ERIC D. HERMAN, M.D.

I was born and raised in the city of Brotherly Love. I moved to the Northwest almost ten years ago. Despite the lack of good cheese steaks and soft pretzels, this program was my first choice and for good reason. It offers outstanding full-spectrum training. Enough said.

Outside of medicine, music is one of my passions and I play guitar and drums whenever I can. I’m a total nerd when it comes to computers and PDA’s but don’t let that scare you. Nerds are, afterall, lovable creatures. I’m a big sports fan and I also enjoy traveling, star gazing and going out with my friends.

In my past life (before medical school) I served 2 years in the Peace Corps and this experience will most likely influence my future career. I believe Medicine will always be a noble profession and I am proud to be at TFM.

CHAD B. KRILICH, M.D.

My life has come full circle at this point. I was born in Tacoma, raised in Federal Way, and spent my years as an undergraduate at the University of Washington. My wife, Julie, and I decided to spread our wings after graduation. We spent four spectacular and fulfilling years in Boston at Tufts University School of Medicine. Training in a highly specialized medical environment, I realized I could not narrow my focus when a patient walked in the room. Instead, I wanted the challenge of trying to incorporate every part of my patient’s life into their visit. Family medicine was a natural fit. Knowing that the west coast held my interest, I researched the programs and discovered to my surprise and horror, that Tacoma Family Medicine had everything. Diverse and talented faculty and residents; strengths in obstetrics, pediatrics, and rural medicine; and, of course, access to a wealth of outdoor activities. As for the horror, returning to our family’s homes has been a pleasant surprise. At some point, we may even choose to raise a family here too.

MICHAEL J. ORLICH, M.D.

One of the few Hoosiers in this area, I was born and raised in Indiana. Except for a year in Spain studying the Spanish language and culture, I spent the last 8 years studying in Michigan, most recently at the University of Michigan Medical School. I have special interests in international medicine and medical missions as well as preventive medicine and public health. Personal interests include my famous orange cat “Pumpkin”, playing guitar and singing, church activities, and taking walks outside. As an intern, I have most appreciated the supportive atmosphere and the strong emphasis on education at TFM.

PAUL W. SCHMIDT, D.O.

I grew up in Gig Harbor, WA and after 8 years away I am glad to be back in the land of good salmon, microbrews and lots of rain. After college at Central Washington University, I married my high school sweetheart. We were then off to Kansas City and the University of Health Sciences — College of Osteopathic Medicine. I am thrilled to be part of Tacoma Family Medicine. The people are great and the training is superb. My wife and two little boys are very happy to be back home and surrounded with family and friends.

LOUIS J. (“JED”) SHARPE, M.D.

I was born in Cuyahoga Falls, OH and received my undergraduate education at Miami University. I attended Wright State University School of Medicine after spending time doing a variety of jobs including ecology genetics lab tech, cook/purse seiner off the Aleutian Chain, emergency medical technician and research SCUBA diver. During medical school I was involved with PRIME (Promoting, Reinforcing & Improving Medical Eduation) where we created a course for up and coming medical students that would expose them to medicine which involved service to the underserved population of the inner city. I hope to be a rural physician. I am an avid outdoorsman and often go to the woods and mountains to find peace. Fishing, backpacking, and cooking are my passions. I am married to a fantastic woman named Val.

BRYAN D. WHITEMARSH, M.D.

Since I grew up in Puyallup and my wife was raised in nearby Spanaway, it was a no-brainer for us to apply for residency at TFM. When we further looked into the program, we were pleasantly surprised to find that not only is it geographically perfect, but the program itself is very strong without being overly brutal. Since matching with this program, I have found the residency here to be even better than expected. The friendly, approachable, and knowledgeable faculty made the transition into residency much smoother than I anticipated. In addition, the procedurally oriented experiences available while working with both rural and underserved urban populations will be invaluable when I eventually establish my practice in this area. I enjoy mountain biking (Victor Falls RULES!), Mariners baseball (Go M’s!), and spending time with my wife, Shannon and our three children: Allen, 12; Jordan, 8; and Cody, 6.

KATHERINE S. (“KATE”) ZOPF LANDY, M.D.

I was a bit of a wanderer in my life before Tacoma. I grew up in the other Washington (the one on the East coast), headed to New York City for college at Columbia. For a change of scene, I drove a bread bakery delivery truck in Seattle for a year, which successfully whetted my appetite for the Northwest. Even my subsequent moves to New Orleans to get my MPH, and to rural Morocco for a two-year stint as a Peace Corps volunteer, couldn’t make me forget Puget Sound. After my four years at University of Rochester Medical School, I finally made my way back to the Northwest, and couldn’t be happier about it. I came to Tacoma because I feel that the comprehensive training we get here will allow me to go wherever I want to go next….although something tells me I’ll be sticking around here for a while.

ALISSA CAMDEN, M.D.

CORDELIA DICKINSON, M.D.

JEANETTE FLAMMANG, M.D.

I was born in Livermore, California to Indian immigrants. I have always been a science geek. My true passions while I was growing up were music (piano and percussion) and biology. I spent most of my childhood discovering the wonders of nature. So naturally, I chose Animal Physiology and Neuroscience as my major at UCSD where I learned, among other things, to be a sun-worshiper. Bench work and clinical trials bored me after college, so I packed up and joined Americorps VISTA in Bend, Oregon. There I fell in love with my husband and found my calling working with the underserved.

I went to medical school in Wisconsin but I longed for mountains, the ocean and the laid back way of life I had in Oregon. Plus, I wanted a residency I could really sink my teeth into - one that would prepare me for anything! So here I am in Tacoma and happy to be here. I tell my friends how lucky I am to be working so long and hard, and that I am still able to say I truly enjoy every minute.

DAVID HANSEN, M.D.

CHRISTINA KELLY, M.D.

I am originally from Ohio where I completed my undergraduate education at John Carroll University in Cleveland and my medical school education at the Ohio State University College of Medicine and Public health in Columbus. I was excited to come to the Pacific Northwest where I would be surrounded by beautiful mountains and evergreens and receive an excellent education in family medicine for my residency.

I chose family medicine because I want to be part of the long tradition of care for the whole patient and the whole family that is at the core of this specialty. I also wanted to be involved in community-based health care, particularly for the underserved population who would otherwise not be able to receive care. I love all aspects of family medicine, but I have a particular interest in women’s health, maternity care and pediatrics.

I am also very passionate about organized medicine and am involved in the American Academy and Washington Academy of Family Physicians. As a medical student, seeing family physicians advocate for their patients and the issues facing family medicine at AAFP and Ohio AFP meetings was inspirational to me. It was a large part of why I wanted to be a family physician. Through my residency and the rest of my career, I hope to contribute to the movement that is making a difference for family physicians, for the specialty of family medicine and most importantly, for our patients.

I am married to a wonderful man, Kevin, who is also a family medicine resident at Madigan Army Medical Center at Ft. Lewis. We have two cats, Sonya and Isabel, who have taken over our home while we are at the hospital. I enjoy running, Pilates, yoga and tennis as well as cross-stitch and other forms of sewing. I also enjoy gardening. In our free time, we like to go to movies, nice restaurants and listen to live music. We are also trying to become wine connoisseurs — on a budget of course!

JONATHAN McBRIDE, M.D.

A native Washingtonian, I was born in Seattle and raised in the small town of Doty, near Chehalis. I attended the University of Washington and earned a Bachelor’s degree in Zoology. After two years of medical research in cardiovascular pathology at the UW, I moved East with my wife and began medical school at New York Medical College. I trained at several hospitals in the northeast, including some in New York City, upstate New York and Connecticut, but my heart remained in the Northwest. It’s nice to be able to greet a strange without being met with skepticism. The climate is especially soothing, even if it is gray most of the year. The real beacon calling us home was Mr. Rainier and the awe inspiring outdoors here in Washington.

I enjoy all aspects of medicine, but have particular interest in obstetrics and pediatrics. Tacoma Family Medicine allows me to develop my interests in these areas with excellent training in obstetrics as we work directly with obstetricians as well as our Family Medicine faculty. TFM is also one of a handful of family medicine residencies where residents train in a children’s hospital unopposed by other residents. Working directly under pediatricians at Mary Bridge Children’s Hospital is one of the highlights of our residency.

SCOTT RENNIE, D.O.

I was born and raised in Washington and finished my undergraduate degree at Western Washington University in Bellingham, however, I also spent some time as an undergraduate studying in Kingston-Upon-Hull, England. I completed medical school at Des Moines University — College of Osteopathic Medicine and Surgery in Iowa and was awarded a National Health Service Corps Scholarship.

I have a passion for rural medicine and plan to provide comprehensive care including OB and endoscopy. I became interested in Tacoma Family Medicine because of the strengths in pediatrics and internal medicine. The staff and faculty at our clinic are great to work with and are exceptional teachers.

My professional interests include preventative medicine, full spectrum family practice with obstetrics, and Osteopathic Manipulative Medicine (OMM). Outside of medicine, I enjoy biking, kayaking, salmon fishing and of course, traveling.

KEVIN F. MURRAY, M.D., PROGRAM DIRECTOR

Dr. Murray joined Tacoma Family Medicine as our new Program Director on November 1, 2000. He comes to us with a wealth of experience in rural practice and administration as a previous residency faculty member in two of the UW Network programs. Dr. Murray received his medical degree from the University of Washington School of Medicine, completed his family practice residency training with our program in 1981, and has now returned to Tacoma Family Medicine. He has a sincere commitment to caring for the underserved in our community and to providing the best training possible for our residents.

ALAN GILL, M.D. RURAL FAMILY MEDICINE FELLOWSHIP PROGRAM DIRECTOR ASSOCIATE DIRECTOR, FAMILY PRACTICE RESIDENCY

I joined the TFM faculty in September, 2000. I was drawn by our mission of preparing family physicians to care for rural and urban underserved patients. I spent the previous six years as faculty at a rural training site for the University of Missouri-Columbia. Prior to that, I was on the Blackfoot Reservation in northern Montana for four years with the Indian Health Service. I attended medical school at the University of Michigan and residency at the University of Missouri-Columbia. I have a strong interest in rural health care and in the role of family physicians in meeting the unique demands of small towns. I enjoy full spectrum family practice with special interest in obstetrics, geriatrics, and disability issues. My family and I love the outdoors, which we enjoy through camping and backpacking..

REBECCA BENKO, M.D.

I grew up in a small rural community in eastern Michigan where my physician role model was a general practitioner who did everything from delivering babies to taking care of the elderly to setting broken bones. Out of this experience I developed a deep respect for family medicine and the need for physicians in rural areas. I subsequently went to medical school at Michigan State University and completed my training in Family Practice at Tacoma Family Medicine in 1996. I recently joined Tacoma Family Medicine after 6 years of practice in Newport, WA, a small rural city on the Idaho border where I practice “full spectrum” family medicine with a total of 5 docs in town and 6 physician assistants. My interests include rural medicine, women’s health care, and procedural skills (including C-sections). During my free time I enjoy biking, swimming, running and spending time with my family.

PAULA A. CONSTANCE, ARNP

I grew up in rural Iowa and settled in the Pacific Northwest in 1984 where I have been part of MultiCare Health System ever since. My graduate work was done at the University of Nebraska (Go Big Red!) in the area of adult and continuing education. I’m very interested in areas of community and patient education as well as medical education. I have two children, Ben and Katie. We enjoy SCUBA diving, photography, music, and anything outdoors. My academic areas of interest include dermatology, women’s health care, orthopedics and acute care.

THOMAS R. EGNEW, Ed.D.

I have been with TFM as the Behavioral Scientist since 1979, after holding a similar position at Madigan Army Medical Center. I hold a Master’s degree in social work from the University of Chicago and have practice experience in individual and marital counseling, grief counseling, parent education, family violence education, hypnotherapy and guided imagery. My doctoral dissertation at Seattle University involved a qualitative study of the definition and mechanisms of healing and the preparation of allopathic physicians to be healers. I have been involved in published research regarding the training for and implementation of end-of-life care. I believe that physicians are healers, but that medical education does little to prepare trainees to assume this mantle. This is an oversight that can lead to cynicism and burnout in practitioners. My hope is to help trainees learn a practice of medicine that is not only exceedingly technically competent, but also feeds the soul of both patient and physician. My wife Joan is a family physician and our daughter, Halley, and son, Hieu, are the lights of our lives.

DAVID B. KILGORE, M.D.

I’m another one of those transplanted Californians. I grew up in Sequoia National Park, as well as the San Francisco Bay area, attended U.C. Berkeley, then did some research in genetics there before completing medical school and residency in Southern California. My practice experience includes a year of private practice followed by five years in a busy semi-rural community clinic. Areas of interest in family medicine include orthopedics and sports medicine, internal medicine, especially diabetes and exercise treadmill testing, and urban family medicine. I’m married with two sons, and my precious time away from medicine is often spent trying to keep up with them on skis or mountain bike, improving my Spanish, or playing guitar with my sons.

LYNN M. QUANRUD, RESIDENCY COORDINATOR

It was my very good fortune to witness the birth of Tacoma Family Medicine in 1978, having worked with Dr. Roy H. Virak, our first director, in his private practice for 14 years before the residency program became a reality. My roots are in Tacoma, having been raised here and attended school not far from where I presently live. It has been my delight to have a part in the training of 129 outstanding graduates. It has been a rewarding experience getting to know each of them. My responsibilities include resident recruitment, developing schedules, coordinating resident functions, and providing all around support and assistance to the residency program as a whole. You will be working closely with me during the application and interview process.

SUSAN ROWE, Ph.D, CLINICAL PHARMACIST

I have been with Tacoma Family Medicine for five years. Prior to Family Medicine, I worked eight years as the pharmacist in the Critical Care Units at MultiCare Medical Center. I graduated from the University of Washington in 1980 and completed a general residency in hospital pharmacy at Harris Hospital Methodist in Fort Worth, Texas. I graduated again in 2001 with my Pharm.D. degree. I teach practical pharmacology during resident precepting and run an anti-coagulation clinic. Anti-coagulation, congestive heart failure, and smoking cessation are areas of interest and expertise for me. My interests outside of work include my husband, two daughters, community volunteer work, basketball and all sports, walking, hiking, and gourmet cooking.

MITCH SAGERS, PA-C

Originally from Iowa, I was transplanted here at age 2 and have lived in Tacoma all my life. I have been interested in the medical field all of my life and intended to go to medical school after graduating from Pacific Lutheran University in 1981. A detour in the road led me into the fire service and I have been a firefighter-paramedic for 19 years, all with the University Place Fire Department. In 1994 I entered Physician Assistant school at the University of Washington School of Medicine and graduated in 1997. Part of my training included a 5 month rotation here at TFM and I instantly knew this was a place where I could grow as a clinician and give back to the very unique population of patients here. I have been here at TFM since January 1998, and enjoy so much the staff and patients here. I enjoy spending time with my wife, son and daughter. In my spare time I love to run, bike, play golf and enjoy boating.

JOE SHERMAN, M.D.

Dr. Sherman is a pediatric physician who joined Tacoma Family Medicine in June, 2000 as a part-time faculty with responsibility for the pediatric training of our residents. He brings over 11 years of practice experience to Tacoma Family Medicine. He graduated from the Medical College of Virginia in 1985, and completed his residency in pediatrics there in 1988. Following private practice in Washington, DC, he spent nearly two years in Uganda as a Research Fellow in Perinatal HIV Prevention with Johns Hopkins University.

LINDA TARBELL, ARNP

I’m another delighted transplant from Southern California, having called it home for 20+ years. I shuffled about the country doing graduate studies in nurse midwifery in rural Kentucky, Cleveland, OH and El Paso, TX. My minor was as a family nurse practitioner. After paying off school loans, I traveled to West Africa and spent one year working there (very interesting and very hot). I then returned to the States and worked in eastern Washington for a couple of years before coming to Tacoma. I enjoy trying to keep up with my daughter and am passionate about adoption issues.

JOHN R. Van BUSKIRK, D.O.

I came to TFM as a second year resident in 1987, after practicing for four years at the Puyallup Tribal Health Clinic. My experiences there reinforced my interest in providing care for the underserved in our society. After completing residency in 1989, I was pleased to join the TFM faculty. I then completed the Faculty Development Fellowship at the University of Washington. I enjoy working with residents to find effective ways to care for disenfranchised people in our community.

KERRY G. WATRIN, M.D.

This is my third tour of duty at TFM, one residency and two faculty stints, the latest beginning in 1990. Terrie, my wife, and I had served in Tanzania from 1986 to 1990. Since returning to the States we have settled into a 60+ year old log cabin, cultivated a garden, and adopted a beautiful curly-haired girl named Lauren and a smiley boy named Nathan. It is paradise to sit with Terrie and the kids and listen to the evening wind blow through the evergreens. I feel called to be a teacher of family medicine, and invite your feedback on how to improve. My special interests include adult learning styles, transition cycles, obstetrics and international health. If I can walk with you in anything, it will be to slow down the moment to a point where you live content in the healing interaction, energized by its special magic, and truly feel a gratitude for the opportunity to be a healer.

INTRODUCTION

In order to provide better service for our patients and to enhance resident education in the diagnosis, treatment, and management of psychiatric disease, TFM has a psychiatrist working in a consultation-liaison role within the clinic. Dr. Frances Hogan is a 0.1 FTE faculty member and generally is here every Wednesday afternoon. She see patients in Dr. Sherman’s office. To meet the needs for both general psychiatric consultation to all clinic patients and specific resident education, Dr. Hogan works in 2 types of clinics as described below.

COUNSELING CLINICS

These clinics are noted int he schedule by the word “COUNSELING” which appears in the appointment blocks when you go to schedule an appointment. Patients from any provider in the clinic can be scheduled for these clinics UPON REFERRAL FROM THE PROVIDER. Generally, the patient will be seen one time by the psychiatrist who will consult with the primary care provider regarding the management of the patient. CHILDREN REFERRED FOR EVALUATION SHOULD BE BOOKED FOR 2-HOUR APPOINTMENT.

PSYCH CLINICS

These clinics are noted in the schedule by the word “PSYCH” which disappears in the appointment blocks when you go to schedule an appointment. Each PSYCH clinic is designated to a specific third year resient once per quarter in the R-3 year. The R-3 “owns” the time and is to refer his or her own patients to the psychiatrist and then joins the psychiatrist in seeing the patient and discussing the results of the evaluation. It is the responsibility of the R-3 to provide the clinical material for these clinics. Failure to do so compromises not only the R-3’s educational opportunity but also our ability to provide needed psychiatric consultation to our underserved population which otherwise has very limited access to psychiatric services. Schedulers will need to check their clinic roster to see which resident is assigned to the PSYCH clinic that particular day. Patients not referred by the resident assigned to the clinic should NOT be appointed in a PSYCH clinic slot, unless specifically approved by the R-3 who “owns” the slot. This is important in order to document adequate resident-psychiatrist teaching interface for residency accreditation purposes.

Should you have any questions, please contact Dr. Egnew at x 2929, or email by clicking here

• First Item
• asdfasdfas
• Item here

Google has more information.

1. Acknowledge the unique demands of a rural practice including:

2. number of hours worked per week in patient care.

3. number of patients seen per week.
4. the difficult patient population.
5. physician isolation.
6. limited resources to access for back-up.
7. home visits.
8. nursing home care.
9. on-call demands.
10. “24 hr” accessibility.

11. the demands on yourself and family.

12. Acknowledge some of the critical issues that rural physicians in practice face with regards to the delivery of health care in a remote community which include:

13. shortage of health care professionals, especially the lack of available consultants in other specialty fields.

14. reimbursement differential for services.
15. financial pressures that can threaten small hospital closure, which in turn affect your mode of practice and your referral pattern.
16. geographical distance to referral center which in turn alters your mode of practice.
17. staffing shortages that alters your mode of practice.
18. facility limitations that affects your pattern of referral.

19. administrative and leadership expectations (e.g. medical director of local nursing home, hospital committee membership, school board, etc.).

20. Understand the important role that time management plays in the rural physician’s ability to balance practice and a normal lifestyle.

21. Understand the importance of establishing good working relationships with other medical colleagues in the same community and with those in outlying areas (referral centers).

22. Understand the benefits of utilizing other community resources in the delivery of health care to the rural population, e.g. public health agencies, home health care, hospice, etc.

23. Acknowledge the many roles that a rural physician inherently accepts in their respective community outside the realms of being a physician, e.g. community leader, hospital advocate, counselor, personal friend, school board member, etc.

24. Understand the importance of identifying their own personal and social needs as a physician living in a remote community.

Cardiology Rotation Syllabus

Welcome to your cardiology month…

The cardiology rotation is primarily clinically based. Your TFM schedule has been created to allow your presence in cardiology clinic at the most clinically useful times. The rotation is at Group Health, located on the far side of Tacoma General. The clinic is on the 1st floor. The Cardiologists are Drs. Golston, Lee, and Chamusco. Dr. Golston is your primary contact. You will work with them primarily in clinic, but may observe procedures such as catheterizations as desired.

You may choose to pursue stress testing during this month. The best experience is through the MIS attendings at TG. Tests are performed daily with a mixture of standard treadmills and pharmacologic and radionuclide tests. Call cardiac rehab at 403-1058 to check on the schedule for a particular day. I suggest Tuesday and Wednesday mornings as the best times around clinic activities. You should be able to get 20 or more tests.

I encourage you to discuss personal goals with your preceptor early in the rotation.

Additional components of the rotation are:

1. Readings. The syllabus includes a series of articles. These are not all-inclusive, but review a variety of topics either of central importance or not addressed elsewhere in our curriculum.

2. Physical exam skills. Three articles are included on the cardiac exam. You are encouraged to work with your preceptor on exam findings. You can check out some heart sounds on the family practice website.

3. EBM component. Perform a literature search on a cardiology topic of interest to you to assess evidence concerning an area of change or controversy. This will give you a chance to look at the primary literature and to discuss your findings with a specialist in the field. We will discuss your conclusions at the end of rotation debriefing. I would appreciate a copy of particularly important/good articles for possible inclusion in future versions of the syllabus.

4. Guidelines. Visit the following websites to familiarize yourself with the availability of guidelines to help you manage your cardiac patients in accordance with evolving standards of care: http://www.guideline.gov and http://www.americanheart.org At the American Heart Association site, go to scientific statements. There are statements on numerous topics.

5. End of rotation debriefing. Schedule a time to meet with me at the end of your rotation. This should take about 30 minutes.

6. Evaluation. Please complete an evaluation of the rotation. Feedback on all aspects (preceptors, scheduling, readings, websites, EBM component) will be helpful in modifying this experience.

Please contact me if you have problems, questions, or suggestions. Alan Gill MD

Goals

1. To familiarize residents with the problem of depression and its management in primary care.
2. To provide the resident a practical experience in the management of patients suffering depression.

Objectives

1. The resident will be able to recognize the common signs and symptoms of depression.
2. The resident will understand the therapeutic approaches to the management of depression.
3. The resident will be knowledgeable about the medications used for the treatment of depression and how to augment pharmacological treatment.
4. The resident will know how to evaluate risks to patients and others.
5. The resident will be familiar with a variety of web-based resources concerning depression.
6. The resident will be familiar with the EPIC smart text for depression.

Methods

1. The resident will read the following required web-based resources:

   • Webb MR, Dietrich AJ, Katon W, Schwenk TL. Diagnosis and Management of Depression. American Family Physician Monograph No. 2, 2000. http://www.aafp.org/afp/monograph/200002/index.html

   • American Board of Family Practice Practice Guideline: Depression http://www.familypractice.com

   • Under “Practice Management Center,” click on “ABFP Guides” Under “ABFP Guides” click on “Reference Guides” then “Depression” Review specifically the information on special populations: Children and the Elderly

   • Cadieux, RJ. Practical management of treatment-resistant depression. American Family Physician. December, 1998. http://www.aafp.org/afp/981200ap/cadieux.html

   • Gliatto MF, Rai AK. Evaluation and treatment of patients with suicidal ideation. American Family Physician. 1999;59:1500-06. http://www.aafp.org/afp/990315ap/1500.html

2. The resident will see clinic patients suffering from depression and apply the information gleaned above to their clinical care, using the EPIC smart text.

Evaluation & Post-test

1. The resident will precept all patients seen in the module clinic with the TFM preceptor of the day.
2. The resident will complete the electronic post-test for the module found on the curriculum website.
3. The resident will complete the electronic evaluation for the learning module found on the curriculum website.

Additional Curricular Resources

The resident will access and become familiar with the contents of the following websites to facilitate further study or for patient education:

For practitioners: Depression Management Tool Kit The MacArthur Initiative on Depression & Primary Care at Dartmouth & Duke http://www.depression-primarycare.org

Click on “Tool Kit” under Resources for Physicians

Practice Guideline for the Treatment of Patients with Major Depression American Psychiatric Association http://www.psych.org/clinres/pracguide.cfm

Select guideline for Major Depressive Disorder

University of Washington Health Sciences Library PrimeAnswers: Best Evidence at the Point of Care http://www.primeanswers.org/primeanswers/

Click on “Common Conditions” tab at top and then “Depression” tab to link to topics

Questions 1-15 have only one correct answer.

1. The “numerator approach” to medical care is concerned with: a. Only patients who can pay b. The patient population from which the practice is derived. c. Meeting the needs of patients who schedule visits with the practice. d. Increasing the volume of the practice. e. Involvement of the many different providers in the practice.

2. A primary care practice is best defined by: a. The population it serves. b. The health care providers who work there. c. The payment structure under which it operates. d. The organizational structure of its management. e. The types of services it provides.

3. The defined target population of a practice for a COPC project: a. Remains constant once it is defined. b. May be changed if the practice is failing. c. Changes continually varies with the different intervention programs under consideration. d. Can be defined exactly, using sophisticated sociologic techniques. e. Should be changed every three months for variety.

4. According to an Institute of Medicine study, community surveys were least likely to be useful for: a. Quantifying the severity of a problem. b. Documenting the presence of a problem. c. Identifying new problems. d. Clarifying the extent of a problem. e. Providing a method for monitoring a problem.

5. A physician is concerned with the large number of women not receiving adequate prenatal care in her community. She uses her position on the advisory board of the local Planned Parenthood clinic to ensure that all women with a positive pregnancy test receive a follow-up call at one month. This practice modification is an example of: a. Altering practice patterns outside the practice. b. An active citizen exerting political influence. c. Altering the types of services the practice offers. d. Altering practice patterns within the practice. e. Altering community perceptions.

6. The intervention strategies of COPC are targeted toward individuals who are: a. Part of the practice. b. Requesting assistance c. At highest risk. d. Interested in help. e. Not active users of the health care system.

7. Which of the following COPC functions is most often neglected? a. Identifying the target population. b. Defining and characterizing the community. c. Identifying community health problems. d. Modifying practice patterns. e. Monitoring the impact of program modifications.

8. Your practice in a Midwestern suburb includes a large population of Hmong refugees. In the past year, three young Hmong men in the community have died suddenly and mysteriously in their sleep. You are considering a COPC project to prevent further similar deaths. Which of the following would prevent you from starting this project? a. The population at risk cannot be defined. b. The topic is of great concern to the community. c. The condition has serious consequences. d. Specific risk factors are unknown. e. Your practice has limited monitoring capabilities.

9. The fundamental step in evaluating the effectiveness of a practice modification for a COPC project is: a. Defining the issues that are being addressed by the practice modification. b. Developing a cost-effective analysis. c. Obtaining the endorsement of community leaders d. Implementing a computer system in the practice. e. Requesting the participation of patients in the practice.

10. A physician who has served a small community for 20 years reviews state data regarding his community and is surprised to learn that substantially more elderly persons live in his community than he would have estimated based on the patients he serves. His inaccurate perception of the community is probably due to: a. Lack of interest in his community. b. Recall bias. c. Reporting bias. d. Relative importance of the problems of different populations. e. Extrapolation from a biased sample (his practice).

11. A major advantage of using information available through the local health department when designing a COPC project is that the data is: a. Extensive b. Geographically based. c. Accurate. d. In ASCII format. e. Clinically specific.

12. The selection of high risk groups for intervention in a COPC project is appropriate because: a. The high risk group contains all the individuals who will develop the target condition. b. The target condition can be prevented in high risk individuals. c. People in the low risk group do not respond as well to prevention efforts. d. People in the low risk group never develop the target conditions. e. It maximized the use of scarce resources when addressing problem area.

13. The first step in the incremental approach to integrating COPC principles into family practice is: a. Obtaining population-based data b. Validating outcome measurements. c. Identifying the practice intervention d. Designing the practice intervention. e. Defining the practice population.

14. The second step in the incremental approach to integrating COPC principles into family practice is: a. Obtaining secondary population-based data. b. Validating outcome measurements. c. Identifying the practice intervention d. Designing the practice intervention. e. Defining the practice population.

15. The third step in the incremental approach to integrating COPC principles into family practice is: a. Obtaining secondary population-based data. b. Validating outcome measurements. c. Identifying a problem. d. Designing, collecting and analyzing new data. e. Defining a practice population.

The next questions may have more than one correct answer.

1. Which of the following is a basic element of COPC? a. A defined population the practice wishes to serve.. b. Provision of quality care. c. A process that addresses major health problems of the target population. d. A primary care practice or program.

2. Which of the following tasks is part of the COPC process? a. Monitoring the impact of program modifications b. Identifying community health problems. c. Defining and characterizing the community. d. Modifying practice patterns.

3. Identification of the important health problems in a community should be based on: a. The perceptions of community members. b. The ideas of community organizations, such as the March of Dimes. c. A community survey. d. The physician’s practice impressions.

4. Potential criteria for setting priorities among various community health problems include: a. Availability of effective treatment. b. Ability to identify high risk individuals. c. Perceptions of the community. d. Economic impact of the problem.

5. Health promotion and disease prevention efforts are appropriate for a COPC project because: a. Risk factors for various conditions are often known, making identification of high risk populations easier. b. Individuals in a population usually consider themselves “well” and do not present for care. c. The interventions are cost-effective. d. Effective interventions are available.