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Governor's Newsletter, Fall 1999

Joel S. Levine, MD, FACP
Governor, Colorado Chapter

The Governor's Corner Transitions

We all have them. Those times in our lives when we have committed to do too much, time is a vanishing commodity, every minute is accounted for, one day flows into the next. It is my experience that Providence typically picks those times to throw a few unexpected things into the hopper, disrupting any retained misperceptions that one has that your life is actually controllable. You know. Those are the times that you (or at least I) start getting that dream where you find yourself in that college French class (boy did I hate French class), the professor that you really hated is passing out those blue test booklets, and you haven't studied for the test! In fact at that moment (fortunately waking in a sweat at that point) you're not sure how to spell "oui."

That's how the last 4-5 months have been for me. For all those whom I have not communicated effectively or rapidly enough, I am sorry.

During this same period the Chapter has been going through the process of selecting the two candidates who will run for Governor-elect in the coming fall elections. As part of the process I spoke with a number of you about interest in the Governor position. Many were honored to be thought of by their colleagues, but just didn't think they would have the time to commit when I described the "job" description. Fortunately, the two Fellows who were mentioned most frequently in the College's solicitation of nominations have agreed to run.

We Have Two Outstanding Candidates:
  • Kelly O'Brien-Falls, MD, FACP, of Denver (general internist, educator, former ACEL Program Committee, Governor's Council, Women's Group) and
  • James Bush, MD, FACP, of Fort Collins (general internist, private practice, Governor's Council, CSIM leadership).

These two exciting candidates have contributed greatly to the work of this Chapter in the past decade. Both were on the ad-hoc merger task force. Each raised concerns about the time commitment, but with my assurances that we would try to change the structure of the Chapter, each was interested in running.

This period of both personal and personnel conundrums, as well as the concerns about the limited time for voluntary work expressed by many of you, have reemphasized to me the importance of considering changing the future leadership structure of the Chapter. Currently, we have a Governor elected for 4 years with one additional year as Governor-elect. We have the strong beginnings of a committee structure that can work independently of the Governor. The Council is advisory since it is not involved in the day to day workings of the Chapter. Fundamentally, the job of Governor has outstripped the capabilities of one person working both the internal operations of the Chapter as well as the external commitments to the College.

I have examined how other Chapters have been trying to solve this problem, and believe that a variation of Florida's solution should be considered. Florida has both a Governor and a President. They divide the work of the Chapter among themselves, with the Governor retaining the external College presence and the President focusing more on state public policy. To me the ideal situation would be to ask for a commitment to leadership for six years, three as Governor-Elect/President
followed by three as the Governor; with the election electing the Governor-Elect/President. That would allow the Governor-Elect/President to focus on the running of the Chapter, and then automatically transition to Governor to focus on national College activities. Unfortunately, the latter sequencing would require a change in the national By-laws. Our new Governor needs help now.

I do believe that we can change our own by-laws to allow the person who gets the second most votes in the coming election to become the President of the Chapter with specific delegated duties. I will ask the Governor's Council to consider this change at their upcoming meeting to present as a resolution for vote at the upcoming Annual meeting. This sharing of responsibility would allow your leadership to focus on their areas of interest and expertise, and assure that occasional lapses as I have suffered over the past few months will be reduced in frequency.

ACP-ASIM Launches Legislative Action Center (LAC)

To make participation in grassroots advocacy easier for its members, ACP-ASIM launched in August the Legislative Action Center (LAC), which may be accessed from ACP-ASIM Online. The LAC allows you as an ACP-ASIM member to view the most current ACP-ASIM Legislative Alerts, find out who your federal legislators are, and send e-mails or faxes to your members of Congress. It also provides you with the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with your legislators. ACP-ASIM encourages you to try the LAC by sending an e-mail to your members of Congress in response to the current Legislative Alert posted on ACP-ASIM Online.

You can access the LAC through the "Where We Stand" section of ACP-ASIM Online at http://www.acponline.org/advocacy/. To send a message to Congress, you are prompted for your zipcode and are zip-matched to your federal legislators. You will then be asked for your name and address (so that congressional offices can identify you as a constituent.) ACP-ASIM encourages you to send a message based on the sample points posted for you, with your own personal anecdotes added. If you have any questions about the LAC or contacting your federal legislators, please contact Jenn Jenkins, Associate for Grassroots Advocacy, at jjenkins@acponline.org.

Congratulations To Our New Fellows!

The following Members were advanced to Fellows of the College at the July Credentials Committee meeting in Philadelphia. Their peers have recognized them for their accomplishments in clinical practice, education, scholarship, and/or community service.

Bahri M. Bilir, MD, FACP—Denver
Gregory T. Everson, MD, FACP—Denver
William H. Farrar, Jr, MD, FACP—Denver
Monical Kraft, MD, FACP—Denver
Robert A. Linden, MD, FACP—Alamosa
Michael D. Schwartz, MD, FACP—Greeley

I would remind all Fellows to look among your colleagues, identify those whom are meritorious, and encourage them to apply for advancement by offering to be one of their proposers.

Colorado Chapter ACP-ASIM Annual Meeting Report From The Year 2000 Program Committee

Chair Robert Swaney, MD, met with committee members: Chris Unrein, Jeanne Seibert, Andy Fine, Hal Spritzer, Laura Lasater, Sterling West and Deb Parsons over this summer. The meeting, which will be held February 3-5, 2000, is shaping up as another excellent educational meeting. All speakers are not confirmed yet but the likely topics include: update on CHF management, update on hypertension management, anticoagulation in cardiac disease, pharmacological issues in chronic anticoagulation, management of headaches, dermatology for the internist, osteoporosis screening and therapy, what's new in degenerative joint disease, what's new in rheumatoid arthritis management, oral contraceptive pill prescribing, management of dyslipidemias, update on hepatitis C, and topics in end of life care.

Associates Committee Meeting

On July 26 1999, attended by Drs. Robert B. Gibbons, William Kaehny, Michael Morton, Mark Reid, and Joel Levine.

  • This year's Associates meeting will be held on Tuesday June 6, 2000, in the Rainer auditorium of the Russell Pavillion at Exempla Saint Joseph's Hospital. Posters will be available for viewing by 4 p.m., registration will begin at 4:30 p.m., and the program will begin at 5 p.m. promptly. This well attended meeting has become an excellent site to demonstrate the scholarly accomplishments of the trainees in Colorado's two premier internal medicine training programs.
  • Two Associates will present oral presentations at the Annual Chapter meeting February 3-5, 2000, at the Broadmoor Resort. They will be provided with lodging for their stay.
  • A formal Associates Committee composed of, and run by, Associates will be created during the upcoming year. The Governor also asked the Associates to ask for volunteers for committee membership within the Chapter.

Corporate and Foundation Grantors

The Colorado Chapter continues to have a broad-based educational mission that consumes more resources than provided by the national office or local dues. Included are our medical student preceptorships, the annual Associates Meeting, the annual submission and support of travel for Associates to the national meeting, and the Chapter Annual Meeting at the Broadmoor. We have been fortunate to receive non-directed educational grants from a number of organizations to support these activities. To highlight the importance of the grants to our Chapter and its membership we will publish the names of each granting organization in each newsletter of a given fiscal year beginning today.

1998-1999

> $1000

  • THE DEPARTMENT OF MEDICINE, UNIVERSITY OF COLORADO SOM
  • THE DEPARTMENT OF MEDICINE, St. JOSEPH'S-EXEMPLA MEDICAL CENTER
  • THE COPIC FOUNDATION
  • THE HEALTH-0NE FOUNDATION
  • TAP PHARMACEUTICALS
  • PFIZER PHARMACEUTICALS
  • SOLVAY PHARMACEUTICALS
  • THE COLORADO MEDICAL SOCIETY

$500-$1000

  • THE COLORADO PERMANENTE GROUP

The Colorado Clinical Guidelines Collaborative

By: Jean Kutner, MD
(Colorado Chapter Representative on CCGC)

Colorado physicians have been inundated with multiple clinical practice guidelines from a variety of sources, often addressing similar and overlapping topics. Health plan, physician groups, insurers, and others independently develop and disseminate guidelines, with limited, if any, success in application of the guidelines in daily clinical practice. The premise behind the formation of the Colorado Clinical Guidelines Collaborative (CCGC) is that in order for clinical practice guidelines to have an impact, these guidelines must be broadly endorsed, credible, widely promoted, and lend themselves to measuring provider practice.

In October 1996, a forum about clinical guidelines in Colorado was held, with significant participation and support from health plans, provider groups, and other organizations. From this forum, the CCGC Steering Committee was founded, which formed several work groups and guideline development committees. In 1998, an executive committee was formed, and the CCGC was incorporated as a 501c3 Colorado corporation. The mission of CCGC is: "A Colorado coalition of Health plans, Physicians, Hospitals, and other Providers working together to improve health care through the development, implementation, and evaluation of evidence-based clinical guidelines." There are currently 54 participants/members of CCGC.

The CCGC has developed processes for topic selection, guideline development, review and endorsement. The guideline topics are nominated and selected by the participant/member organizations and are prioritized by a committee. The guideline development process begins with compilation of existing guidelines from local and national sources. A draft guideline is prepared and reviewed by a multi-disciplinary committee that focuses on literature-based evidence. The guideline is then formatted for ease of use by practicing providers and reviewed by an Advisory Panel. The final guideline is then endorsed by CCGC participants/members.

To date, the CCGC has completed three clinical guidelines with medical record flow sheets and patient brochures: "Continuing Care of the Adult Patient with Diabetes Mellitus," "Pediatric Immunization Recommendations" and "Colorectal Cancer Screening: A Guide for Adults." The guidelines and related materials are available directly from CCGC, on the Copic Insurance Company and Colorado Medical Society web pages, from the Colorado Department of Public Health and Environment, and from Colorado Area Health Education Centers. The guidelines were also published in Colorado Medicine.

Currently, the CCGC is working on guidelines for asthma management and for respiratory antibiotic use. The current priorities of the CCGC are business development, strategic partnerships, market research, and building the necessary infrastructure to support the organization's mission. Membership is open to interested organizations or individuals. For more information, contact the CCGC (4300 Cherry Creek Drive South, 5th Floor, Administration, Denver, CO 80246-1530, (303-692-2575).

Coming This Fall Use Member Connection

Need to correspond with a member of the College, but don't have the current mailing address? USE "Member Connection."

Member Connection, the College's new online membership directory, will be accessible to members-only via ACP-ASIM Online. Updated weekly, the information in Member Connection is taken directly from the main membership database at the College's headquarters. You can use Member Connection to find colleagues by name, state, city, zip or postal code, country, region, or specialty.

Use Member Connection to access contact information for ACP-ASIM Medical Student Members, Associates, Members, Fellows and Masters across the country. All you need to do is log on to www.acponline.org and check out Member Connection. It's fast, it's easy. It's got the contact information you need.

Please Note: College members who wish to be excluded from Member Connection must so request in writing. Please contact our Customer Service Department at (800) 523-1546, ext. 2600 to obtain a directory exclusion form. The form may also be obtained in the members-only section at www.acponline.org and submitted via mail or fax.

Group Insurance Administrators

By: Jack Finnegan, GIA, Vice President of Insurance and Financial Planning

Who are these people? Oh, they are the folks that set up the College Display at Chapter Regional Meetings. Yes they do that, but let's look at Group Insurance Administrators' (GIA) principal responsibilities in providing benefits of membership for ACP-ASIM members.

The appointed administrator of ACP-ASIM sponsored Insurance and Financial Planning Services, GIA has been providing its expertise in these services for over 45 years. Currently over 28,000 ACP-ASIM members benefit through participation in insurance plans, which are designed exclusively for them and administered by the staff of GIA. An added benefit is that GIA devotes all of its skills to ACP-ASIM members only!

GIA understands your needs for protection in the event of death, disability, medical expense and financial planning. They also recognize that members of the College are preferred risks and this is reflected in the low premium rates charged.

GIA's insurance and financial planning services are monitored by the Board of Regents' Member Insurance and Financial Services Subcommittee. The members of the subcommittee include ACP-ASIM's Executive Vice President and Treasurer, as well as one member of the Board of Regents and four members of the Board of Governors. For more information, contact GIA at 1-800-GIA-PLAN.

Helpful Resources for Clinical Preceptors

By: Stephanie Woodward, Research Coordinator

More and more of our members in Colorado are participating in preceptor programs. We've collected some helpful resources for physicians who want to gain a better insight on the elements of mentoring, brush up on existing skills or just find out what is available. We've included both web sites and Clearinghouse resources. The Clearinghouse is a collection of program materials, articles, books and videotapes relating to Community-Based Teaching. The Clearinghouse resources listed below can be ordered by calling 800-523-1546, ext. 2588.

http://www.mentoringgroup.com/ For physicians who mentor medical students and residents. Of particular interest are the "Mentoring Ideas" and " Tips for Mentors" pages, which are updated monthly.

http://www.im.org/apm/ Mentoring will be one of the topics of focus during the Association of Professors of Medicine Fall Symposium "Mentoring, Solving Problems, and Establishing Culture in Departments of Internal Medicine" in Ontario, October 1-3. This symposium will include a workshop called "Mentoring Myths and the Realities of Developmental Relationships." Call 202-861-7700 for more information.

In addition, the Clearinghouse contains these articles on mentoring:

Item 395: Defining Preceptor, Mentor, and Role Model, Rick E. Ricer, Family Medicine, 1998;30:328. This article clarifies some of the commonly used language in a physician-student interaction.

Item 401: Generalist Pathway Project, Michael J. Reichgott, and Elizabeth Goldman, Albert Einstein College of Medicine. Einstein's mentorship/preceptorship program materials contain a description of preceptor duties and responsibilities. This document also describes the components of the program.

Item 341: Workshop: Mentoring and the Profession of Medicine-Written materials, Society of General Internal Medicine, 1993:21. This packet contains articles and references on mentoring. There is also a document from Boston University School of Medicine designed to recruit students for a first-year Family Medicine Mentorship Program.

Preventive Health News

Testing For Chlamydia and Taking a Sexual History in Adolescent Females - Results From a Survey of Colorado Primary Care Providers

By: Kenneth Gershman, MD

The Colorado Department of Public Health and Environment (CDPHE) conducted an anonymous mail survey during July through December 1998 of a random sample of Colorado physicians (obstetrics /gynecology, family practice, pediatrics, internal medicine), nurse practitioners, and physician assistants. The purpose was to assess clinical practices in chlamydia testing and sexual history taking when providers see adolescent females, the group at highest risk for chlamydial infections.

The survey sample included 1265 providers, and 576 completed surveys were returned after three mailings for a response rate of 71% (adjusted for ineligible providers; i.e. those not currently practicing and those not providing gynecologic care.) Of the respondents, 66% were physicians, 23% nurse practitioners, and 11% physician assistants. Most respondents reported their practice specialty as family practice (46%), obstetrics/gynecology (23%), or internal medicine (17%).

Only 54% of providers reported regularly ("often" or "always") testing sexually active adolescent females for chlamydia and only 26% reported "always" testing this group. With regard to sexual history taking, 72% of providers reported regularly ("likely" or "very likely") obtaining this during an annual or new patient visit. Female providers reported significantly more frequently regularly testing for chlamydia (64% vs 39%) and taking sexual histories (85% vs 53%) than male providers. Of note, the reported practice behaviors of female physicians were more similar to those of nurse practitioners (high frequencies of these practices) than to those of male physicians (low frequencies of these practices).

Editorial

Chlamydia is the most prevalent reportable STD in the US and Colorado. In 1998, laboratories reported 9,850 positive tests for chlamydia to CDPHE. Complications of chlamydial infections include pelvic inflammatory disease and subsequent tubal infertility, ectopic pregnancy, and chronic pelvic pain. Adolescent females are the demographic group at highest risk for chlamydia.

CDPHE endorses recommendations from the Centers for Disease Control and Prevention (Recommendations for the Prevention and Management of Chlamydia trachomatis Infections. MMWR 1993;42[RR-12]:10-11) that "all sexually active women <20 years of age should be tested for chlamydia."

In addition, women >20 years of age with signs, symptoms, or risk factors (inconsistent barrier contraception use, new sex partner or >1 sex partner during the last three months) should be tested. In some settings, testing all sexually active women <25 years of age may be indicated based on the prevalence of chlamydia in these patient populations.

For more information about the provider survey or about chlamydia screening guidelines, contact Dr. Kenneth Gershman, CDPHE, at (303) 692-2657.