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SEPTEMBER 2020


Dear FCM Colleagues,
 
Welcome to the second edition of FCM Bulletin! 
 
As you all know, the UA has been implementing a “phased re-entry” approach to the fall semester with heavy emphasis on “Test, Trace, Treat.”  Still, there is concern about potential increases in COVID-19 cases following the Labor Day holiday weekend (view the latest re-entry briefing here). The UA and Pima County are working closely together to expand testing and contract tracing, and are very closely monitoring the numbers of COVID-19 cases to decide on next steps. There is huge recognition of the importance of everyone getting a flu-shot this year.
 
Earlier this month I attended (virtually) some of the Society of Teachers of Family Medicine conference and had the opportunity to listen to how other family medicine departments all around the country have responded to the COVID-19 pandemic. And I also heard a lot about how these departments are now working hard to adapt to the “new normal” in the era of COVID-19. And knowing that flu season is fast approaching. It also gave me the opportunity to reflect on our own department’s experiences over the past 6 months…
 
The pandemic has challenged us all in ways we never could have imagined. We know that COVID-19 will still challenge us in ways we cannot foresee. These challenges have also been compounded by a national awakening and reckoning with the legacy and the continuing impact of systemic racism. I understand that feelings of anxiety, fear, anger, and perhaps even despair have been experienced by all of us over the past six months. And I also know that our people have shown truly amazing caring, compassion, courage, and resilience. Let us all remember that.
 
As FCM’s department chair, some of the proudest and most emotional moments in the last six months have come from witnessing or hearing about how our faculty, staff, and learners have pulled together through all of these challenges—and continue to do so. I understand that we are tired of facing challenges—some days more than others.  I also know that the road ahead is not short nor smooth. So, I ask that each and every one of us, each of us doing our best and contributing in our own way, and with the teams with we work with—to keep pulling together, supporting each other, and treating each other with caring and compassion.
 
And please keep yourselves and your loved ones safe. Keep following the public health guidelines to mask up, wash hands and social distance. And get a flu-shot.

This month’s  clinical practice update highlights our Primary Care Program for Adults with Intellectual Developmental Disabilities, a family medicine clinical program, in collaboration with the Sonoran UCEDD. The program is located at the Banner – University Medicine Family Medicine Clinic at South Campus.

Elements of the program include enhanced access to care, physical accessibility, case management, staff/provider education, and quality management. Dr. Tammie Bassford is the lead physician and provides quality assurance and clinical oversight for the 85-110 patients who may be enrolled at any time. 

Valerie Mata is the case manager and she is the first point of contact for patients and their families/support people. She facilitates the first visit, assures transfer of records, assists with scheduling appointments, assists with access to sub-specialists, works with community service providers and the Division of Developmental Disabilities to meet patient needs. She also attends the family medicine visits with patients in order to assist with behavioral/social issues identified at the visit and models patient-centered care and person-first language to our providers, many of whom are residents.

Dr. Bassford provides resident education, and real-time consultation. She and Valerie staff the panel weekly and perform chart reviews for preventive examinations. They also provide outreach for annual flu vaccines, educational opportunities through the Sonoran UCEDD, and time-critical information (such as during the recent COVID-19 pandemic).

Each patient has an assigned primary care physician, which may be Dr. Bassford, another FM faculty member, or an FM resident under the supervision of a faculty member.

The program's impact on quality and cost has been evaluated through an analysis of Medicaid insurance claims for all enrolled IDD patients in Arizona. Patients enrolled in our program, when compared to samples of Medicaid enrollees matched by diagnosis, had twice as many Evaluation and Management (E/M) visits as the comparison group, and 40% lower non-E/M professional visits. This indicated improved access to primary and cognitive care, and fewer visits for diagnostic/therapeutic procedures. This translated to a cost savings of $473 per member per month, which increased to $520 when controlled for age/gender/race-ethnicity/chronic health conditions, and IDD diagnoses. 

Additionally, the program anchors educational opportunities through sub-internships for UA undergraduate students (Colleges of Science and Public Health), and a required curriculum in Developmental Medicine for the South Campus Family Medicine Residency program—which includes didactic sessions, support for resident care of patients with IDD in the clinic, supervised resident home visits to patients with IDD and resident visits to community sites relevant to the care of their patients.

August has been a busy month in FCM Education.

Undergraduate/Graduate Education
  • All of our fall semester Undergraduate and Graduate courses were successfully adjusted, revised, and are now ready to go for a mix of online and in-person learning, as students return to campus at the end of the August.
     
  • Yumi Shirai was awarded funding from the College of Medicine to develop her course entitled: Arts and Community Health: Intercultural Perspectives and Applications. She aims to offer this course in the Fall of 2021.
     
  • The BS in Medicine Program has agreed to support Alicia Allen in her efforts to develop courses to be included in this degree program.
     
  • Jacy Farkas is working with the faculty from UCEDD in developing additional courses related to disabilities to be offered in Spring 2021.
College of Medicine
  • Recruitment for the Class of 2025 has begun, this year it is all online. Tejal Parikh, as the assistant dean for Admissions, is looking for our help. As a department, I would like to see us all be involved in some way in recruiting this class. One great way to do this is to be an MMI evaluator (multiple mini-interviews). If you would like to participate please let me know or reach out to COM Admissions directly. At the end, I would like to recognize everyone who participated – so please let me know that you have participated.
Residencies and Fellowships
  • Residency programs are beginning to gear up of an all virtual recruitment season.
     
  • We are continuing to recruit for an Associate Program Director at the Alvernon Residency Program, if you know of anyone who would be a good candidate, please let me know or contact Jessie Pettit.
     
  • RSPP Updates: Second-year residents at both Alvernon and South Campus will be matched with mentoring teams in September, with additional training and projects launching in September and October. Mark your calendars now to see works-in-progress presentations by third-year residents from both programs on Thursday, October 8th at 4pm (more details to follow).
Over the next few months, I will be creating an education dashboard with metrics on our educational activities.

Thank you again for your continued work in support of our department’s educational goals.
 
 

As we enter into the month of September, it is time for summer to come to an end and to begin to prepare for the start of the fall season. I think one common theme for this year is that this was a summer we won’t soon forget. As COVID-19 required us to be creative in how we served our community, I have been so impressed with the resiliency of our community engagement programs to continue to serve patients and clients amidst all of the challenges resulting from the pandemic. I want to highlight some of the major projects and activities going on in the programs over the summer.
  • American Indian Youth Wellness Initiative: Although the program was unable to hold the in-person camp this summer due to COVID-19, the staff got creative and provided fitness and nutrition programs remotely to Native American youth and their families.
     
  • ArtWorks: The program has been able to continue to serve some of the artists with in-person programs, while also offering remote art classes to those clients who are at a higher health risk or who chose not to come into the center because of COVID-19.
     
  • Camp Wellness: The program was able to continue to serve clients with both in-person programs and remote learning activities for those who had access to the internet. The AZAHP Workforce Alliance acknowledged Camp Wellness for their commitment to the ongoing training of their team, level of engagement with stakeholders and the overall culture of the program.
     
  • Mobile Health Program: When the partnering sites had to close due to COVID-19, the program continued to serve patients through telehealth and then reopened to in-person care as soon as the sites began to come back online. The prenatal clinics continued to see patients throughout the COVID-19 pandemic to make sure women had access to good prenatal care. We were excited to welcome Alicia Dinsmore as the new program coordinator and Dr. Ana Gonzales as the new medical director. A big thank you and expression of gratitude to Patrick Rivers and Dr. Ravi Grivois-Shah for their years of service to the program and dedication to caring for the patients.
     
  • Native American Research and Training Center (NARTC): The center supported and assisted the Tribal Images Youth Coalition and Tucson Indian Center Youth Council to produce and film PSA announcements on anti-vaping/COVID-19. The Tribal Images Youth Coalition and Tucson Indian Center Youth Council also collaborated to produce Reach the Loop coloring book in three languages. The REACH staff made masks for several tribal programs and led donation drives and delivered the donations to Hopi, Navajo and Southern Arizona Urban Native Indigenous COVID Relief. NARTC was also part of a new grant funded by the National Cancer Institute. The goal of this funded study is to identify causes of kidney cancer surgical disparities using a mixed method approach combining semi-structured, in-depth interviews and analysis of clinical data. Dr. Francine Gachupin, who is a faculty member affiliated with NARTC, is part of the research team. 
     
  • Sonoran Center for Excellence in Disabilities (UCEDD): The UCEDD recently released their year-end numbers that demonstrate the significant impact the center has on helping those with disabilities. For the 2019/20 fiscal year, the UCEDD reached more than 57,050 individuals through outreach, community education, model programs and dissemination of information. The center received 27 grants that totaled over $3.1M. During this time the UCEDD was involved in 18 different research studies and participated in 37 local, national and international conference presentations. In August the center was notified that they were funded for a collaborative project working with the UCEDD at Northern Arizona University. Another collaborative project that is getting ready to launch is in partnership with ASU to become an ECHO site. If you would like to learn more about all the projects that the UCEDD is involved in, please join their newsletter distribution list by emailing ucedd@email.arizona.edu.
     
  • Tucson Family Advocacy Program Medical Legal Partnership for Health (TFAP): The program is helping improve access to critical resources during the COVID-19 pandemic by providing frequent updates to refugee resettlement agencies, and other community partners, on COVID-19 related changes to public benefits eligibility and resources for vulnerable populations. TFAP also recently received notice of funding for the fourth year from the Arizona Department of Economic Security Office of Refugee Resettlement for their ongoing work with refugee communities.
     
  • Workforce Development Program: At the beginning of the COVID-19 pandemic, the program completely restructured its training program to a remote learning format. The program was recently approved for a HRSA grant in collaboration with the Department of Pharmacology. The grant is focused on preparing peer mentors to work with children and families impacted by opioid and substance use disorders.
These updates represent only a portion of all the great work that our community engagement programs are involved in. As we approach the fall season, there are many exciting projects that these programs are working on.
 

Following the general introduction on research in last month’s bulletin, we are now settling into a “template” for the monthly issues. Just as on NPR, we’ll “first do the numbers,” with Ed Rose updating our funding data. Next, we’ll highlight a new grant or initiative, which this month is an NCI-funded project led by Dr. Uma Nair. Finally, I also would like to highlight a (potentially) high-impact publication every month. This month’s feature is a recent publication by Dr. Karen Lutrick and colleagues.

The Numbers:


 

Featured Grants:
This past month, two NIH grants involving FCM research faculty were funded.

Uma Nair received a grant from the National Cancer Institute under its Geographic Management of Cancer Health Disparities (GMaP) program. Dr. Nair and colleagues aim to understand factors associated with cervical cancer screening among lesbian and bisexual women and transgender men (LBT) in Arizona using a multilevel framework. This project fits eminently with FCM’s commitment to diversity, as well as research on reducing health disparities in minority and at-risk populations.
 
Low rates of cervical cancer screening among LBT individuals is an understudied but pertinent area in cancer control research. Dr. Nair and her colleagues aim to gain a comprehensive understanding of multi-level factors (individuals and healthcare providers) associated with engaging in and uptake of routine cervical cancer screening among LBT individuals, specifically within the cultural context of Arizona. The team will be using two approaches: (a) use of a statewide quantitative survey examining routine cervical cancer screening practices among LBT individuals residing in Arizona, and (b) in-depth interviews with healthcare providers to understand provider-level experiences on recommending screening practices for all patients in general, and sexual and gender minority populations in particular.
 
A community advisory board comprising clinicians, community members, and individuals working in organizations serving LGBT+ populations will provide guidance and feedback on all aspects of the study. The results will guide the development of a conceptual framework of multi-level factors associated with cervical cancer screenings among LBT individuals in Arizona and inform development and testing of targeted multi-level interventions to increase rates of cervical cancer screenings among LBT populations in larger scale trials.
 
Alicia Allen and Nicole Person-Rennell are part of a multi-center grant coordinated by the University of Minnesota that will be evaluating how modifying progesterone and estradiol levels may prevent postpartum cigarette smoking relapse and reduce secondhand smoke exposure in infants and children. Postpartum smoking relapse rates have remained stagnant for over a decade with more than 50% of those who are able to achieve smoking abstinence during pregnancy relapsing within the first few months after childbirth – with negative health consequences for both mother and child. Research to identify safe and novel postpartum smoking relapse prevention interventions is needed. From its preliminary studies the team has learned that giving exogenous progesterone (Prog) in the early postpartum period reduces several smoking relapse related risk factors (e.g., craving) and improves smoking abstinence at 12-weeks postpartum. These findings concur with a wealth of prior literature that demonstrates the protective effects of progesterone on a variety of addictive behaviors. In another preliminary study involving non-pregnant premenopausal women by the team, depot medroxyprogesterone acetate or DMPA, which blocks ovulation for 12-weeks which subsequently decreases estradiol levels, was associated with longer previous quit attempts and reduced smoking motives.

These observations have shaped the central hypothesis that the combination of increased progesterone and decreased estradiol will prevent postpartum smoking relapse. The team will conduct a double-blind, placebo-controlled, randomized clinical trial that will enroll healthy pregnant women who have recently quit smoking and intend to stay abstinent postpartum. Participants will be randomized into one of four assignments: (1) Prog + DMPA, (2) Prog + placebo, (3) placebo + DMPA, and (4) placebo + placebo. They will be followed for days to smoking relapse, smoking relapse-related risk factors (e.g., craving), and infant health outcomes from gestational week 36 through 9 months postpartum. Importantly, this study will evaluate a safe and innovative intervention to examine the impact of manipulating postpartum physiology to influence the behavior of a new mother which will lead to improved health outcomes for her and her infant.
 
Featured Publication:
I asked the research faculty to send me papers, but they are either too modest or too busy (probably both) to nominate a recent publication. This led me to PubMed, where I found a systematic review by Dr. Karen Lutrick and colleagues (PMID: 3249349; PMCID: PMC7268476; DOI: 10.1186/s13643-020-01383-w) on bullying and depression in children, with special consideration of bullying of Latinx children.

The authors focused on studies published within the past 20 years that included a Latinx population of at least 25%, and were especially interested in finding out if and how race/ethnicity was included in these studies. Bullying – or, more technically, peer victimization - included direct, indirect, and cyber forms. Unsurprisingly, this systematic review required a lot of upfront work, whittling down a search that yielded 957 unique papers to settle on 17 articles that met the inclusion criteria. The principal finding was that all 17 studies reported a statistically significant relationship between bullying and depression – treating bullying mainly as an explanatory variable for the observed depression.

Focusing further on the Latinx population, 9 studies included race/ethnicity as a variable of interest and/or a component of the analysis. Here the principal finding was that the bullying experiences of Latinx adolescents and other immigrant-based populations may reflect sociocultural factors that are different from those of their white peers. Important also was the observation (and need for further research) that there might be differences across Latinx subgroups based on nation of origin or acculturation factors. Commenting on the study she led, Dr. Lutrick points out that “understanding bullying and the effects it may have on adolescents is difficult, and doing so removed from the cultural contexts of the affected adolescents could severely limit what we know.”
 
 

From Lisa Welsh, FCM Banner assistant department administrator:
  • Banner’s fiscal year is the same as the calendar year and we are in the process of submitting the clinical budget for 2021. This is in the early budgeting phase and not yet finalized. Final clinic volumes will be reviewed in October.
     
  • We are approaching the flu season and the No Flu for You initiative officially started 8/31/2020. All team members, providers and volunteers must get a flu shot or have an approved medical or religious exemption on file by 11:59 p.m. (MST) Nov. 9, 2020. Please note: the links in this section below are only accessible from a Banner computer or Banner network.
  • Annual BLC compliance modules are due October 10, 2020. Please ensure you have completed your assigned modules prior to the deadline. Weekly reports are monitored, and reminders will be sent to employees and managers. As a reminder, anyone who has access to Banner systems, must complete BLC’s. Please see access instructions below:
    • To access the Banner Learning Center from a non-Banner computer: https://bannerhealth.sabacloud.com
    • To access from a Banner computer: Go to the Banner Intranet homepage and under Systemwide Links on the right-hand side there is a link for the Banner Learning Center. 
 
From Claudia Gallego, FCM UA assistant department administrator:
  • The University of Arizona implemented Furlough and Furlough-Based Salary Programs August 10, 2020 – June 30, 2021, in recognition of the extreme financial crisis resulting from the unprecedented impact of the COVID-19 pandemic.
    • Employees who have time funded by sponsored awards are participating in the Furlough Program. The required furlough days will be proportionate to the FTE (hours) distributed to sponsored accounts.
    • Employees participating in the Furlough-Based Salary Program received a reduction in their salary in addition to receiving a balance of paid Personal Flex Time. The balance of Personal Flex Time will be in an amount equivalent to the pay reduction (not to exceed 39 days).
    • The UAccess Employee Pay Reduction Tracking Tile for the Furlough and Furlough-Based Salary Programs were updated on your UAccess Employee Main Homepage on Monday, August 24.  The programs will be re-evaluated in October 2020 and March 2021.
       
  • The University of Arizona has extended the Hiring Waiver Process to June 30, 2021.
    • For the past several months, the UA has had a hiring slowdown in place to help mitigate the financial impact of COVID-19This hiring slowdown and waiver process was originally scheduled to last until July 31, 2020; however, it has been extended until June 30, 2021.
       
  • We are in the recruitment process for a replacement IT Student Assistant. Please contact Veronica Cortez with questions.

 






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UA Department of Family and Community Medicine · 655 N. Alvernon Way, Ste. 228 · Tucson, AZ 85711 · USA

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