Current Projects

Pediatric Research In Office Setting (PROS)
Presently there are 2 pediatric clinics in the state of Montana who participate in PROS.  Read below to learn more about PROS and consider adding your practice to the network of practices who participate in office based research.

PROS (Pediatric Research in Office Settings) is a practice-based research network that was established by the American Academy of Pediatrics (AAP) in 1986.  PROS consists of about 1800 pediatric practitioners from 700 practices in all 50 states, Puerto Rico and Canada, teamed with a research staff at AAP headquarters in Elk Grove Village, IL and research consultants from around the country. 

The mission of PROS is to improve the health of children and enhance primary care practice by conducting national collaborative practice-based research.
PROS practitioners and researchers work together to generate research questions, design study materials and protocols, obtain research funding, collect study data, analyze collected data, and publish results.  Since its inception, PROS has studied child health topics as diverse as the prevalence of preschool vision screening (Pediatrics, 1992; 89: 834-838), the onset of secondary sexual characteristics in young girls (Pediatrics, 1997; 99:505-512 and 2001: 108:347-353), the immunization status of children seen in private practice (Arch Pediatr Adolesc Med 1996; 150:1027-1031), the treatment of pediatric patients with psychosocial problems by primary care providers (Pediatrics electronic pages 2000: 106(4): e44), the coordination of referrals to specialists (Arch Pediatr Adolesc Med 2000; 154: 499-506), the management of very young febrile infants (JAMA 2004; 291: 1203-1212), decision-making for postpartum discharge of mothers and their healthy infants (Pediatrics, 2008, accepted for publication), and how practitioners diagnose child abuse in primay care settings (Pediatrics, 2008, accepted for publication). The new knowledge generated in PROS studies has led to changes in the clinical guidelines of the AAP and other organizations. 

As a practitioner, you possess expertise on how a primary care practice runs and know which research questions are important for pediatric practice. By linking you with experts in study design and research methodology, PROS capitalizes on your expertise and lets you participate in generating new knowledge about pediatric practice and child health. You might even be able to see your own question develop into a project that can be researched throughout the network.
PROS practitioners tell us that they enjoy being part of an overall research effort that routinely solicits their input on study questions and study designs (protocols and materials) and that examines questions relevant to the day-to-day practice of pediatrics. They also tell us that parents view research involvement on the part of the pediatric practice in a very positive light, and are eager to fill out questionnaires when they are a part of a study. In addition, all participating practices are acknowledged at the end of published articles.

PROS is currently recruiting practices to participate in two large studies: CEASE to examine effective strategies to promote parental smoking cessation, and BMI2 to identify effective strategies to decrease BMI in obese and overweight children.  Soon a follow-up study on pediatrician response to suspected abuse will be underway as well.

To join the PROS network, or to learn more, go to http://www.aap.org/pros/howjoin.htm  or contact Dr. Sue Daniels who is the PROS coordinator for the state of Montana at 406-522-5437 or sdaniels@acornpediatrics.com. 

Fluoride Varnish in Montana
Fluoride Varnish Information Sheet (PDF)
This past year we were fortunate to have Dr Charlie Czerepak DDS and Amos Deinard MD cover the central and eastern parts of our state showing us how to do Caries Risk Assessment and Fluoride Varnish Application to help us in dental caries prevention.  Through their hard work we received approval to use the Dental Code D1206 for Caries Risk Assessment and Fluoride Varnish Application.  It will be reimbursed at $28.16.  The patient must be <20 years of age (hopefully most of the kids we do this to will be under 1 year of age and will be finding their dental home shortly after that).  We will be reimbursed for doing a caries risk assessment and talking about prevention and in the MODERATE and HIGH RISK patients applying fluoride varnish. 

Those of you who were not able to attend these talks in March and April of 2008 can get DVD copies of the talks from Molly Taylor our ED, and you may get CME’s for that at the AAP website under the oral health area.  If you prefer to refer those HIGH RISK patients but are unable to find a dentist in your area, Jane Gillette DDS, PC 1-406-586-5880 has agreed to help you.  She has been working as liaison between the AAP and MT Dental Association.  She spoke at our annual meeting this year.  If after watching the video you would like a demonstration in your office, with your nurses, I would be happy to do that. 

This really, as you will see in the video with Dr Rencher DDS from Helena, is quite an easy process.  I  hope everyone gets talking about this and implementing it in their offices asap, as it is the right thing to do for our patients to decrease tooth decay.  In other states, like North Carolina, who have taken this approach and “talked the talk”, they have greatly decreased childhood caries. 

One fluoride varnish that Drs  Czerepak and Deinard used when here was Cavity Shield from Omni Pharmaceuticals and it has a brown color so that you can see where it was applied.  They had another varnish named Vanish also from Omni that comes in cherry and mint flavors and you didn’t see it on the teeth.  These both came in unit doses with applicators.  There are multiple other companies and varnishes out there but I am not familiar with their properties.  I have a more complete list if anyone is interested.  I also have a Fluoride Varnish Information Sheet with Risk Assessment and Consent Form on the back that you are welcome to copy and use in your office if you desire.

If you have questions please don’t hesitate to contact me at CMWMD@yahoo.com or 1-406-454-0145.

To many beautiful smiles across our great state,

Cathy White MD

Montana Nutrition and Physical Activity Program (NAPA)
www.montananapa.org
The Montana Nutrition and Physical Activity Program (NAPA) recently received a 5 year grant of over 4 million dollars from the Centers for Disease Control (CDC) for the purpose of preventing and controlling obesity in our state.  This group is housed at MSU in Bozeman.  The funding will support local county and tribal health departments in strengthening the obesity-prevention infrastructure in the state.  Specifically the grant has 4 main goals:

1. Improve the nutritional environment by improving the affordability of healthy foods. NAPA will be working with interested grocery store and restaurants (including children’s menus) to improve the availability, pricing, and promotion of fruits, vegetables and other healthy foods.
2. Increase breastfeeding rates by working with local hospitals to implement the UNICEF/WHO “Ten Steps to Successful Breastfeeding.”
3. Improving the built environment by working with city planners, developers, elected officials, and school personnel to make communities more conducive to walking and biking.
4. Improve availability of healthy foods and physical exercise on the worksite.

As a part of the this grant all Montana AAP members will be receiving free handouts/posters in the mail to promote Turn Off TV Week which is April 20-26, 2009.   Please post them in your office in April.  Check out www.montananapa.org to get details on this amazing opportunity for our state.

Marian Kummer Receives AAP CATCH Grant
Dr. Marian Kummer, pediatrician in Billings, received a CATCH grant in 2004 and completed it in April of 2006.  The original grant was submitted to determine the effectiveness of care coordination for Children with Special Health Care Needs (CSHCN) families in an urban pediatric clinic and a rural family practice.  The project included assessing the degree of care coordination needed via practice surveys, parent interviews and community focus groups.  Wolf Point family practice was the rural site and the Childrens Clinic in Billings was the urban site.  Dr. Kummer partnered with Dianna Frick with the Maternal Child Health Bureau in Helena.  She was instrumental in developing a meaningful survey and analyzing it.

2000 surveys were sent out and approximately half were returned.  Surprisingly 86% of parents stated that their child’s health care was well coordinated.  Many respondents had more than one care coordinator.  The most commonly listed coordinator was a family member and just under half listed a medical provider.

The top three needs sited were clinics to address the child’s special needs (62%), health insurance (54%), and access to dental care (52%).  The barriers to obtaining these services were availability and cost.  48% of respondents had trouble accessing health care and cited cost as the major barrier.

83% of families were satisfied with the care their child received from their primary care physician.  There was an opportunity for families to detail how their doctor could be more helpful to them (752 comments).  Basically families wanted their doctors to be available 24/7 and to be knowledgeable about their child’s condition.  Doctors needed to listen more to the parents concerns and take time to address the concerns.

Dr. Kummer presented the results of the grant at the state public health conference in the spring of 2006 and at the state pediatric conference in the fall of 2006.  She also wrote an article for the (Parents Let’s Unite for Kids) PLUK newsletter- a statewide parents organization for CSHCN.

Dr. Kummer mentioned that the grant allowed her to work with several great people and to hear many parent’s concerns.  She feels strongly that the state of Montana still needs a system that details all services available for this population.