The Queen Street Update    

   All the Latest News from Family Health Center of Worcester  
Winter  2014
Inside This Edition
Reflections From the Education Director
Our Commitment to Children With Special Health Needs
Global Health Track 2014: A Resident's Journal
Our Office-Based Opiod Treatment Program
Learning Lunches Schedule
                    Reflections From the Education Director         
                                                  By Lisa Carter, MD, MPH
At least once a week my husband asks me, "Are you all caught up, Sweetie?"  He is always teasing and he knows it will make me laugh.  Often this question comes on a Monday night when I have come home tired after having worked non-stop a full day, only to find myself more behind on my workload than when the day started.  So I have been thinking lately about strategies to cope with the reality of my endless "to-do" list.  As our health center has been expanding our facilities and services in so many areas at once this year, maybe there are other faculty and residents who can identify with this predicament. 

One thing that always helps me feel better is to take stock of what I have done.  Burnout doesn't come from working too hard.  It comes from working too hard and still not feeling satisfied with what you accomplished.  So I try to develop a discipline of regularly taking my eyes off the "to-do" list and glancing at the "what I have done" list.  For instance, just think about some of the things that we, as a faculty and resident group, have accomplished in the past year:

*    We achieved recognition as a level 2 PCMH with our very first application and are working on 
      achieving level 3.

*    We have quality improvement projects underway to improve our referrals process, new patient
      orientation, childhood obesity services, diabetic registry, children's oral health services,
      vaccines, interconceptional care, advance directives, and transitions of care.

*    Our suboxone education program is fully implemented and operating successfully.

*    We have opened a new primary care team that is piloting a redesigned model of service-delivery.

*    We have moved our consultant psychiatrist from the social services office to the primary care     
     teams, to facilitate better communication and teaching.

*    We have hired 7 new faculty with zero attrition of existing faculty.

*    We got approval to start a primary care fellowship in HIV and viral hepatitis.

Any one of these successes would be a pretty good year's work. And this is not even a complete list.  Nor does it count the thousands of low-income patients who receive excellent medical care, whose lives are immeasurably better because of their relationship with a well-trained, committed family doctor.  This is certainly our most important accomplishment.

So whether or not we are "caught up," let's celebrate what we have done.  We are a pretty amazing group, and we are doing great things.
Our Commitment to Children with Special Health Needs 
By Valerie Pietry, MD, MS 
More than 5,000 children currently receive their care at the Family Health Center of Worcester (FHCW.) In a recent conversation, Valerie Pietry, MD, MS says the health center's providers are particularly well-suited to treat the city's youngest residents. "For pre-natal and peri-natal patients, school-aged children and adolescents, there are many opportunities for learners to jump in," she says. "There is lots of resident teaching through such rotations as behavioral pediatrics."

Children's health services at FHCW include case management services for all mothers and babies up to two years old, breastfeeding support, post-partum support and an array of behavioral development resources. School-based health centers located around Worcester also keep children healthy. "We have sites located where the schools are," Dr. Pietry points out. The ADHD clinic (now in its tenth year) offers evaluation and treatment of ADHD and other behavioral issues. Adolescent patients can receive confidential reproductive health services at the teen clinic.

FHCW also provides care for refugees and offers oral health services to all of its patients. Additionally, Linda Weinreb, MD takes care of homeless families at FHCW. "Social services provide a helpful family connection," Dr. Pietry says. "We like to be able to provide services tailored for those populations that need it." 
                           Global Health Track 2014: A Resident's Journal
by Monica Agarwal, MD, PGY-3  
As part of the Global Health Track, I recently went back to Nicaragua for my third trip during residency. After a week of intensive language immersion training, I worked closely with our local partners to implement a needs assessment on breastfeeding practices in the rural community of El Tololar, Nicaragua. This is a small community with a population of approximately 6,000 people.  We were fortunate to be able to travel to every part of the community to invite women to participate in our survey. We also invited various groups of women for more detailed focus group discussions. 

En route for field day in El Tololar!

It was an amazing experience overall, and we were able to learn about cultural beliefs that influenced breastfeeding practices. The next step of the project is to present the results back to the community and work with them to develop possible interventions. It has been a memorable experience to be part of the Global Health Track and have the opportunity to learn about the culture and breastfeeding practices in this rural Nicaraguan community.

Interviewing local women about breastfeeding practices in El Tololar

  Our Office-Based Opioid Treatment Program

by Philip Bolduc, MD


The Family Health Center of Worcester serves patients in the Main South neighborhood of Worcester and throughout Worcester County.  Opiate and opioid addiction is a widely destructive force in the lives of many of our patients, be they suffering from addiction themselves or from the impact of addiction on their families and community.  Lost jobs, squandered resources, domestic violence, petty and violent crime, broken homes, infectious and other diseases and premature death are just some of the burdens addiction brings to our community. 

The FHCW Office-Based Opioid Treatment (OBOT) program seeks to address the problem of drug addiction through a combined approach of structured opioid maintenance therapy with Suboxone, referral for psychological and/or psychiatric care, and education of primary care providers in addiction treatment.  The OBOT program provides structure and guidance to FHCW attendings, residents and nurses in their roles managing patients with opioid addiction, and offers the primary care physician a powerful tool to significantly change the course of a patient's life and their impact on their family and community.

The goals of our OBOT program are therefore summarized as follows:
*       Cessation of drug abuse
*       Restoration of health and wellness that have been disrupted by drug abuse
*       Improvement in function and quality of life for patients and their families
*       Reduction in HIV and Hepatitis transmission
*       Reduction in criminal activity related to drug abuse

                         Learning Lunches Schedule (February-March 2014)                

Feb. 19 -  Sexual History  (Hannah Roy, med student) 
Feb. 26 -  Case Conference Review  (Dr. Shields)  
  Mar. 5 -  Breastfeeding  (Dr. Agarwal) 
Mar. 12 -  HIV topics (Dr. Bolduc) 
Mar. 19 -  JNC8 New Lipid Guidelines (Dr. Rodenas-Martinez) 
Mar. 26 -  Case Conference Review  (Dr. Shields)