My dad was right; I'm not that smart. In my more than 20 years as a PA, I've never practiced a day of primary care, opting instead to concentrate on cardiothoracic surgery and cardiac electrophysiology. For me, limiting my focus has been far easier than trying to remember everything about everything, not to mention having to “change gears” every time I enter another clinic room. I've always admired those who can do this, particularly whenever I have to take the recertification exam.
It's no surprise to practitioners or patients that there has been a staggering proliferation of medical information and health policy regulation over the past two decades. Advances in diagnostics and therapeutics have been accompanied by a steady stream of guidelines and protocols, some of which conflict with one another. Health care legislation and mandates seem to come along at twice the rate of medical advances and to change almost as soon as they are implemented.
The history of CSAC
The physician assistant profession was not forgotten by organized medicine during these years of change. Since the mid-1990s, the AAPA has regularly been asked to review, endorse, and/or distribute recommendations and guidelines for patient care issued by various medical societies and agencies. The interest in our profession expressed by various medical organizations at a time when Web-based medical information was not readily available prompted Lynn Caton, then the president of the AAPA, to create the Clinical and Scientific Affairs Council (CSAC). CSAC was introduced to Academy members through a March 1997 Sounding Board in JAAPA written by James Taft.
CSAC's responsibility to the Academy and to its members includes identifying, monitoring, and disseminating information regarding clinical and scientific developments related to the practice of medicine. This includes assisting primary care PAs with the formidable task of sorting through the rapidly mounting stack of guidelines and practice parameters in order to provide better patient care. To facilitate this objective, the CSAC Special Report was born.
The first Special Report was published in JAAPA in April 1998 and reviewed the new classification system for diabetes mellitus that had been released the previous year by the American Diabetes Association and was supported by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Subsequent Special Reports that first year included overviews of the sixth
report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and of new guidelines for the diagnosis and management of asthma. Nine years later, CSAC has published more than 25 Special Reports on a range of subjects, including stroke, tools for evaluating clinical practice guidelines, immunizations, biological and chemical terrorism, cancer screening, and women's health. All are available in the JAAPA archives at www.jaapa.com and at www.aapa.org.
As CSAC Special Reports evolved, they became more detailed and broad-ranging. Although the indepth reports benefited readers, their breadth and scope increased CSAC's preparation time and limited the number of reports that could be written in any given year. Indeed, over an 18-month period in 2004- 2005, only two Special Reports were published—and it was becoming difficult to meet the Council's objective of helping primary care PAs sort through the plethora of guidelines and practice parameters. At Leadership Summit in July 2006, council members discussed the Special Reports with the editor and editor in chief of JAAPA, with the goal of improving the reports to better serve Academy members. We recognized that while JAAPA's readership includes PAs practicing in a wide range of practice areas, most are in primary care. We acknowledged that practice guidelines, protocols, and other types of new health care information were coming out too fast for us to keep up with them. We also recognized that readers needed the information we could provide more frequently than we had been providing it, and in a format that would be quick and practical to read. Clearly, change was needed. As we begin a new year, you'll notice several changes in the information that CSAC provides to JAAPA readers. First, CSAC Special Reports has been renamed and is now called Clinical Watch—a name that reflects what we hope will be a more precise, practical, and useful tool for the primary care practitioner. Second, we recognize that PAs are busy and want to receive new information rapidly, so we have shortened our offerings. Information is now organized in concise sections that utilize a question-and-answer format, and each Clinical Watch offers take-home points that PAs can use in their practice. We will provide tables, algorithms, and other useful enhancements when these are helpful, but they won't lengthen our articles. Finally, Clinical Watch will appear significantly more often—six times a year— than the old Special Reports did. Look for it every other month in 2007, starting this month.
CSAC's first Clinical Watch submission for 2007 addresses community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections. This article covers the who, what, when, where, and why of CA-MRSA to provide practitioners with the pertinent information needed in their practices this very day. Topics to be covered in subsequent months include the new HPV vaccine and new guidelines on atrial fibrillation, sexually transmitted diseases, and pediatric advanced life support.
A word of thanks
I am privileged to have worked with such an intelligent and enthusiastic group of CSAC colleagues. I've served under chairs Rick Davis, Sarah Toth, Debi Gerbert, and Larry Herman—all gifted and bright individuals. I am most grateful to the council members with whom I've worked—Rick Muma, Tim Quigley, Ed Blanchard, Eileen Van Dyke, Cindy Ulshafer, and Dan O'Donoghue—and to AAPA staffers Bob McNellis, Marie-Michèle Léger, and Greg Thomas. I didn't have the good fortune to work with Rick Donnelly, Sharon Girard, or Jim Taft during their tenures on CSAC, but I have certainly benefited from their work. Finally, none of us would have had the success we've enjoyed without the help of AAPA staffer Cheryl Holmes, who has been the “glue” that holds us all together. As my tenure on CSAC comes to an end in May this year, I only hope my colleagues don't find out what my dad has known all along. JAAPA
The author is a faculty member of the Division of Cardiology, Cardiac Electrophysiology, at the University of Washington, Seattle. He is a member of CSAC, the Clinical and Scientific Affairs Council of the AAPA.