Prevention and Health Promotion
Primary Care Practice:
Since 1986 Dr. Dietrich and his colleagues Carol
Sox, Patricia Carney,
Charlotte Winchell,
Tor Tosteson, and
mailto:Mary.R.Burns@Dartmouth.EDU have been developing
interventions that promote provision of indicated preventive services in
primary care practice. This work has led to widespread use of preventive
services office systems nationally. The office system consists of established
routines, carefully planned teamwork and collaboration between physicians
and other clinicians in the practice with the nursing and reception staff,
and the use of tools such as flow sheets. Dr. Dietrich and Carol Sox have
applied this work subsequently to federally sponsored primary care centers
for the underserved in the New York City metropolitan area, to Yupik Eskimo
villages in southwestern Alaska focusing on cervical cancer early detection,
and to the identification of HMO patients previously exposed to diethylstilbestrol
(DES). Dr. Dietrich and Dr. Carney and this team are deeply committed to
the application of their research findings and in so doing have had close
collaborations with the New England Division of the American Cancer Society,
American Academy of Family Physicians, and other national groups.
Depression in Primary Care:
These efforts have recently been expanded to include
the study of mental health issues in primary care through the MacArthur
Initiative on Depression in Primary Care. The MacArthur Foundation launched
the Initiative in 1995 under the direction of James
Barrett, MD, to enhance physicians' ability to recognize and treat
depression. Since Dr. Barrett's retirement, the Initiative has been directed
by Dr. Dietrich.
The Initiative's mission through 1999 is to enhance care of patients with depressive disorders who are seen in a primary care setting. Specific aims have been to understand current practices better, develop educational materials of proven efficacy, identify better systems models of primary care/mental health services, and disseminate information and materials through medical schools, health care institutions and professional organizations (such as the American Academy of Family Physicians, the American College of Physicians, and the American College of Obstetricians and Gynecologists).
Community Research:
Community-based research that includes, but goes beyond,
the physician's office has been a relatively new focus. The New Hampshire
Sun Protection Project, headed by Dr. Dietrich, is in its 4th year of promoting
sun protection behavior in young children through school-based interventions,
recreation interventions, and primary care offices.
Dr. Diane Harper continues into her third year of the Robert Wood Johnson Generalist Physician Faculty Scholars Program. This research focuses on women's preferences for management after a mildly abnormal Pap smear and will be assessed in communities of New Hampshire women. Other community based research is her work with Telecolposcopy. Dr. Harper is funded by the state of New Hampshire's Health Care Transition Fund to demonstrate that the colposcopic examination can be transmitted in both store forward and real time formats for the purposes of distance learning and second opinion medical consultation. This one year project will link a rural community hospital to Dr. Harper's telecolposcopy laboratory.
Dr. Harper continues her research in the implementation of cervical cancer prevention through her participation in the NCI funded ASCUS and LSIL Triage Study (ALTS), where she is the committee chair for the Quality of Life assessment and the Cost Effectiveness Analysis for the trial.
Interdepartmental Research Development in Family Medicine:
Collegiality among other Departments both within the Medical
School and more broadly within Dartmouth College provides Dr. Harper with
the opportunity to develop new research tools for cervical cancer precursors.
She is collaborating with the Department of Pathology to develop a self
administered tool for human papillomavirus testing that can be used in
field work for future longitudinal studies. The Thayer School of Engineering
is collaborating with Dr. Harper as well, to develop a laser based spectral
imaging mechanism to identify cervical cancer precursors without invasive
biopsies.
Family Practice Research Center Proposal:
The Department is working diligently to respond to the AAFP's
request to create research centers in Family Medicine. At the time of distributing
this document, it is still too early to ascertain how well we have done
in the competitive selection process, we remain hopeful. A draft proposal/letter
of intent is displayed on the following page.