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ACPM
Policy Committee Meeting
February
21, 2003
6:00-8:00
a.m.
Paradise
Point Resort –
San
Diego
,
CA
MINUTES
Participants
Mark Johnson (Chair), Kathleen Acree,
Maria Agelli, Halley Faust, Arvind Goyal,
Jim Guillory, Tom Houston, Neal Kohatsu,
Liana Lianov, Perrianne Lurie, Joel
Nitzkin, Nancy Sheehan, Debra Smith, Hugh
Tilson, Stephanie Zaza, Mike Barry (staff)
Welcome
and Introductions
Mark Johnson called the meeting to order
at 6:08 a.m.
He led introductions.
The minutes from the November 2002
Policy Committee meeting were approved.
Continuing
Business
Job Market Initiative – Proposed Career
Tracks
Joel Nitzkin updated the group on the
activities of the Job Market Initiative (JMI).
He described his vision of the JMI
as increasing the demand for preventive
medicine physicians in the marketplace by
one-hundred-fold and the support for
preventive medicine residency training by
ten-fold.
He described his proposed list of
job/functional roles appropriate for
preventive medicine-trained physicians as
a way of marketing the specialty and PM
physicians to potential employees and
promoting these roles as the domain of the
specialty.
The committee agreed that the roles could
be used to highlight specific job examples
where PM physicians can excel, emphasize
the types of training and competencies
that PM physicians receive, and provide a
categorization schema for an inventory of
jobs that are appropriate for PM
physicians.
Committee members offered several
specific suggestions for improving the
list.
Action:
The committee passed a motion calling on
the Board to adopt the “Roles of
Preventive Medicine Physicians” as
presented, and refer them back to the Job
Market Initiative for further explication
and use as a framework for categorization
of preventive medicine jobs and marketing
of preventive medicine credentials.
Health Insurance Subcommittee – Position
Statement
Dr. Johnson summarized the discussion at
the ACPM Open Policy Forum about ACPM’s
draft policy statement, Health Insurance
for All (HIFA).
Most of the Forum participants
agreed that ACPM has an ethical obligation
to be on record with a statement about the
uninsured. However, the thrust of
the comments offered at the Forum was that
the statement was too detailed and too
prescriptive about how to reconfigure the
whole health care system, focusing on issues
(e.g., financing and regulatory
provisions) beyond the sphere of the
College's influence. Forum
participants recommended that ACPM pare
back the statement to be a much shorter
consensus statement on core principles and
concepts that focus on universal access
and assurance of preventive services.
The Policy Committee agreed that what was
needed was a shorter consensus statement
of ACPM's core principles derived from the
attached statement and ACPM's past
policies on this issue. Once ACPM's
stakes out its position, it will be able
to compare it to the reform proposals of
other entities, determine which proposals
to endorse, and form strategic alliances
to advocate for its principles.
Action:
The committee passed a motion referring
the statement back to the subcommittee to
prepare a simplified statement of ACPM
guiding principles on health insurance
reform, with a focus on preventive
services.
Maintenance of Policy
Mike Barry discussed the Maintenance of
Policy procedures in the ACPM policy
manual and the need for ACPM to determine
a process to implement the procedures so
that ACPM’s policies can remain current.
He discussed the concern raised by
Dr. Kohatsu about the change made by the
Policy Committee at its last meeting to
impose a five-year default sunset on
policies, rather than a three-year
default, particularly with
clinical/practice policies.
The group agreed that a five-year
default was appropriate from a workload
perspective and that it was incumbent upon
the Prevention Practice Committee and
Board to specify shorter sunset dates at
the time of adoption for policies about
which the evidence is likely to change.
Action: The
committee recommended that the
chairs of the Policy Committee and
Prevention Practice Committee, with the
help of one or more subcommittees as
needed, be charged with the task of
annually reviewing all ACPM policies
developed by their respective committees
and making recommendations to the full
committees on the action needed to
maintain the policy (i.e., archive as
inactive, revise to reflect current
evidence, or reaffirm for a time certain).
The committees should provide an
interim progress report to the Board of
Regents each November (beginning in
November 2003) and recommend action on
each policy at the annual meeting in
February (beginning in February 2004).
New
Business – ACPM Resolutions
Resolution 01-03, Patient Safety
Action: The
committee recommended adoption of the
proposed resolution with the following
amendments:
- Amend
the 4th Resolve to read:
THAT: The ACPM, in collaboration with
others, work to enhance the evidence
base in patient safety, both specific
to clinical preventive services, and
as part of the population-based
approach to balance the benefits and
risks of interventions.
- Add
"evidence-based" to the 7th
Resolve.
- Add
an 8th Resolve: THAT: The
ACPM encourage the Task Force on
Community Preventive Services to
review the effectiveness of health
care system interventions that assure
patient safety and to make
recommendations for their use and for
additional research.
Remarks:
Dr. Kohatsu presented the resolution at
the ACPM Open Policy Forum and to the
Policy Committee. Forum participants and
committee members were unanimous in their
support of the resolution. A suggestion
was made to enhance the fourth Resolve to
ensure that ACPM would work in partnership
with other organizations to advance the
research of medical errors and how to
prevent them. There was some debate about
whether or not the resolution should also
address errors of omission. It was agreed
that the Resolve should address research
of population-based approaches that seek
to balance the benefits and risks of
interventions. Similarly, the committee
agreed to add a Resolve calling on the
Task Force on Community Preventive
Services to review the effectiveness of
population- or system-based approaches.
Resolution 02-03, Abolition of Symptomatic
Coronary Heart Disease
Action Taken: The
Policy Committee recommended that the
resolution be referred to the ACPM
Prevention Practice Committee for further
review of the science on which the
recommendations are based.
Remarks: Dr.
Joel Nitzkin presented the resolution at
the Open Policy Forum on behalf of the
author, who was not able to attend the
ACPM annual meeting. There seemed to be
consensus both at the Forum and among
Policy Committee members that the overall
evidence base was too small to support the
recommendation espoused in the 1st
Resolve. Most individuals felt that
recommending "abolition" of
symptomatic coronary artery disease was
beyond what the current evidence would
support and that perhaps we should focus
instead on making dramatic reductions in
disease rates. Concern was also raised
that this resolution focuses on only one
risk factor for heart disease and that we
should think more broadly.
It was noted that the recommended extreme
diet regimen clearly could work for some
individuals, but that the effects of
implementing such a regimen on the
population at large were still unknown. It
was suggested that we still don’t know
the ratio of risk to benefits of this diet
and that if the USPSTF analyzed the
evidence for this intervention, it would
find "insufficient evidence" to
make a recommendation for the population.
It was suggested that ACPM be consistent
with its current diet recommendations, as
recently adopted in the ACPM position
statement on weight management and
prevention of obesity, type 2 diabetes,
and insulin resistance.
There was support for the overall theme of
the recommendations in the 2nd
Resolve calling for additional analysis of
the evidence and identification and
funding of research needs.
Public
Health Code of Ethics
Jim
Guillory presented a draft “Principles
of the Ethical Practice of Public
Health,” being developed by the Public
Health Leadership Society.
He noted that he is seeking
ACPM’s support for the document, and
would like to see ACPM officially
represented on the working group
overseeing the development of the
document.
Action:
The
committee passed a motion recommending
that ACPM appoint a liaison to the Public
Health Leadership Society’s Ethics Work
Group to support the evolution of a Code
of Ethics for Public Health.
Other
Business
-
Mike Barry will revise the
proposed Policy Committee annual
objectives for 2003 and post them to
the committee listserv for review and
comment.
-
Dr. Nitzkin asked about the
status of Consultative Preventive
Medicine resolution adopted by the
Board last year and requested that
ACPM make it a priority in the coming
year.
-
Several committee members
again recommended that ACPM look for
ways to hold its Open Policy Forum at
a time that does not compete with
other sessions.
Concern was also raised about
the nine-month gap between in-person
meetings of the Policy Committee.
Dr.
Johnson adjourned the meeting at 8:03 a.m.
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