518 sponsored by Senator David Sater was debated Wednesday. This bill would extend MO HealthNet managed care statewide for the current managed care populations as of Jan. 1, 2014. Currently, managed care plans are used in 54 counties out of 114 (I-70 corridor). Supporters of extending the program statewide 16 Missouri Family Physician January - March 2014

say the change would save the state about $15 million annually and improve the Medicaid system. However, there were many concerns expressed during the debate. This bill would move “fee for service” patients not already in managed care to those plans currently in place for patients already in managed care. Senator Paul LeVota (D-Independence) offered an amendment to expand Medicaid to 138% of the Federal poverty level, but the amendment failed to pass. The companion to SB 518 was filed in the House by Rep. Todd Richardson (HB 1662). New Bill of Interest Filed: HB 1773 – Sponsored by Dr. Keith Frederick (R-Rolla) - Creates the Board of Medical Scholarship Awards to provide scholarships and loans to encourage physicians to practice medicine in underserved areas of the state. http://www.house.mo.gov/billtracking/bills141/biltxt/intro/ HB1773I.htm ******** Access MAFP tracked legislation under the “Advocacy” tab on our website at www.mo-afp.org Please let me know if you have any questions or comments Pat Strader - plstrader@embarqmail.com - (573) 680-6431

MAFP PAC Join Club Jefferson Simply pledge $2 per week, $104 per year and you can help us shape the future of patient care and family medicine in Missouri. Our goal is to involve as many members as possible. We begin by seeking that one voice in one hundred – yours! Donate online at www.mo-afp.org/political.htm

Job Opportunities MAFP

Discover new opportunities. Recruit qualified applicants.

The Missouri Academy of Family Physicians (MAFP) has partnered with HEALTHeCAREERS to power the association’s online job board, FP Jobs Online. It is the preeminent employment site for the Family Medicine specialty. ,

Lookin perfect match:

Looking for a new job? Or looking to hire a FP? Employers, ACOEM Career Center offers a robust suite of hiring strategies: Employers - Niche Recruitment Personal customer support as well as a dedicated acount manager. • Job •postings receive exposure to hundreds of family physicians. • Exposure to thousan o recruitment ccupational contracts and environmental medicine professionals. Including access to a deep • Take advantage of flexible that include competitive posting rates. resume database to contact candidates proactively.

• Advertising products that extend your brand to an audience of family medicine practitioners. • Efficient, cost-effective tools to manage your job postings and organize hiring strategies.

Advertising products that extend your brand by reaching a large audience. Job •Seekers - Advance Your Career

• Hundreds of position listings fromyour employers of all types and sizes. Job Seekers, advance career with ACOEM Career Center: • Job •Alerts automatically notify from you employers each timeofaallnew opens up that matches your criteria. Hundreds of position listings typesposition and sizes. • Apply jobs directly for allows free and your entire jobsearch. search with your personal account. • Atopersonal accountonline login that you manage to easily manage your job • notifying A redesigned career center that that offers career Event Connection, and e-mail jobs alerts you about new postings match youradvice, searcheNewsletters, criteria.

Visit FP Jobs Online today at www.healthecareers.com/fpjo

Visit the ACOEM Career Center today! www.healthecareers.com/acoem

(888) 884-8242

Missouri Family Physician January - March 2014

MAFP 2013 AFC Sponsors & Exhibitors

2013 Annual Fall Conference Sponsors & Exhibitors

AbbVie, Inc. Amgen Anthem Blue Cross/Blue Shield Astellus Pharmaceuticals Citizens Memorial Hospital Corizon Cox Health Docs Who Care Fresenius Medical Care Genzyme Health Diagnostic Laboratory, Inc. HealthLink Home State Health Plan Ideal Protein Kowa Pharmaceuticals Medtronic, Inc. - Deep Brain Stimulation Medtronic, Inc. - Spinal Midwest Dairy Council 18 Missouri Family Physician January - March 2014

MAFP wishes to recognize and thank the organizations who supported and participated in the 21st Annual Fall Conference at Big Cedar Lodge in November. Join us in expressing our appreciation to the following:

Missouri Army National Guard Missouri Beef Council Missouri Professionals Mutual (MPM) MMIC Group MO Health Professional Placement Services MoDocs MSMA Insurance Agency Novo Nordisk Pfizer Physicians Professional Indemnity Association (PPIA) Saint Louis University Hospital SuccessEHS Takeda Pharmaceuticals TEVA Pharmaceuticals U.S. Army Healthcare Recruiting U.S. Navy Recruiting

Tar Wars MAFP

Educate 4th and 5th grade students about the dangers of tobacco Do your local schools participate in the Tar Wars Program? Tar Wars ® is a program for fourth-and/or-fifth-grade students involving a one-hour class session and a follow-up poster contest. The first part is a lively, interactive lesson in which students learn why people use tobacco, the consequences of tobacco use, and the truth about tobacco advertising. A poster contest is encouraged following the presentation. Beginning in 2014, schools will have the opportunity to submit the top 3 posters to MAFP before April 18, 2014. In the past, MAFP only accepted one poster from each school. The top five posters are chosen by a panel of judges and awarded prizes. The state poster winner, along with a parent or guardian, will receive a complimentary trip to the Tar Wars National Conference held in Washington, DC, on July 21-22, 2014. The national competition includes the opportunity to win other great prizes.

Today

more than 3,500 children will try their first cigarette. Stop kids from starting. Volunteer to be a Tar Wars presenter.

Electronic Cigarettes - Call For More Research The American Academy of Family Physicians (AAFP) recognizes the increased use of electronic cigarettes (i.e., e-cigarettes) especially among youth and those attempting to quit smoking tobacco. Electronic cigarettes are unregulated, battery-operated devices that contain nicotine-filled cartridges. The resulting vapor is inhaled as a mist that contains flavorings and various levels of nicotine and other toxic substances. Although e-cigarettes may be less toxic than smoking combustible tobacco cigarettes, there is no empirical evidence supporting the efficacy of e-cigarettes as a smoking cessation device. However, some physicians and public health groups consider the use of said devices as a viable harmreduction strategy. Anecdotal accounts of people using e-cigarettes as a cessation device have led some to believe that these products have the potential to help them quit – especially the long-term, highly addicted smoker. Others are concerned that e-cigarettes may contribute to nicotine dependence, promote dual use of both products, and encourage nicotine consumption. E-cigarettes may also introduce children to nicotine and potential addiction. There are concerns about the lack of any regulatory oversight by the Food and Drug Administration’s Center for Tobacco Products (FDA CTP) on the manufacture, distribution and safety of e-cigarettes. Therefore, the AAFP calls for rigorous research in the form of randomized controlled trials of e-cigarettes to assess their safety, quality, and efficacy as a potential cessation device. The AAFP also recommends that the marketing and advertising of e-cigarettes, especially to children and youth, should cease immediately until e-cigarette’s safety, toxicity, and efficacy are established. (January 2014 Board Chair)

www.tarwars.org

Supported in part by a grant from the American Academy of Family Physicians Foundation.

Missouri Family Physician January - March 2014

U stability N predictability P reliability A believability R sustainability A L trustability L respectability E accountability L availability E D professional liability Timothy H. Trout Managing Director

287 North Lindbergh Blvd. Saint Louis, Missouri 63141

314 587 8000 OFFICE 314 587 8001 FAX mpmins.com / mpmks.com