Screening: Family Medicine Clinics Raise Awareness

Fall 2013

UAMS Family Medical Center physicians didn’t wait for a software developer to create the tools to initiate a rigorous program of patient screening for certain cancers and other diseases. They went ahead and made the tools themselves.

Arlo Kahn, M.D., UAMS College of Medicine professor of family and preventive medicine, and other family medicine faculty members and staff several years ago began work on getting prompts built into the Centricity electronic medical record (EMR) system the clinic uses. The prompts remind a patient’s doctor and clinic nurses to look for certain cancers and other diseases if the patient falls into a particular risk group for it.

A patient may be at risk for colon cancer and need a colonoscopy. It may be time for a female patient to have a pap smear to check for cervical cancer.

Such reminders have become standard in EMR systems.

The Family Medical Center at UAMS as well as family medical centers at the university’s regional centers in Fort Smith, Texarkana, Jonesboro, Fayetteville, Pine Bluff and Magnolia all train medical residents how to screen.

At the UAMS Family Medical Center, residents do six prevention projects each year and about half of those involve cancer screening.

“It’s both a learning project for them and a quality improvement project for us,” Kahn said. “We always have a little extra activity going on to figure out how well we’re doing with cancer screening. We issue reports and keep up with that. We make changes in our system if that’s needed.”

Geoffrey Goldsmith, M.D., M.P.H., helped secure a four-year NIH grant to boost colorectal screening rates at the regional centers.

Tiffany Williams, R.N., checks a patient’s medical records for needed screenings while Arlo Kahn, M.D., examines the patient.

Tiffany Williams, R.N., checks a patient’s medical records for needed screenings while Arlo Kahn, M.D., examines the patient.

Mark Mengel, M.D., UAMS vice chancellor for regional programs, said the program helped increase overall screening rates at the centers from 20-30 percent to more than 50 percent.

He said the centers have begun a similar program to raise breast cancer screening rates, and it’s already producing positive results by pushing them from about 42 percent to more than 60 percent.

“We take an evidence-based approach,” Mengel said. “It has to be proven that it’s a cancer you can screen for successfully. Screening lowers mortality rates.”

In addition to screening, residents and physicians at all the UAMS family medical centers counsel patients whose habits and lifestyles may be increasing their risk of developing cancer.

Kahn said to effectively reach a patient about obesity, a UAMS Family Medical Center dietician will meet with that patient 12-15 times a year to help work through a weight-loss program.

The UAMS Family Medical Center was recently recognized for a second time as a Level 3 — the highest level — patient-centered medical home by the National Committee for Quality Assurance. As all of UAMS moves toward that health care model, it’s hoped patients will feel more responsible for their health care and even more motivated to make healthier choices.

“Team-based care is what is going to allow this to happen,” said Daniel Knight, M.D., chair of the Department of Family and Preventive Medicine. “You’re not just going to have a doctor scolding the patient about their weight, their smoking or alcohol use. You’ll have a team and care managers to get resources to the patients and get them in. That’s what’s going to be effective.”