Peter House

Student providers aspiring to rural and underserved experiences at the University of Washington: promoting team practice among the health care professions.

In the United States there are shortages of health care providers for both rural and underserved populations. There are also shortages of interprofessional or team-based training programs. To address these problems, the University of Washington’s Area Health Education Center program and School of Medicine offer a voluntary extracurricular program for students in the university’s six health science schools. The Student Providers Aspiring to Rural and Underserved Experiences (SPARX) program is an interprofessional, student-operated, center/school-supported program consisting of a wide range of activities. SPARX supports students interested in practicing among rural and urban medically underserved patients and in interacting with their peers in other health professions schools. A brief history and description of the program are presented, along with results of a survey of students indicating that SPARX reinforces their interest in practice among the underserved and influences their understanding of other health professions. Data on residency choices of medical students who have participated in the SPARX program are presented, indicating that these students are more likely to select primary care residency programs than the average students in their classes.

Identifying the Gaps between Biodefense Researchers, Public Health, and Clinical Practice in a Rural Community.

OBJECTIVE It is essential for health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine how well biodefense and emerging infectious disease research information was being disseminated to rural health care providers, first responders, and public health officials. METHODS Semi-structured interviews were conducted at a federally funded research institution and a rural community in Washington state with 10 subjects, including researchers, community physicians and other health care providers, first responders, and public health officials. RESULTS The interviews suggest there is inadequate information dissemination regarding biodefense and emerging infectious disease research and an overall lack of preparedness for a bioterrorist event among rural clinicians and first responders. Additionally, a significant communication gap exists between public health and clinical practice regarding policies for bioterrorism and emerging infectious disease. There was, however, support and understanding for the research enterprise in bioterrorism. CONCLUSIONS Biodefense preparedness and availability of information about emerging infectious diseases continues to be a problem. Methods for information dissemination and the relationships between public health officials and clinicians in rural communities need to be improved.

30 IDENTIFYING THE GAPS BETWEEN BIODEFENSE RESEARCHERS, PUBLIC HEALTH, AND RURAL CLINICAL PRACTICE.

Objective It is essential for health care professionals to be prepared in the event of a bioterrorist attack or other public health emergency. Despite this, many physicians and public health officials still feel unprepared for a bioterrorist event. We sought to determine how well biodefense and emerging infectious disease research information was being disseminated to rural health care providers, first responders, and public health officials. Methods In June-July, 2005 we conducted semi-structured, audio-taped interviews using the key informant technique. Interviewees were selected from a federally funded research institution and a rural community in Washington State. Population Ten interview subjects included researchers, community physicians, other health care providers, first responders, and public health officials. Outcomes Measured Perceived level of biodefense preparedness; quality and quantity of information disseminated regarding biodefense and emerging infectious diseases; communication between clinicians and public health officials; and importance of basic research in biodefense and emerging infectious diseases. Results Based on interviewee responses, we found that there is inadequate information dissemination regarding biodefense and emerging infectious disease research and an overall lack of preparedness for a bioterrorist event exists among rural clinicians and first responders. In addition, a significant communication gap exists between public health and clinical practice regarding policies for bioterrorism and emerging infectious disease. However, we were surprised to find that there was a great deal of support and understanding for the research enterprise in bioterrorism. Conclusions Biodefense preparedness and availability of information about emerging infectious diseases continue to be a problem. Further research is needed to develop methods for adequate information dissemination. In addition, the relationship of public health officials and clinicians in rural communities needs to be improved.

Electronic Billing for the Primary Care Physician

Jimmy comes in for his well-child check. He needs his kindergarten immunizations—tetanus-diptheria (DT), polio, and measles-mumps-rubella (MMR). He also needs a follow-up hemoglobin to see if the iron supplement that he is taking has resolved his anemia. The care Jimmy will get is both routine and complex, and his encounter with his caregivers starts in motion a series of events and creates a cascade of records all in the name of getting the caregivers paid for their services. The office team will do the work to get the practice paid; the provider may never see any of the billing paperwork and may have little understanding of what her office team does. Is that reasonable delegation of a clerical task, or is it a dangerous dereliction of responsibility?