Health Sciences Report Summer 2006

Health Care for the Other Half
Center of Excellence Opens the Door to Preventive Care for Women

By Phil Sahm
Photos By Steve Leitch

Utah, according to the Centers for Disease Control and Prevention, ranks near the bottom of the country in several key areas of women's preventive health: 44th in cholesterol screening; 47th in mammography; 48th in routine checkups; 46th in occult blood screening; and next to last in pap smears. Kathleen B. Digre, M.D., professor of neurology and ophthalmology and visual sciences at the University of Utah School of Medicine, finds those numbers disquieting.

"We're good at taking care of children," Digre said, "but we have not paid attention to women's health."

With the help of a $500,000 grant from the U.S. Department of Health and Human Services (HHS), she and colleagues at the health sciences center are changing that. Digre is director of a new Center of Excellence in Women's Health, headquartered in the University's Madsen Health Center. It will be Utah's first clinic to provide integrated, multidisciplinary care for women.

Utah's first clinic to provide integrated, multidisciplinary care for women draws upon the expertise of many University faculty and staff, including: standing, from left: Clara Michael, M.D.; Leissa Roberts, C.N.M., M.S.; Michael Varner, M.D.; Kathleen Digre, M.D.; Jan Bowker; Leanne Johnston; and seated, from left: Karen Miller, M.D.; Nancy Nickman, Ph.D.; Sally Patrick, M.L.S.; and Yvette LaCoursiere, M.D.

Since HHS established the centers of excellence (CoE) program in women's health in 1999, 20 centers and three demonstration projects have been established nationwide. As the newest demonstration project, the U of U will receive $125,000 annually the next four years. After that, the center will be eligible for permanent CoE designation.

HHS chose the University for several reasons, Digre said. Utah badly needs to improve women's health care. The Intermountain region did not have a CoE. As an academic medical center, the U of U is perfectly suited to provide the multidisciplinary care women need.

The project will involve every school and college in the health sciences center--medicine, nursing, pharmacy, and health--as well as the Spencer S. Eccles Health Sciences Library. The group also has partnered with the Utah Department of Health. The CoE will focus on five areas:

  • Community Outreach and Public Education
  • Clinical Care
  • Professional Education
  • Research
  • Recruitment, Retention, and Promotion of Women Faculty

Within these areas, 13 smaller groups will address issues ranging from adolescent health care to coordination of educational resource centers.

"We're trying to be culturally sensitive to our state's needs. A major component of the CoE will be community outreach and we want to include the whole university in the project," Digre said. "We have the opportunity to train the next generation of caregivers to provide better health care for women."

Lack of preventive screening is an issue for women in all socioeconomic tiers, but it's particularly prevalent among Latinos and Medicaid patients. Because of this, the CoE will include a major component in community outreach and public education, according to Yvette LaCoursiere, M.D., assistant professor of obstetrics and gynecology, and CoE co-director. Two off-campus health centers, the University's South Main Clinic and Ellis R. Shipp Clinic, which already serve as important health-care resources for Latinos and medically underserved women, will play major roles, said LaCoursiere, who'll lead the outreach and public education effort.

Faculty and students from the U College of Nursing and medical school's departments of pediatrics and obstetrics and gynecology long have worked with South Main and Shipp clinic patients. The new CoE will let these practitioners work in concert to give patients multidisciplinary, integrated care. To better understand patients' needs, LaCoursiere plans to hold focus groups with women served by the South Main and Shipp clinics. She also plans to teach these patients how to access health-care information through computers. Once a core group of women is trained, they can share that knowledge with others.

"I'd like to see a community more literate about what's available in health care," she said. "More women can take a role in helping their neighbors become better informed."

Part of Utah's low preventive screening rate among women stems from lack of access to health care, according to Jennifer Van Horn, M.D., assistant professor of obstetrics and gynecology, and Women's Health Clinic director.

The Madsen center currently houses ob/gyn, family medicine, and internal medicine clinics. But if additional services can be brought into one location, it may give more women the incentive to get screened, Van Horn believes. She's already started talking with colleagues in other departments about offering their specialties at Madsen.

To make a long-term impact on women's health care, two other components of the CoE will be essential: professional education and research. Just as clinical care has been lacking, women's health care also has been ignored in the classroom, said Lynne Durrant, Ph.D., associate professor of health education and promotion in the College of Health. Durrant's role in the CoE is to assess what the U of U offers to educate future women's health practitioners. So far, she's found few, if any, classes geared specifi cally to women's health, but that doesn't surprise her.

"Women have been an overlooked population," she said. "But we are starting to see that change."

In her own area of expertise, drug and alcohol treatment, education and research long were based solely on studies of men. But women view addiction much differently from men: a mindset that has been recognized only in the past 15 or so years, according to Durrant. Her goal is to devise a tool to assess the University's curricula in women's health and, ultimately, make an impact through the education of people who'll teach in the fi eld.

Patricia A. Murphy, C.N.M., Dr.P.H., who holds the Annette Poulsen Cumming Presidential Endowed Chair in Women's and Reproductive Health in the College of Nursing, is leading the group to look at research in women's health. To gain a broad perspective, the group is identifying investigators campuswide, in everything from gender studies to social work. She plans to form a core group that will research and publish on women's health issues.

Murphy, whose expertise is in reproductive health and fertility control, is particularly interested in access to health care and preventive services. She believes ability to pay, where people live, education about women's health issues, and even cultural issues infl uence access to health care and Utah's low screening rates, In fact, the reasons behind the low screening rate would make an important research topic, she said.

"We're really trying to coordinate what is a scattershot approach to women's health," Murphy said. "The center of excellence can make a big impact by highlighting the issues and bringing the right specialists together."

A key component in the success of the CoE and its ultimate impact on the health of Utah women will be training women faculty. Digre will lead the effort to assess, mentor, retain, and promote women faculty in health-care disciplines. One of her goals in this area is to see more of the U of U's experienced researchers mentor younger women just staring their careers.

Each of the working groups will partner with the Spencer S. Eccles Health Sciences Library. Through Utahealthnet, the Eccles Library is connected by computer with public libraries statewide, giving thousands of Utahns access to the latest health-care information (see pg. 4). The library also translates, using native speakers, health information into 24 languages on its Web site,

Sally Patrick, M.L.S., Utahealthnet director, will set up resource centers at the Madsen, Shipp, and South Main clinics, where women will be able to look up health-care information as part of their clinic visit. In addition, the Eccles Library's new goLocalUtah program will allow people statewide to fi nd information from the National Library of Medicine's MedlinePlus health information Web site, as well as provide links to health-care services and resources available in individual Utah communities.

Visit the Center of Excellence in Women's Health

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