Comfort, Complexities, and Confrontation: Health Care Provider Communication and Prescription Drug Abuse and Misuse

This presentation describes (1) the role of communication in prescription drug abuse prevention and treatment and (2) the outcomes of 5 focus groups conducted in the Appalachian Region

Does surgery for carpal tunnel syndrome improve outcomes?

Good evidence supports the use of surgery for carpal tunnel syndrome over nonsurgical therapies such as wrist splints, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, occupational therapy, local steroid injections, work modification, and oral vitamin B6 (Grade of Recommendation: A, based on extrapolation from a systematic review of 1 randomized controlled trial [RCT], 1 additional recent RCT, and 2 cohort studies). Surgery is likely worth the extra costs when conservative therapy (up to 3 months) fails to improve symptoms and return of function, because delayed surgery is as successful as surgery performed shortly after diagnosis. Closed endoscopic release and open release surgery are equally effective therapies for controlling symptoms (Grade of Recommendation: C, based on extrapolation from a systematic review of RCTs). However, whether endoscopic release results in more rapid regain of function and return to work is unclear

A New Model for Assessing Teaching Quality Improvement to Family Medicine Residents: Does It Work?

Objective: To develop and implement a formal didactics and experiential curriculum to train Family Medicine (FM) residents in Quality Improvement (QI) knowledge and skills. Method: 1) All FM faculty participated in seven workshops on QI theory and design. 2) All second year residents received a day-long workshop on knowledge and skills of QI and conducted QI projects for up to two years. Results: Knowledge and confidence scores significantly improved following training,

Does Structured Quality Improvement Training for Residents Increase QI in Practice?

East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training

Enhancing Research in a Family Medicine Program: One Institution\u27s Story

Background and Objectives: To enhance research productivity among East Tennessee State University\u27s faculty, the Department of Family Medicine developed and implemented a multi-component initiative to expand multidisciplinary primary care research. Methods: The research support infrastructure expanded to include a family physician research director, three PhD faculty researchers, two research assistants, a statistician, and a grant/science writer. A monthly seminar series, quarterly workshops, and a formal mentoring program paired more-experienced with less-experienced faculty researchers. Through a competitive mechanism in which junior faculty submitted proposals, a multidisciplinary committee selected two family physician researchers to receive protected time to develop their research. Results: From 2001-2006, more than 25 experienced researchers served as mentors, lecturers, consultants, or reviewers. Fifteen mentor-mentee pairs were formed. Of 30 family medicine faculty, the number actively engaged in research, including project design, data collection, oral presentation of results, or journal article submissions, increased from seven (23%) to 19 (63%). From 2001-2006 the number of presentations at professional meetings increased, and articles in peer-reviewed journals increased nearly fivefold. Grant submissions increased, with 19 faculty members participating in grant-writing teams. Based on the success of this initiative, the program has expanded to include faculty members in general internal medicine and general pediatrics. Conclusions: Our multi-component initiative successfully builds and sustains a primary care research program

Subclinical Thyroid Disorders and Cognitive Performance Among Adolescents in the United States

Background: Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States. Methods: Study sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Serum thyroxine (T4) and thyroid stimulating hormone (TSH) were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments. Results: Subclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level. Conclusion: Subclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor

Prescription Drug Abuse Communication: A Qualitative Analysis of Prescriber and Pharmacist Perceptions and Behaviors

Background: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. Objectives This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Methods: Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Results: Respondents\u27 trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Conclusions: Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment

Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. Results: Physicians\u27 practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents\u27 readiness to make small changes for their overweight or obese children. Physicians\u27 self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. Conclusion: Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice