Family Medicine Commons^™

Sbirt Workflow, Dory Hart Emery, Tory Gamage, Sara Watts, Carol Mcclure, Anne Barker, Liz Berry, Liz Anderson

Operations Transformation

SBIRT stands for Screening – Identify patients with unhealthy substance use. Brief Intervention – A collaborative conversation that raises a person’s awareness of substance use and its consequences and encourages behavioral changes. Referral to Treatment – Actively link patients to resources when needed. It is a substance use screening tool that we ask patients 18 yrs. old and older to fill out once a year when having their CPE or AWV. SBRIT has been recognized as an integral part of primary care. It is an approach that delivers prevention, detection, and early intervention for individuals at risk of substance use …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Evaluating Engagement In Health Care And Substance Use Disorder Services Among People Who Use Drugs, Tiffany Mckenney, Kevin Cobty, Divya Boorle, Julie Gleason-Comstock

Medical Student Research Symposium

An urban community-based organization conducted a study to examine demographics of individuals who use drugs and their approaches to risk reduction. A substantial proportion reported encountering significant barriers to accessing substance use disorder (SUD) services.

In collaboration with a state survey, the community organization recruited a convenience sample of individuals who actively used drugs, examining substance use patterns, healthcare access, and barriers to SUD services. Community health workers facilitated outreach efforts, focusing on harm reduction engagement, and healthcare access.

Data were collected from 55 individuals. 51% identified as male, 48% as female, and 2% as LGBTQIA+. 67% identified as White/Caucasian, …

Variation In Treatment Recommendations For Low-Risk Prostate Cancer: A Focus On Active Surveillance Across Physician Specialties, Sinyu Yang B.S., Tiffany Chu B.S., Cathryn Bock Ph.D, Jinping Xu M.D.

Medical Student Research Symposium

Prostate cancer (PC) is the second leading cause of cancer-related death in men globally, with 1 in 8 men in the US diagnosed during their lifetime. For Low-Risk Prostate Cancer (LRPC), management options include Watchful Waiting (WW), Active Surveillance (AS), or curative treatments such as prostatectomy or radiation. While curative treatments can have significant long-term side effects like urinary incontinence and sexual dysfunction, AS is less invasive and preferred due to fewer adverse effects. However, variations in physician training may lead to differing recommendations, potentially causing confusion or frustration for patients consulting multiple specialists. This study investigates whether treatment recommendations—AS, …

Establishing A Student-Run Mobile Clinic In Appalachian Kentucky: A Community-Based Pilot Program To Address Health Inequities, Bradley A. Firchow, John C. Cornelius

Journal of Appalachian Health

The establishment of a student-run mobile clinic in Morehead, Kentucky, led by students from the University of Kentucky College of Medicine’s (UKCOM) Rural Physician Leadership Program (RPLP), aims to address health inequities in rural Appalachian communities. This pilot program is designed to serve vulnerable populations, including the unhoused, by delivering free, accessible healthcare services directly to underserved populations. This program serves as a model for expanding access to healthcare in rural regions while promoting a collaborative, community-based approach to addressing social determinants of health.

Implementation Of Endometriosis Toolkit: A Quality Improvement Project To Enhance Nurse Practitioners’ Knowledge And Management, Hasbun Rachel

DNP Qualifying Manuscripts

Abstract

Background: Endometriosis, characterized by the ectopic growth of endometrial-like tissue, affects approximately 11% of reproductive-aged women in the United States. Diagnosing endometriosis is challenging due to its diverse clinical presentations, reliance on laparoscopic procedures, absence of biomarkers, and limited awareness among healthcare providers and patients.

Local Problem: The diagnostic complexity of endometriosis, compounded by reduced provider awareness and a lack of comprehensive resources, leads to delayed and suboptimal care for affected women.

Methods: This Doctor of Nursing Practice quality improvement project aimed to enhance nurse practitioners’ (NPs) knowledge and management of endometriosis through a 1-hour educational session at the …

Abortion Training In Family Medicine: A Post-Dobbs Examination, Innes Tounkel, Lauren Kasoff, Brittany Macdonald, Krys Foster, Allison Casola, Glen Atlas

Cooper Rowan Medical Journal

No abstract for this article type.

Racial Disparities Of Type 2 Diabetes Through Exercise: The Multi-Ethnic Study Of Atherosclerosis, Tong Xia, Roch A. Nianogo, Qingzhao Yu, Tamara Horwich, Preethi Srikanthan, Kosuke Inoue, Matthew Allison, Zuo-Feng Zhang, Karol E. Watson, Liwei Chen

School of Public Health Faculty Publications

Introduction: Persistent racial and ethnic disparities exist for Type 2 diabetes in the U.S. Racial and ethnic minorities have a higher risk of Type 2 diabetes, and studies suggest that they engage in less exercise than White population. This study examined whether and to what degree racial differences in Type 2 diabetes were explained by exercise. Methods: Adults aged 45–84 years without Type 2 diabetes at baseline (2000–2002) were included from the Multi-Ethnic Study of Atherosclerosis cohort and followed through 2020. Associations between race and Type 2 diabetes were examined using multivariable Cox proportional hazard regression. The effects of exercise …

Factors Affecting The Joy Of Life In Old Age: A Scale Development Study, Yalçın Karagöz, Yusuf Karaşi̇n, Mustafa Filiz, Mehmet Ateş

Adultspan Journal

This study aims to introduce a measurement tool into the literature that can reveal the factors affecting the joy of life in older adulthood. Participants included 266 individuals aged 55 and over living in Izmir, Turkey. The process of developing the scale includes the following stages: problem identification, item pool creation, expert opinion, form shaping, pilot application, and finalizing the scale. The exploratory factor analysis revealed that the scale consists of 6 different dimensions, and the variance explained by these dimensions was found to be 65.184%. The acceptable values for the scale's fit indicators are as follows: χ²/df0.90, IFI > 0.90, …

An Evaluation Of The Decline In Primary Care Physician Visits, 2010 To 2021, Anuradha Jetty, Marie Ezran, Alison Huffstetler, Yalda Jabbarpour

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

METHODS: The Medical Expenditure Panel Survey data (2010-2021) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls

Family and Community Medicine Faculty Publications

Introduction: Several factors influence individuals’ confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure.

Research design and methods: We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between …

Education Interventions Implemented To Increase Lung Cancer Screening Rates, Arpit Arora, Crystal Bharat, Sophia Zia, Pooja Paunikar, Dana Simpson

South Atlantic Division GME Research Day 2025

No abstract provided.

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Perceived Patient-Centered Care In Marching Band Artists, A L. Merrill, Z K. Winkelmann, N A. Uriegas

Bakerman Student Research Awards

Objective: Approximately 27,000 college marching band (MB) artists in the United States could benefit from access to healthcare services and patient-centered clinicians. The purpose of this study was to explore HCPs MB artists have access to and their perceptions of patient-centered care (PCC). Methods: We used a cross-sectional web-based survey of MB artists (n=751, age=20±8 years). MB directors from 242 colleges were emailed a survey link to forward to MB artists. Participants indicated which HCPs they could access. Those who reported no access or unsure were prompted to describe what they would do if an injury or illness occurred. Participants …

Social Media As Health Educator: An Assessment Of The Understandability And Accuracy Of Tiktok Content About Contraception, Julianna Coleman, Maetal Haas-Kogan, Andrea Pelletier, Rachel Stoddard, Natasha Johnson, Julia Beatini, Nora Sun, Alex Keuroghlian, Deborah Bartz

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Contraception knowledge and attitudes are largely formed from conversations within one's social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy.

METHODS: This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment …

Health Outcomes Reported By Healthcare Providers And Clients Of A Community-Based Medically Tailored Meal Program, Jessica M. Sautter, Jule Anne Henstenburg, Adrian Glass Crafford, Ian Rowe-Nicholls, Victor S. Diaz, Kaitlyn Ann Bartholomew, Julia S. Evans, Maria R. Johnson, Jeffrey Zhou, Deeksha Ajeya

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).

METHODS: Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' …

Maternal Cortisol Concentration Is Associated With Reduced Brain Activation To Infant Cry And More Intrusive Parenting Behavior, Andrew Erhart, Sarah Enos Watamura, Aviva K. Olsavsky, Alexander J. Dufford, Rebekah C. Tribble, Tom Yeh, Pilyoung Kim

Psychology: Faculty Scholarship

Previous research indicates that maternal cortisol function and maternal brain response to infant are each in turn related to variations in parenting behavior. However, little is known about how maternal cortisol and maternal brain function are associated, thus studying these two mechanisms together may improve our understanding of how maternal cortisol assessed during interactions with own infant is associated with brain response to infant cry. First-time mothers (N = 59) of infants aged 3-4 months old were recruited to participate. Mothers' cortisol concentration was measured during a naturalistic interaction with their infant and their behavior was coded for two parenting …

Early Intervention System Contextual Factors Contributing To Treatment Attendance And Clinical Outcomes, Anthony Eldridge

Theses and Dissertations

Early Intervention Programs (EI) are an established method of addressing and treating earlier childhood developmental problems that involves a system of complex processes which families must navigate to secure and maintain care. Extensive wait times and multiple service providers burdensome caregivers which may impact treatment engagement. Telehealth offers some clinical utility for improving EI service provision. However, little is known how system contextual factors predict a child’s Part B Eligibility and level of engagement with treatment. The primary aim of this study is to describe the effect that wait time, number of service providers, number of treatment services, and treatment …

Impact Of Covid-19 Lockdown On Patient-Provider Electronic Communications, Michael A Hansen, Rebecca Chen, Jacqueline Hirth, James Langabeer, Roger Zoorob

Faculty, Staff and Students Publications

BACKGROUND: SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature.

METHODS: All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

Physicians’ Attitude, Knowledge, And Perceived Control Towards The Use Of Exercise As A Form Of Preventive Medicine, Matthew Robert Warner

All-Inclusive List of Electronic Theses and Dissertations

Exercise is a component of physical activity that can aid in the reduction of deaths, lowering obesity rates, and chronic illness. However, many Americans are not meeting the recommended physical activity levels (Carlson, et al., 2018). Quality and accurate health information regarding physical activity is one way to help combat health disparities. Health professionals such as primary care physicians can aid in promoting this lifestyle modification. However, there are shortfalls in physicians’ knowledge of using exercise as a form of preventive medicine for chronic illness. Many medical programs have little to no training in exercise principles (Cardinal et al., 2015). …

"It Shouldn't Be Just Hush-Hush": A Qualitative Community-Based Study Of Menstrual Health Communication Among Women In Philadelphia, Allison R. Casola, Lynette Medley, Brianna C. Kunes, Nya Mcglone, Alexis Silverio

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

METHODOLOGY: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N …

Lifestyle Medicine For The Health Care Worker, Workplace, And Community Well-Being: A Butterfly Effect, Karina Doucet, Nicholas D'Angelo

HCA Healthcare Journal of Medicine

Burnout is a prevalent and expensive problem in the US, and the National Plan For Health Workforce Well-Being included a goal to institutionalize well-being as a long-term value. Lifestyle Medicine (LM), an evidence-based practice using behavioral interventions to treat, prevent, and reverse certain chronic conditions, can achieve this goal. Implementing small changes in the workplace that support lifestyle medicine has a butterfly effect on both workplace and community well-being. Furthermore, the health of health care workers (HCWs) and patients improves, and health care costs decrease. This can be done with LM wellness programs or LM training for HCWs. LM wellness …

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …

A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood

Adultspan Journal

Adult cancer survivors represent an important–and growing–population that could benefit from counseling services. This study employed consensual qualitative research to examine the well-being experiences of eight cancer survivors. Findings suggest a broad range of changes to individual well-being following cancer diagnosis and treatment, and indicate counseling can provide an ideal setting for processing such changes. Recommendations for counseling practice and future research are provided.

Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …