Sinusitis Njafp PDF

A View of Family Medicine in New Jersey Volume 4, Issue 1 Jan/Feb/March - 2005
An Update
on Sinusitis
This condition affects 30-35 million Americans
and accounts for over 25 million office visits.
Learn the latest treatment recommendations.
Call for Resolutions

and Nominations
The House of Delegates needs to hear your voice.
See page 16 to learn how you can be part of
setting the direction for the Academy
Planning for the Future

Whats NEW in AAFPs Effort to Implement
the New Model of Family Medicine
Perspectives
now accredited with
AAFP Prescribed credit.
Journal of the New Jersey Academy of Family Physicians
See page 35 for details
IN THIS ISSUE
Volume 4, Issue 1 Jan/Feb/Mar 2005
Remember When.
Not long ago the official communication of the NJAFP was called
On The Cover Sinusitis is the third most common diagnosis for which an antibiotic
is prescribed. Though most physicians agree that antibiotics are over-prescribed, 50% of
patients are given an antibiotic when presenting with cold-like symptoms. Learn about
new recommendations for treating sinusitis on page 9.
Academy View. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Presidents View . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Executive Vice Presidents View. . . . . . . . . . . . . . 8
Clinical View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Quality View . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
InfoTech View . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Educational View . . . . . . . . . . . . . . . . . . . . . . . . 16
New Jersey View . . . . . . . . . . . . . . . . . . . . . . . . . 22
Government Affairs View. . . . . . . . . . . . . . . . . . 24
Resident and Student View . . . . . . . . . . . . . . . . 26
From My View . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Foundation View. . . . . . . . . . . . . . . . . . . . . . . . . 29
Special Projects View . . . . . . . . . . . . . . . . . . . . . 30
NJAFP News Notes. It was an 8-page, black and white piece that
contained news of the Academy. As the Academy grew, News
Notes grew into New Jersey Family Practice. The Academy kept
growing and Ray Saputelli, CAE, Executive Vice President of the
NJAFP and the Executive Committee visualized what New Jersey
Family Practice could become. And so began the process of moving
from a newsletter format to a magazine containing information
specific to the practice of family medicine in New Jersey. For four
years we have been building the reputation of our state journal and
today Perspectives: A View in Family Medicine in New Jersey has
grown to a respected magazine with strong clinical content.
As the Managing Editor, I have had the pleasure of working
with members of the Academy who have pulled together to make
this journal what it is today. It is because of the efforts of the writers, editors and other contributors to Perspectives that I am pleased
to be able to say that as of this issue, Perspectives: A View of Family
Medicine in New Jersey will now carry CME Credit. Special acknowledgements go to Joseph Wiedemer, MD, the first Executive Editor
of Perspectives, who lent his vision to the development of the magazine and shepherded the beginnings, and to current Executive
Editor, Jeff Zlotnick, MD, and Medical Editors Richard Corson, MD;
Cindy Barter, MD; Jeanne Ferrante, MD; and John Ruiz, MD whose
dedication led to the accreditation.
In this issue you will find CME offerings in respiratory medicine
topics, as well as in medical information and quality topics. Look for
this symbol
to find those articles that carry accreditation. In
future issues we hope to also add EB-CME for certain articles.
Besides the CME articles, you will also find stories on what is
happening with the Future of Family Medicine (courtesy of the
Texas AFP chapter), information about the upcoming Summer
Celebration and Scientific Assembly, a review of the recent NJAFP
Leadership Retreat, stories on what different members have accomplished in their careers, and much, much more.
To continue to build on its success, Perspectives needs authors
who are willing to write on clinical topics and on other issues that
are relevant to family medicine in New Jersey. If you are interested
in becoming a contributor to Perspectives, please contact me in the
NJAFP office (609-394-1711) or email me at editor@njafp.org.
Happy reading,
Special Feature: Adding It Up. . . . . . . . . . . . . . . 32

Closing View . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
CME Quiz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Theresa J. Barrett, MS, CMP

Managing Editor
Printed by Citation Graphics, Pennsauken, NJ 08109 856-813-1153 www.citationgraphics.com
2005 New Jersey Academy of Family Physicians
ACADEMY
VIEW
NJAFP Wins ASAE's 2005 Associations Advance America Award of Excellence
The NJAFP has won the Award of Excellence in the 2005
Associations Advance America (AAA) Awards program for its
MedFest Program. The award is part of a national competition
sponsored by the American Society of Association Executives
(ASAE), Washington, D.C.
MedFest is a volunteer physician program organized by the
NJAFP in partnership with Special Olympics New Jersey (SONJ). The
purpose of MedFest is to qualify people with developmental disabilities to participate in Special Olympic activities. All athletes, no matter what their abilities, must receive pre-participation examinations
prior to engaging in organized sports. Program Chair and current
NJAFP Vice President, Jeff Zlotnick, MD noted, The inspiration for
the program stemmed from the fact that our special needs population is a tremendously underserved community that encounters
great difficulty obtaining even basic medical care. Many individuals
live in group homes with limited access to health care, or are shuttled between specialists without the benefit of a medical home.
The MedFest
program not
only gives athletes access to
the games, but
also offers them
the opportunity
to establish a
relationship
with a Family
Physician who
will provide the
coordinated care that so many special needs patients lack a true
medical home. In addition, through CME courses designed by Dr.
Zlotnick (or just Dr. Z to many of his patients) volunteer Family
Physicians participate in additional specialized training in working
with this complex population.
Now in its 15th year, the prestigious Associations Advance
America (AAA) Awards program recognizes associations that propel America forwardwith innovative projects in education, skills
training, standards-setting, business and social innovation, knowl-
What has the NJAFP Done For You Lately?

Dr. Jeff Brenner (Camden) and Dr. Tom Ortiz (Newark) testified on behalf of the NJAFP before the Senate Health Committee
on January 24, 2005 in favor of legislation that proposes to reform
the New Jersey Family Care Program. Drs. Brenner and Ortiz provided the committee with the perspective of private practice family physicians with respect to their experience in their communities
with the current program and the difficulties and confusion for
Family Care beneficiaries. The focus of the proposed legislation is
on increasing access to the program by allowing adults to qualify
for the program again, improving enrollment by streamlining the
administrative process for applicants, and expanding the opportunities for educating the population about the program.
Perspectives 1Q05
edge creation, citizenship, and community service. Although association activities have a powerful impact on everyday life, they
often go unnoticed by the general public.
It is an honor and an inspiration to showcase this activity as
testament to the heart and soul of Family Physicians, as well as an
example of the many contributions associations are making to
advance American society, remarked Ray Saputelli, CAE, NJAFP
Executive Vice President.
The MedFest program is now in the running to receive a
Summit Award, ASAE's top recognition for association programs,
to be presented in ceremonies at ASAE's 6th Annual Summit
Awards Dinner Sept. 27, 2005, at the National Building Museum in
Washington, DC.
Perspectives Now
Carries CME Credit
Your state journal, Perspectives: A View of Family Medicine
in New Jersey has made another exciting leap forward, adding
even more value to your membership. Having grown from an 8page newsletter to a full-color magazine with clinical content
under the direction of Executive Editors, Joe Wiedemer, MD and
Jeff Zlotnick, MD and Managing Editor, Theresa Barrett, MS,
Perspectives now has the distinction of being CME accredited.
Beginning with this issue, Perspectives is now a peer-reviewed
journal that carries AAFP Prescribed CME Credit.
Members of the 2005 Editorial Review Board are Richard
Corson, MD; Cindy Barter, MD; Jeanne Ferrante, MD; and John
Ruiz, MD, Jeff Zlotnick, MD (Executive Editor), and Theresa
Barrett, MS (Managing Editor).
Articles on clinical topics, practice management, quality and
technology, as well as personal insights into the practice of family medicine are welcome. Interested authors should contact
Theresa Barrett, MS at tjb@njafp.org or 609-394-1711 for information on submitting material.
Who is representing you at the AAFP?

New Jersey is becoming a well-respected presence at AAFP.
Aside from Delegates Robert Pallay, MD and Richard Cirello, MD
and Alternate Delegates Richard Corson, MD and Mary
Campagnolo, MD, New Jersey is represented on the following
Committee and Commissions:
Commission on Scientific Programs
Richard Corson, MD
Commission on Quality and Scope of Practice
Mary Campagnolo, MD
Commission on Student and Resident Issues
Ray Saputelli (reappointed for a second term)
Commission on Education
Diana Carvajal (Student at UMDNJ Camden)
PRESIDENTS
VIEW
Ideal and Real

Caryl J. Heaton, DO is President of the
New Jersey Academy of Family Physicians
and Vice Chair of the Department of
Family Medicine at UMDNJ-New Jersey
Medical School in Newark, NJ.
his past fall I traveled to three
national meetings and I thought
I would share the lessons I have
learned. Each meeting has been important and significantly different from the others, each with its own take home message.
AAFP Congress of Delegates

In October the New Jersey delegation traveled to the AAFP
Congress of Delegates and Annual Scientific Assembly in Orlando,
FL. The Congress is similar to our own House of Delegates in many
ways, with representation of all states, resolutions brought and
debated, and elections of national officers. The process for resolutions is that each state submits them to the national office by
September, after that they are forwarded to what are known as
Reference Committees. Any delegation member, or for that matter,
by Caryl Heaton, DO
any AAFP member, can come to the Reference Committee meeting

and testify for or against a resolution. The process is formal, you
are only given five minutes if there will beextensive testimony ie.,
there are lots of people there. When speaking to a resolution, the
member identifies their role in the Academy and then states
whether they are speaking on behalf of themselves, their state chapter or their delegation. I noticed that the timing of our NJ Board of
Trustee meetings could be scheduled better in order to give us the
opportunity to discuss these resolutions, among ourselves at least,
before the national meeting. We will do this next year. Next year we
will also make every effort to put a response page on the NJAFP
website, so members can write us with their opinions.
The most contentious resolutions of this years meeting were
resolutions to stop or modify the Maintenance of Certification
(MOC) process of the American Board of Family Medicine. State
representatives from Michigan and Indiana lead resolutions to stop
the process all together, other resolutions asked for a slow down,
or some other mechanism to substitute for the computerized Self
Assessment Modules. I had not taken the Diabetes module at the
time, so could not speak to how difficult it was or how slow the
Continued on next page
Perspectives: A View of Family Medicine in New Jersey

The Journal of the New Jersey Academy of Family Physicians
Acting Executive Editor
Jeffrey A. Zlotnick, MD
Managing Editor
Medical Editor
Richard Corson, MD
Editorial Board
Cindy Barter, MD
Jeanne Ferrante, MD
John Ruiz, MD
Contributing Photographers
Jeffrey A. Zlotnick, MD
Perspectives: A View of Family Medicine in
New Jersey is published four times a year
by the New Jersey Academy of Family
Physicians. Deadlines for articles and
advertisements may be obtained from the
NJAFP office. The Editors reserve the right
to accept or reject any article or advertising
material. Some material may be submitted
to the Board of Trustees for review.
The views, opinions and advertisements in
this publication do not necessarily reflect
the views and opinions of the members or
staff of the New Jersey Academy of Family
Physicians unless stated.
Subscriptions for non-NJAFP members are

available for $50 per year. Contact the
NJAFP office for information.
112 West State Street, 2nd Floor
Trenton, NJ 08608
Phone: 609/394-1711
Fax: 609/394-7712
Email: office@njafp.org
Website: www.njafp.org
STAFF
Executive Vice President
RAYMOND J. SAPUTELLI, CAE
Ray@njafp.org
Deputy Executive Vice President
THERESA J. BARRETT, MS, CMP
TJB@njafp.org
Government Affairs Director
CLAUDINE M. LEONE, ESQ.
Claudine@njafp.org
Insurance Programs Administrator
JOHN ELTRINGHAM, CPCU
Insurance@njafp.org
Office Manager
CANDIDA TAYLOR
Candida@njafp.org
Copyright 2005 New Jersey Academy of Family Physicians
OFFICERS
BOARD MEMBERS
President
CARYL J. HEATON, DO
973/972-7979
Board Chair
TERRY E. SHLIMBAUM, MD
609/397-3535
President-Elect
ROBERT SPIERER, MD
609/395-1900
Vice-President
JEFFREY A. ZLOTNICK, MD
609/394-1711
Treasurer
THOMAS S. BELLAVIA, MD
201/288-6781
Secretary
JOHN D. RUIZ, MD
973/746-7050
Board of Trustees
Cindy Barter, MD 2007
Salvatore Bernardo, MD 2007
Annabelle B. Dimapilis, DO 2006
Amparito I. Fiallo, MD 2005
Anthony G. Miccio, MD 2006
Stephen A. Nurkiewicz, MD 2006
Thomas R. Ortiz, MD 2005
Marty D. Sweinhart, MD 2007
John F. Tabachnick, MD 2005
Resident Trustees
Vicky B. Tola, MD 2006
Christopher P. Zipp, DO 2005
Student Trustee
Sarita A. Bharadwaj 2005
Molly Cohen 2006
Voting Past Presidents
Kenneth W. Faistl, MD 2005
Arnold I. Pallay, MD 2005
AAFP Delegates
Richard Cirello, MD 2006
Robert M. Pallay, MD 2005
AAFP Alternate Delegates
Mary F. Campagnolo, MD 2005
Richard L. Corson, MD 2006
Perspectives 1Q05
Ideal and RealContinued

downloads were. I have since taken it, and although it was hard, it
was fair and do-able, it just takes some time. (I will be speaking
at our annual meeting on Diabetes and will share most of what I
learned about taking a SAM at that time.)
We cant forget that the Maintenance of Certification was a
process change made by the American Board of Family Medicine.
The Academy does not have control over the ABFM, it is an independent entity. The ABFM is a member of the American Board of
Medical Specialties and each one has committed to some form of
MOC. To review the Congresss resolutions on the Maintenance of
Certification visit http://members.aafp.org/members/PreBuilt/congress_2004summary.pdf, page 15.
Annual Conference on Patient Education

The 26th Annual Conference on Patient Education is a joint
meeting sponsored by the Academy of Family Physicians and the
Society of Teachers of Family Medicine. The meeting this year was
held in San Francisco and co-chaired by New Jerseys own Cindy
Barter, MD. A pre-conference addressed How to Make Money for
Your Practice: Billing for Patient Education by AAFP Speaker-elect
Tom Wieda, MD of Pennsylvania. Other great presentations included how to set up an effective asthma program, and how to use
the National Diabetes Education Programs website.
This conference is useful for doctors who want to do more
patient education, but arent sure where or how to get started. Its
a low-key meeting. You can pick and choose the areas of interest. I
was happy to see next years theme as Patient Education: Your
Role in the New Model for Health Care. I believe that this conference can and should be a meeting that is devoted to presentations
on the New Model. Most of our low cost CME has been funded
through pharmaceutical companies and we are grateful for their
support. But the result of this is that most CME, at least at local
levels, has more to do with medical treatments i.e., therapeutics,
than with how we must effectively change our offices and the way
we work.
16th National Forum on Quality Improvement in

Health Care
Changing medical care to improve quality is the focus of the
Institute for Healthcare Improvements 16th National Forum on
Quality Improvement in Health Care. This meeting attracts over
6,000 physicians, nurses, administrators and insurance executives,
despites its hefty price tag. The meeting is so pricey that primary
care docs who may just want to improve their practice wouldnt
generally be able to afford itanother reason to look to the
national Academy to home grow this kind of CME.
The IHI had presentations from many well known authors
from Family Practice Management. There were presentations on Ed
Wagners Chronic Care Model (http://www.improvingchroniccare.org)
and some limited sessions on advanced access. There was almost
nothing on computerized medical records. This group generally
assumes that all physicians have them. Dr. David Wasson and
Charles Kilo asked us to think about two questions for our
patients; 1) Are there things about your medical care that could be
Perspectives 1Q05
better, and 2) How confident are you that you can manage and
control your health problems or health concerns? Im afraid that
in my patients, the answer to those questions would not be
resoundingly positive.
While this meeting was very exciting (to me at least), I couldnt
help but notice that there was a big discrepancy between the
ideal and the real. I could see how large, well-to-do health conglomerates can buy EMRs and the consultants to operate them efficiently. But what wasnt clear was how individual small groups of
practitioners should make these changes. Should we take baby steps
or make sweeping changes? If we take small steps, in what order
should we take them? Will the benefit of these changes in the long
run be less than the cost? In this months Perspectives we included
an overview article from the Texas Academy about the Future of
Family Medicines Task Force VI: Report on Financing the New Model
of Family Medicine by Stephen J. Spann (Ann. Fam. Med, Nov 2004;
2: S1 - S21.) Its a great introduction to the issue of why to make the
financial decision to go for the New Model of care.
Be assured that the NJAFP will continue to explore ways to
bring these types of presentations to New Jersey. We are in the
planning stages for an Electronic Health Record (EHR) Summit so
that members can start to compare the costs and value of popular
computer software programs. The NJAFP is also presently working
with the Commission on Quality and Scope of Practice to bring a
Quality Improvement program to NJ. You will be hearing more
about that, next summer.
In all of these meetings, and in many of the activities and initiatives
of the Academy, there is ideal and there is real. We would like to
think that these two things match, but they dont always. Still, as leaders,
we work to close the gap between what the ideal world would look like
and what the real world is. We do that through resolutions, life-long
learning, quality improvement, initiative and perseverance. It may take
time and it definitely will take patience, but as a family of family
physicians we are moving forward.
NEW JERSEY DELEGATION TO THE

AAFP HOUSE OF DELEGATES
Delegates
Richard Cirello, MD
Robert Pallay, MD
Alternate Delegates
Richard Corson, MD
Mary Campagnolo, MD
Board Chair - Terry Shlimbaum, MD
President - Caryl Heaton, DO
President-Elect - Robert Spierer, MD
Vice President - Jeffrey Zlotnick, MD
Executive Vice President - Ray Saputelli, CAE
Deputy Executive Vice President- Theresa Barrett, MS, CMP
EXECUTIVE
VPS VIEW
An Aerial View
Raymond J. Saputelli, CAE is the Executive
Vice President of the New Jersey Academy
of Family Physicians and the Executive
Director of the New Jersey Academy of
Family Physicians Foundation.
I missed the deadline for this article. I had

lots of valid reasons (ok, a few reasonable excuses):
I was sick, I was backed up with other important
stuff, I had writers block... The truth: I didnt
know what I wanted to say. Its important to me to use this editorial to add value to
your life. I feel that if youre taking the time to read it, I ought to write something
worth reading. So I struggled. Today I started three more versions none made it
past the first paragraph before falling victim to my delete key. Then I asked myself,
Why are you having such a problem? There are plenty of issues our members are
dealing with, lots of areas where staff and leadership are working hard to ease the
burden. Whats the trouble? The answer came to me somewhere between my third
cup of coffee and my younger daughters second attempt of the morning to rid the
world of her older sister. The trouble was that there is TOO MUCH to saya monumental number of issues to discuss and work on, both good and challenging. I was
feeling overwhelmed with all we had yet to accomplish. Then it occurred to me that
we are all so focused on moving forward that we seldom stop and look back on all
the good weve done. With my writers block dissolving I decided to provide you with
a retrospective of the past years achievements. This is by no means a complete list of
our activities, but a sampling of our most notable accomplishments.
2004 Summer Celebration and Scientific Assembly

After several years of up and down performance, which left staff and leadership feeling we hosted the best party that no one came to, we made the decision in
mid-2003 to get out of the annual meeting business. After a great deal of discussion,
and the requisite gnashing of teeth, the NJAFP Board agreed to outsource the production of our annual event to a company who suggested that they could produce our
meeting with complimentary CME. It seemed too good to be true, but the company
was credible and we took the chance. In late 2003 the company realized it could not
produce the meeting as planned and after several weeks of negotiation we mutually
agreed to dissolve the partnership. In December 2003, leadership charged staff with
the production of our meeting with less than 6 months to do so. They set specific
goals in the area of revenue, CME, and attendance, and then allowed the staff the
freedom to build the event. The outcome was a meeting that offered over 14 prescribed CME credits for a modest fee ($49). Our attendance topped our previous 5year high, and the meeting was financially successful. Member feedback according
to meeting evaluations was excellent, and more than 20% of our active membership
reported that they found value in the event. For information on our 2005 meeting,
(May 20-22 in Atlantic City), see page 16 in this issue or go to www.njafp.org and click
on the 2005 Summer Celebration and Scientific Assembly.
Perspectives: A View of Family Medicine in New Jersey

Our premier success story for the past 3 years has been this magazine, and this
held true in 2004. Perspectives is now published in full-color, is revenue neutral, and as
of this issue carries AAFP Prescribed CME. It is our signature communication vehicle.
Much of the credit for these accomplishments goes to Managing Editor Theresa
Barrett, MS, CMP, original Executive Editor Joe Wiedemer, MD, and current Executive
Editor Jeff Z Zlotnick, MD. With the assistance of the new editorial board,
Perspectives will continue its evolution by increasing the amount of CME content while
providing information that is specific to family doctors in New Jersey. I encourage any
member interested in writing to contact the editors at editor@njafp.org.
Perspectives 1Q05
By Raymond J. Saputelli, CAE
Legislative Victory Health Enterprise Zones

So often our legislative action consists of reaction. In late 2003, the NJAFP decided that in order to truly bring value to members in the legislative arena, we needed to
be proactive in Trenton. Using an idea and the boundless energy provided by Tom
Ortiz, MD and the skill of our Government Affairs Director, Claudine Leone, Esq., the
NJAFP drafted what became known as the Health Enterprise Zone bill which was
signed into law in 2004. This law provides incentives for primary care medical and dental practices to remain located or to locate in -- or within 5 miles of -- designated
Health Enterprise Zones (HEZs). HEZs are medically underserved areas as identified by
the NJ Department of Health and Senior Services through the states Primary Care Loan
Redemption Program. More information on the HEZ law and its potential benefits can
be found in the Government Affairs View (p. 24) in this issue, at www.njafp.org, or by
calling the NJAFP Office.
MedFestA partnership between NJAFP and Special Olympics of NJ (SONJ)

Under the efforts of Program Coordinator, Candida Taylor and Program Chair, Dr.
Z, the NJAFP has partnered with SONJ to produce MedFest. This program brings Family
Docs to developmentally disabled athletes wishing to participate in Special Olympic
Activities. On the surface this seems like a worthwhile but simple event: athletes need
pre-participation physicals to participate in the games; Family Docs provide the physicals. There is, however, so much more to it than that. This event provides participating
NJ family physicians with education in dealing with this complex population, sends
those docs into the community, offers the athletes the opportunity to make, what for
many, is their first true contact with a physician who can provide their medical
home, and allows for close to 100 special needs athletes to be cleared to participate
in Special Olympics in just one morning. To say that this event improves the lives of all
who participate is an understatement. The value to the athletes and caregivers is clear,
and one needs only to look at the tired smiles on the faces of the staff and volunteers
to know what it meant to the members who participated. However, there is value even
to those members who have not participated. In 2004, MedFest won a Summit Award
from the American Society of Association Executives (ASAE). This national recognition
allowed us to showcase the value that Family Physicians bring to their communities.
The positive impact this recognition has had on the publics perception of Family Docs
is priceless. The next MedFest is scheduled for April 15. Contact Candida in the NJAFP
Office to participate in this wonderful event.
Under the efforts of Program Coordinator, Candida Taylor and Program Chair, Dr.
Z, the NJAFP has partnered with SONJ to produce MedFest. This program brings Family
Docs to underserved athletes wishing to participate in Special Olympic Games. On the
surface this seems like a worthwhile but simple event: athletes need pre-participation
physicals to participate in the games; Family Docs provide the physicals. There is, however, so much more to it than that. This event provides participating NJ family physicians with education in dealing with this complex population, sends those docs into
the community, offers the athletes the opportunity to make, what for many, is their
first true contact with a physician who can provide their medical home, and allows
for close to 100 special needs athletes to be cleared to play in the games in just one
morning. To say that this event improves the lives of all who participate is an understatement. The value to the athletes and caregivers is clear, and one needs only to look
at the tired smiles on the faces of the staff and volunteers to know what it meant to
the members who participated. However, there is value even to those members who
have not participated. In 2004, MedFest won a Summit Award from the American
Society of Association Executives (ASAE). This national recognition allowed us to showcase the value that Family Physicians bring to their communities. The positive impact
this recognition has had on the publics perception of Family Docs is priceless. The next
MedFest is scheduled for April 15. Contact Candida in the NJAFP Office to participate
in this wonderful event.
CLINICAL
VIEW
AN UPDATE ON SINUSITIS
Richard Levine, MD is a faculty member at West Jersey-Memorial
Family Practice Residency Program.
inusitis is a condition that affects 30-35 million Americans and

accounts for over 25 million office visits. With direct costs of
$2.4 billion per year, and an additional $1 billion for surgical
costs, it is a huge problem. Sinusitis is the third most common diagnosis for which an antibiotic is prescribed. Even though most physicians
agree that antibiotics are over-prescribed, 50% of patients are given
an antibiotic when seeing the doctor for cold-like symptoms.
To review, sinus health depends on mucous secretion of normal
viscosity, volume, and composition; normal mucociliary flow to prevent mucous stasis and subsequent infection; and open sinus ostia to
allow adequate drainage and aeration. Not only do sinuses provide
mucous to the upper airways for lubrication and to trap viruses, bacteria, and foreign material, but they also give characteristics to our
voices, lessen skull weight, and are involved in olfaction.
Why do people with upper respiratory infections complain of
sinus infections? The most likely explanation is that the sinus mucosa
is contiguous with the nasal mucosa, so that people with a cold feel
pressure and congestion in their sinuses. Further confounding the
diagnosis of an acute bacterial sinusitis are allergic symptoms. People
with allergic rhinitis tend to suffer from nasal congestion, clear rhinorrhea, itching red eyes, and possibly a nasal crease. Distinguishing viral
rhinosinusitis from bacterial sinusitis is more difficult. Bacterial sinusitis
can be classified into four categories:
Acute Bacterial lasts four weeks, symptoms resolve completely
Subacute Bacterial begins at week 4, lasts up to 12 weeks
Chronic symptoms last more than 12 weeks
Recurrent Acute episodes lasting fewer than 4 weeks, separated by at least 10 days, or 3 episodes in 6 months
While a viral URI tends to be worse at the beginning of the illness and last no more than 10 to 14 days, a bacterial sinus infection
persists for more than 10 days. Although not very specific, physical
findings include mucopurulent nasal discharge, swelling of the nasal
mucosa, sinus pain, and possibly periorbital swelling. A history of
double sickening, in which the symptoms were getting better after
a few days and then became severe again often points to a bacterial
sinus infection.
The objectives of treating a bacterial sinus infection are to
decrease the recovery time, prevent chronic disease, decrease exacerbations of asthma, and to do so in a cost-effective way.
Antihistamines are recommended if there is an allergic component to
the sinusitis, while topical and/or oral decongestants can help with
the symptoms of congestion. Keep in mind that nasal decongestants,
while helpful, should only be used for three or four days to prevent
rebound congestion. Nasal irrigation may be helpful but is not done
in the majority of primary care offices. Guaifenesin, at a dose of
200mg to 400mg every six hours, might help symptoms as well.
Finally, if indicated, an antibiotic may be prescribed. The decision to
use an antibiotic is still controversial, since many cases of clinically
diagnosed sinus infections are viral and the literature is still reluctant
By Richard Levine, MD
to state that antibiotics provide an overwhelming advantage in the

treatment of sinusitis. Factors such as cost, side effects, antibiotic
resistance, and antibiotic reactions should be factored in when deciding on prescribing an antibiotic.
Amoxicillin is still a good first-line agent at a dose of 500mg
every eight hours for ten to fourteen days because 80% of patients
will respond. If the patient is penicillin allergic, then clarithromycin or
azithromycin would be a good choice. Unfortunately, erythromycin
does not provide adequate coverage, and there is too much pneumococcal resistance to recommend trimethoprim, sulfamethoxazole. If
there is no response to the antibiotic within three days, then a
stronger antibiotic may be used if the patients symptoms have not
changed. Depending on the situation, the patient may need to be
reassessed. The Cochrane Library reviewed acute maxillary sinusitis in
2002 and found that, although the evidence is limited, confirmed
cases of sinusitis, either by aspiration or radiographs, could be treated
with amoxicillin for seven to fourteen days.
In children and young adults aged one to twenty-one, a task
force of the American Academy of Pediatrics has proposed recommendations in treating acute sinusitis:
Recommendation 1 The diagnosis of acute bacterial sinusitis is based on clinical criteria with patients presenting with URI
symptoms that are either persistent or severe
Recommendation 2a Imaging studies are not necessary to
confirm a diagnosis of clinical sinusitis in children younger than
six (older than six is controversial)
Recommendation 2b CT scans of the paranasal sinuses
should be reserved for patients in whom surgery is being considered, patients who do not respond to medical regimens
which include adequate antibiotic use, or in assisting in the
diagnosis of anatomical changes interfering with airflow or
drainage
Recommendation 3 Antibiotics are recommended for the
management of acute bacterial sinusitis to achieve a more
rapid clinical cure, but patients should meet requirements of
persistent or severe disease
As you can see, bacterial sinusitis is a difficult diagnosis to make.
The British Medical Journal found no evidence that amoxicillin was
effective in reducing or curing symptoms when the diagnosis of sinusitis was not confirmed by radiographs or aspiration. Therefore, it is up
to the physician, in conjunction with patient input, to decide on the
use of antibiotics when acute bacterial sinusitis is suspected. Many
patients are willing to ride out the symptoms when physicians discuss
the side effects often experienced by patients taking antibiotics.
Bibliography:
Sheldon L. Spector, MD Parameters for the Diagnosis and Management of
Sinusitis Journal of Allergy and Immunology 102(6), 1998
James E. Leggett, MD Acute Sinusitis: When and when not to prescribe
antibiotics Postgraduate Medicine 115(1) Jan. 2004. 13-19
Kim Ah-See Sinusitis (acute) American Family Physician 69(11) 2635-2636
See CME test on page 35.

Perspectives 1Q05
PERSPECTIVES
FOR PATIENTS
The NJAFP realizes that being able to provide your patients with good patient education
materials is important to you. The Internet is a valuable resource for education, but some
patients do not have access to the Internet, are not computer savvy or may not be able to
distinguish valid information from commercial hype. In an effort to provide you with additional resources to help you educate your patients, the NJAFP has made the following
patient education piece available on the Members Only section of www.njafp.org.
Simply log in using your AAFP member ID number and download this 1 page, pdf file.
Perspectives for Patients: Sinusitis
What are the Symptoms of Sinusitis?
Are you one of the 37 million Americans affected by sinusitis

every year? If so, here is some information from your family physician
to help you understand this condition.
You should see your family physician if your cold has lasted
longer than a week, you're still having trouble breathing through
your nose and when you lean forward, you feel throbbing pain in
your face.
You may also have a stuffy nose, fever, thick green or yellow
nasal mucus, and an ache in your upper teeth. Other symptoms you
may notice include:
Headache when you wake up in the morning
Pain when your forehead is touched over the frontal sinuses
Swelling of the eyelids and tissues around your eyes, and pain
between your eyes.
Tenderness when the sides of your nose are touched, a loss of
smell, and a stuffy nose
Earaches, neck pain, and deep aching at the top of your head.
Fever
Weakness or tiredness
A cough that may be more severe at night
What is Sinusitis?
Sinusitis simply means your sinuses the air chambers in the bone
behind your cheeks, eyebrows and jaw - are infected or the lining of one
or more of the sinus cavities in the facial bones around your nose is
inflamed. What is not simple is the pain that this condition can cause.
Sinusitis can make life miserable, causing tenderness in your face,
aching behind your eyes and difficulty breathing through your nose.
Healthcare experts usually divide sinusitis cases into two categories: Acute and Chronic.
Whats the Difference Between Acute and Chronic

Sinusitis?
Acute Sinusitis usually lasts 3 weeks or less and responds well to
antibiotics and decongestants. Chronic sinusitis usually lasts for 3 to 8
weeks but can continue for months or even years.
How do I Tell if I have Sinusitis?

Because your nose can get stuffy when you have a cold, you
may confuse simple nasal congestion with sinusitis. A cold, however,
usually lasts about 7 to 14 days and disappears without treatment.
Sinusitis often lasts longer and typically causes more symptoms than
just a cold.
Symptoms for acute sinusitis include facial pain/pressure, nasal
obstruction, nasal discharge, diminished sense of smell, and cough
not due to asthma (in children). Additionally, you could have fever,
bad breath, fatigue, dental pain, and cough. The doctor may determine sinusitis to be present if you have two or more of these symptoms and/or the presence of thick, green or yellow nasal discharge.
How Did I Get Sinusitis?

Most cases of acute sinusitis start with the common cold, which
is caused by a virus. Colds do not cause symptoms of sinusitis, but
they do inflame the sinuses. The sinuses - the air chambers in the
bone behind your cheeks, eyebrows and jaw - make mucus that
cleans bacteria and other particles out of the air you breathe. Each
sinus has an opening into the nose for the free exchange of air and
mucus, and each is joined with the nasal passages by a continuous
mucous membrane lining. Because of this, anything that causes a
swelling in the nose - an infection, an allergic reaction, or a cold can also affect the sinuses. Air and mucus are trapped behind the
narrowed sinus openings. When these openings become too narrow,
mucus cannot drain properly and this sets up prime conditions for
bacteria to multiply.
Most healthy people harbor bacteria in their upper respiratory
tracts with no problems until the body's defenses are weakened or
drainage from the sinuses is blocked by a cold or other viral infection. The bacteria that may have been living harmlessly in your
nose or throat can multiply and invade your sinuses, causing an
acute sinus infection.
10
Perspectives 1Q05
What is the Treatment?

Acute sinusitis is generally treated with 10 to 14 days of antibiotics. Antibiotics are effective only against sinus problems caused by
a bacterial infection. It is important to take this medicine exactly as
your doctor tells you and to continue taking it until it is gone, even
after youre feeling better.
Taking Care of Yourself When You Have Sinusitis

Get plenty of rest.
Drink plenty of fluids.
Apply moist heat by holding a warm, wet towel against your face
or breathing in steam through a cloth or towel.
Talk with your doctor before using an over-the-counter cold medicine.
Some cold medicines can make your symptoms worse or cause
other problems.
Dont use a nose spray with a decongestant in it for more than 3
days. If you use it for more than 3 days, the swelling in your sinuses
may get worse when you stop the medicine.
Use an over-the-counter medicine such as acetaminophen for pain.
Rinse your sinus passages with a saline solution. You can buy an
over-the-counter saline solution or ask your doctor how to make
one at home.
Where Can I Get More Information About Sinusitis?

Additional information about sinusitis can be found at:
American Academy of Family Physicians
www.familydoctor.org
The National Institutes of Allergies and Infectious Diseases
http://www.niaid.nih.gov/factsheets/sinusitis.htm
MedLine Plus (The National Library of Medicine):
http://www.nlm.nih.gov/medlineplus/sinusitis.html
The Mayo Clinic.com: Acute Sinusitis
http://www.mayoclinic.com/invoke.cfm?id=DS00170
Reviewed January 2005 by Richard Corson, MD
Sinus and Allergy Partnership Updates Sinusitis Guidelines:

Recent Increase In Antibiotic Resistance Plays Prominent Role In Changes
ollowing the recent dramatic increase in antibiotic resistance

in the United States and the availability of new, highly potent
antibiotic drugs, the Sinus and Allergy Partnership (SAHP),
along with leading experts, updated its guidelines for the diagnosis
and treatment of acute bacterial rhinosinusitis (ABRS), commonly
known as sinusitis. The original guidelines were issued in 2000.
Differentiating bacterial from viral rhinosinusitis is often a challenge because the clinical features of the two diseases are similar.
Antibiotics kill bacteria, not viruses, and growing misuse of antibiotics
to treat viral illness such as colds, flu and viral sinusitis is a leading
cause of antibiotic resistance.
The Centers for Disease Control and Prevention (CDC) report
that the rate of penicillin resistance in Streptococcus pneumoniae (the
most common respiratory tract pathogen) has increased more than
300 percent in the United States during the past five years. The SAHP
has updated the guidelines to help physicians distinguish between
viral and bacterial sinusitis and treat the disease appropriately.
To enable appropriate choice of treatment for bacterial sinusitis,

the guidelines use the Poole Therapeutic Outcomes Model to group
commonly used antibiotics into categories based on efficacy against
bacteria that cause ABRS Streptococcus pneumoniae, Haemophilus
influenzae or Moraxella catarrhalis. The Poole Therapeutic Outcomes
Model is a mathematical model that predicts the efficacy of the
antibiotics based on pathogen distribution, resolution rates without
treatment and in vitro microbiologic activity.
In addition to presenting efficacy criteria, the guidelines propose
that physicians use antibiotic treatment for sinusitis in accordance with
disease severity, disease progression and risk factors for infection with
a resistant pathogen, including recent antibiotic exposure. (See footnote below table for more risk factors.) The guidelines separate sinusitis diagnosis into two categories: mild and moderate. Since each
patients recent history of antibiotic use significantly affects the risk of
infection due to resistant organisms, the guidelines also divide patients
into groups based on antibiotic exposure in the past 4-6 weeks.
Based on disease category and recent antibiotic exposure, the guidelines recommend:
Mild ABRS with No Recent Antibiotic Use (Past 4-6 Weeks)
amoxicillin/clavulanate
(1.75g-4g/250mg/day) *
amoxicillin (1.5g-4g/day) *
Mild ABRS with Previous Antibiotic Use or Moderate Disease
high-dose amoxicillin/clavulanate
(4g/250 mg/day)
cefpodoxime proxetil
respiratory fluoroquinolones
(gatifloxacin/ levofloxacin/moxifloxacin)
cefuroxime axetil
ceftriaxone
cefdinir
*Higher daily doses of amoxicillin (4g/day) are recommended for patients with risk factors for infection with a resistant pathogen. These risk factors include:
recent antibiotic use, exposure to young children, living in areas with a high prevalence of penicillin-resistant S. pneumoniae or DRSP, and living in areas
with a high volume of pediatric antibiotic use.
The national average penicillin resistance level is recorded at

22% in 2004, but many states and cities have a higher percentage.
Louisiana (48%), Texas (41%), Florida (39%), Arizona (38%) and
Mississippi (34%) have the highest rates in the continental United
States. Of the top ten cities with the highest resistance levels, five are
Florida urban areas, and two are Texas cities. The highest recorded
resistance percentage was recorded in Jacksonville, FL (60%).
Bacterial sinusitis is usually a complication of a viral upper respiratory infection (URI), such as the common cold. The updated
guidelines suggest that bacterial sinusitis be diagnosed in adults or
children when a viral URI remains unimproved 10 days after onset
(or worsens after five to seven days), and exhibits the following
accompanying symptoms: nasal drainage, nasal congestion, facial
pressure/pain (especially when the pain occurs on one side and is
focused in the region of a particular sinus), post-nasal drainage,
reduced sense of smell, fever, cough, fatigue, dental pain in the
jaw, and ear pressure or fullness.
Approximately 20 million sinusitis cases appear in the U.S.

annually, with an estimated annual economic impact of $3.5 billion.
Sinusitis is the fifth most common diagnosis for which an antibiotic
is prescribed.
The Sinus and Allergy Health Partnership is a not-for-profit
organization created jointly by the American Academy of Otolaryngic
Allergy, the American Academy of OtolaryngologyHead and Neck
Surgery and the American Rhinologic Society.
The guidelines were originally published in the journal
Otolaryngology-Head and Neck Surgery. They are available by mail
from The Sinus and Allergy Health Partnership, 1990 M Street NW,
Suite 680, Washington, DC, 20036, or online at www.sahp.org.
See CME test on page 35.
Perspectives 1Q05
11
QUALITY
VIEW
The Basics of Measuring Patient

Satisfaction in a Primary Care Practice
By Vincent E. Green, MD
Vincent E. Green MD is the Medical Administrator for the Family
Medicine Center at Lumberton and a faculty member at West
Jersey-Memorial Family Practice Residency Program.
s Family Physicians we want our practices to meet the needs

of our patients. However, many of us struggle to identify the issues
that matter most to patients. How do we know what our patients
expect from a visit to our office? More importantly, how well
would our patients rate us at meeting their needs?
Practices have used many methods to monitor patient satisfaction. One method is the patient survey. Patient satisfaction surveys
can help you identify ways of improving your practice and can
demonstrate an interest in quality and in doing things better.1
There are several commercially available satisfaction surveys. These
surveys are typically mailed directly from the vendor to a random
sampling of patients. The completed surveys are returned to the
vendor who then analyzes the data and sends the practice a report
detailing the results. These externally developed surveys have two
primary advantages: 1) The vendor does the data analysis and 2)
the vendor can provide data from other similar practices against
which you can compare your performance. These surveys also have
some disadvantages. For example, if your practice has features that
make it dissimilar to other practices in the databank, there may be
no meaningful benchmark data for comparison. The cost of this
type of survey could also be prohibitive to smaller practices.
An alternative to using a survey developed by an outside vendor is to develop your own patient survey. This is a manageable
task, but it can be time consuming and you should keep in mind
the pressure you may be placing on your internal staff. If you
decide to develop your own survey, follow a stepwise approach
and keep a few guiding principles in mind.
The first step in the process is deciding whom you want to
survey and how frequently to survey. When you distribute your
questionnaire, try to survey the largest group possible. This will
improve your chances of getting an adequate number of responses.1
The greater the number respondents, the more likely you are to
get a true assessment of patient satisfaction In my experience with
our patient survey, approximately one third of the patients who are
given surveys will complete them. Therefore, you should keep the
expected response rate in mind when determining the number of
surveys to distribute. Evelyn Eskin, MBA of HealthPower Associates
Inc, in Philadelphia states that the number of surveys depends on
the size of your practice, but the ideal would be to get at least 200
surveys per physician (assuming a response rate of 25 percent, that
would mean sending out 800 surveys). If the ideal is out of reach,
collect as many surveys as your resources will allow.2
When deciding how frequently you want to survey your
patients, I would suggest asking yourself, What do I want to do
12
Perspectives 1Q05
with the data I collect? If your goal is to develop an improvement

plan based upon the results, you should allow enough time
between surveys to implement the plan and measure its success.
Our practice surveys patients twice yearly: in the spring and fall.
Once you have decided when you want to conduct the survey,
the next step is deciding how you want to distribute the survey.
When distributing the survey, you should make every attempt to
maintain the anonymity of respondents. Patients are more likely to
answer questions truthfully if they feel their responses are anonymous.1
One distribution approach is to mail surveys to patients to complete
and mail back. Another approach is to distribute surveys in the
office and request that patients return the completed survey to a
confidential dropbox at the end of their visit. Regardless of the
distribution method you choose, I would suggest including a statement on the survey assuring patients that their responses are truly
anonymous and that the results will be used to help the practice
continue to provide them with the best possible service.
Patient satisfaction surveys can help

you identify ways of improving your
practice and demonstrate an interest
in quality...
Now you need to decide what you want to measure. Avoid
the trap of asking questions pertaining only to the physicians in
the practice. According to Mertzs3 article citing The Horizon Group
Ltd., 1997 Survey of Family Practice, physicians finished fourth on
a list ranking the top four factors influencing patient satisfaction.
Obviously, there are several other aspects of a medical practice that
patients feel are important when rating their level of satisfaction.
Typically, the most common areas covered are: access (getting
through on the phone, ease of getting an appointment, waiting
times); communication between patient and office (quality of
health information materials, getting a return phone call, getting
back tests results); staff (courtesy of the receptionist, caring of
nurses and medical assistants, helpfulness of people in the business office); and the interaction with the doctors (whether the
doctor listens, thoroughness of explanations and instructions,
whether the doctors take time to answer questions, how much
time the doctors spend with the patient).4 Most surveys also
include a category assessing the Practice as a whole. Patients consider all of these factors when rating satisfaction; therefore each
category measured by your survey should be weighed equally. For
instance, questions regarding wait time and office staff should be
given equal importance to questions pertaining to physicians.
The final step is writing questions. Once you have decided the
general categories you want to assess you can now begin writing
questions for each category. There should be enough questions to

get an assessment of what you are trying to measure, but there
should not be so many questions that completing the survey
becomes a burden to your patients. As a general rule of thumb,
two or three questions for each of the categories being measured
should be sufficient. Rather than simply assessing whether your
patients are satisfied, your survey questions should attempt to
gauge their level of satisfaction. For this reason, surveys utilize
scales for responses. We use a Likert scale consisting of Strongly
Agree, Agree, Disagree, and Strongly Disagree, and assign a
numerical value to each response. The most generally used and
accepted scale that you'll see quoted in the literature and utilized
by the NCQA is the five-point scale ranging from excellent to
poor.1 Due to variations in patient educational backgrounds, we try
to use questions that are at a sixth grade reading level. When writing questions remember that each question should be used to
assess only that factor being measured. Questions should be short,
easy to read, and easy to answer.
You are now ready to begin developing a patient satisfaction
survey that should meet the needs of your patients and your practice.
In the upcoming issues I will be examining how to analyze the data
and how a practice can then use the data to implement a plan that
improves patient satisfaction. Based upon my experience with our
practices survey, the information obtained will give you valuable
insight into your patients perception of your practice. It will also

provide you with the information necessary to ensure that your
patients are receiving the service that they both desire and deserve.
Additional Reading
Baker SK. Improving Service and Increasing Patient Satisfaction.
Family Practice Management. July/August 1998.
Mertz, M. What Does Walt Disney Know About Patient Satisfaction?
Family Practice Management. November/December 1999.
White, B. Measuring Patient Satisfaction: How to Do It and Why
to Bother. Family Practice Management. January 1999.
References
1. White, B. Measuring Patient Satisfaction: How to Do It and Why to
Bother. Family Practice Management. January 1999.
2. Ask FPM. Family Practice Management, June 1998. Patient Satisfaction
Surveys. Available at http://www.aafp.org/fpm/980600fm/askfpm.html.
Last Accessed, January 2005.
3. Mertz, M. What Does Walt Disney Know About Patient Satisfaction?
Family Practice Management, November/December 1999.
4. Walpert, B. Patient satisfaction surveys: how to do them right. From the
April 2000 ACP-ASIM Observer, copyright 2000 by the American
College of Physicians-American Society of Internal Medicine. Available at
http://www.acponline.org/journals/news/apr00/surveys.htm. Last
Accessed January 2005.
New National EHR Systems Initiative:

Using Electronic Health Records to Positively Impact Physician Practices and Patient Care
By: Cari Miller: PRONJ
Mary Campagnolo, MD; Chair NJAFP Quality Committee
PRONJ, The Healthcare Quality Improvement Organization of New
Jersey, Inc., is implementing a national electronic health record (EHR) initiative for physicians in our state. The Doctors Office Quality Information
Technology project, or DOQ-IT, is sponsored by the Centers for Medicare &
Medicaid Services (CMS) and designed to meet the following objectives:
To foster the implementation and use of EHR systems in small- to mediumsized physician offices
To improve outcomes for patients with chronic illnesses by using EHR systems and health information technology
In mid-2004, the U.S. Department of Health and Human Services
(DHHS), CMSs parent organization, released an outline for a 10-year plan to
transform the delivery of health care by building a new health information
infrastructure, including EHRs and a network to link health records nationwide. At that time, former DHHS Secretary Tommy G. Thompson emphasized
that America needs to move much faster to adopt information technology in
our healthcare system. Electronic health information will provide a quantum
leap in patient power, doctor power, and effective health care. We cant wait
any longer.
The pilot phase of the DOQ-IT initiative is already occurring. PRONJ started recruiting physician offices in November 2004 to participate in the first stage
of the project. As participants, physicians and their office staffs will:
Receive free assistance in enhancing current EHR systems, or in selecting,
purchasing, and implementing one
Hear from experts currently using these systems in their practices

Improve patient outcomes, staff satisfaction, and practice performance
measures
Receive evidence-based guidelines for practice redesign and care management, as well as obtain suggestions and techniques on how to effectively
apply these guidelines in your practice
PRONJ is looking for family physicians or internists who are committed
to developing or strengthening computer expertise in EHR systems and
whose practice population includes Medicare patients. Through on-site visits
and office assessments, PRONJ staff members will help participating physicians and their office staffs develop processes for EHR system implementation, as well as practice and workflow redesign.
Key national partners working with CMS on DOQ-IT include the
American Academy of Family Physicians (AAFP), the American Medical
Association (AMA) and the American College of Physicians (ACP).
DOQ-IT should prove to be an important project for making headway in
providing EHR systems that are interactive, standardized, and compatible,
thereby improving healthcare communications among medical facilities and
providers. You can be part of this effort by contacting PRONJ to participate in
DOQ-IT. Visit http://www.pronj.org/projects/3/19 to obtain information or call
Carolyn Hezekiah Hoitela, MLS, Project Leader, by phone (1-732-238-5570,
ext. 2012) or E-mail (Choitela@njqio.sdps.org).
The NJAFP Quality Committee will also be in contact with PRONJ on the
progress of this important project. Contact Ray Saputelli at 609-394-1711
or ray@njafp.org if you are interested in joining the Quality Committee or
would like to learn more about its activities.
Perspectives 1Q05
13
INFOTECH
VIEW
Introduction to Medical Informatics

for the Family Physician
by Kennedy Ganti, MD
Kennedy Ganti, MD is a 2nd year resident in Family Medicine at

the UMDNJ-Robert Wood Johnson Medical School program in New
Brunswick. He is also involved with the UMDNJ Informatics Group.
Email him with questions or correspondence at
gantike@umdnj.edu.
lectronic Health Records. PDAs. Electronic prescription

writing. PACS. Are these buzzwords merely the latest
fad to hit clinical medicine or a harbinger of things to
come? For those professionals who concern themselves
with the balance of cost and the delivery of the highest possible
quality of health care, these tools represent a new foundation in the
practice of medicine. Moreover, they represent a fundamental shift
in how physicians practice medicine. Why are these changes happening? Where can a family physician go to find tools to handle
the change?
The InfoTech View, a new column in Perspectives, seeks to
answer these and many more questions about computers in medicine.
This first issue will address what informatics is, why it is important,
and introduce tools that family physicians can use to improve different aspects of their delivery of care. The beginning of this article
is intended as a fundamental introduction; tech-savvy readers may
find this a bit basic.
What is medical informatics?

Medical informatics is an emerging discipline that has been
defined as the study, invention, and implementation of structures
and algorithms to improve communication, understanding and
management of medical information.1 Simply put, it is the interdisciplinary study of how to manage medical information electronically. Medical informatics is a branch of the larger biomedical informatics, which also includes biological sciences and clinical health
and services research.
Why all the hype around medical informatics?

In 1999, the Institute of Medicine (IOM) published their now
famous report To Err is Human: Building a Safer Health System.
This report, as part of a larger focus on the quality of healthcare
practice and delivery, addressed fundamental pitfalls and systemic
errors in the healthcare system that resulted in a loss of between
17 and 29 billion dollars in hospitals nationally. Moreover, between
44,000 to as many as 88,000 people lost their lives as a result of
these errors.2 This report, needless to say, stirred up quite a bit of
controversy.
In 2001, the Institute of Medicine released the follow up to To
Err is Human called Crossing the Quality Chasm: A New Health
System for the 21st Century. In this report, the IOM called for a
detailed plan where health care should be supported by systems
14
Perspectives 1Q05
that are carefully and consciously designed to produce care that is

safe, effective, patient-centered, timely, efficient, and equitable.3
Since then, medical informatics (as a discipline) has gained
momentum in terms of the amount of attention and monies that it
receives resulting in a push by both private sector and government
authorities. Here in New Jersey, the PRO-NJ organization, a functionary of CMS (the Centers for Medicare and Medicaid) are seeking
to help physicians throughout the state, with family physicians in
particular, to adopt informatics initiatives in an overall strategy for
quality care improvements to Medicaid and Medicare recipients.
[See Sidebar article: DOC-IT] This phenomenon has since percolated
through the everyday practice of medicine.
Different kinds of computers now permeate the medical environment delivering an unprecedented amount of computing power
into the hands of physicians. Notebook PCs and Personal Digital
Assistants (PDAs) are now quickly gaining favor among physicians.
Along with new choices in hardware, what kinds of resources are
available to family physicians?
Resources for physicians:

The most prevalent applications are found on the Internet.
These tools can be broken down into websites and online applications. Of the websites, there are ones that are specific to family
medicine and ones that are intended for a larger audience. The
websites are either free to access or have a membership charge
associated with them.
Websites: Two important websites for family physicians are
the American Academy of Family Physicians (www.aafp.org) as
well as our very own NJAFP website (www.njafp.org). Both sites
are rich in information related to not only to the practice of family
medicine, but also in all the various activities, initiatives and partnerships that the AAFP and NJAFP are involved in. The NJAFP has a
Members Only section with information that is specific to family
physicians in New Jersey.
Another resource for family physicians is Family Practice
Notebook at www.fpnotebook.com. At printing, this website features clinical information based on body system and disease states
with 4316 topics organized into 616 chapters in 31 subspecialty
books. This website has a free version that contains advertisements
from sponsors, and a subscription based version that is ad-free and
has a downloadable component, which allows the website to be
placed on a PDA. More complete information is available on the
website.
www.familypractice.com is another website of value to family
physicians. This website contains information about issues of practice management, earning CME, and disease specific information.
Familypractice.com also has ABFP style board review questions that
are modeled after questions from the boards and can serve as a
valuable resource for those taking the exam for the first time as
well as those who are going for re-certification.
Literature searches have always been popular among the general physician community. Medline, once restricted to medical
libraries, is available through the National Library of Medicines
PubMed resource at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi.
Many other websites also now integrate Medline searches within
their site. Medical websites for general information retrieval (news,
simplified Medline searches and original articles) can be accessed
through free physician memberships made available through
Medscape (www.medscape.com), a division of WebMD. Another
valuable free site for clinicians is www.medicalstudent.com.
Though initially assembled for medical students,
medicalstudent.com serves as a great resource for fundamental
medical information for all physicians.
The MerckMedicus website (www.merckmedicus.com) is an
advertising-free medical portal consisting of comprehensive medical resources available on the Internet. It contains a combination
breaking medical news, online learning resources, diagnostic tools,
and patient's perspective on the world of medicine. Membership is
free to physicians but requires registration with a state license
number. Also available on Merckmedicus.com is access to
Harrisons Online, the online version of Harrisons Principles of
Internal Medicine, as well as other popular specialty based textbooks. MerckMedicus has versions for both Palm and Pocket PC
PDAs that integrate the famous Merck Manual as well as other
useful programs like Theradoc, a PDA guideline based program
that helps make point of care decisions regarding appropriate use

of antibiotics. The PDA version of MerckMedicus also features a
handbook of laboratory diagnostic tests.
There are some fee-based websites and applications that can
serve as valuable tools for family physicians. Medical publishing
giant Elsevier has MDConsult (www.mdconsult.com) a large website that combines a website with robust offerings such as online
versions of popular textbooks (like Rakels Textbook of Family
Practice and Nelsons Textbook of Pediatrics), expanded Medline
searches that includes actual articles in online and PDF formats, as
well as a large section on patient handouts. MDConsult also has a
PDA version that integrates daily medical and drug news, journal
abstracts and Mosbys Drug Consult Interaction tool. Go to
www.mdconsult.com for various subscription offers.
InfoPOEM Inc. offers InfoRetriever, an evidence based
resource created by family physicians. It features the entire mainstream 5 Minute Clinical Consult series, clinical calculators, ICD-9
code lookup and POEMs (Patient Oriented Evidence that Matters).
The site offers InfoPOEMs review monthly and updates
InfoRetriever several times a year. As a part of the subscription,
family physicians have access to the Windows version of the software, Pocket PC and Palm versions as well as the online version.
As of the publication of this article, a yearly subscription to
InfoRetriever was $249.
A final resource that family physicians may find useful is a
subscription to UpToDate (www.uptodate.com). This is an authoritative source on the latest concepts and practices in Internal
Medicine, Surgery, Pediatrics, OB/GYN, and Family Medicine.
UpToDate features information that delves into the basic science
aspects of diseases and works on up through the latest clinical
advances. UpToDate is evidence based, but in a different manner
than InfoRetriever. UpToDate cites more disease oriented evidence
than patient oriented evidence. As a part of the subscription,
physicians are given access to Windows, Macintosh, Internet and
Pocket PC versions of the software. As of the publication of this
article, the cost of UpToDate was $395 per year.
The resources mentioned in this article are those that are most
used in New Jersey academic circles. There are many more information resources available for family physicians. Many individual
family physicians, departments of family medicine residency programs and organizations have websites and new applications
become available everyday.
The next column in this series will discuss the Electronic Health
Record and some of its advantages and tips for implementation.
The key to successful change is in understanding the key aspects
of what new ideas and technologies bring.
References
1. Zakaria, A. (2004) What is Medical Informatics? Retrieved December
28,2004 from http://www.faqs.org/faqs/medical-informatics-faq/ .
2. Institute of Medicine(1999) Report Brief. To Err is Human, Building a
Safer Health System. Retrieved on December 28,2004 from
http://www.iom.edu/includes/dbfile.asp?id=4117
3. Institute of Medicine(2001) Report Brief. Crossing the Quality Chasm:
A New Health System for the 21st Century Retrieved on December
28,2004 from http://www.iom.edu/report.asp?id=5432
Perspectives 1Q05
15
EDUCATIONAL
VIEW
2005 Summer Celebration and Scientific Assembly

Information for Today
by Jeffrey A. Zlotnick, MD CAQ
Vice President, NJAFP Annual Meeting Chair
This year, I have the opportunity to be the Chair of the

2005 Summer Celebration and Scientific Assembly. As in past
years, I am proud to invite you to THE meeting that brings together
experts to provide you with cutting edge information on family
medicine.
Last year, we revamped our educational program and it was an
amazing success! We also lowered our registration fee to make the
meeting quite affordable for our membership. I am happy to report
that again this year, if you register early you can attend the entire
meeting for $49. You would find it difficult to get this kind of high
quality, family medicine oriented CME while having a great time
interacting with your peers for that kind of price. Apparently, about
185 of your colleagues agreed and attended last years meeting.
We have two incredible keynote speakers this year: Victor
DeNoble, PhD, the man responsible for shining the light on the
true nature of nicotine addiction and what the tobacco companies
knew about that; and Larry Greene, MD from the Robert Graham
Policy Center in Washington D.C. Dr. Green will be speaking on
the how of implementing the Future of Family Medicine. These
two powerful speakers are guaranteed to be talking about subjects that youll want to know more about.
Our educational offerings this year will focus on the hot issues
important to family docs. We will be offering sessions on childhood obesity, adult ADHD, updates in the treatment of osteoporosis, cardiovascular disease, pain management, and many other
topics. Some educational sessions will carry EB-CME, which is now
worth double credit.
The 2005 meeting will be held at the Sheraton Atlantic City
Convention Center Hotel and the Atlantic City Convention Center
in Atlantic City, NJ on May 20th through the 22nd. Atlantic City
has just gone through some major renovations. Now, besides the
beach, the boardwalk, and the entertainment, there is the outdoor
Walk featuring great shopping and dining. While you are in sessions, there will be no lack of opportunities for your family to
explore and have fun.
You should have received your registration materials in the
mail. Online registration is available on the NJAFP website at
www.njafp.org. Click on the link for the 2005 Summer Celebration
and Scientific Assembly. You will also find up-to-the-minute developments on the agenda, special guests and other activities.
Educating our members is one of our prime missions. Through
education we assist our members in being the best physicians they
can be thereby helping to improve overall patient care for the citizens of New Jersey.
I hope this years meeting will provide something a little unique
in Academy CME; the best, most varied, most useful information you
can get in two and a half days. I look forward to seeing you there!
16
Perspectives 1Q05
ONE VOICEYOUR VOICE

CAN CHANGE THE WORLD
Submit a Resolution for the
House of Delegates
When one person cares enough to make their voice

heard, the world can change. When one person has the
courage and the passion to take a stand, the world can
change. When one person makes an effort not waiting for
someone else to do it the world can change.
Are you ready to be part of the change? If so, take the
first step and write a resolution for the 2005 House of
Delegates.
Resolutions are a request to establish Academy policy,
request implementation of Academy programs, address issues
of interest or concern to family physicians and the specialty of
family medicine, or request the elimination of Academy activities considered non-essential. In addition, there are special resolutions of commendation or in the memory of deceased officers or delegates.
Writing a resolution follows a specific protocol, but it is
easy to master. For a complete guide to writing resolutions for
submission to the House of Delegates, go to the Members
Only section of www.njafp.org and follow the links for the
HOD Information page under Member Services. Click on the
document Call for Resolutions 2005. You can also call the
NJAFP office at 609-394-1711.
Resolutions may be sent by regular mail, fax or email:
Attn: Speaker of the House
112 West State Street, Trenton, NJ 08608
Fax: 609-394-7712 Email: ray@njafp.org
Deadline for Resolutions is

Friday, April 15, 2005
Emergency resolutions submitted after April 15th will be
considered received at the House of Delegates and presented
to the Delegates at the discretion of the Speaker.
Resolutions will be heard at the

House of Delegates
The House of Delegates convenes at 8:00am
on Friday, May 20, 2005 at the Sheraton Atlantic City
Convention Center Hotel in Atlantic City, NJ
CALL FOR FAMILY PHYSICIAN OF THE YEAR

The Family Physician of the Year Award provides a means for
recognition of individuals who embody the principles of excellence
in family medicine. It is the Academys most prestigious award.
The Selection Committee is making its first call for nominees
for this award. Please consider family physicians you know who
would represent New Jersey as the best of the best.
County chapters, other groups or individuals have the opportunity to submit nominations. The physician selected will be recognized in the public relations efforts of the NJAFP, and will be forwarded as the New Jersey nominee for the prestigious AAFP
Family Physician of the Year award.
GUIDELINES FOR SELECTION:

Provides his/her community with compassionate, comprehensive
and caring medical service on a continuing basis
Is directly and effectively involved in community affairs and activities that enhance the quality of life in his/her home area
Provides a credible role model, emulating the family physician as
a healer and human being to his/her community, and as a professional in the service and art of medicine to colleagues, other
health professionals, and especially to young physicians in training and to medical students
Specific to New Jersey:

Has been in Family Practice in New Jersey at least five consecutive
years
Must be board-certified in Family medicine
Must be a member in good standing in his/her community
Must be a member in good standing of the NJAFP
Members wishing to place a candidate in nomination should
submit the following material to the Selection Committee,
care of the NJAFP Office, no later than April 15, 2005.
NOMINATION MATERIALS TO BE INCLUDED:

The following materials must be included to be considered:
Name, address and phone numbers of the nominee
Name address and phone numbers of the nominating individual
A letter of nomination (no more than two pages)
A current CV
Three letters of support two (2) from colleagues and one (1)
from a person in his/her community.
Other supportive material, as appropriate (not over 15 pages)
Mail to:
Deadline for Nominations for Family Physician

of the Year is April 15, 2005
Family Physician of the Year

NJAFP
112 West State Street
Trenton, NJ 08608
Call for Nominations for the 2005 House of Delegates

The NJAFP Needs You!
Call for Nominations for the Board of Trustees
Nominations are being sought for the Board of Trustees for
the 2005-2006 year. Your involvement is neededYour voice is
neededYour views are neededYou are needed.
We anticipate that three full-term positions for Board Trustees
will be open in 2005. Also open are the Vice-President, the
Secretary and the Treasurer positions, one position for AAFP
Delegate and one position for AAFP Alternate Delegate, as well as
one Resident and one Student Trustee position. Depending on the
outcome of the elections partial terms may need to be filled. Visit
www.njafp.org/membersonly and click on HOD for more information.
Members in good standing of the NJAFP may be considered
on the slate of nominees upon submission of the following documents and the approval of the Nominating Committee:
1. A letter of interest indicating the position for which you
plan to run
2. Your current CV
3. Two letters of recommendation/nomination from members
of the Academy
4. A declaration of any conflict of interest (form available
through NJAFP Office)
Individuals who have not served on a committee or on the

Board in previous years may be asked to interview with the
Nominating Committee.
Elections will be held at the House of Delegates, which convenes
at 8:00 a.m., on Friday, May 20, 2005 at the Sheraton Atlantic City
Convention Center Hotel in Atlantic City, NJ. The meeting is open
to all members.
Trustees duties include attending approximately five meetings
each year (with additional preparation time of approximately 2-4
hours prior to each meeting) and possibly serving on other committees at the discretion of the President. More specific duties and
responsibilities for each position are available through the NJAFP
office or on the web at www.njafp.org in the Members Section.
Nomination materials may be sent by regular mail,
fax or email:
Nominating Committee
C/O Ray Saputelli, CAE
NJAFP, 112 West State Street, Trenton, NJ 08608
Fax: 609-394-7712
Email to: ray@njafp.org
Deadline for Nominations is April 15, 2005

Perspectives 1Q05
17
Educational Offerings at the 2005 Scientific Assembly

Visit www. njafp.org and click on the links for the Scientific Assembly to see the most up-to-date agenda and faculty listing.
Register online at www.njafp.org. Follow the links for the 2005 Summer Celebration and Scientific Assembly.
6:00 AM
THURSDAY
FRIDAY
SATURDAY
6:30 AM
7:00 AM
6:15 am-7:30
AIM for Fitness
(Breakfast CME)
Delegate
Registration and
Breakfast
7:30 AM
SUNDAY
Breakfast & Exhibits
8:00 AM
8:30 AM
9:00 AM
9:30 AM
House of Delegates
8:00am - 3:00pm
Sheraton
10:00 AM
8:00 - 8:55
Metabolic Syndrome
TBD
8:00 - 8:55
TBD
9:00 - 9:55
Insln Resist &
B Cell Dys
M. Sandburg
9:00 - 9:55
HPV
Bhattacharyya
Break 10:00 - 10:15
10:30 AM
11:30 AM
12:30 PM
Delegates Lunch
Lunch and Exhibits
1:30 PM
2:00 PM
SA Registration ACCC
2:30 PM
3:00 PM
3:30 PM
4:00 PM
Executive
Committee
Meeting
4pm - 6pm
6:00 PM
6:30 PM
1:15 - 2:15
From
What to What
Green
2:15 - 3:10
2:15 - 3:10
Osteoporosis
Update Allergy
Updates
and Asthma
J. Levine
TBD
Break 3:00 -3:15
3:30 - 4:25
Migraines
TBD
3:30-4:25
Updates in
Dermatology
E. Schlam
3:30 - 4:25
Update Hepatitis
A. De La Torre
3:30 - 4:25
Fibromylaigia
R. Podell
4:30 - 5:25
Restless Leg
Syndrome
E. Schalm
4:30 - 5:25
Adult ADHD
D. Baron
4:30 - 5:25
Vaccine Update
S. Barone
4:30 - 5:25
Mens Health
TBD
5:30 - 6:25
Lipid Therapy
to Reduce Risk
P. Altus
5:30- 6:25
Improving
Diabetic Care
C. Heaton
4:30 PM
President's Reception 6:15pm - 7:00pm
7:00 PM
7:30 PM
8:30 PM
Town Hall
Meeting
7pm - 9pm
Exhibitor's
Reception
6:30pm - 8:00pm
President's Gala
7:00pm - 11:00pm
9:00 PM
9:30 PM
10:00 PM
10:30 PM
11:00 PM
18
Perspectives 1Q05
Cox 2s
Myth vs. Reality
TBD
Assmbly Concludes
1:00 PM
8:00 PM
9:30 - 10:25
Am I Hungry
May
10:45 - 11:40
Child Obesity
May
12:00 PM
5:30 PM
8:30 - 9:25
Psycopharma
drugs
TBD
Break
10:30 - 12:00
Tales from the
Dark Side
DeNoble
11:00 AM
5:00 PM
Breakfast
Resident
Knowledge Bowl
8:00pm - 11:00pm
Better Bones
Workshop
Learning to Communicate
By Vicky Tola, MD
Vicky B. Tola, MD is a Resident Trustee of

the Board of Directors for the NJAFP and a
PGY 2 at Hunterdon Medical Center in
Flemington.
he annual NJAFP Leadership conference in November 2004 was a complete success. Terry Shlimbaum, MD
spoke about leadership and why we were
there. Tom Ortiz, MD exemplified for us
how a Can Do attitude and dedication
and belief for a cause will take you to great
heights and inspire others to follow your
footsteps. He related to us his vision of
helping the underserved populations by
nurturing an idea that developed into the
bill on Health Enterprise Zones. Claudine
Leone enthralled us with the adventures
and perils they faced as that bill journeyed
through the legislature. Mary O'Halloran,
former Iowa state legislator, political activist
and media consultant, spoke of effectively
communicating your message. She interviewed some of us unsuspecting volunteers
on live TV and gave us constructive criticism
and feedback. In essence, this conference
reviewed leadership and identified language
as its main tool.
Ms. OHalloran quoted James C.

Humes, the noted speech writer: The language of leadership is the language of the
heart. She said that In order to communicate this language you must arm yourself
with knowledge and understanding. When
you speak to an audience, 70% of what
they remember will be your appearance,
20% will be how you delivered your message
and 10% will be the message. Therefore,
we must enhance our communication skills

by being confident. If you are confident, you
are there in the moment, you are present. To
be present, you must be fearless. To be
fearless, you must be prepared. Mary
went on to explain how we must frame
our topic, choose our main message
and be ready with sound bytes.
As part of an exercise were handed
some current medical issues that would be
discussed by a group of panelists. Little did I
know what was in
store for me when I
volunteered to participate in the on
the air interviews
with Mary. There I
was, the only resident on a physician
panel made up of
seasoned family
physicians who have
probably been interviewed before. The
topics of discussion
were worthy of
hours of debate and
preparation but what did we interviewees
get? Fifteen minutes! Certainly not enough
time for what our facilitator espoused as
the most important aspect of conveying a
message: preparation. It was an anxiety-provoking and nerve-wrecking experience. But
it was also heartening, edifying and a whole
lot of fun!
Mary gave us all insight into little
things we could change or improve in our
physical presence to enhance the chances
of our message getting across to the masses,
such as do not cross your legs; smile

more, fidget less; do not fold your arms
across your chest, instead rest them on
your lap; and look at the interviewer when
answering questions. When critiquing our
4C's of competent, compassionate, comprehensive and cost-effective quality care,
Ms. OHalloran pointed out that competence and compassion were a given and
assumed by the patient. To call attention to
these qualities would query their existence.
Here are a few more sound bytes
from our conference as food for thought:
People don't care how much you know
until they know how much you care.
You must know the audience. Who are
these people who are going to listen to
you? What do they care about? What do
you care about? Confidence is the
physical manifestation of the ease and
grace in your heart and mind. The enemy
of confidence is fear and anxiety.
Preparation liberates you from fear!
The panel discussion made us examine
the question: what's so special about family
medicine? Distilled answer: by virtue of the
fact that we take care of a myriad of
diseases we must possess and hone our
clinical skills in order to recognize and treat

the gamut of medical illness amidst a
broader biopsychosocial picture.
By the end of the conference, we left
a little wiser and reinvigorated with the
energy to better the world, ameliorate
suffering, and heal the system starting
with our own communities. To communicate
our value and affect any kind of change to
our current system we will need the gifts of
leadership and language and this conference
was a fine start.
Perspectives 1Q05
19
ABFM Moves to
Online Registration
The American Board of Family Medicine is offering online registration for its 2005 certification, recertification and
sports medicine exams. The online application process has streamlined registering for the examination. In many instances, the physician can complete the entire process in minutes at a single sitting.
The online application process began December 1, 2004 and
test center selection came online 2 weeks later. The online registration and test center selection applications can be accessed at
www.theabfm.org. With the move to computer-based testing last
year, the ABFM is now able to offer nine exam dates, including
Saturdays, at over 200 test centers throughout the United States,
Puerto Rico and U.S. territories.
Diplomates are encouraged to visit the website to complete
their applications as early as possible to increase the probability of
selecting the test center of their choice. All eligible candidates for
the 2005 exam can login to their Physician Portfolio and follow
the Online Application link to access the application. Once an
approved application has been completed, the Diplomate will then
be able to choose a test center. The link to Test Center Selection is
also found in the Physician Portfolio.
For more information, please contact the ABFM Help Desk at
(877) 223-7437.
The Board of Trustees, members, and staff of

the New Jersey Academy of Family Physicians
are pleased to announce the Candidacy of
Robert M. (Butch) Pallay, MD, FAAFP for
position of Director of the American Academy
of Family Physicians. Learn more about Butch,
ask questions, or make suggestions
at www.DrButch.com.
Butch Pallay
Straight Talk, Solid Leadership
20
Perspectives 1Q05
Learn How to
Defend Yourselves
in a Lawsuit
CME seminars Sponsored by NJ PURE
Subpoenas, interrogatories, depositionsthese are terms
physicians never expected to study. After all, physicians are
healers--not lawyers. But with the sharp increase in medical
malpractice lawsuits, doctors find they must study the finer
points of legal defense or risk losing their practices.
In order to help physicians
understand what they may
face in a malpractice
suite, NJ PURE, a notfor-profit medical
malpractice reciprocal exchange, is
sponsoring
Preventing and
Defending Claims
and Lawsuits, The
seminar is part of NJ
PUREs ongoing Loss
Control Risk Management
Series, Knowledge is Power,
designed to empower and educate physicians in the areas of
malpractice claims and lawsuit prevention/process management.
The presentation stresses those actions a physician can
take to prevent being sued in the first place: practicing empathy, communicating effectively, disclosing complications, and
documenting all aspects of patient care. It then reviews what to
do if you are faced with a lawsuit, and covers pre-litigation,
affidavit of merit, interrogatories, and depositions.
NJ PURE is a reciprocal exchange focused on providing
at-cost solutions to the current crisis in medical malpractice
insurance in New Jersey. Costs are minimized through the
process of writing directly to responsible physicians eliminating the high costs associated with commissions for agents.
NJ PURE also lowers their risk by capping the number of doctors who practice in certain high-risk specialties. Other costsaving strategies include handling all claims administration
in-house, adopting a portfolio of liability limits of $1 million/$3 million, and eliminating the added costs of agents
and brokers.
NJ PUREs 2005 Knowledge is Power seminars will
take place on Thursday, May 12 at the Eatontown Sheraton;
Thursday, September 8 at the Clarion Hotel in Egg Harbor
Township; and Wednesday, November 2 at the Holiday Inn in
Monroe Township.
For further information about the seminars or about NJ
PURE, call 877-2NJ PURE (877-265-7873), or visit the companys website at www.njpure.com.
NEW JERSEY
VIEW
NJAFP
Members
in the
News
The State of the
Union.
When medical liability reform was spotlighted in
the State of the Union address
in January, Family Medicine
stepped into the front line. On
February 2nd Arnold Pallay, MD, of
Montville, NJ (Past President of the NJAFP) was featured
on the Paula Zahn Now program immediately before the live broadcast of the Presidents address.
President Bush has made tort reform including medical liability reform one of his second-term priorities. Expecting a reference
to the issue in the state of the union address, CNN dispatched Jeff
Toobin, senior law correspondent, to Pallays office for a six-hour
interview. The result: a five-minute segment on CNN in which Pallay
explained the effects of skyrocketing malpractice insurance premiums on medical practice. In his case, the impact was loss of obstetrical services for his patients when Pallays premium ballooned from
$7,000 a year to $60,000.
If this continues at this present trend, Im very afraid family
physicians will stop delivering babies, said Pallay. And good
OB/GYNs will stop. So whos delivering our babies?
Other Members in the News

Caryl Heaton, DO
UPN local news in Secaucus (Channel 11) on how to prevent,
recognize, and treat flu and similar illnesses. (January 2005)
Richard Paris, MD
Herald News Article on the struggle primary care physicians
face in a managed care environment (Health of doctors
incomes: November 9, 2004).
Arnold Pallay, MD
Daily Record on the Presidential Debates (Morris reacts to presidential debate: October 9, 2004)
Robert Spierer, MD
Star Ledger in an article on the prevalence of flu-like viruses in
the area. (Variety of viruses putting many in flu-like misery:
January 07, 2005)
22
Perspectives 1Q05
The Honorable Wilfredo

Caraballo is awarded the
2004 Edward A. Schauer, MD
Public Policy Award
The NJAFP awarded New Jersey Asssemblyman Wilfredo
Caraballo the Edward A. Schauer, MD Public Policy Award. The
Public Policy Award seeks to recognize those individuals who promote constructive engagement between family medicine advocates
and governmental leaders for the purpose of delivering high quality
healthcare services. Assemblyman Caraballo was recognized for his
support of the Health Enterprise Zone legislation (See Government
Affairs View, p. 24).
Assemblyman Caraballo with NJAFP Leadership (l to r), Board Chair, Terry Shlimbaum, MD;
President Caryl Heaton, DO; Assemblyman Caraballo; Board Trustee, Tom Ortiz, MD
Wilfredo is the Assemblyman for New Jerseys 29th District that

includes the Township of Hillside and Newark City (partial). He was
first elected to the Assembly in 1995 and has been re-elected five
times. He is Parliamentarian, also Chairman of the
Telecommunications and Utilities Committee and Vice-Chair of the
Transportation Committee. His legislative office is located in Newark.
Edward A. Schauer, MD Public Policy Award

In 2003 the NJAFP instituted the Edward A. Schauer Public
Policy Award. This award is to be presented each year to an
individual who has made significant efforts to use public policy
to advance opportunities for access to comprehensive health
care and promote high quality standards for family physicians
who are providing continuing health care to the public. Any
appointed or elected public official or leader in the healthcare
community is eligible to receive the award. If you would like
details on the Award or would like to nominate a candidate to
receive the Award, contact Claudine Leone, Government
Affairs Director at 609-394-1711 or Claudine@njafp.org.
Helping People Find and Form Support Groups

There are over 4,000 support groups that meet in New Jersey
for just about any type of stressful situation that affects the well
being of an individual. Persons seeking support groups often express
their desire to meet others who share similar experiences, pool
together practical information, exchange coping strategies, and be
part of a community that understands. C. Everett Koop, MD, former
U.S. Surgeon General once said, My years as a medical practitioner,
as well as my own first-hand experience, have taught me how
important self-help groups are in assisting their members in dealing
with problems, stress, hardship and painToday, the benefits of mutual aid are experienced by millions of people who turn to others with
a similar problem to attempt to deal with their isolation, powerlessness, alienation, and the awful feeling that nobody understands.
The New Jersey Self-Help Group Clearinghouse operates a
statewide toll-free help-line providing contact information to selfhelp groups, toll-free specialty help-lines, community help-lines, and
local psychiatric emergency lines. The support groups cover a broad
spectrum of stressful life situations and adversities such as addictions,
bereavement, disabilities, mental health, families of the mentally ill,
parenting, illness, care giving, and much more. Many callers to the
Clearinghouse are surprised to learn that support groups have been
developed for very specific concerns. For example, within the listing
of support available for parents there are groups for: single parents,
foster parents, parents of disabled children, parents of toddlers, parents
of adolescents, parents of children with emotional difficulties, parents
of children with illness, and stay at home parents, among others.
The Clearinghouse also provides free consultation and training
services to persons developing no-fee support groups. Consultants
provide free assistance with the how to of starting a group:
finding a meeting space, reaching prospective members, creating a
flyer, writing a press release, establishing group discussion guidelines,
structuring a meeting, and more. Consultants can also provide a
wide range of printed materials related to self-help groups such as:
how to deal with difficult people, how to be a contact person for
a group, developing listening skills, and facilitation skills. In conjunction
with the consultation services the Clearinghouse provides free
training workshops on the development and facilitation of selfhelp groups.
For information on finding or forming a support group, call the
New Jersey Self-Help Group Clearinghouse at 1-800-367-6274 or
973-326-6789. Trained volunteers and staff are available to handle
requests Monday thru Friday, 8:30am-5pm.
Congratulations to
Degree of Fellow Conferred
David Swee, MD, who has been named Acting Senior Associate
Dean for Education at UMDNJ-Robert Wood Johnson Medical
School. In this new position Dr. Swee will have responsibility for
Student Affairs.
Those candidates receiving the Degree of Fellow have

been members of the AAFP for a minimum of six years, have
completed extensive continuing medical education, participated in public service programs outside their medical practice,
conducted original research and have served as teachers of
family medicine.
The following NJAFP members have been awarded the
Degree of Fellow of the American Academy of Family Physicians.
David Swee, MD on his appointment to the Accreditation

Review Council of the ACCME.
Alfred Tallia, MD, MPH, who has been named Acting Chair of
the Department of Family Medicine, UMDNJ-Robert Wood
Johnson Medical School.
Richard Corson, MD on the re-opening of his private practice
in Hillsborough, NJ
Adity Bhattacharyya, MD; Hoboken, NJ

Dennis A. Cardone, DO; New Brunswick, NJ
Josette C. Palmer, MD; Glassboro, NJ
Elisabeth F. Spector, MD; Somerville, NJ
Anna E. Sweany, MD; Neptune, NJ
Rx4NJ:
Prescription-Drug Assistance Program for Your Patients
Rx4NJ is a new prescription-drug assistance program that links low-income or medically uninsured individuals with sources of more
than 1,800 medications at vastly reduced prices.
Pharmaceutical manufacturers have sponsored low-cost drug programs for economically disadvantaged Americans, and charitable
organizations have done the same. But these organizations have operated independently of one another. With Rx4NJ, these resources are
placed in one accessible site, providing patients with a single source to most of the prescription drugs they need.
Rx4NJ is supported by the NJAFP and many other non-profit organizations. The website, www.rx4nj.org, is a portal providing
access to more than 300 patient-assistance programs and their free or low-cost medicines. Rx4NJ can also be reached by telephone at
1-888-RXFORNJ. The site is user-friendly and trained specialists are available to help applicants.
For more information on Rx4NJ visit www.rx4nj.org.
Perspectives 1Q05
23
GOVERNMENT
AFFAIRS VIEW
A How To on Realizing the Benefits of

the Health Enterprise Zone Law
By Claudine M. Leone, Esq.
Claudine Leone, Esq is the Director of

Governmental Affairs for the New
Jersey Academy of Family Physicians.
n 2004 the Health Enterprise

Zone bill was signed into law.
This law was an NJAFP supported initiative providing incentives for primary
care medical and dental practices to
remain located or to locate in Health
Enterprise Zones (HEZs). NJAFP supported this initiative with the leadership of its sponsors; Assembly Speaker Sires, Assemblyman
Caraballo, and Senators Rice and Buono, and is pleased to provide
NJAFP members with guidance on how to benefit from this measure in their own community.
BRIEF DESCRIPTION OF THE LAW

Health Enterprise Zones are state-designated medically underserved areas identified by the New Jersey Department of Health
and Senior Services through the states Primary Care Loan
Redemption Program. While we will refer to practices located in
HEZs, the law also allows practices located within 5 miles of an
HEZ to access the same benefits under the law with some restrictions. There are three main sections of this law:
1. Gross Income Tax Deduction - A primary care medical and
dental practice located in an HEZ will be allowed to deduct from
the taxpayers gross income in a taxable year an amount equal to
amounts received for services from the Medicaid program, including amounts received from managed care organizations under contract with the Medicaid program, the Family Care Coverage
Program and the Childrens Health Care Coverage Program, for
providing health care services to eligible program recipients. This
tax deduction begins for the taxable year 2005. Talk to your
accountants!
2. Low Interest Loans - A primary care medical or dental practice
located in an HEZ will have access to a state administered low
interest loan program for the purposes of constructing and renovating medical offices in HEZs, and purchasing medical equipment
for use by primary care providers at practices located in HEZs. The
New Jersey Economic Development Authority will be administering
this program and information will be made available to members
as soon as the NJEDA is ready to receive applications under the
program. The NJEDA website is www.njeda.com and their phone
number is (609) 292-1800.
3. Property Tax Exemption - The final part of this law requires
proactive measures by NJAFP members to pursue a municipal
24
Perspectives 1Q05
ordinance providing for the property tax exemption authorized by

this state law. The law only authorizes municipalities identified as
medically underserved (or HEZs) to pass an ordinance allowing for
a property exemption for the portion of a structure or building that
is used to house a primary care medical or dental practice. The
exemption can only be achieved if an ordinance in your municipality
is introduced and approved. Once the ordinance is approved, the
law provides that the landlord of these properties submit an annual
application to the tax assessor for this exemption. The amount of
the exemption must be rebated to the primary care medical or
dental practice tenant and proof of that rebate must be provided
to the municipality annually for the property to continue receiving
the exemption. The burden is on individual family practices to
educate their landlords of this ordinance. There is no direct benefit
to the landlord (except where you are your own landlord) from this
exemption since it is passed along to the tenant. Keep in mind
when speaking to your landlord or local representative, that while
there is no direct benefit to the landlord, this incentive can be used
by them to encourage primary care medical practices to lease
space in their building and therefore increase access to primary
care physicians in the town.
WHERE ARE THESE HEALTH ENTERPRISE ZONES?

The municipalities listed below are on the state designated
medically underserved areas list and qualify as HEZs under the law.
Municipalities with Populations of 30,000 or more

Newark City
Trenton City
Passaic City
Union City City
West New York Town
Atlantic City City
Paterson City
Irvington Township
Lakewood Township
Camden City
Jersey City City
New Brunswick City
Plainfield City
East Orange City
Perth Amboy City
Elizabeth City
Vineland City
Municipalities with Populations of 5,000 to 29,999

Bridgeton City
Fairfield Township
(Cumberland)
Asbury Park City
Paulsboro Borough
Salem City
Buena Vista Township
Pleasantville City
Lower Township
City of Orange Township
Phillipsburg Town
Egg Harbor City City
Keansburg Borough
Woodbury City
Mullica Township
Middle Township
Gloucester City
Maurice River Township
Millville City
Glassboro Borough
Hammonton Town
Fairview Borough
Mount Holly
Long Branch City
Burlington City
Clementon Borough
Clayton Borough
Harrison Town
Egg Harbor Township
Garfield City
North Hanover Township
Upper Deerfield
Ocean Township
(Ocean County)
Lodi Borough
Riverside Township
Pine Hill Borough
Union Beach Borough
Franklin Borough
Geographic areas that are not designated on the Index can be

considered by the Department of Health and Senior Services on a
case-by-case basis to support the designation.
HOW TO GET A MUNICIPAL ORDINANCE INTRODUCED?

our municipality will draft an ordinance according to the
requirements of the HEZ law signed by the Governor [See
Sidebar Draft ordinance for the Health Enterprise Zone
Property Tax Exemption as a guide to what this ordinance might
look like.] We recommend presenting this ordinance proposal as
one that would benefit the community as a medically underserved
area for primary care practices. Many local officials are not aware
that their communities are on this state designated underserved
list. As a result, you may be surprised how simple a process this
really can be when a community has the opportunity to better
provide for its constituencies.
There are a variety of ways to have an ordinance introduced in
your municipality, however here is a basic How To.
1. Call you local municipal representative (council members,

mayor etc.) directly and request a meeting to discuss the
introduction of an ordinance to encourage primary care medical
practices to be established in the municipality. They may not be
familiar with the HEZ law and you may be the first to educate
them on the law. If all goes well, the local official will request
the ordinance be drafted and put on the agenda for a future
meeting and vote. If you are successful, you must stay connected to the council member or staff to know when a hearing will
be held on the ordinance so that you can provide information
to the entire council on the subject.
2. Also, you may want to call your state representative (state senator
or state assemblyperson) to help educate the municipal officials in
their district about their designation as a state designated medically
underserved area for primary care medical and dental services.

Important to note is that this measure was strongly supported by
the Legislature with 114 out of 120 votes in favor of the bill and
not a single no vote cast so your state representative will likely
be supportive of your advocacy on this issue.
3. As always there is power in numbers. Join forces with other

primary care practices in your community as advocates for the
approval of these ordinances. Be prepared and know the
approximate number of family physicians in your municipality
(NJAFP can help with this information). Give references to family
physicians or other primary care physicians who are no longer
accepting new Medicaid patients . . .etc. This type of information may be new to a local official and help them advance this
type of ordinance. Remember, this law is about patient access
to primary care services and is intended to keep existing family
practices in your community and encourage new ones.
We hope you will take advantage of the HEZ law and encourage
your colleagues to do the same. We believe this HEZ law will provide
some necessary financial relief to those family physicians who wish to
continue practicing in these communities and hopefully encourage
the establishment of new practices, as well.
If you have any questions or need additional information or
assistance, please contact me at (609) 394-1711 or Claudine@njafp.org
For an example of an HEZ Ordinance visit www.njafp.org, click
on Members Only and scroll down to HEZ Model Ordinance
under Member Resources or call the NJAFP office at 609-394-1711,
or email us at office@njafp.org.
RESIDENT &
STUDENT VIEW
Students Succeed with HOP
By Molly Cohen
and accompanies the patient to the visit.

The HOP clinic is managed by the HOP steering committee. The
HOP steering committee, comprised of one student director and six student organizers, gain exposure and insight into the healthcare system
through the management of a primary care facility. They are responsible
The Healthcare Outreach Project (HOP) Clinic is a primary care
for scheduling patients, recruiting and assigning student doctors, and
center run by the third-year medical students of Robert Wood
recruiting and scheduling faculty preceptors for each clinic session They
Johnson Medical School in Camden. Started in October 2000 by
compile and actively maintain all patient charts, as well as collect patient
three RWJ students, it provides free health care and medications to
information, specific diagnoses and specialist referrals for statistical purthe uninsured of Camden. In 2003, HOP expanded to include a pediposes. The committee guides student doctors through the protocol for
atric clinic. Since the project began hundreds of uninsured Camden
patient referrals including specialist visits, diagnostic tests, and billing
residents have benefited from free, accessible health care.
processes. They act as liaisons between the
The goals of the HOP are to provide
clinic, the dean, the faculty advisors and the
access to quality health care for uninhospital administration. Committee memsured patients in the City of Camden,
bers run a pharmacy within the HOP clinic.
promote the value of continuity of care
They compile a drug formulary, order all
among RWJMS- Camden students,
medications, dispense medications during
reduce health care disparity in the city of
clinic hours, help student doctors make
Camden, and promote community health
informed decisions on drug therapy for
advocacy skills in the student body
each patient, and instruct students on how
through exposure to the healthcare systheir patients can apply for the indigent
tem and its disparities.
drug program. The steering committee also
The adult HOP Clinic is open
Student Doctors plan for patient care (L to r) Doris Fadoju,
oversees all financial aspects of the HOP
Wednesday evenings at the Health and
Anit Mankad, Chiagozie Adibe, Molly Cohen
clinic, including grant writing, balancing the
Human Services Center of the LEAP
budget, and implementing innovative ways to increase funding for HOP.
Academy Charter School and currently serves 110 Camden residents.
The HOP Clinic is currently funded by grants from the AAMC,
The pediatric HOP clinic is open two Thursdays a month in the same
Campbell Soup Company and the Deans Department of Robert Wood
location. There are approximately 45 student doctors - almost the
Johnson Medical School - Camden. The majority of the grant money is
entire third-year class of RWJMS-Camden. Patients are assigned their
used to purchase all medications and medical supplies for HOP patients.
own student doctor who acts as their sole primary care provider, fosThe students at RWJMS- Camden are proud of the work that they
tering in the student a sense of responsibility for continuous patient
are doing at their clinic, as are the faculty and the Dean. They have
care. Beside providing primary care, the student doctor accompanies
described it as an incredible educational experience - learning patient
their patient to specialist visits, diagnostic tests, procedures, surgeries,
management skills and the humanism behind the practice of medicine.
and financial assistance offices, participating in all aspects of their
patients care.
For more information contact HOP Student Director
HOP provides a comfortable environment for students practice
Marie-Laure Geffrard at geffram1@umdnj.edu or Urban Health
primary healthcare skills such as performing full histories and physiInitiative Coordinator Maya Yiadom at yiadomma@umdnj.edu.
cals, writing notes and HOP prescriptions, formulating plans, and
educating patients. Students practice technical skills such as vaccine
administration, pap smears, and glucose checks. Students also prepare and present lectures to their peers, discussing topics such as
Resident members of the NJAFP now have exclusive access to a listserve
general medicine, healthcare policy, biopsychosocial issues, and
designed for Residents in NJ Family Medicine Residency programs. This memhealthcare economics.
ber benefit is for NJAFP RESIDENT MEMBERS only - any postings to the listserve
Each week a faculty preceptor oversees the HOP clinic. Nineteen
ARE and WILL BE just between residents. The listserve is a valuable resource for
faculty members volunteered to precept during the 2003-2004 acaresident communication. Get involved by sharing your thoughts and ideas.
demic year. Students present their history, physical exam and plan There are currently 179 members subscribed to the listserve. If you are a
including medication suggestions - to the faculty preceptors.
NJ Resident and dont have access to the listserve, it means we do not have
HOP patients receive regular primary care and free medicayour email address on file. If you would like to join your colleagues in this elections as well as free consultation visits. The clinic has specialists
tronic forum, contact Ray Saputelli at ray@njafp.org and let him know you
would like join the residents listserve.
from many of the hospital departments who have volunteered to
If you have questions, contact Resident Board Trustees Chris Zipp, DO or
see HOP patients free of charge. From June 2002 to September
Vicky Tola, MD or EVP Ray Saputelli, CAE. All can be reached through the NJAFP
2003, HOP referred patients for 20 different specialty visits. The
office at 609-394-1711.
student doctor referrers the patient, schedules the appointment
Molly Cohen is a fourth-year medical student at UMDNJ-RWJ Medical
School in Camden and an NJAFP Student Trustee. She was the 20032004 Student Director of the HOP clinic.
Listserve Now Available for Residents
26
Perspectives 1Q05
FROM MY
VIEW
An Experience Not To Be Traded

Diana Carvajal is a fourth-year medical
student at RWJMS-Camden.
Id always heard fourth year of

medical school is the best, so I was looking
forward to my final year as a time to relax,
enjoy, and plan for the years to come. As
fourth year approached, I decided to
explore my interest in international medicine and global health. I wanted to achieve
my goal of traveling to different lands; I
wanted to learn more about how other
cultures practice medicine. Never in a million years would I have imagined the
incredibly amazing experience awaiting me
in my final year.
It wasnt until late in my third year
that I had the opportunity of a lifetime. A
physician from the OB/GYN department at
the hospital with which my medical school
is affiliated has been planning mission trips
to Ghana, West Africa for the past several
years. This year, he was offering a scholarship for one student to come along! The
trip was described as a medical mission
with the goal of improving womens health
and health care in an underserved area of
Ghana. This was the perfect opportunity
for me to study and explore many of the
interests Ive always had but never had the
time or resources to discover. I immediately
found out what had to be done. There
was a lengthy application process, requiring an essay and several interviews, but I
nearly fainted when I heard the news that I
was the lucky student selected to go on
the mission trip to Africa!
I geared up, went to all the preparatory meetings, got the necessary vaccines,
closed my eyes, held my breath, and the
next thing I knew, I had landed in Accra,
Ghana. It was the great continent of
Africa, one that I had seen and appreciated only in my dreams. We arrived in the
late evening on a Sunday night, gathered
our heaps of luggage, and prepared for
the subsequent three hour road trip which
was to lead us to our final destination:
Cape Coast, Ghana. Cape Coast is a town
located on the southwestern coast of
Ghana; it is the town from which the
28
Perspectives 1Q05
groups leader hails. The

road trip was long,
incredibly bumpy
(an understatement!), and dark.
Yet, I was amazed,
grateful, and incredulous at the idea that I
was actually in Africa. From the
old, dilapidated van, even
though night had fallen several
hours before, I could see the vast,
intriguing land before us under the
African moonlight.
I spent the next two weeks, with
several doctors, nurses, and anesthetists
working at one of two hospitals in town; it
is the newest and was built by the United
Nations several years ago. Although the
hospital is considerably more contemporary
and technologically advanced in comparison with others, the structure and arrangement of the buildings are unlike those in
the U.S. It is a very simple and standard
building in appearance. The in-patient
units of the hospital consist of separate
buildings outside of the main hospital,
termed wards. Several patients (between
six and twelve) are housed in each section
of the ward. The operating room is also a
separate building situated close to the
wards and is referred to as the theater.
The beds and medical equipment are also
quite basic; I saw nothing new, shiny, or
state of the art, as is custom in many
U.S. hospitals. Although it is the newest
and more modern of the hospitals in Cape
Coast, there seems to be an impression of
an archaic and perhaps dilapidated place.
Each day, I experienced something different. I scrubbed in on surgeries, saw
patients in the Gynecology clinic, witnessed ultrasounds, and even had the
chance to attend a midwifery conference. I
worked with very dedicated nurses and
primary care doctors including Family
Medicine physicians, OB/GYNs, internists,
and also general surgeons. We saw many
patients, several with incredible pathology
conditions that we Americans only read
about in books. Most of the patients were
By Diana Carvajal
of quite meager means and came with

long ignored ailments simply
because resources were unavailable not only to the patients
themselves, but also to those
treating them. I learned and
saw a great deal of physical
illness, but I also witnessed
much emotional ailment as
consequence of the diseases
with which many were
plagued. Although I experienced extraordinary learning, I
found it extremely difficult to care
for some patients as their illnesses
were often times advanced beyond medical help. I experienced personal moments
of distress, sadness, and even helplessness
at the reality of many situations. Still, there
were instances of triumph and joy when
we were truly able to help someone, and I
drew the greatest pleasure from the warm,
friendly faces and grateful attitudes of our
Ghanaian patients.
My trip was amazing; it was all I had
envisioned and more. I learned so much
from every single person I met including
doctors, patients, and others I happened
to meet and befriend. They welcomed us
to their homeland with open arms and
incessant gratitude. However, my learning
experience would not have been complete
without equal exposure to the harsh realities and unfortunate economic disparities
of this third world nation. I witnessed
death, misfortune, devastation, hunger,
and extreme need during the few days I
spent in Cape Coast. Many events and situations were especially heart-wrenching
because they were circumstances I had
never before encountered during my brief
years of medical training in the United
States. I learned theirs was a very different
way of life from ours; there is a distinct
and unique practice of medicine based on
social and cultural environment, economic
resources, and technological capacities. I
was happily amazed and sadly stunned; I
was emotionally enthralled and yet psychologically fatigued. And, it was an experience I would not trade for the world.
FOUNDATION
VIEW
The Foundation is supported through the generous
contributions of the following members. It is through
their gifts that the Foundation is able to support its
many programs and services.
The New Jersey Academy of

Family Physicians Foundation
would like to extend its sincere
appreciation to its 2005 Corporate
Advisory Council Members
Aventis Pasteur
Eli Lilly & Co.
GlaxoSmithKline
Pfizer Pharmaceuticals
Schering-Plough Corporation
Wyeth
Platinum Level Donors
Gold Level Donors
Michael Doyle, MD
Theresa Triebenbacher
Theresa Barrett
Ken Faistl, MD
Amedeo Scolamiero, MD
David Swee, MD
Silver Level Donors
Donors
Ben Glaspey, MD
John Pastore, MD
Mary F. Campagnolo, MD
Frank Kane, MD
Darryl Kurland, MD
Robert Maro, MD
Carl Meier, MD
Alfred Tallia, MD
Mary Willard, MD
Severino Ambrosio, MD
Jennifer Glassman, MD
Richard Paris, MD
Julio Araoz, MD
Ana Gomes, MD
Anthony Picaro, MD
Thomas Armbruster, MD
Ahmad Haddad, MD
John Pilla, MD
Maria Auletta, MD
Mary Haflan, MD
Mary Previty, DO
Christopher Ballas, MD
Caryl Heaton, DO
Jamie Reedy, MD
Nahum Balotin, MD
Mary Ellen Hoffman, MD
Carl Restivo, MD
Kevin Anthony Barry
Carla Jardim, MD
Marlene Rodriguez, MD
Salvatore Bernardo, MD
Sergiusz Kaftal, MD
Alfred Santangelo, MD
Peter Boyer
Ohan Karatoprak, MD
R. Santiago, MD
Jeffrey Brenner, MD
Irving Kaufman, MD
Joseph Schauer, MD
Theresa Bridge-Jackson, MD
Alan Kelsey, MD
John Scott, MD
John Brown, MD
Yoonjoo Kim, MD
Melissa Selke, MD
John Bucek, MD
Elise Korman, MD
Carol Sgambelluri, MD
Max Burger, MD
Douglas Krohn, MD
Catherine Sharkness, MD
Elise Butkiewicz, MD
Frank Lasala, MD
Terry Shlimbaum, MD
Doina Cherciu, MD
Richard Levandowski, MD
Valentino Sica, MD
Mugurel Cherciu, MD
Paul Madonia, MD
Andrew Sokel, MD
Deborah Clarke, MD
Raymond Marotta, MD
John Sonzogni, MD
William Cribbs, DO
Paul Marquette, MD
Seymour Taffet, MD
Liana Dao, MD
Anthony Miccio, MD
Joseph Termini, MD
George Dendrinos, MD
John Mifsud-Navaro, MD
Kathleen Thompson, MD
John Domanski, MD
Giulio Mondini, MD
Peter Tierney, MD
Elaine Douglas, MD
Lisa Morton, MD
John Tinker, MD
Joseph Duffy, MD
Lisa Neumann, DO
Vicky Tola, MD
Leo Fabbro, MD
William Newrock, MD
Christopher Tolerico, MD
Kennedy Ganti, MD
David Niedorf, MD
June Vecino, MD
Mark Gassemi, MD
Dennis Novak, MD
Robin Winter, MD
Ron Gelzunas, MD
Robert Pallay, MD
Frances Wu, MD
Kevin Gillespie, MD
Vincent Palmisano, MD
Michael Yoong, MD
John Tabachnick, MD
Century Club
Albert Almeda, MD
Anna Chen, MD
Gerald Corn, MD
Ann Dimapilis, DO
Amparito Fiallo, MD
Betty Hammond, MD
Stephen Land, MD
George Leipsner, MD
Dennis Novak, MD
Ginia Pierre, MD
Frank Snope, MD
Robert Spierer, MD
Rebecca Steckel, MD
Samir Sulayman, MD
Marty Sweinhart, MD
CME Test Answers: 1.T; 2.T; 3.T; 4.F; 5.T; 6.T; 7.F; 8.T; 9.F; 10.T; 11.T; 12.T
Perspectives 1Q05
29
SPECIAL
PROJECTS VIEW
New Jerseys progress in Tobacco Control

American Lung Association State of Tobacco Control 2004
Data Snapshot - The State of Tobacco Control 2004 grades federal
and state tobacco control laws and regulations. The complete
snapshot summarizes data in each of the four categories of tobacco prevention and control: spending, smokefree air, cigarette excise
tax and youth access. The report lists New Jersey as one of the
states that increased Cigarette Excise Taxes in 2004. The excise tax
increased from $2.05 to $2.40.
The American Lung Association State of Tobacco Control 2004
report shows that most states failed to fund tobacco control and
prevention programs at the minimum level recommended by the
Centers for Disease Control and Prevention (CDC). Five states Arkansas, Delaware, Hawaii, Maine and Mississippi - received a
grade of A, representing a funding level of 90 percent or more of
the CDC minimum for each state. Rather than face worsening
budget shortfalls in the future, these states will see their healthrelated costs gradually drop as prevention and cessation programs
reduce the prevalence of smoking and tobacco-related disease.
Unfortunately, 36 states and the District of Columbia received a
grade of F in 2004, representing a funding level of less than 60 percent of the CDC minimum. Three states - the District of Columbia,
New Hampshire and South Carolina - provided no funding at all.
American Lung Association State of Tobacco Control 2004
Report Card gives New Jersey the following scores
Tobacco Prevention
& Control Spending
Smokefree Air
Cigarette Tax
Youth Access
The report shows few states made improvements to their

youth access laws. Oklahoma enacted a law prohibiting sales of
tobacco products by self-service display, and made changes to
other youth access laws governing random, unannounced inspections and graduated penalties to retailers. New Jersey passed a law
prohibiting the sale of single cigarettes or cigarettes in packs of
less than 20. Seven states received a grade of A for youth access
while 23 states received a grade of F based on criteria developed
by the National Cancer Institute. Every day, 6,000 children under
the age of 18 start smoking for the first time and close to 2,000 of
them become established daily smokers. Enactment and enforcement of policies to restrict the sale and distribution of tobacco
products to minors are effective components of a comprehensive
tobacco control program.
Another step in a comprehensive tobacco control program
and one that you can take immediate advantage of is Tar Wars.
30
Perspectives 1Q05
Dr. Jeff Kane with the winners of the 2004 Tar Wars Poster Contest
Tar Wars was founded in response to this growing, yet preventable,

health crisis. Targeting fourth and fifth grade students, this awardwinning, youth tobacco-free education program and poster contest
of the American Academy of Family Physicians adopts an effective
and innovative approach to teaching tobacco prevention. The
program focuses on the short-term, image-based consequences of
tobacco use and how to think critically about tobacco advertising.
A follow-up poster contest at the school, state, and national levels
is conducted to reinforce the Tar Wars message.
For more information on the American Lung Association
State of Tobacco Control 2004 visit www.lungusa.org.
For more information on Tar Wars visit www.tarwars.org
Become a Tar Wars Volunteer visit www.njafp.org, click on
the Tar Wars link and then Become a Tar Wars volunteer
There is a new national quitline number: 1-800-QUIT NOW. This tollfree number (1-800-784-8669) is a single access point to the
National Network of Tobacco Cessation Quitlines. The AAFP is very
supportive of both the national quitline number and the website
resources which can be found at http://www.smokefree.gov. In the
For Health Professionals section you will find a number of
resources to assist you with helping your patients to quit smoking.
Among them is the National Cancer Institute's Handheld Computer
Smoking Intervention Tool (HCSIT). This tool is designed for clinicians
to assist with smoking cessation counseling at the point-of-care.
This easy-to-use program can be used with both Palm and
Microsoft Pocket PC handheld computers.
Tars Wars in sponsored in part by a grant from:
Smiles abound at MedFest

Its Time to Register for MedFest4!
Are you ready to be a part of helping an athlete reach their dream of participating in Special Olympics?
If so, sign up for MedFest, scheduled to take place on April 15, 2005 from 9am-2pm at Special Olympic headquarters in Lawrenceville, NJ.
Plan to spend the day with some truly outstanding people and earn some smiles of your own.
For information on how you can become a volunteer contact Candida Taylor in the NJAFP office: 609-394-1711 or candida@njafp.org.
at
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nl .org
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Re ww
Perspectives 1Q05
31
SPECIAL
FEATURE
++
++
ADDING IT UP
Can the Future of Family Medicine recommendation to build a new model

of family practice improve the bottom line? By Jonathan Nelson
Jonathan Nelson is the editor for Texas Family Physician. This article was
originally published in Texas Family Physician, Oct./Nov./Dec. 2004, Vol. 55
No. 4. and is reprinted with permission.
Unless there are changes in the broader health

care system and within the specialty, the position
of family medicine in the United States will be
untenable in 10 to 20 years.
This statement appears in the report of AAFPs Task Force One, one of five
original task forces commissioned to participate in the Future of Family
Medicine (FFM) project, an ambitious effort to examine the state of the
specialty in the context of the current health care system and recommend
a new vision and direction for family medicine.
The authors of the report came to this conclusion after reviewing
the results of an exhaustive research campaign that constituted the first
phase of the FFM project. The research showed that family medicine is
facing some major challenges: a lack of understanding of the specialty
among the general public, a lack of respect in academic circles, low reimbursement and other challenges in the managed care environment that
make running a profitable practice difficult, to name a few.
To bring about the changes the authors deemed necessary, they proposed the development of a new model of family medicine, an idea that
became the centerpiece of the FFM final report and recommendations,
published in a supplement to Annals of Family Medicine last April. As Task
Force One described it, the new model would be a medical practice for
people of all ages and both genders that emphasizes patient-centered,
evidence-based, whole-person care provided through a multidisciplinary
team approach in settings that reduce barriers to access and use advanced
information systems and other new technologies. The new model would
provide better, more consistent care for patients and it would have to
make the practice of family medicine more rewarding for physicians.
The new model requires redesigned offices, retooled scheduling
strategies and new avenues of patient/doctor communication, not to
mention the implementation of electronic health record systems. With
practice margins stretched to the breaking point, the question many family physicians have is how are we going to pay for all of this? Thats also
the question AAFP has been working to answer since before the FFM
report was published. A sixth task force was commissioned early this year
to work with health care consulting firm, The Lewin Group to construct a
financial model that would sustain the new model. The chair of the new
task force was Steve Spann, M.D., chair of the Department of Family and
Community Medicine at Baylor College of Medicine and one of the report
authors of Task Force One. The much-awaited Task Force Six report should
be published in the November/December issue of Annals of Family
Medicine, but the prognosis looks good.
Spann says if you take a practice today with the current reimburse-
32
Perspectives 1Q05
ment system and you implement all of the elements of the new model,
the task force estimates you should see an increase in physician compensation by about 26 percent. Part of the increase comes from adopting
open access scheduling. One of the issues that we talk a lot about in the
new model is elimination of barriers to access, Spann says. If a patient
can call today for what he or she wants today, the models show the
intensity of the visit codes should rise and the number of no-shows should
decrease. Physician Web portals will allow patients to view the days availability and schedule their appointments online. Patients should also be
able to download education materials and find links to trustworthy medical information on the Web portal.
Adding asynchronous communication, like secure e-mail, can
increase office efficiency as well. The physician could review symptoms for
a cold, bladder infection or other simple problems that could be solved
without examination through an e-consultation and still get paid.
Facilitating prescription refill requests online could boost efficiency, too,
especially if the physician is using an electronic health record.
According to the FFM report, the new model depends on EHRs. We
really see the EMR as the central nervous system of the new model practice, Spann says, using the term electronic medical record instead of electronic health record. We believe that the EMR ultimately can make docs
more efficient, can for example cut down on medical records staff, medical records cost, paper cost, eliminate transcription cost, can improve Eand-M coding so theres evidence out there that using an EMR actually
can improve the bottom line.
Along with shoring up the financial viability of family practice, these
changes help fulfill one of the central tenants of the new model putting the patient at the focal point of the provision of care. Of course most
family doctors would probably argue that theyre already providing
patient-centered care. According to James Martin, M.D., of San Antonio,
chair of the AAFP Board of Directors, the new model requires a paradigm
shift. Right now, everything doctor/patient contact is totally based on
the physicians schedule, the physicians preferences, says Martin, who
has spearheaded the FFM project and the initial implementation efforts
during his term as AAFP President and in his position as board chair. Open
access scheduling, e-mail communications, phone consultations, group
visits and expanded clinic hours should allow patients to have more say in
when and how they receive care.
Patient-centered care in the new model definition also means that
care will be culturally and linguistically appropriate. The key is that the
family physician or whoever is doing the new model has to be very aware
of the patients preferences and value system, Martin says, adding that
physicians have to help patients become active participants in their care.
Lets say for example, someone comes in with high cholesterol. In the
past, most doctors routinely just say, Here, start taking statin and Ill see
you back in X period of time. In the new model, doctors will access
reports and graphs online to show patients the anticipated results of different alternatives. Heres the percentage of success if you exercise and
diet. Heres the percentage if you take niacin. Heres the percentage if you
take Lipitor, so that the patient has more information to help be a partner
in making those decisions, Martin says.
The 26-percent increase in physician reimbursement that Task Force
Six estimates for new model implementation assumes there is no change
in the way physicians are currently paid, but the task force has been working on another financial model that includes some new twists for the U.S.
health care system. Martin says along with traditional fee-for-service reimbursement plus payment for e-consultation and group visits, the Academy
is pursuing a blended payment model including patient management
fees, chronic care management fees and pay for performance initiatives.
AAFP recently adopted a new policy position that could help bring
about a blended payment system. The policy has been published in a
going to be willing to reimburse us for practicing better quality, and so in

the long run, we think that will reap revenues, Spann says.
According to Martin, payers are interested in the possibilities proffered by the new model. He says hes had talks with insurance company
representatives who are so impressed with the new model that some may
give support to a number of clinics as part of a demonstration project.
And its not just insurance companies that are interested.
Were getting just tremendous response, Martin says, even in
Washington, D.C. There are members of the Senate who think the FFM
new model is where they should be going to correct health care disparities rather than [Federally Qualified Health Centers]. There are just some
very powerful people that are looking at this and coming back and saying,
go forward.
There are members of the Senate who think the FFM new model is where they should be going to
correct health care disparities rather than [Federally Qualified Health Centers]. There are just
some very powerful people that are looking at this and coming back and saying, go forward.
document called The New Model of Primary Care: Knowledge Bought
Dearly, which is acknowledged as a synthesis of existing literature and
new analyses by the Robert Graham Center: Policy Studies in Family
Medicine and Primary Care. The document describes the burden of chronic care on the Medicare system and some devastating predictions for the
near future. Currently, less than 20 percent of Medicare patients have five
or more chronic diseases, yet that population accounts for more than
two-thirds of Medicare spending.
The purpose of the Graham study was to demonstrate that if you
have a family physician managing the chronic disease of a patient, then
A.) the patient satisfaction goes up; B.) the quality is extremely high; and
C.) it costs less, Martin says. The document backs up those claims, showing possible savings of over $50 billion to the Medicare system if family
physicians serve as the usual source of care for Medicare patients with
chronic diseases.
In a letter to AAFP chapter presidents that accompanied the document, Martin writes: Effective delivery of care requires consultation with
the patient, organization of the patients care and encouragement of the
patient to become a partner in that care. Our payment system penalizes
physicians for taking each of those actions. The document goes on to
recommend that changes be made to the way family physicians are paid
that would include the adoption of a patient management fee and a
chronic care management fee.
Martin says the argument is bolstered by a recent article published in
Health Affairs by two Dartmouth professors entitled Medicare Spending,
the Physician Workforce, and Beneficiaries Quality of Care, which compares Medicare spending and quality of care among the states. The study
reports that in states with higher Medicare spending and a higher concentration of specialists delivering the care, the quality of care and the level of
patient satisfaction are lower and the cost is higher than in states where
primary care physicians deliver more of the care.
Other AAFP initiatives are working to interest payers in providing
financial incentives to physicians for reaching a set of quality standards. If
the physician is able to lower the cholesterol to certain standards or lower
the hemoglobin A1c to certain standards, then there are extra payments,
bonuses paid to the physician for doing those things, Martin says.
Dr. Spann believes the use of advanced information systems championed in the new model holds the promise of greatly improving the quality
of care family physicians deliver, particularly in cases of chronic disease and
prevention. We believe that in the long term, insurance companies are
For Drs. Martin and Spann, the question now is how does the
Academy begin to implement the new model and do it in a cost effective
way. Task Force Ones report called for the development of a national
resource center that might use demonstration projects, or new model
beta sites to fine tune the practice, and then package the parts in a
turnkey solution that would make implementation easy and seamless.
AAFPs Board of Directors asked Spann to serve as a consultant to a
team that has been working on a business plan for the national
resource center. This plan was presented to the Board at their annual
meeting in October 2005.
The purpose of the center after the initial demonstration project is
over will be to act as a consultant service, helping family physicians or
whoever else is interested in transitioning to the new model. For some
practices already meeting many of the new model requirements, the
resource center might do as little as pass on some tips via e-mail, or it
could start from the ground up for other practices, providing software and
intensive training. Martin says the resource center would have to be
financially viable, so the service wouldnt be free, but part of the centers
purpose would be to make sure the new model improves a physicians
bottom line. He believes the center could begin to take shape in the next
six months to a year.
Martin says the new model is necessary to the success of the U.S.
health care system, and certainly that of family medicine. Yes, this is a
mountain we have to climb, but its doable. And the tools will be provided
to help get there, but its not something that were going to have the
opportunity to pick and choose on. He says that in this case, the old
adage Ill believe it when I see it has to be turned on its head. Ill see it
when I believe it, Martin says. I think that if we are at a point where we
believe this can happen, it will.
LINKS
www.annfammed.org/content/vol2/suppl_1/
Future of Family Medicine Report plus the task force reports published in
Annals of Family Medicine
www.aafp.org/x3318.xml >> AAFP Care Management Policy The New
Model of Primary Care: Knowledge Bought Dearly
www.internetcme.org >>Access audio and slides from Dr. James Martins
FFM presentation at TAFPs 2003 Annual Session and Scientific Assembly.
Perspectives 1Q05
33
CLOSING
VIEW
Jeffrey A. Zlotnick MD, CAQ, FAAFP is Vice
President of the NJAFP and an Assistant Clinical
Professor of Family Medicine & Primary Care
Sports Medicine in the Department of Family
Medicine at UMDNJ RWJ Medical School in New
Brunswick. He is also the Medical Consultant for
the Healthy Athletes Initiative for Special
Olympics New Jersey.
Im sitting at the bar with my friend Harry. Were having an in depth

conversation about the ups and downs of our jobs. Harrys quite an
interesting bloke (hes British, you know). Harrys a music instructor specializing in bass and guitar. Im one of his students. We should be
in his studio practicing, but Harry decided I needed a break so we walked
over to the local pub for a drinkor two. Seems kind of odd for me to
walk into his studio after work dressed in a suit and run into students
who are less than a third my age (no age comments). I definitely stick out,
but that doesnt seem to bother Harry.
He has quite an interesting history. When I met him I was certain he
Small Miracles
By Jeffrey A. Zlotnick, MD, CAQ
was a blowhard over-indulging in alcohol and inflating small life events.

Then he showed me the album covers. Seems Harry was the quite the
studio musician. Hes played with some of the biggest names in classic
rock: Pink Floyd, Queen, David Bowieto name a few. Hes the real
thing! As Ive learned in the few months taking lessons from him, hes an
incredibly bright and talented musician with a personality to match. When
youre with him, its difficult to not find yourself laughing.
Unfortunately, Harrys also an example of what drugs and alcohol
can do. They took a major toll on his health and career. Now he teaches
in a small New Jersey studio and no longer plays with those big names.
Yet, hes also a man that is happy and satisfied with life. I can hardly
remember a time where I have not seen him smiling or laughing. He obviously loves his work with students. Harrys most fulfilled when he sees a
student get it. You can see the joy in eyes when talks about those
moments with his students when small miracles occur.
I can hear Theresa Z, youre supposed to talk about Family
Medicine! Youre supposed to use your column to help your fellow
physicians not to talk about music! Well, Theresa, thats exactly where
were headed.
In my last two editorials Ive spoken about bringing joy and control
back into being a physician. In these crazy times, its easy to lose the sense
of why we became family physicians in the first place. Were so worried
about controlling the forest we forget the individual trees. That theme has
not escaped Harry; he takes care of the individual trees and lets the forest
reap the benefit.
Many of us become so overwhelmed trying to take care of the forest
we dont see what weve accomplished when we take care of that one
tree. Ive seen this most in the residents and students Ive worked with. I
refer to it as the Albert Schweitzer Syndrome. Many residents and students go into medicine with the desire to save the world. Then reality hits
34
Perspectives 1Q05
and they realize theres very little chance theyre going to accomplish that
lofty goal. They begin feeling that theyve failed, theyll never be the
physician they wanted to be and theyll never be able to help others. They
become jaded and medicine becomes a job. They never realize their
small miracles.
Small miracles: those little things you do for a patient that may
seem small, but have a huge impact on their life. Let me tell you about
Ed. Ed was about five years old at the beginning of this story. Eds family
had lost part of their health insurance coverage courtesy of cost cutting
measures by their managed care company. Eds father called me one
evening because Ed had a rash he had never seen before and he was
running a temperature. I was no longer their official doctor because of
the MCC changes, but Dad was upset and wanted to talk to someone
he knew. I told him to bring Ed in and wed work out everything else
later. One look and I knew something serious was going on. A few
phone calls and we had Ed admitted to the hospital for an emergency
bone marrow biopsy. The results were done stat and the news was
what I expected: leukemia. A few more phone calls and Ed was on his
way to Sloan Kettering for his initial bout of chemotherapy. Eds now
finishing his senior year in college. All it took was a little caring and a
few phone calls. Small miracles.
One Christmas evening I was covering for a fellow physician. I
received a call from a dad saying his daughter was having severe ear pain.
They were away at relatives and had visited the local ER. Diagnosed with
otitis media, they had given her a prescription. What theyd forgotten was
that all the pharmacies were closed. I know we could have had one open
on an emergency basis, but I knew I had samples in my office. I told Dad I
was out anyway and would put some in a paper bag and leave it in a lab
boxes outside my door. They could get it and it should hold them until the
pharmacies opened. A week later I received one of the nicest letters I have
ever gotten telling me how I had saved their holiday with a simple act.
Small miracles.
Jim was a star athlete for the local high school when he noticed foot
and knee pain. He wanted to excel at track and field but the pain was
getting worse by the day. His father took him to an orthopedic surgeon
who said hed grow out of it and prescribed OTC NSAID. When he came
to me I saw a very upset young man who wanted to be field and track
star. What I didnt know was that he wanted to be that star so he could
earn a college scholarship. For Jim, it was the only way hed be able to go
to college and he was seeing his dream fade away. Upon examination I
found what we Sports Med folk call Miserable Misalignment Syndrome: a
tough combination of pes planus, genu valgus, and patellar femoral syndrome. We started an intense program of physical therapy combined with
different types of OTC orthotics, but we finally had to get him fitted with
a set of custom made ones. It took a few months but the pain began to
fade, his ability to run increased and his time decreased. It wasnt until I
saw him a few years later for minor injury that occurred in college that I
learned the full extent of what working with him had done. To me it was
the day to day routine of seeing patients. It had never occurred to me
until then how much impact I had on his life. Small miracles.
I could on about Anna with her migraines, Fred with his diabetes,
but Im hoping now you get it. In your day-to-day routine of seeing
patients, youll impact someones life in a huge way. What you may feel is
mundane can be a turning point in a patients life. So leave the forest to
itself and take care of those individual trees. Be just like Harry and never
lose sight of those small miracles.
QUIZ
Instructions: Read the article designed with the
icon and
answer each of the quiz questions. Mail or fax this form within one
year from date of issue to: NJAFP CME Quiz, 112 West State Street,
Trenton, NJ 08608 Fax: 609-394-7712
Perspectives: A View of Family Medicine in New Jersey has been approved by the
American Academy of Family Physicians as educational content acceptable for
Prescribed credit. Terms of approval covers issues published within one year from
the distribution date of 1-1-05. This issue, (volume 4, issue 1- Jan/Feb/Mar 2005)
has been reviewed and is acceptable for up to 1 Prescribed credit. Credit may be
claimed for one year from the date of each issue. AAFP Prescribed credit is
accepted by the American Medical Association as equivalent to AMA PRA category 1 credit toward the AMA Physician's Recognition Award. When applying for
the AMA PRA, Prescribed credit earned must be reported as Prescribed credit,
not as category 1.
Members - To obtain credit:

1. Complete and return this quiz to the NJAFP
2. Report your credit directly to the AAFP
Nonmembers To obtain credit:
1. Complete and return this quiz to the NJAFP with a check for
$15 made payable to the NJAFP and a self-addressed, stamped
envelope to NJAFP CME, 112 West State Street, Trenton, NJ
08608. A certificate of completion will be sent to you.
Members are responsible for reporting their credit to the
AAFP. To report credit go to www.aafp.org/myacademy/
or call 800-274-8043.
Name: _____________________________________________________________________________________________________________________
AAFP Membership Number:___________________________________________________________________________________________________
Street Address: ______________________________________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________________________________________
Email Address: ______________________________________________________________________________________________________________
Phone:_____________________________________________________________________________________________________________________
Fax: _______________________________________________________________________________________________________________________
Indicate True (T) or False (F)
An Update on Sinusitis
1. ___ Acute Bacterial, Subacute Bacterial, Chronic, and Recurrent
Acute are the four categories of Bacterial sinusitis.
The Basics of Measuring Patient Satisfaction

in a Primary Care Practice
2. ___ Bacterial sinus infection persists for more than 14 days.
8. ___ Patients are more likely to answer questions truthfully if

they feel their responses are anonymous.
3. ___ The objectives of treating a bacterial sinus infection are to

decrease the recovery time, prevent chronic disease and to
decrease exacerbations of asthma.
9. ___ When preparing a survey to measure patient satisfaction,

you should focus only on the physicians in the practice.
4. ___ Amoxicillin is not a good first-line agent for treatment of

sinusitis.
10. ___ When developing a survey you should not only assess
whether your patients are satisfied, but also their level of
satisfaction.
Sinus and Allergy Partnership Sinusitis

Guidelines Update
5. ___ The clinical features of bacterial rhinosinusitis and viral rhinosinusitis are similar, making differentiation a challenge.
Introduction to Medical Informatics for

the Family Physician
6. ___ Bacterial sinusitis is usually a complication of a viral upper

respiratory infection (URI), such as the common cold.
11. ___ The study, invention, and implementation of structures and

algorithms to improve communication, understanding and
management of medical information is called medical
informatics.
7. ___ The updated guidelines suggest that bacterial sinusitis be

diagnosed in adults or children when a viral URI remains
unimproved 5 days after onset.
12. ___ An organization that is seeking to help family physicians in

New Jersey adopt informatics initiatives in an overall strategy for quality care improvements is PRO-NJ.
Answers on page 29
Perspectives 1Q05
35
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112 West State Street
Trenton, NJ 08608

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A View of Family Medicine in New Jersey Volume 4, Issue 1 Jan/Feb/March - 2005

Call for Resolutions

Planning for the Future

Journal of the New Jersey Academy of Family Physicians

See page 35 for details

Special Feature: Adding It Up. . . . . . . . . . . . . . . 32

Theresa J. Barrett, MS, CMP

Printed by Citation Graphics, Pennsauken, NJ 08109 856-813-1153 www.citationgraphics.com

2005 New Jersey Academy of Family Physicians

What has the NJAFP Done For You Lately?

Who is representing you at the AAFP?

Ideal and Real

AAFP Congress of Delegates

any AAFP member, can come to the Reference Committee meeting

Perspectives: A View of Family Medicine in New Jersey

Subscriptions for non-NJAFP members are

Copyright 2005 New Jersey Academy of Family Physicians

Ideal and RealContinued

Annual Conference on Patient Education

16th National Forum on Quality Improvement in

NEW JERSEY DELEGATION TO THE

I missed the deadline for this article. I had

2004 Summer Celebration and Scientific Assembly

Perspectives: A View of Family Medicine in New Jersey

By Raymond J. Saputelli, CAE

Legislative Victory Health Enterprise Zones

MedFestA partnership between NJAFP and Special Olympics of NJ (SONJ)

inusitis is a condition that affects 30-35 million Americans and

to state that antibiotics provide an overwhelming advantage in the

See CME test on page 35.

Perspectives for Patients: Sinusitis

What are the Symptoms of Sinusitis?

Are you one of the 37 million Americans affected by sinusitis

Whats the Difference Between Acute and Chronic

How do I Tell if I have Sinusitis?

How Did I Get Sinusitis?

What is the Treatment?

Taking Care of Yourself When You Have Sinusitis

Where Can I Get More Information About Sinusitis?

Sinus and Allergy Partnership Updates Sinusitis Guidelines:

ollowing the recent dramatic increase in antibiotic resistance

To enable appropriate choice of treatment for bacterial sinusitis,

Mild ABRS with Previous Antibiotic Use or Moderate Disease

The national average penicillin resistance level is recorded at

Approximately 20 million sinusitis cases appear in the U.S.

The Basics of Measuring Patient

s Family Physicians we want our practices to meet the needs

with the data I collect? If your goal is to develop an improvement

Patient satisfaction surveys can help

questions for each category. There should be enough questions to

insight into your patients perception of your practice. It will also

New National EHR Systems Initiative:

Hear from experts currently using these systems in their practices

Introduction to Medical Informatics

Kennedy Ganti, MD is a 2nd year resident in Family Medicine at

lectronic Health Records. PDAs. Electronic prescription

What is medical informatics?

Why all the hype around medical informatics?

that are carefully and consciously designed to produce care that is

Resources for physicians:

that helps make point of care decisions regarding appropriate use

2005 Summer Celebration and Scientific Assembly