Family Medicine Commons^™

"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 …

A Mixed Methods Acceptability And Feasibility Study Of A Patient-Initiated Approach To Increasing Weight Communication In Primary Care, Jocelyn E. Remmert, Leon Mccrea, Nicole T. Crane, Adam Gilden, Meghan L. Butryn

The Journal of Integrated Primary Care

Background: Weight discussions between patients and physicians can have a positive impact on patients’ health, yet they occur infrequently in primary care. No study to date has promoted patient-initiated weight discussions. This study aimed to test the feasibility, acceptability, and explore trends of the effect of a waiting room-based pamphlet intervention to promote patient-initiated weight discussions.

Methods: Adults (n=60) with overweight or obesity attending a primary care appointment were recruited from the waiting room and randomized to receive the intervention pamphlet or to a non-intervention control condition. All participants attended their appointment and completed post-appointment assessments.

Results: Three …

Modeling Interprofessional Excellence Transforming Medical Education For Collaborative Care, Kerry Miller, Paige Hardy, Neil Kalsi, Nathan Gollehon, Brianna Brei, Jason Burrows, Liliana Bronner

Posters and Presentations: Family Medicine

In our medical school, we designed an innovative interprofessional education (IPE) experience to prepare medical students for collaborative healthcare. Through a family-centered NICU high-risk follow-up clinic, students observed and engaged with a diverse team, including a developmental specialist, neonatal nurse practitioner, physician, and nurse. We developed a rubric based on the four IPEC competencies, evaluating students’ understanding before and after the rotation. Results from 118 participants showed significant improvement (p < .001) across competencies, with large effect sizes (Cohen's d: 1.02 to 2.14). This experience highlights the effectiveness of clinical modeling in enhancing interprofessional practice skills among medical students.

Administrative Time Expectations For Residency Core Faculty: A Cera Study., Bryce A Ringwald, Stephen Auciello, Joseph Ginty, Melissa Jefferis, Stephen Stacey

Medical Education Articles

BACKGROUND: Academic family medicine (FM) physicians aim to balance competing needs of providing clinical care with nonclinical duties of program administration, formal education, and scholarly activity. FM residency is unique in its scope of practice, clinical settings, and training priorities, which may differ between university-based and community-based programs. In both types of programs, these competing needs are a source of faculty dissatisfaction and burnout. We performed this study to explore the allocation of nonclinical administrative full-time equivalents (FTE) for FM residency core faculty members.

RESULTS: Reported nonclinical administrative FTE time allocation is equivalent between university/medical school-based and community-based programs. The …

The Heart Of Residency, Julia Fashner, Samantha Gionocchio

HCA Healthcare Journal of Medicine

As part of wellness activities in 2023, our family medicine residents produced individual paintings. Samantha coalesced these 4 x 4 canvases to create this heart. The following quote is also poignant for those of us in family medicine:

Wherever the art of Medicine is loved there is also a love of Humanity. -Hippocrates

Resident Feedback On Incorporating Reflection Rounds Into A Family Medicine Residency Wellness Curriculum: A Brief Report, Stacy Ogbeide, Jasmin Aldridge Hamlett, Inez Isabel Cruz

HCA Healthcare Journal of Medicine

Background

We sought to understand well-being from the perspectives of residents in a family medicine residency program and to assess the residents’ opinions on implementing “Reflection Rounds” (RR) to promote wellness and combat burnout through self-reflection. These aims were achieved through descriptive qualitative analysis of a focus group of family medicine residents.

Methods

Participation was voluntary and open to all 45 residents in the program. The final participant sample consisted of 14 residents who shared similar characteristics, including level of training and being exposed to similar training stressors. Both a priori and open coding were used for this analysis.

Results …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

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 …

Small Intestinal Bacterial Overgrowth, Sandesh R. Parajuli, Anish C. Paudel, Anthony Donato

Transformative Medicine

No abstract provided.

Compassionate Curiosity: Mitigating The Effects Of Biasthrough Motivational Interviewing, Paul J. Hershberger, Dean A. Bricker, Angie Castle, Timothy N. Crawford, Stacy R. Flowers, Alexandria L. Goff, Katharine Conway

Family Medicine Faculty Publications

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient’s point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Sodium-Glucose Transport Protein 2 (Sglt2) Inhibitors And The Risk Of Pancreatitis: A Case Report, Zamanali Khakhar, Soraiya Manji, Ronakkumar Patel, Sayed Karar

Internal Medicine, East Africa

Acute pancreatitis is a condition seldom encountered with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors. They are beneficial in the treatment of various conditions and offer great promise. Despite this, they are associated with several adverse effects, necessitating vigilance and further research. This case study reports a 69-year-old male with multiple comorbidities who presented with epigastric pain radiating to the back. Laboratory tests revealed elevated AST, ALT, GGT and lipase. The patient was diagnosed with acute pancreatitis secondary to the SGLT2 inhibitor therapy regimen. Cessation of dapagliflozin resulted in a complete resolution of symptoms. There is credible evidence to …

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.

Factors Associated With Intention To Implement Sbi And Sud Treatment: A Survey Of Primary Care Clinicians In Texas Enrolled In An Online Course, Alicia Kowalchuk, Tiffany G Ostovar-Kermani, Kylie Schaper, Larissa Grigoryan, Jacqueline M Hirth, Maria Carmenza Mejia, Kiara K Spooner, Roger J Zoorob

Faculty, Staff and Students Publications

BACKGROUND: Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice.

METHODS: This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory …

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 …

Reducing The Burden Of Diabetes Mellitus: Is It Achievable?, Rafay Iqbal, Raheel Ahmad, Aisha Ambreen

Department of Family Medicine

Diabetes mellitus is rapidly on the rise globally, particularly in low- and middle-income countries. Pakistan has emerged with the highest prevalence of diabetes by percentage according to recent estimates. Evidence is available for different strategies to reduce this burden. Screening high-risk individuals can reduce burden of undiagnosed diabetes and improve outcomes. Although prediabetes can progress to type 2 diabetes, it has the potential to regress to normoglycaemia as well. Interventions like lifestyle modifications and metformin in high-risk individuals can reduce the risk of progression to diabetes. Furthermore, there is a potential to reverse diabetes in some individuals in the early …

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

Healthier Together: A Holistic Office Protocol Addressing The Chronic Nature Of Children And Adolescents With Adhd, Kimberly Olmos

Evidence-Based Practice Project Reports

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent, chronic condition with symptoms that include inattention, hyperactivity, and impulsivity. ADHD affects six million children in the United States (Tran et al., 2021). The purpose of this evidence-based practice project was to implement a holistic office protocol that addressed the chronicity and future health outcomes of children and adolescents, ages 2-17 years with ADHD through stimulant or non-stimulant medication prescriptions, behavioral therapy referrals, and education surrounding diet, and exercise. A comprehensive, systematic literature search yielded 16 articles to determine best practice when treating children and adolescents with ADHD in primary or …

Health Outcomes Of Hispanic Clients In A Community-Based Medically Tailored Meal Program, Victor Diaz, Jule Anne Henstenberg, Adrian Crafford

Health Equity and Quality Improvement (HEQI) Summit

Introduction and Objectives

• The Philadelphia-based Metropolitan Area Neighborhood Nutrition Alliance (MANNA) is a community-based organization that home delivers medically tailored meals (MTM) to local residents with serious illness andnutritional risk.
• Previous research has shown that in the U.S., Hispanics bear a disproportionate burden of major pathologies such as kidney disease [1] and experience lower rates of healthcare utilization [2].
• The objective of this project is to describe health outcomes of 258 Hispanic clients (mean age 57, 50% women) enrolled in MANNA’s program for 3-6 months between 2020-2022.

Improving Site-Specific Sti Screening In A Philadelphia-Based Academic Family Medicine Office, Brittany Macdonald, Md, Marie Ezran, Md, Haley Smallwood, Md, Gisel Garcia, Md, Maia Mandel, Md, Amaka Amobi, Md, Marshal Miller, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• In the last decade, rates of sexually transmitted infections (STIs) are rising both in Philadelphia and across the United States^{1, 2}
• STIs are often asymptomatic³
• Site-specific screening for gonorrhea and chlamydia (GC/CT) infections may increase STI detection o Genitourinary (GU), pharyngeal, and rectal sites o GU is the most common site tested, but GU-only testing may lead to missed diagnoses⁴

Patient Perceptions Of Screening For Social Determinants Of Health In A Primary Care Setting, Blaise O'Malley, Zarin Mohsenin, Olivia George, Geoffrey Mills

Health Equity and Quality Improvement (HEQI) Summit

Background

• Social determinants of health (SDOH) screenings have become increasingly common in healthcare settings over the past decade (Berkowitz et al., 2021; Rogers et al., 2020)
• These screenings can help healthcare providers direct care and provide resources to patients with social needs (Bleacher et al., 2019)
• The sensitive nature of the screening questions may cause patients to feel uncomfortable (Broaddus- Shea et al., 2022)
• Many related studies focus on the perspective of adult caregivers of pediatric patients, less on the perspective of adult patients (Emengo et al., 2020)

Project Aims

1. To further our understanding of adult patient perceptions of the …

Implementation Of Pediatric Behavioral And Developmental Health Screening Tools At Student-Run Free Clinics In Philadelphia Shelters, Renee Li, Jasmine Miller, Martin Henry, Do, Bob Motley, Md, David Beckmann, Md, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background & Project Aims

• Children experiencing homelessness (CEH) are at increased risk for behavioral health problems: 78% show behavioral problems, academic delays, or depression.¹

• Recent research suggests an increased prevalence of Autism Spectrum Disorder (ASD) among people experiencing homelessness.^2,3

• Psychosocial challenges are exacerbated by limited access to behavioral health and developmental disability screening, which is essential for early intervention.^4-6

• Recent studies have found that behavioral health screening in shelters is feasible, can generate a large number of referrals, and can be carried out by a student-run clinic without significantly disrupting workflow.^7,8

Correlation Of Neck Circumference With Bmi And Waist Circumference In A High-Risk Urban Cohort, Jay Satasiya, Bs, Meera Patel, Bs, Antoinette Portnoy, Bs, Noel Tharakan, Bs, Brian D. Fedgchin, Md, Glenn S. Cooper, Md, Cindy Cheng, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Obesity is a global epidemic requiring accurate ongoing clinical assessment, as it increases risk of multiple health conditions, such as CVD.
• Body mass index (BMI) is the most widely used anthropometric measure.
• Waist circumference (WC) is an accurate measure of visceral fat.
• Neck circumference (NC) is a newer, simple assessment tool positively correlated with percent body fat, BMI and WC.
• NC is easier to measure than WC, and unaffected by external factors like lean muscle mass for BMI, and abdominal distension, respiration, and patient discomfort for WC.

Hypothesis:

• NC, less studied in black patients, who are at …

Addressing Gaps In Care Through A Medical Student-Led Cancer Screening Project, Matthew Green, Hannah Ngo, Dakota B. Pastore, Jenna Zappetti, Olivia Siciliano, Meghan Mcquade, John Sauer, Anne Jones

Rowan-Virtua Research Day

Background: Colorectal cancer (CRC), breast cancer (BrCa), and cervical cancer are three of the most preventable cancers. Despite the known significance for early detection and treatment, barriers to screening remain. We developed a medical student-led project to improve adherence to national cancer screening guidelines in patients across Rowan-Virtua Family Medicine (FM) practices. This study assesses the initiative’s efficacy in improving adherence to CRC, BrCa, and cervical cancer screenings.

Methods: Rowan-Virtua FM patients between the ages of 21-75 (n=735) were identified as due or up-to-date on cancer screenings based on chart review. Student volunteers were trained to contact patients to discuss …

A Novel Approach To Hiv Testing: Group Harm Reduction And Testing For High Risk Women In Nj, Gabrianna A. Andrews

Rowan-Virtua Research Day

Outreach programs have been implemented aimed at providing healthcare to minority populations and those considered high-risk for acquiring HIV. Variables such as these cause hesitance in community members, preventing HIV screenings and adherence to follow-ups. This study provides and evaluates a new approach: group HIV testing. Data was collected from 6/2/2023 to 4/19/2024 by surveying participants at the end of the interaction. 87.5% of participants rated their care at the mobile clinic as ‘Excellent’, 8% as ‘Very Good’, and 4.5% as ‘Good’. 95.6% of participants ranked Group Harm Reduction Counseling as ‘Definitely’ helpful. 84.4% of participants did not find that …

Barriers To Healthcare Access Between English And Spanish Speakers In An Underserved Population, Adeena Javed, Dale Johnson, Gerardo J. Rivera-Colón, Nathaniel J. Byrnes, Kristin Bertsch, Anne C. Jones

Rowan-Virtua Research Day

• According to the NJ State Department of Health, Atlantic County has higher rates of smoking, respiratory disease, hypercholesterolemia, as well as death rates due to coronary heart disease, HIV, and all cancers compared to the NJ state average1,2.

• With over 20% of Atlantic County's population identifying as Hispanic, Spanish speakers encounter greater obstacles compared to their English-speaking counterparts in accessing healthcare services and improving health outcomes1,2 .

• Existing research indicates that various factors, including health insurance coverage, proximity to healthcare facilities, transportation options, health literacy levels, and trust in the medical profession, significantly influence access to healthcare …

Improving Behavioral Health Counseling Scheduling Rates On Same Day Of Referral, Benjamin Rogers, Md, Rachel Pallay, Md, Edward Delesky, Md, Meg Broderick, Md, Jade Enright, Md, Eunice Choe, Md

Department of Family & Community Medicine Posters

Background

• Studies suggest 1 in 5 adults in the US suffer from mental illness, with up to 46% of Philadelphia residents reporting poor mental health.
• Care integration beginning with primary care physician evaluation and management is becoming more common.
• Behavioral health counseling (BHC), provided by a primary physician and trained psychologist, is vital in management of mental health conditions.
• Studies suggest same-day scheduling of follow up appointments improves treatment adherence.
• Goal: Improve BHC scheduling rates on same-day of initial referral.

The Use Of A Short And User-Friendly Questionnaire As A Screening Tool To Identify Potential Gaps In Nutrition Knowledge Of Adolescent Athletes, Roben Ohev Shalom, David Lick, Virginia E. Uhley

Posters

Nutrition knowledge in adolescent athletes is rarely formally assessed by physicians. Current popular nutrition questionnaires include the CDC’s Youth Risk Behavior Survey (YRBSS) and the Nutrition for Sport Knowledge Questionnaire (NSKQ). These questionnaires are long and are not optimal to assess nutrition knowledge in adolescent athletes at their preparticipation examinations. A systematic review conducted by Tam et al, showed that questionnaires would benefit from interactive and attractive features including images. A novel nutrition questionnaire was adapted from the NSKQ that was user friendly, short in length, electronic and included images. We hypothesized that through collecting physicians feedback on the questionnaire …

Increasing Utilization Of Community Resources To Address Social Determinants Of Health Barriers In Patients With Diabetes Mellitus Type 2, Kimberly Williams

The Eleanor Mann School of Nursing DNP Capstone Projects

PURPOSE: To determine if identifying SDOH barriers to care in adults with DMT2 and providing information about community-based resources designed to decrease the impact of these barriers will improve adherence, decrease SDOH barriers, and reduce HbA1c levels.

DESIGN/METHODS: Quasi-experimental design. Participants completed PRAPARE screenings and received handouts detailing contact information for local resources. HbA1c levels were collected prior to or at the initial appointment. Contact was attempted at 4-6 weeks to ensure resources were utilized. 3-month follow up appointments were completed during which PRAPARE screenings were repeated, HbA1c levels were collected, and post-intervention surveys were completed.

CONClUSIONS: Participants who did …