CME / Events

Change Gives FPs Flexibility to Choose Best Learning Formats

In the AAFP’s latest move to adapt to family physicians’ evolving needs, the Academy has eliminated the requirement for active members to earn 25 credits of CME through live activities. The change will allow active members to pick the learning formats that best suit their needs and preferences.

Learn More

Save the date!

April 6-9, 2022
Maine AFP 30th Annual Family Medicine Update

South Portland, DoubleTree by Hilton
Schedule and registration info available in January 2022

The Annual MAFP Family Medicine Update is presented by the Maine Academy of Family Physicians to provide ongoing quality education through engaging didactic lectures and breakout sessions on subjects of interest to family doctors.

Full Schedule and Registration information will be available in January 2022. Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.

Registration Refund Policy: A full refund less a $45 administrative fee will be issued to prepaid registrants unable to attend when requested in writing. **Refund Request Deadline – postmarked or emailed March 27, 2022**

 

Dec 6-10

Family Medicine Update Livestream. Get timely, ready-for-practice updates taught by family physicians for family physicians.

 

Learn More

New Website

We have a brand new website! Check it out at www.maineafp.org
We heard from you, our physician members, and want to make sure we are doing everything we can to provide you all with useful, timely, succinct, and easily navigable information that will assist you in your professional and personal lives.

Medical training during a pandemic: Original writing from a 4th year medical student from Maine

In the winter of 1918 my great grandmother was at home in South Portland, pregnant and suffering from the Spanish Flu. It was her 3rd of what would be 13 pregnancies. She went into early labor and my grandmother was born; preterm but vigorous. I could never have imagined that just over 100 years later, the clinical years of my journey through medical school would be dominated by another pandemic. Training during the COVID-19 pandemic has been a unique, sometimes frightening and intense learning experience. 

One of the main reasons for my interest in Family Medicine is that patient interaction is in my nature. I enjoy learning about people–their families, their interests, and their goals–and trying to understand the context they live in. Patient interactions during the pandemic have been unusual, to say the least. Without families or caretakers in the room, my conversations have been more intimate but perhaps less complete. It seems patients are more willing to share honest or hard truths when they don’t have to worry about the impact of these truths on people they love. However, without families in the room, I am not learning to manage the complexity of their role in the patient-physician relationship or benefiting from their synergistic memories.

Interactions are also affected by the nagging sense that patients are now dangerous. This has further been heightened as breakthrough cases in vaccinated individuals become more common. Patient visits are shorter, if for no other reason than I spend 2-3 minutes donning and doffing PPE. Given the myriad ways that COVID can present it seems that it’s always on my differential with anyone other than the completely well patient. It is frightening to know that I could bring a potentially deadly virus home to my family, including my two young kids and asthmatic mother. 

My fears came true in a sense when I contracted COVID from a patient during a recent rotation at Maine Medical Center. The patient was not under suspicion for COVID, and was vaccinated, as am I. Luckily, due to excellent contact tracing, advice from employee health, the Maine CDC and an unexpected ten day backyard camping trip, I got through the infection without severe symptoms or spreading COVID to my family. It felt like a close call and was draining to think that even after having been vigilant for nearly 18 months, one patient interaction of approximately 20 minutes could potentially reverse all the hard work. The additional cognitive and emotional load has been difficult to bear in an already challenging time in training.   

As I look toward residency, I suspect I am more prepared in some ways than past students. For instance, most patients I’ve seen during emergency department rotations have more acute illness than I would suspect was typical pre-COVID. The less acute are not present with a higher threshold to come in and thus most patients are presenting later in their disease course. Because of this there are many common conditions that I have only seen once or twice. Colds and flu seem as rare to me as melanoma or pancreatitis – the latter two of which I have seen far more of; even with months spent in primary care offices in third year. I have to trust that my training will give me the skills to treat future patients despite this difference. It will be interesting to see how my cohort performs overtime and where our deficiencies and assets lie. 

Both my great grandmother and grandmother lived into their late 90’s. Although they are not with us to experience the current pandemic I wonder what their perspective would be and what wisdom they could share about surviving and moving beyond challenging times which they both knew so much about. They were resilient, powerful women and I can only hope my colleagues and I can follow their example and learn from these demanding times. Hopefully rising as more resilient and resourceful clinicians and people from this current pandemic.     

Ben Davison is a 4th year MD candidate at Tufts University School of Medicine (Maine Track) and student board member of the Maine Academy of Family Physicians. He lives in New Gloucester, Maine with his wife and two children.

Advocacy & Legislative Updates

Reproductive Health Update – Maine AFP

  • Texas’ SB 8 went into effect on September 1 after the Supreme Court failed to intervene and subsequently rejected an emergency request to block it. This is a ban on abortion at approximately six weeks, before many people even know they’re pregnant, grants private citizens the power to sue abortion providers and anyone else who helps someone access abortion care and be rewarded with $10,000 or more. With almost no exceptions (rape or incest are not considered exceptions), people who need abortions will need to leave the state, an undue burden. More than that, communities are now polarized against each other with a “bounty hunter” scheme of suing anyone involved in providing an abortion, whether a healthcare provider or even the taxi driver that drove the patient to a clinic.
    • In response, The Women’s Health Protection Act (WHPA) was written. This would protect the right to abortion throughout the United States by creating a right for healthcare providers to provide abortion care and a corresponding right for people to receive that care, free from bans and medically unnecessary restrictions that single out abortion and block access. The house approved this bill on Friday, 9/24, and it is awaiting Senate approval.

Weekly legislative calls

The MMA Legislative Committee holds weekly conference calls during the legislative session to review and finalize the MMA’s position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week. For more information or to join the calls, please contact Dan Morin, Director of Governmental Affairs and Communications at dmorin@mainemed.com or 207-480-4199.

 

Delay in AAFP Congress of Delegates and plan for Maine AFP town hall to discuss member opinions

Every year, the American Academy of Family Physicians convenes a Congress of Delegates (COD), which is the Academy’s policy-making body. Its membership consists of two delegates and two alternates from each constituent chapter and from the member constituencies including new physicians, residents, students, and other constituency groups represented at the National Conference of Constituency Leaders.

The Congress elects new officers and three members to serve on the Board of Directors for the following 12 months. AAFP members are welcome to participate in hearings of the five reference committees: Advocacy, Education, Health of the Public and Science, Organization and Finance, and Practice Enhancement. Reference committees are committees of the COD that consider business (resolutions) items referred to them for recommendation to the COD for debate and action.

The COD generally happens just prior to FMX, but this year, due to COVID-19, the COD has been split into two different meetings. The first meeting, occurred September 27 and 28 only addressed electing new officers and members of the Board of Directors. There will be a second meeting which will address business (resolutions) items. Resolutions are typically submitted by the constituent chapters and debated by the congress, then voted on for action by the AAFP. This meeting is scheduled for February 5 and 6, 2022. It is anticipated that this will be held in person in Kansas City, Missouri. Your delegates will be attending. For more information go to: www.aafp.org/congress

MAFP Member Virtual Town Hall – Your constituent chapter, the Maine Academy of Family Physicians, will be holding a town hall meeting January 13, 2022, via zoom (or similar carrier), to discuss how you would like your delegates to the COD to approach the resolutions which will come up for debate. For more complete information and to Register go to: MAFP Member Virtual Town Hall

Dues & Getting Involved

Questions about dues? Need to pay your dues?

Check your status here:

Check My Dues
  • Want to get involved with the MAFP?
  • Is there someone you’d like to nominate to be a board member?
  • Do you have someone in mind for our annual Maine Family Physician of the Year?
  • Are you interested in having your original writing featured in our newsletter?
We welcome all of your input and suggestions. Please contact our Executive Director, Deborah Halbach, at maineafp@tdstelme.net.

Practice Pearls

COVID practice update

Long Covid Clinic:

Northern Light Mercy Hospital launches post-COVID care

Northern Light Mercy Hospital has launched a new effort to help those who are experiencing lingering symptoms even after they have recovered from COVID-19 infection. The hospital has brought together a select group of providers to focus on the evaluation and treatment of post-COVID patients. This approach will help Mercy clinicians work efficiently with Massachusetts General Hospital on developing evolving clinical guidelines to provide the most up to date care for these patients.

Post-COVID patients may have a range of symptoms that could require evaluation from a variety of specialists. During the initial visit, each patient undergoes a comprehensive intake and physical evaluation. A patient navigator then arranges additional imaging, testing, and/or referrals to specialists as needed.

Those seeking evaluations can call 207-857-8375 to schedule an appointment. Northern Light Mercy Hospital – Northern Light Health


OK to have flu shot and COVID vaccine at the same time:

The U.S. CDC and the Advisory Committee on Immunizations Practices recommend that if a patient is eligible, both the flu and COVID-19 vaccines can be administered at the same visit. In addition to flu vaccine, the COVID-19 vaccine can be given with other vaccines as well. Even though both vaccines can be given at the same visit, people should follow the recommended schedule for either vaccine. Previously, CDC guidance recommended healthcare professionals administer COVID-19 vaccine alone. This recommendation was out of an abundance of caution during a period when these vaccines were new and not based on known safety or immunogenicity concerns. However, substantial data have now been collected regarding the safety of COVID-19 vaccines currently approved or authorized by FDA.

Coadministration of Influenza and COVID-19 Vaccines.pdf


Monoclonal Antibody (mAb) Therapies for Treatment of Individuals with COVID-19

Maine Provider Info Sheet (October 29, 2021)

Introduction: The U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUAs) for use of three monoclonal antibody (mAb) products for the treatment of mild to moderate COVID-19 in non-hospitalized adults and pediatric patients who have tested positive for COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization or death. These include:

  • Casirivimab/imdevimab (REGEN-COV – Regeneron) – FDA EUA Provider Fact Sheet (09/2021)
  • Bamlanivimab/etesevimab (Lily) – FDA EUA Provider Fact Sheet (09/2021)
  • Sotrovimab (Xevudy – GSK) – FDA EUA Provider Fact Sheet (09/2021)

Who may receive mAb treatment?

Under the terms of current EUAs, mAbs may be used for the treatment of mild to moderate COVID-19 in adults and pediatric patients who meet all of the following:

  • Had positive test for SARS-CoV-2 (molecular/PCR or antigen test)
  • Are within 10 days from the start of their COVID-19 symptom onset
  • Are at least 12 years of age or older and weigh at least 40 kilograms (88 pounds)
  • Are not currently hospitalized but at high risk for progressing to severe COVID-19 and/or hospitalization.

Because national mAb supplies are constrained, Maine DHHS has currently prioritized use of mAbs for treatment of individuals diagnosed with COVID-19 over the routine use for post-exposure prophylaxis, though use for post-exposure prophylaxis is encouraged specifically in the setting of high-risk congregate settings such as Long Term Care facilities and correctional facilities.

How & where to refer patients for mAb treatment:

There currently are several sites in Maine that offer mAb treatment, including many hospitals, free-standing infusion centers, urgent care centers, and some primary care practices. Providers should refer patients who qualify for mAb therapy to a facility in their area that offers mAb therapy as soon as possible following diagnosis (see list of Maine mAb treatment sites).

Additionally, providers and patients can search for mAb treatment site in their area by checking the online infusion center locator from the National Infusion Center of America (NICA) at https://covid.infusioncenter.org.

Definition of “high risk” patients:

The FDA EUAs for the three therapies define individuals at high risk for progressing to severe COVID-19 as either adults or children who meet one or more of the following criteria:

  • Older age – e.g., 65 years of age or older
  • Obesity or being overweight (for example, BMI >25 kg/m2 , or if age 12-17yrs, have BMI ≥85th percentile for age and gender based on CDC growth charts, https://www.cdc.gov/growthcharts/clinical_charts.htm)
  • Pregnancy
  • Chronic kidney disease
  • Diabetes
  • Immunosuppressive disease or immunosuppressive treatment
  • Cardiovascular disease (including congenital heart disease) or hypertension
  • Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)
  • Sickle cell disease (cont’d)
  • Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)
  • Having a medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19))
  • Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and authorization of REGEN-COV under the EUA is not limited to the medical conditions or factors listed above.

NOTE: Because unvaccinated individuals are at higher risk for progressing to severe disease, Maine clinicians are encouraged to prioritize referral of unvaccinated individuals for mAb treatment, as well as vaccinated individuals who are not expected to mount an adequate immune response (e.g., those who are immunocompromised).

Use of mAbs in pregnant patients with COVID-19:

  • Pregnancy is one of the recognized COVID-19 “high risk” conditions, and the American College of Ob-Gyn (ACOG) has updated its guidance on use of mAbs in pregnancy within its COVID-19 FAQs.
  • Per ACOG, “Obstetric care clinicians may consider the use of monoclonal antibodies for the treatment of non-hospitalized COVID-19 positive pregnant individuals with mild to moderate symptoms, particularly if one or more additional risk factors are present (e.g. BMI >25, chronic kidney disease, diabetes mellitus, cardiovascular disease).”

Use of mAbs in children with COVID-19:

  • American Academy of Pediatrics (AAP) has developed an FAQ on Outpatient Monoclonal Antibody Therapy for high risk youth >12 years.
  • If you have a patient that might benefit from COVID-19, contact a pediatric Infectious disease specialist to discuss.

Who should NOT receive these mAbs?

These three mAb therapies may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation. Under the terms of the current EUAs, these mAbs are not authorized for use in patients who meet any of the following:

• Are hospitalized due to COVID-19

• Require oxygen therapy due to COVID-19

• Require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity

What are mAbs and how do they work?

Monoclonal antibodies are man-made proteins produced in the laboratory that mimic the immune system’s ability to fight off harmful antigens such as viruses. mAb’s to treat COVID-19 are directed against the spike protein of SARS-COV2 and block the ability of the virus to attach and enter human cells, thus neutralizing the virus that causes COVID-19.

How are mAb treatments given?

All three mAbs authorized for COVID-19 can be given by intravenous (IV) infusion and should be administered in settings in which health care providers have immediate access to medications to treat severe infusion reactions, such as allergic reaction, and the ability to activate the emergency medical system, as necessary. Additionally, casirivimab/imdevimab (REGEN-COV) may be given by subcutaneous administration.

Why consider mAb treatments now?

Maine continues to experience a statewide surge in COVID-19 cases related to rapid and extensive spread of the Delta variant, which has resulted in high rates of hospitalization and Intensive Care Unit (ICU) utilization. Appropriate and timely use of COVID-19 mAb therapies for individuals at risk for progressing to severe disease can help decrease the number of individuals who develop severe COVID-19 and can also help to decrease the pressure on Maine’s hospital and ICU treatment capacity. As of late October 2021, Maine is still seeing ~600-800 COVID-19 cases reported per day, with fewer than 500 patients per week receiving mAb treatment.

How & where to refer patients for mAb treatment:

There currently are several sites in Maine that offer mAb treatment, including many hospitals, free-standing infusion centers, urgent care centers, and some primary care practices. Providers should refer patients who qualify for mAb therapy to a facility in their area that offers mAb therapy as soon as possible following diagnosis (see list of Maine mAb treatment sites).

Additionally, providers and patients can search for mAb treatment site in their area by checking the online infusion center locator from the National Infusion Center of America (NICA) at https://covid.infusioncenter.org.

For questions or other related issues, providers may also contact Dr Lisa Letourneau at ME DHHS: lisa.letourneau@maine.gov.

For more information on mAb therapies, visit https://combatcovid.hhs.gov/


Monoclonal antibodies:

The following information was accurate as of 9/23/21.

As a hospitalist currently facing the difficulty of trying to get hospitalized patients the care they need with essentially no hospital beds available in the state, I ask that you consider referring qualifying patients for monoclonal antibody treatment, both to help the patient by potentially preventing the disease from progressing, and also to help keep patients out of the hospital if possible.

While there are currently no FDA approved therapies for the management of patients with COVID-19 in the outpatient setting, the FDA has provided Emergency Use Authorization for some monoclonal antibodies. The approved options include both Bamlanivimab-etesevimab and carisirivimab-imdevimab. Both are given by IV infusion.

Inclusion criteria are either age 18 or older, or age 12-17 and weight 40kg or more, and not hospitalized for COVID-19, and not requiring supplemental oxygen (or not greater than baseline if on supplemental oxygen at baseline), and high risk of progression to Severe Covid-19, hospitalization, or death. In addition to the above inclusion criteria, patients also have to meet the following eligibility criteria: presenting within 10 days of symptoms, confirmed COVID-19 via laboratory testing in the previous 10 days, and mild to moderate COVID-19.

There previously was an indication for prophylaxis, however, due to shortages, monoclonal antibodies are not available for prophylactic use at this time.

Infusion center sites include NL-EMMC (207-973-8286), St. Joseph’s Hospital in Bangor (207-907-3000), NL-Mercy (207-879-3355), NL-Inland (207-861-3380), NL- Sebasticook Valley Hospital (207-487-4089), NL-Mayo (207-564-4283), NL-AR Gould (207-768-4158), NL CA Dean (207-695-5270), NL Maine Coast (207-664-5470), NL Blue Hill (207-374-3996), NL Acadia (207-973-6160), Down East Community (207-255-0435), Cary Medical Center (207-762-0457), NL monoclonal antibody team (207-400-8790). This may not be an all inclusive list.

You may also search for a mAb site using this tool.


Please see attached guidance below regarding coadministration of influenza and COVID-19 vaccines.


MaineHealth ECHO Project in Neurology Needs YOUR Help –

I am a PGY-2 neurology resident at MMC. We are establishing an Extension for Community Healthcare Outcomes (ECHO) for neurology.

ECHO is a forum for delivering high-quality specialty care to underserved communities. Through monthly Zoom sessions on a variety of specialty care topics, physicians and other care team members from across the MaineHealth system connect for didactic presentations and case discussions. (For a fuller explanation visit https://www.mainehealth.org/Healthcare-Professionals/Project-ECHO).

What topics would be useful to your practice? We would be very appreciative if you could complete a short – 6 question survey – (<2 minutes to complete)

https://www.surveymonkey.com/r/82MKZTL

Thank you for taking the time to answer our survey!

Clifton Lewis DO, PGY2, MMC Neurology Residency