Health care reform during the early part of this decade boosted primary care to the top of the priority list of academic health centers, which traditionally had paid more attention and resources to specialists.

In many parts of the country, including California, schools have been mandated to increase training of primary care practitioners.

A new UCSF center has been established, however, to make sure that this is much more than a numbers issue and that practitioners on the patient care frontlines in this new era have the proper setting and tools to deliver the best possible care.

The UCSF Center for Collaborative Innovation in Primary Care (CCIPC), which began last fall, is the campus’ focal point for advancing primary health care education, research and practice. And to do so, it is teaming faculty in the four UCSF schools, hoping that they can pool their experience and creativity to expand primary care beyond its traditional boundaries. While UCSF practitioners in training will see the first results, the ultimate beneficiaries will be the people in the community who will receive innovative primary and preventive care.

“This campus has a wealth of expertise,” said Diana Taylor, associate professor of family health nursing and co-director of the new center. “A goal of the center is to nurture interdisciplinary activities.” She noted that the School of Dentistry, with its successful neighborhood clinics, is well-established in community-based care. In the School of Nursing, 70 percent of its training programs are geared to primary care. School of Pharmacy faculty already play a key role consulting with clinicians about drug therapies and educating community patients. The School of Medicine, which this year placed fourth in primary care in U.S. News and World Report’s medical school rankings, also has technology and policy experts who can team with those who provide the hands-on care.

Stephen McPhee and Diana Taylor

“Preventive medicine is the heart of primary care,” said Stephen McPhee, a professor in the division of general internal medicine who co-directs the CCIPC with Taylor. “We want to take prevention up a notch.”

The roots of the CCIPC go back to the fall of 1995, when former chancellor Joseph Martin appointed a group of faculty and administrators from the four schools to explore ways to increase the campus’ efforts in preparing its graduates for primary care. A committee -- headed by Catherine Gilliss, chair of the department of family health care nursing, and Lee Goldman, chair of the department of medicine -- recommended that the campus develop an interschool primary care agenda, create the new center, and contribute pertinent findings from research and clinical trials to help guide primary care delivery and education. Last year, Martin committed five years of funding for the CCIPC and appointed Taylor and McPhee to direct its efforts. A steering committee of faculty from all UCSF schools is forming to set goals and plan strategy.

The center already has linked faculty from different schools for two projects. Family health care faculty in nursing and medicine are proposing to pilot a program to provide group medical visits and comprehensive wellness services to low-income women in San Francisco. The program would combine the expertise of the physicians, who staff the medical visits, with nursing faculty who have developed women’s wellness and symptom management approaches.

Another program would have medicine and nursing faculty provide comprehensive care and family caregiver support for seriously ill outpatients with cancer, congestive heart failure and chronic obstructive lung disease who are “at the intersection of curative and comfort care.” The research proposal, which is designed to improve the care of patients nearing the end of life, is one example of how the role of the primary care practitioner is being redefined and extended.

Other areas that Taylor and McPhee plan to target include:

• Developing and disseminating preventive care reminders for patients. This would include mailed, telephoned and automated voice-messaging outreach for patients. Current programs target healthy adults and patients with diabetes and HIV. An expanded program would target pediatric immunizations and spread general information beyond the UCSF Medical Center.

• Coordinating chronic pain management, including approaches to problems such as sickle cell disease, chronic pelvic pain, headache and substance abuse. Established groups from different schools, including the Pharmacy and Therapeutics Committees, the UCSF Pain Center and the Center for Symptom Management, would collaborate. Research would examine the primary care clinician’s understanding of chronic pain and how to translate new knowledge to patient care.

• Develop a primary care curriculum -- with faculty from all four schools -- that would include a postgraduate program for primary care physician residents and nurse practitioners and pharmacy and dental graduate students.

The center is now compiling a roster of UCSF faculty and their research and teaching specialties, so others can match their interests and propose partnerships. The center has some funds to start new projects, according to the directors.

For more information, call the CCIPC at 476-4557.

By Andy Evangelista

1st appeared 2/26/98

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