KOLAHUN

Cotton-pickin' Primary Care: the growing reliance on a minority labor force.

    

Across the health care system, in for-profit, non-profit and government primary care centers, the pressure is on primary care providers to use the same limited time and resources that they've always had to deliver preventive care, chronic care, acute care, evidence-based care and charitable care to an increasing number of patients, who bring with them increasing demands and expectations for medical care.  As the US population ages and the prevalence of chronic diseases such as heart disease, diabetes and hypertension increasing, the burden of proving patients with comprehensive management solutions to their health problems will also be greater.

 

One of the leading thinkers of primary care reform, Dr. Thomas Bodenheimer, a professor at the Center for Excellence in Primary Care in the Department of Family and Community Medicine at the University of California, San Francisco, asked in his August 2006 New England Journal of Medicine Perspective editorial on the decline of primary care, "Who might support a national policy to rescue primary care?"  Well…we kinda already have a lower-cost policy solution: Let the minorities do it.

O Mundo Lusophone

Você sabe em quais paises se fala Português?  The list of countries follows the break...there are 9 countries where Portuguese is the official language.

O Re-iniciado com Cervical Cancer

Peço a descuple de todos, mas ninguém escreveu neste blog desde Janeiro 2009.  Não sei o que aconteceu com Jubei, mas para mi, tenho ficado nos últimos nove meses aqui em Moçambique..

...learning Portuguese and working on a PEPFAR funded rural HIV project.  Perhaps we'll deconstruct the process and experience as we go along.  There's a lot to praise and criticize, both within the PEPFAR world, the international NGO context and with the country of Moçambique itself. 

But for now, perhaps it's better to just jump into the world of 'articles-i'm-stunned-by'.  This week the New England Journal of Medicine published a Gates Foundation funded study of the best way to screen for cervical cancer in low-resource settings.  They followed about 130,000 women in villages in India and tried to find out which of three methods of screening would save lives.  In the end, they found that a one time screening for HPV, the causative virus of the vast majority of cervical cancers, after the age of 30 worked best amongst the three methods (the other two being normal pap smears and a simple staining method called VIA). 
 
A related editorial from two National Cancer Institute physicians argues that this study is so persuasive, the international community should 'now adapt HPV testing for widespread implementation.'  That seems premature.  This is still only one study.  And we're not sure what modifications or errors will soon be unearthed.

That being said, there's a few of impressive aspects to this study we should note while we await further confirmation and validation.  First, the study studied 131,746 women over 8 years in India.  That's stunning.  Over 130,000 women!  In India...in villages.  Most uneducated (70% without formal education) and most working at home (60%).  The logistic achievement of following, screening and treating 130,000 is almost incomprehensible.