Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.
Research conferences should be an opportunity to gain insights from discussion and collegial debate about new research. At times, though, I have seen debate become adversarial and counterproductive; questions can be aggressive and speakers defensive. But one of the great attributes of the North American Primary Care Research Group annual meeting (NAPCRG) is the culture intellectual rigor yet respectful and collegial discussion, and the support for early career researchers. Researchers with impressive track records in publication in international journals are always keen to share their knowledge and help their colleagues. David Meyers, a long time NAPCRG supporter unable to attend the conference this year due to illness sent a video message in which he said, "May you find meaning in your work and friendship in your colleagues." ...continue reading →
The High Plains of eastern Colorado have been referred to as a dwindling remnant of the “worst hard time”, reminding us of a not too distant past that included the dust bowl and westward out-migration to the West Coast. Rural Colorado has become mostly a crop-circle curiosity or a time to “put your seat into the upright and locked position” for the thousands of travelers that fly over at 30,000 feet. The small town of Last Chance, Colorado sits at the junction of 2 blue highways. It is home to just 22 residents.
Last Chance once had a Dairy King and 2 gas stations, and was for many, the last chance for food and fuel before heading east into the vast open plains of eastern Colorado. ...continue reading →
Kirsten Patrick is Deputy Editor at CMAJ. She is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.
In the plenary session on providing primary care for refugees, one of the speakers, Kim Griswold, shared an image, now familiar to many, that is designed to help people to understand the difference between equality and equity. It demonstrates how some people start off at a relative disadvantage and need extra help to be able to achieve or access things that more advantaged people are able to experience easily. This image, and similar ones, have been criticized by some social justice thinkers who point out that ...continue reading →
Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.
Not many primary care doctors have an 8 billion dollar budget. Mitch Katz, who gave the opening keynote address at NAPCRG 2016, is director of the Los Angeles County Health Agency which combines the Departments of Health Service, Public Health and Mental Health into one service. He continues to see patients and described how he had become so specialised in his career in a primary care AIDs clinic in San Francisco, that he found returning to generalist practice extremely difficult. When he focused on AIDS he was on top of his topic like any specialist, but, as a generalist, he had to cope with anything from a heart attack to broken heart.
Kim Griswold is Associate Professor of Family Medicine, Psychiatry, and Public Health and Health Professions at Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. Dr Griswold will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.
Communities in every nation are faced with providing competent, equitable and culturally appropriate services for resettling refugees. Health centric disciplines are not enough to meet the challenges presented by these newly arriving populations, nor to alleviate the disparities they face – such as isolation, limited English proficiency, differences in patients’ attitudes and health literacy levels, and a lack of cultural awareness on the part of providers.
Health inequity can be defined as: “unjust differences in health between persons of different social groups.” ...continue reading →
Kevin Pottie is Associate Professor of Family Medicine and Epi & Community Medicine at the University of Ottawa, as well as co-Chair of the Canadian Collaboration for Immigrant and Refugee Health, and a family physician at the Immigrant Health Clinic of Ottawa, which he helped to found. Dr Pottie will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.
My residency training in Ottawa began with a wave of refugees from El Salvador and Guatemala. Most conflict-affected refugees - Somali, Sudanese, Congolese, Karen, Bhutanese, Colombian - come quietly and settle rapidly in our communities. And, even in instances when the media cover the arrival of large waves of refugees, such as the Vietnamese boat people or the recent Syrian war victims, the refugees themselves settle quietly in our communities.
In the early 1990s, it felt almost revolutionary to care for refugees. There were few primary care practitioners trained and ready to lead ...continue reading →
Mark Harris is Foundation Professor of General Practice and Executive Director of the Centre for Primary Health Care and Equity at the University of New South Wales in Australia. Dr Harris will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.
After working with refugee populations resettled in the urban fringe of Sydney in the 1990s, I began volunteer clinical work in 2000 with an NGO working with asylum seekers. Asylum seekers do not have access to the national health insurance system that funds primary care for all Australians and subsidizes medications. Despite having greater health needs due a variety of acute and chronic physical and mental health problems, refugees often suffer worse access to health care in resettlement countries like Australia. ...continue reading →
Fern R. Hauck is Professor of Family Medicine and Public Health Sciences at the University of Virginia. Dr Hauck will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.
The scope of the crisis is staggering! The number of people displaced by war, conflict or persecution has hit a record high—over 65 million with 21 million of these being refugees. Most face an uncertain future. Those who are resettled to a developed country are among the lucky ones. Nonetheless, they face many challenges in their new home, including accessing culturally sensitive health care.
My involvement with refugees began on the Thai-Cambodian border, where I spent a year providing primary health care to Cambodian refugees who were living in the largest border camp, having fled there after the Khmer Rouge were ousted after years of genocide. Moving to Charlottesville, Virginia, in 2000, I never expected to find that refugees were being resettled in this small city. ...continue reading →
Michelle Greiver is a family physician with the North York Family Health Team in Toronto
As a family doctor, I sometimes wonder if I provide too much care for some patients in my practice. Do my elderly patients with diabetes need very low A1Cs? What about the risk of falls and fractured hips due to hypoglycemia associated with enthusiastic use of diabetic medications? Should patients over the age of 90 really be on a statin? Should they be on anything that does not improve their quality of life? Perhaps I should be asking them what they would like? ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Some sessions just stand out. Dee Mangin's stunning distinguished presentation of her research into whether iron deficiency without anaemia in infants affected their long term developmental outcomes. They had, incredibly, 100% recruitment with blood tests in infants, and they followed the kids meticulously for 6 years with validated outcomes for intellectual and psychomotor ability. There was no loss to follow up with only minimal data loss e.g. 5% missing blood data blood at age 6 years. Dee’s presentation kicked off a superb afternoon on Tuesday at NAPCRG 2015 of ground-breaking trials asking important clinical questions... Do steroids help in chronic cough? What's the effectiveness of maintenance SSRI (and what happens with antidepressant withdrawal)? It would be unfair to release any of these findings in a blog and we all look forward to publication of the papers. Suffices to say, they will be practice-changing. ...continue reading →