2nd Annual Quality Conference (2011)

Council Co-chair Karen Rosene-Montella, MD opened this year’s Conference by describing the common themes that have come to define the Women’s Health Council of RI. Specifically, collaboration among members of many disciplines, practical application of new ideas, and the present push to bridge physical and behavioral health.

Information on this website showcases the Council’s areas of focus to date:  Women’s Health in terms of obesity and exercise, Intimate Partner Violence, Smoking Cessation, Pregnancy as a health stress test, and a new focus on Bridging Physical and Behavioral Health in the area where women are at high risk: depression and suicide.

“In all these areas,” Dr. Rosene said “We need to continually address new program, policy and payment models.”

Lt. Gov. Elizabeth Roberts, MBA, greeted attendees by saying “Women’s health is a big determinant of family health.” She noted that people at this conference are changing the healthcare landscape. And policy makers are increasingly aware that they now have the opportunity to redefine health reform to get the healthier outcomes we all want.

Linda Carpenter, MD spoke in detail about the interface between depression and physical illness. 1 in 10 Americans have or had or will have Major Depressive Disorder. Patients typically focus on physical health with their primary care provider and don’t mention emotional or mental health. In 69% of patients, only physical symptoms were reported but all went on to meet criteria for depression. In describing how to recognize depression, the physician starts with 2 simple questions to determine if there has been a change in sense of well-being and a change in functioning. Dr. Carpenter’s slides showed the longer list of symptoms, including loss of hedonic drive and hopelessness leading to suicide. While there are multiple factors contributing to depression, early childhood stress including mother’s stress while infant is in utero, puts the patient at greater risk and makes recovery more difficult.

Teri Pearlstein, MD reviewed current treatment protocols for depression and suicide prevention. She stressed that primary care providers who screen for depression need to know where to refer patients for further evaluation and treatment. Screening is most beneficial when staff-assisted care and follow-up systems are in place. Evidence-based treatments for depression include psychotherapy, medication and alternative treatments, Efforts are ongoing to establish integrated care, ideally coordinated by care managers at regular PCP visits. The easy accessibility and follow-up of care is necessary because depressed patients face many barriers to receiving treatment. There is a 50% chance of another episode after first remission and anti-depressants work only 50-60% the first time.

Dr. Pearlstein also described the progressive phases of suicide, which begin with the idea, then thoughts, followed by plans. Successive suicide plans and attempts grow in intention and lethality until patient is successful or there is an intervention. She noted that suicidality may be a risk with anyone first starting anti-depressants and should be monitored.

Beatriz Perez, MPH, discussed suicide as a public health issue. In her role with the RI Department of Health, she described statewide violence and injury prevention programs she administers for the CDC and SAMSHA. She noted that RI women are below the national average for suicides, but suicide in men is showing a steeper increase than the national rate. Ms. Perez rarely sees an individual with just one risk factor and cautioned that any screening should consider multiple factors. Her programs make an effort to get to children at risk before depression sets in. And she teaches parents in at risk neighborhoods how to suicide-proof their homes by removing weapons and making medications unavailable.

Michaei Fine, MD, Director of the RI Department of Health,introduced the keynote speaker Regina Benjamin.

US Surgeon General Regina M. Benjamin, MD, MBA began her talk by observing that community events such as our council are important: they allow one person to stand up and make a difference whether in practice or policy.

Dr. Benjamin’s purpose as America’s Doctor is to stop illness and disease before it starts by using an integrative and holistic approach. She learned early in her career that practicing medicine was not about medicine alone, so she became involved in every organization that might help her patients receive better health services.

Today as Surgeon General her focus is on prevention and eradicating preventable causes of illness and disease.

In addition to the new American Affordable Healthcare Act, her policy agenda includes

  • Let’s Move – supporting First Lady Michelle Obama’s exercise programs, especially for children and people over 50
  • Addressing poverty, which has greatest negative impact on health
  • Promoting Surgeon General’s Call to Action for Breastfeeding
  • Improving ratio of full-term births
  • Improving access to health care
  • Reducing smoking rates
  • Slowing sudden growth of HIV and AIDS in young women
  • Stopping intimate partner violence, especially with young people
  • Stopping prescription drug abuse by young people
  • Improving patient compliance with prescribed medications
  • Supporting the UN program to reduce Non-Communicable Diseases
  • Supporting the Girls Not Brides program to keep girls around the world from being sold as brides.

Dr. Benjamin’s solutions focus on providing the best information available to live a healthy life. She has created the National Prevention, Health Promotion and Public Health Council, and released a National Prevention Strategy(www.healthcare.gov/prevention/nphpphc/strategy/report.pdf).

Her approach combines state of art medicine with an integrative and holistic approach for:

  1. Healthy and safe communities and environments (homes)
  2. Clinical and community-wide preventive services for better outcomes
  3. Empowering people with tools and information making healthy choices easy and affordable.
  4. Elimination of health disparities

This approach she believes can reduce the five leading causes of illness and death.

“We need your help,” Dr. Benjamin said as she introduced a new campaign to help change how everyone looks at health. In her program, health is translated as joyful, active living and includes activities that bring joy.

Kicking off on December 2, 2011 is a radio campaign called the “Surgeon General’s Dance Break,” a 60-second music broadcast urging people to stop what they’re doing, stand up and dance for 60 seconds every day.

Her closing words of advice: “Take care of yourself first. Relax, enjoy, and dance!”


Moderated by Rebekah Gardner MD and facilitated by Lisa Shea, PhD

This wide-ranging discussion touched on the following topics:

  • Build behavioral health treatment into primary care training.
  • RI is moving to achieve universal health coverage by 2014.
  • Integrated programs are going to work the best for keeping people out of hospitals and living more joyful lives
  • Support advocacy groups to reduce mental health stigmas
  • Intervene and help families at risk early on
  • Patient-centered home initiatives
  • Build depression screening into regular practice. This is a culture change for providers. Create engaging ways for patients to fill out screening instrument.
  • PCP’s must follow up with patients because there is much more to treating depression than giving medication.
  • AMA is looking at ways to reduce burden of paperwork and record keeping for PCP’s.
  • Incorporate dentists; note correlation between dental problems and heart disease.
  • Both telemedicine and social media represent enormous opportunities to improve care: younger generations plug in to health issues online.
  • Include nurses, especially because they are skilled at getting out into the community.

CLOSURE Mary Reich Cooper, MD, JD

Dr. Cooper described RI as a “magical state,” because of people’s willingness to collaborate across disciplines on new solutions to improve women’s healthcare. “But,” as she thanked the participants, “we still have a lot of work to do!”

FOLLOW-UP The next Critical Workshop Training, Practical Applications: Bridging Physical and Behavioral Health, is scheduled for March 6, 2012. Presenters will offer more in-depth training for providers in how to implement the “chain of care” so patients receive more integrated and holistic treatment.

US Surgeon General Regina M. Benjamin, MD, MBA

Regina Benjamin wants to change the way we think about health in this country.

As the US Surgeon General, Dr. Benjamin is on a mission to improve preventive care and reduce the five leading causes of preventable death. Part of her efforts include a new campaign to redefine health as a “Journey to Joy.”

When she spoke at our Second Annual Quality Conference on November 10, 2011, Dr. Benjamin gave an overview of her perspectives on the current challenges in healthcare. In order to change our thinking, she said, we need to take a much more integrative and holistic approach. She invited us to help with the implementation of her new campaign by encouraging patients to find their own levels of fun and healthy activities, foods and friendships…and to bring more joy into their lives as well as our own.