judith palfrey, md past president aap generations together massachusetts aap november 1, 2013 a life...
TRANSCRIPT
Judith Palfrey, MDPast President AAP
Generations TogetherMassachusetts AAPNovember 1, 2013
A LIFE IN PEDIATRICS:ADVOCACY, ADVENTURES AND
THE AAP
PEDIATRICS ADVOCACY ROOTS
• George Armstrong
• Abraham Jacobi
• Mary Putnam Jacobi
• Emily Blackwell
• Job Lewis Smith
• Martha May Eliot
• HelenTaussig
• Robert Haggerty
• Joel Alpert
• Berry Brazelton
• Barry Zuckerman
CHILD HEALTH IN AMERICA
Child health in America is not what it should be given the enormous resources we have in this country
INFANT MORTALITY
The United States ranks 34th in Infant Mortality
UNICEF RATINGS
Compared to 29 other industrialized nations, Unicef ranked the US
First (Worst) in Obesity
First (Worst) inTeen Births
25th in Child Health and Safety
SOCIAL DETERMINANTS
COMMUNITY MEDICINE AND ADVOCACY
Pediatrics would be
stronger and
more effective if community medicine
and advocacy were core elements of our training and practice
PEDIATRIC ADVOCACY
SO I HAVE QUITE HAPPILY
ENDED UP WITH A LIFE IN
MOTIVATION
MOTIVATION
MOTIVATION
MOTIVATION
NEW YORK, NEW YORK
Vanderbilt Clinic: Take a ticket, sit on a bench, see whoever is next in line
Jacobi Hospital: Skydivers and Children Can’t Fly
Montefiore: Adolescent Medicine needs to be practiced where the teens are
BOSTON 1974-Present
Bullshark44
COMMUNITY CHILD HEALTH
Building strong communities
Honoring children and families
Emphasis on health of body, mind and spirit
Dr. Julius Richmond
COMMUNITY CHILD HEALTH
• Primary Care
• Community Involvement and Consultation
• Research into Programmatic Innovations– Early Childhood– School Health – Adolescent Health
PEDIATRIC ADVOCACY
ADVENTURES IN
PROJECT SCHOOL CARE
CHILDREN WITH SPECIAL HEALTH CARE NEEDS
13%
6%
30%
Mod/sev functional limitations
MCHB definition
Any occurrence
6%13%
30%
ABILITY NOT DISABILITY
PL94-142/IDEA
• The Education for All Handicapped Children Act passed in 1975
• Advocacy by parents, policymakers, professionals
• Based on several court cases about classes of children PARC vs Pennsylvania, Mills vs the Board of Education
• Collaborative Study in 5 cities
PROJECT SCHOOL CARE
• Documenting the need – Census of children assisted by medical technology
• Program development – consultation to schools – Pediatric fellow and Nurse Practioner
• Creation of Guidelines for Care• Promotion of the Project School Care
Model
CENSUS ON CHILDREN ASSISTED BY MEDICAL TECHNOLOGY
• 1 in 1000 children in Massachusetts
• Consider that average pediatric practice is 1500 to 2000 children
• Small towns may have 2000-3000 children in the schools
TRAINING
• Training in the school• Bring in the experts• Involve the kids• Work together• Have fun
PEDIATRIC ALLIANCE FOR COORDINATED CARE
MEDICAL HOME
PACC MODELENHANCED CARE FOR
CHILDREN WITH (COMPLEX) SPECIAL HEALTH CARE NEEDS
PhysicianLocal Parent Consultant
Nurse Practitioner/Case Manager
Child and Family
PACC’S GOALS
• Comprehensive primary care services at the community level
• Enhanced availability and coordination of necessary secondary and tertiary services
• Improved communication between primary and secondary care providers
• Coordination of health and other services • Maximization of family participation
PACC EXPERIENCE
Six primary care practitionersReal world, real time experimentAddition of a day a week of a nurse
practitionerFamily consultant time/Community
FocusDocumentation through an IHPContinuing medical education
THE INTERVENTION
Totals
About $15,000/yr/practice
8 hrs PNP CME/CEULPC
Stipend IHP+ ++
EMERGENCY VISITS
0
510
1520
2530
3540
4550
None One to Five Six-Nine >=10
PrePost
HOSPITALIZATIONS
0
10
20
30
40
50
60
None One-two Three-five Six-Ten
PrePost
IMPACT OF THE CONDITIONWORK MISSED IN LAST 6 MONTHS
FOR PARENTS (n=150 )
0
5
10
15
20
25
30
35
None 1 to 3 4 to 9 10 to 20 >20
PrePost
%
PEDIATRIC ADVOCACY
The AAP and
AGENDA FOR CHILDREN
2009-2011 HIGHLIGHTS
• Health Care Reform-ACA Passage
• H1N1
• Disasters – Haiti, Chile, Philippines, Pakistan
• Attacks on Immunizations
• Obesity Epidemic and Roll-Out of Let’s Move
DISASTER RESPONSE
www.aap.org/disasters/index.cfm
– Hurricanes
(Katrina, Ike, Gustav)– Pediatric Education in
Disasters course– H1N1 Pandemic– International (China,
Philippines, Haiti, Chile, Pakistan)
– Oil Spill – Japan Nuclear Crisis
HEALTH CARE REFORM
KIDS MADE A DIFFERENCE!!
HEALTH CARE REFORM ?!?
• Follow Info on www.aap.org
• Join FAAN or Key Contacts
• Meet with your Congress reps
• Send Op-Eds• Keep up the
Pressure
ACA
ASSURES HEALTH CARE ACCESS FOR ALL CHILDREN
Now all children (US citizens) assured accessIncluding up to 26 years
Including children with pre-existing conditions
THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:
ACA
GUARANTEES SERVICES UNIVERSALLY IN A MEDICAL HOME, THAT COORDINATES PRIMARY CARE, EMERGENCY SERVICES, SUBSPECIALTY AND HOSPITAL CARE.
Medicaid pilots and supportive language for the concept
THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:
ACA
HAS A CONSISTENT AND FAIR PAYMENT SCHEDULE THAT ASSURES PHYSICIANS AND THEIR STAFFS RECEIVE APPROPRIATE COMPENSATION FOR THE WORK THEY PROVIDE.
Medicaid to Medicare Parity Included
THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:
ACA
IS COST SAVING THROUGH THE USE OF HIGH QUALITY, WELL DEVELOPED INTERVENTIONS AND TRIED AND TRUE PREVENTIVE SERVICES.
Bright Futures
Home Visiting Programs
Dental Services
THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:
FIRST LADY’S OBESITY INITIATIVE
• To end childhood obesity in one generation
• Public/Private
• Everybody
• Pediatricians will:– Calculate BMI
– Prescribe healthy foods and fitness
HELPING BABIES BREATHE
A BIG FAVORITE THING
A BIG FAVORITE THING
SOMSRFT
5th Annual Advocacy Project:
ImmuneWiseSection on Medical Students, Residents, and
Fellowship Trainees2009-2010
Brought to You By:
• SOMSRFT Executive Committee Advocacy Subcommittee– Co-Chairs
• Drs. Katie Snyder and Jennifer Williams
– Members• Drs. Shawn Batlivala, Clara Filice, Jenni Linebarger,
Christina Robinson, Sara Slovin, Josh Smith, Amy Starmer, David Tayloe
– Other Contributors/Supporters• Lucy Crain, MD, FAAP, Buz Harlor, MD, FAAP,
Michael Warren, MD, FAAP, Julie Raymond, Ian Van Dinther
MeaslesEpidemiology
Measles Clinical Presentation
Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT)
Advocacy Campaign 2013-2014
Firearm Injury Prevention: Clinic
• Create/distribute parent handouts– i.e. AAP Connected Kids– Display the 2013 P.A.V.E. poster
• Educational commercial/video in waiting rooms
• Dispensing of gun safe locks• Discuss teen violence, how to
to avoid it, and ways to have positive conflict resolution
• How to talk to children after a firearm-related injury
Educate Parents and Patients
• Safest way = no firearms in the home • Discuss the dangers of guns; they are not
toys• ASK: Are guns in the homes where your
children play?– Where is it stored? – How is it secured? – ASK Campaign
Source: healthychildren.org
• For parents who choose to keep firearms in the home:– Always keep the gun unloaded and locked
up – Bullets locked and stored separately– Hide keys– Never tell child the lock/safe’s code– Discuss repercussions
Advice to Parents
Source: healthychildren.org
Firearm Injury Prevention: Community
• Speak to school groups about firearms– Incorporate guest speakers impacted by
firearm injury
• Parent education at after school programs• Collaborate with law enforcement, Boys &
Girls Club, community centers, etc.• Partner with ED/Trauma teams for high
school education
FIREARM INJURY PREVENTION: STATE/FEDERAL LEVELS
Read AAP’s federal policy positionsContact your state and federal legislators Support common sense firearm legislation that protects kids
P.A.V.E template letter & http://federaladvocacy.aap.org
Organize or participate in a firearm injury prevention advocacy day
Write an op-ed or letter to the editor
PEDIATRIC ADVOCACY
THANK YOU.
KEEP DOING WHAT YOU DO IN
IT’S ABOUT THE KIDS