August Monthly Meeting Synopsis
What Schism? Local Public Health and Primary Care in the 21st Century
At the August DFM meeting, we had three distinguished colleagues from Denver Health speak to us about:
- community-level prevention – a key strategy for overcoming the high-cost/poor outcome paradox of healthcare in America
- a conceptual model for roles of public health and medical care in community-level prevention
- two examples: childhood obesity and prevention of complications of HPV infection
First, Dr. William Burman made the case for community-level prevention by pointing to life expectancy, diabetes, smoking, and motor vehicle accidents as examples of problems where medical care is critical but insufficient to attain desired results.
- In medicine, the patient is the individual; in public health, the patient is the community
- Public health diagnoses the health of the community using public health science
- Treatment of the community involves new policies and interventions
- Goal of medicine is cure; goal of public health is prevention of disease and disability
Second, Dr. Art Davidson reminded us that the schism between primary care and public health began with the creation of two parallel educational functions, responsibilities and sets of schools, and the unintended consequences from these institutional and professional initiatives led to the separation we see today.
Dr. Davidson also pointed us to exemplar community-level interventions to address obesity, and reminded us that prevention is the key to controlling obesity and its adverse consequences.
Lastly, Dr. Judy Shlay described a highly-effective vaccine for preventing infection with Human Papillomavirus (HPV) with very disappointing population coverage and therefore less prevention effectiveness than is desired. Using this example, she illustrated the roles that public health and medical care could play in addressing this problem.
- Population-level data – population coverage of HPV vaccine, identification of populations in need
- Population-level thinking – importance of health system policies, possible role for vaccination in non-traditional settings (e.g., school-located programs)
- Community engagement – work with providers and communities in areas with decreased vaccine coverage to identify barriers to broader use, improve communication about HPV vaccine
- Monitoring – provide feedback on vaccine coverage following interventions and changes in HPV-related health outcomes
- Appropriate and standardized messaging about HPV vaccine
- Convenient and effective ways of assuring vaccine administration in a very high percentage of those in care
- Assuring that payers provide appropriate funding for vaccination (per the requirements of the ACA)
- Assist with evaluation of the effects of vaccination on HPV-related health outcomes (e.g., cervical dysplasia and cancer, genital and anal warts)
In summary, the presenters left us with these parting thoughts:
- We are in a time of unique opportunity
– Crisis in health care costs and suboptimal outcomes is now increasingly recognized
– State policymakers are willing to make major changes in the fragmented elements of health and medical care in the U.S.
- The alignment of public health (population health and prevention) and medical care (high-value care for the individual) can play a critical role in developing a true health system and achieving the Triple Aim.
- Long-term – we need to shift funding from medical care to non-medical sectors that are critical in community-level prevention (e.g., transportation, education, social services).
To view their slides, please click here.
Name: Laura Pickler, MD
Position: Associate Professor, Children’s Hospital Feeding & Swallowing Program
Who you are and what you do:
My clinical practice is at Children’s Hospital Colorado. I direct two multidisciplinary clinics and am involved in a third all working to improve access to high quality care for children and youth with special health care needs.
What are the three most important things you’re working on?
1. Providing access to high quality care for children and youth with special healthcare needs and mentoring others to do so too.
2. Building a clinical model to provide excellent team based care for girls and women with Turner syndrome.
3. Improving, implementing and supporting transfers of care for young adults who have previously been served by pediatric providers in the pediatric system here locally and also nationally.
Why do you like working for DFM?
I never have to wonder if my ideas will be heard or supported. I can be honest and also know that the feedback I get will be helpful. Sherry Holcomb and Natalie Buys are wonderful team members and SHINE compared to their counterparts in other departments. I’m glad to be part of DFM and hope to find more ways to fit my interests into what is happening departmentally in the future.
What are your passions?
Access to appropriate healthcare for ALL people regardless of disability or medical condition. We have a long way to go in our country to make this happen. Medical home is one way to approach this challenge. Training medical professions students is another. I believe health is a vehicle to having choices in how people spend their time. My ultimate goal for all of my patients, regardless of disability, is that they would have some choice in what they do when not in my office.
What do you do away from work?
Mostly I’m bicycling with my husband and playing with my puppy. We spend as much time as possible outside.
I enjoy many types of music, depending on my mood. These days classical guitar is what helps me relax.
Favorite movie and why?
Chicken Run. I am a picky movie watcher and this cartoon was probably the last movie where I was fully entertained.
I grew up traveling with my family in the Army. I have lived in three countries, 10 states and moved 13 times before high school graduation. I traveled around Europe extensively in the 80’s and early 90’s with a passport so full they issued me new pages. I haven’t left the US now in 22 years and my passport expired. I’d rather be on a bicycle than in a plane.
Three brave staff members took the ALS Ice Bucket Challenge on Friday, 8/22 after being nominated by another brave staff member (Stephanie Livingston) earlier in the week. Venus Mann, Deanna Schroder and Chris Seek all took the icy plunge. Additionally, Stephanie Mitchell made a generous donation to the ALS foundation in lieu of ruining her ‘do! You can still donate to this worthy cause (or a charity of your choice!) on behalf of the DFM.
Movin’ on Up!
The following faculty members were recently approved for promotion by the School of Medicine:
Professor of Clinical Practice: Kent Voorhees, MD
Associate Professor: Linda Montgomery, MD; Tammy Myers, MD; Laura Pickler, MD: Brad Winslow, MD
Assistant Professor: Heather Bleacher, MD
Senior Instructor: Caroline Emsermann, PhD: Linda Zittleman, PhD
Everything’s coming up…vegetables?
The BRANCH crew got a boost on their community gardening project on Saturday, 8/23, when over 30 DFM employees, students from around AMC, and other community members turned out for a work day at the Hinkley High School Community Garden. Volunteers dug up countless weeds, shoveled yards and yards of gravel to make plot boundaries, and got the effort off to a good start. Thanks to Dave Gaspar and family, Robert McGranaghan, Lori Sachau and her husband, Deanna Schroder and her daughter, and project lead Robyn Wearner for their hard work – it was hot and sweaty manual labor!
BRANCH (Bridging Research & Aurora Neighborhoods for Community Health) is a DFM-led student interest group that partners with Aurora communities by promoting, supporting, and implementing programs that encourage Aurora community members to take an active role in their own health and the health of their community. They have a thriving community garden already in place at North Middle School. For more information, contact .
Looking for a deal? Check out BenefitHub
As a University of Colorado employee, you have access to BenefitHub, the State of Colorado Employee Discount Marketplace. This online service allows eligible employees to take advantage of hundreds of national and local discounts ranging from travel and tickets to apparel and electronics.
Signing up is quick, easy and free. Simply go to the website: https://stateofcolorado.benefithub.com/. There, you will be guided to create an account. You will need to use your CU email and create a password. Click ‘create account’ and you will have access to all the site’s deals. Plus, you can pin your favorite deals for easy access later and earn cash back credits to use on future purchases.