SEPTEMBER 10, 1998-vol30n3:'Leap foward' for med school in primary care

VOLUME 30, NUMBER 3 THURSDAY, SEPTEMBER 10, 1998

'Leap forward' for med school in primary care
Grants put Family Medicine in pivotal role of administration, research at new centers

By LOIS BAKER
News Services Editor

The Department of Family Medicine in the School of Medicine and Biomedical Sciences has taken a leap forward on the state and national primary-care scene through its leadership on two new grants totaling nearly $4 million.

The university, through the department, recently was named the lead institution on a three-year, $3 million grant from the U.S. Department of Health and Human Services to fund start up of an Area Health Education Center program, or AHEC, in New York State. The grant covers the first phase of a 12-year program with a potential for $22 million in federal funding.

And earlier this week, the department learned that the Center for the Value of Family Practice, a four-institution consortium of which it is a part, is one of three centers out of 65 applicants nationally selected to receive $900,000 over four years to conduct research on the way primary-care medical services are delivered and assessed.

On the AHEC initiative, the UB Department of Family Medicine will team with the SUNY Health Science Center at Syracuse and other New York professional schools to help alleviate the shortage of health professionals in the state's underserved communities, both rural and urban, by establishing clinical teaching and practice sites in those areas. Each AHEC site will be managed by a locally appointed director and advisory board, and will be linked to a SUNY medical school.

Through these sites, residents in medicine and dental medicine, and students in medicine, pharmacy, nursing, allied health, dentistry and social work will get first-hand experience living with and caring for patients in these underserved areas. The centers also will provide continuing-education courses for health professionals already serving the communities, and assess the health-care needs of each region.

"We urbanize most of our medical students during their training," said Thomas C. Rosenthal, professor and chair of the department, who will oversee the initiative. "The high-profile urban medical setting is what young physicians are comfortable with, so that is where they tend to practice.

"They cluster in prosperous areas of cities and suburbs also for personal reasons. Most want to raise families where they will have the greatest opportunities, so it is difficult to retain providers in underserved rural communities in particular. It requires a person who understands and values rural America. The only way they will see themselves in those communities," he continued, "is to be in those communities."

The New York program is part of a nationwide effort launched in 1972, based on the 1970 Carnegie Commission's "Report on Higher Education and the Nation's Health." AHEC programs now operate in 41 states. An earlier effort to establish such a program in New York failed due to lack of institutional support.

During the program's first three years, UB will set up the state-wide administrative office in its Department of Family Medicine, and help establish regional offices at the SUNY Health Science Center at Syracuse and Albany Medical College/State University at Albany School of Public Health.

During subsequent funding cycles, center staff will help establish AHEC regional centers at the State University at Stony Brook and SUNY Health Science Center at Brooklyn. Each regional center will be responsible for setting up two community-based AHEC sites in underserved areas by the end of the 12-year federal funding cycle. New York State is required to begin funding the AHEC program in its 6th year, and eventually to assume full financial responsibility.

Diane G. Schwartz, director of special projects for the UB medical school, will be deputy director of the statewide program office.

The $900,000 grant is part of a major initiative being undertaken by the American Academy of Family Physicians to promote science-based research on the importance of an integrated, whole-health approach to the practice of family medicine.

In addition to UB, the Center for the Value of Family Practice is composed of Case Western Reserve University in Cleveland, University of Nebraska Medical Center in Omaha and Lehigh Valley Hospital in Allentown, Pa.

Carlos R. Jaén, associate professor of family medicine and director of UB's Center for Urban Research in Primary Care, is the UB co-director of The Center for the Value of Family Practice.

"This is very exciting for us," Jaén said. "The competition was quite stiff. This initiative will give us a chance to help make family practice better for all physicians and patients."

He and his fellow co-directors will develop a detailed map of the core structures and processes of family practice, addressing five priorities:

· Managing chronic diseases within the context of each patient's needs and priorities

· Increasing the ability of family practice to serve as an outlet for applying new technologies

· Integrating mental-health care into comprehensive medical care

· Developing practice-tailored systems to deliver preventive service

· Increasing the community focus of family practice.