Systematic Reviews & Meta-Analyses

Objectives At the end of this session: You will understand the process of conducting a SR&MA You will be able to better read and understand journal articles that are reports of SR&MA You will have resources for further exploratio

Evaluation of the Jefferson Family Medicine Associates’ Diabetes Information and Support for Your Health (DISH) Program [presentation]

Type 2 diabetes is increasing in incidence and prevalence, and contributes to significant morbidity, mortality, and costs. Type 2 diabetes management is complex and requires continual patient self-management. However, many physicians lack the time and training to deliver comprehensive diabetes self-management training to their patients, and only 56.8% of individuals with Type 2 diabetes have received formal diabetes education. Group medical visits (GMVs), which combine one-on-one clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management. This dissertation used a quasi-experimental nonequivalent groups design to evaluate the four-session Diabetes Information and Support for your Health (DISH) program at Jefferson Family Medicine Associates (JFMA). DISH participants were compared to a group of non-participating subjects with type 2 diabetes at JFMA on baseline demographics. Next, propensity score matching was used to match DISH participants with a comparison group DISH participants and the matched group were then compared for changes in hemoglobin A1c (HbA1c), systolic blood pressure, low-density lipoprotein cholesterol, and body mass index, and compared on their change trajectories. A sub-analysis also examined the HbA1c change of the initial cohort of DISH participants from 2009. DISH participants and the matched comparison group were also compared on rates of retinal exam completion and nephropathy screening, and on the mean number of primary care visits, emergency department visits, and hospital admissions in the 1-year time period following DISH participation. This study’s contributions include: (a) an evaluation of a group visit program in a predominantly African American population; (b) an evaluation of an established group visit program in a primary care practice; (c) the use of data derived from electronic medical records for group visit evaluation; (d) a comparison of group visit participants and nonparticipants; (e) an analysis of group visits’ impact on HbA1c, systolic blood pressure, low-density lipoprotein cholesterol, and body mass index change and change trajectories, including 5-year HbA1c change; and (f) an analysis of group visits’ impact on processes of care and utilization. Findings on the clinical outcomes and costs of the DISH program can be used to inform future DISH iterations at JFMA. Finally, the results may have implications for health policy, specifically chronic illness care models and group visit reimbursement

Factors Influencing Resection in Locoregional Pancreatic Cancer Patients

Objective: Identify factors associated with resection in a national sample of locoregional pancreatic cancer patients. Poster presented at ISPOR conference in Washington DC.https://jdc.jefferson.edu/jcphposters/1008/thumbnail.jp

Accelerating Primary Care Transformation at Jefferson (JeffAPCT): Reflections from a Five- Year HRSA Grant

JeffAPCT Overview Five year HRSA-funded grant (7/1/15-6/30/20) Leadership team from Family Medicine, Internal Medicine, Physician Assistant Program Objective 1: To improve/ expand primary care and population health curriculum across the continuum of primary care providers and trainees (students, residents, and practitioners) Objective 2: To create an enhanced, sustainable model of primary care physician faculty development for PCMH Transformation Objective 3: To create a new, sustainable model of faculty development for community-based primary care preceptors (MD/DO, PA, NP, others

“Taking the Pulse of Jefferson Primary Care: Provider and Team Wellness Survey Results and Next Steps”

Agenda Context (Randa Sifri) Results (Amy Cunningham) Action Steps (Keith Sweigard) Q&

Adolescent HIV Pre-Exposure Prophylaxis Prescribing Practices Among Family Medicine Physicians: Limited Immediate Uptake

Introduction: In the United States, individuals aged 13-24 made up 21% of new HIV infections in 2016. In 2018, the FDA approved tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) for adolescents aged 15-17. In 2019, we examined adolescent PrEP prescribing practices among family medicine physicians at an academic family medicine practice. Methods: Physicians were invited to complete an online questionnaire assessing PrEP knowledge, attitudes, and prescribing practices. Differences in PrEP knowledge and attitudes among providers who prescribe PrEP to adolescents versus those who do not were examined using independent samples t-tests. Results: 50 out of 99 surveys were completed. Respondents were 90% White, 84% heterosexual, 50% attendings, 50% residents/fellows, and 2% HIV specialists. All respondents had heard of PrEP before the survey, 76% had prescribed PrEP and 70% reported being aware of the FDA approval of PrEP for adolescents. While 86% reported treating patients aged 15-17, only 6% reported having prescribed PrEP to this demographic. Physicians who reported prescribing PrEP to adolescents reported greater comfort assessing for indications for PrEP, t(48)= -2.23, p \u3c 0.05, greater PrEP knowledge, t(47)= -3.34, p \u3c 0.005, and felt PrEP was safer, t(48)= -2.09, p \u3c 0.05, compared to physicians who had not. Conclusion: Despite universal awareness of PrEP, high rates of prescribing to adults, and awareness of FDA approval of PrEP for adolescents, PrEP prescribing to adolescents in our sample remains limited. Differences between providers who have and have not prescribed PrEP to adolescents suggest targeted training may boost prescribing to this demographic

Jefferson Primary Care Champions (JeffPCC) Fellowship Program

Agenda Background Objectives Project Team Fellowship Recruitment, Responsibilities & Support Curricula Fellowship Cohorts and Projects Highlights and Challenges Evaluation Next Step

Research in the DFCM

Objectives Scope of Family Medicine/Primary Care Research Overview of Departmental Research Infrastructure/research seminars/meetings Departmental Research Topic Areas How to get involved Research Website/IRB issues Research Fellowship Resident research lectures/curriculu

Research in the Department of Family and Community Medicine at Thomas Jefferson University

Objectives: Quick overview of Departmental Research processes: Infrastructure/Research Seminars/meetings Department Research Topic Areas How to get involved Research Website/IRB issues Research Fellowship Resident research lectures/curriculum Presentation: 51:5

The Intersection Between Medication Tablets and Electronic Tablets: Determining the Usability and Acceptability of a Patient-Centered Cardiovascular Risk Assessment (PCCRA) iOS App

Background One American dies from cardiovascular disease (CVD) every 40 seconds. Risk factor awareness, assessment, and communication has been shown to improve efficacy of patient treatment and also decline overall risk in the population over time. Traditional cardiac risk assessment tools (e.g. Framingham risk assessment, FRA) generate a risk score in a format that may not appreciated or easily understood by all patients. A new patient-centered approach, in which the patient becomes an active participant in the decision-making process, has shown significant increase in patient-provider communication and diagnosis/management.https://jdc.jefferson.edu/cwicposters/1010/thumbnail.jp