Family Physicians in Rural Health

1. Family Physicians in Rural Health Wahkiakum Family Practice Clinic, Cathlamet, WA Rural Health Group, Jackson, NC Benton City Clinic, Benton City, WA Republic Medical Clinic, Republic, WA

2. Family Physicians Also known as: General Practitioners Family Practice Providers Primary Care Providers Country Doctors “My Doctor” Family medicine: “Officially recognized in February, 1969 as the 20th primary medical specialty. “ (American Board of Family Medicine)

3. Education Post-Secondary Education Bachelor’s Degree Medical School Residency Continuing Medical Education (CME)

4. Education (continued) • Three years to prepare for board certification in family medicine specialty. • American Board of Family Medicine requires subspecialty certification in adolescent, geriatric, hospice and palliative care, sleep, and sports medicine. • Additional subspecialty training and fellowships optional in emergency, internal and pediatric medicine. • Board certification is not required, but highly valued because it “demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice” (American Board of Medical Specialties) Residency

5. Education (continued) • Family Medicine specialty first to require CME (American Family Physician) • 50 credits annually to maintain board certification • EB-CME: Evidence-based CME • “Improve patient outcomes through evidence-based medicine” and to “prepare family physicians for the measures insurers and payers will require” (American Family Physician) Continuing Medical Education (CME):

6. What do rural physicians do? • Preventative and routine care: physicals, immunizations • Acute care: hospital stays • Chronic disease management: diabetes • End-of-life care • Coordination of care: referrals to specialists • Types of care: (some overlap with other specialties) Similar to urban physicians Most often first point-of-contact for patients Care for patients in a wide range of settings Build continuing relationships with their patients. Comprehensive Care • Adolescent • Geriatric • Hospice and Palliative • Sleep • Sports • Internal medicine • Obstetrics and gynecology • Emergency medicine • Pediatric

7. Rural Health Clinics “A Rural Health Clinic is a clinic certified to receive special Medicare and Medicaid reimbursement and must be located in non-urban rural areas with current health care shortage designations.” (http://www.raconline.org/

8. Rural Health Physician • Health Professional Shortage Areas • Often remote and underserved • Economic: health insurance availability, practice costs • Geographic: travel distances, seasonal weather changes, distribution of primary and ancillary services • Programmatic: system challenges such as electronic health records, clinical information systems, administrative, • Others: recruitment and retention, workload, vacations, schools, income, spousal job opportunities, professional and cultural isolation Challenges “Rural health professionals have a number of additional information issues: isolation, lack of library services, and inadequate access to information.” Dorsch, 2000

9. Maps of Washington Source: Washington State department of Health (http://ww4.doh.wa.gov/gis/standard_maps.htm)

10. Rural Health Physician • Clinical autonomy • Providing needed care in remote areas • Developing strong relationships with patients • Enjoy living the country lifestyle Rewards

11. Information Needs • Patient data: medical history, ancillary data • Population statistics: patterns of illness • Medical knowledge: textbooks, original research, common knowledge • Logistic information: administrative, organizational • Social influences: local practice patterns • Seek human resources, print resources, electronic resources Same basic needs as urban physicians

12. Instructional Video • "In the wake of the wide application of the Internet, the Web has become more popular for educational instruction" (Liaw, 2004) • "Most Internet users start at a search engine when looking for health information online. Very few check the source and date of the information they find" (Fox, Pew Internet, 2006) • Video presentations have "been successfully used in accident and emergency waiting areas where patients' subjective comments have been favourable and indicated that, at the very least, the videos help them pass the time" (Koperski, 1989).

13. Instructional Video: Health Websites • Design and create video of “actual” search • May be used in waiting rooms or exam rooms • Improve health literacy • Educate patients about health information websites • Encourages proactive, preventative care through self-discovery • Patients may be better prepared to discuss health issues. • Patients can make better decisions regarding their health and wellness. • May promote healthy lifestyles through preventative care education • Patients can improve searching or perhaps bypass the search engine approach. Example: Educational video using MedlinePlus

14. Conclusion • Rural health physicians, located in remote and underserved areas can be assisted in providing effective health care through information technologies. • We can improve point-of-care services by educating patients on issues surrounding wellness and preventative care. • Patients can take a more proactive role in their own health through awareness of available resources. • Health information website instructional videos can help in this process.

15. Bibliography • American Board of Family Medicine (https://www.theabfm.org/index.aspx) • American Board of Medical Specialties (http://www.abms.org/) • American Academy of Family Physicians (http://www.aafp.org/online/en/home.html) • Washington Rural Health Association (http://www.wrha.com/) • National Rural Health Association (http://www.ruralhealthweb.org/) • Beaudin, B., Quick, D. Instructional video evaluation instrument. Journal of Extension. 1996 June; 34 (3). • Chalmers JM, FAU - Robinson, J., Robinson J, FAU - Nankivell, N., & Nankivell N. The practical oral care video--evaluation of a dental awareness month initiative. - Aust Dent J.2005 Jun;50(2):75-80., (0045-0421 (Print) • Chimoskey SJ, FAU - Norris, T. E., & Norris TE. Use of MEDLINE by rural physicians in washington state. - J Am Med Inform Assoc.1999 Jul-Aug;6(4):332-3., (1067-5027 (Print)

16. Bibliography • Dorsch JL. Information needs of rural health professionals: A review of the literature. - Bull Med Libr Assoc.2000 Oct;88(4):346-54.PMID- 15784135 OWN - NLM STAT- MEDLINE, (0025-7338 (Print) • Gorman, P. N. (1995). Information needs of physicians. Journal of the American Society for Information Science, 46(10), 729-736. • Koperski M. Health education using video recordings in a general practice waiting area: An evaluation. - J R Coll Gen Pract.1989 Aug;39(325):328-30., (0035-8797 (Print) • Liaw, S. (2004). Considerations for developing constructivist web-based learning. International Journal of Instructional Media, 31(3), 309. • Pathman DE, FAU - Williams, E. S., Williams ES, FAU - Konrad, T. R., & Konrad TR. Rural physician satisfaction: Its sources and relationship to retention. - J Rural Health.1996 Fall;12(5):366-77. • Pew Internet and American Life Project (http://www.pewinternet.org/ • Rural Assistance Center (http://www.raconline.org) • Stenger J, FAU - Cashman, S. B., Cashman SB, FAU - Savageau, J. A., & Savageau JA. The primary care physician workforce in massachusetts: Implications for the workforce in rural, small town america. - J Rural Health.2008 Fall;24(4):375-83., (1748-0361 (Electronic))

17. Thank You! Questions?