Primary Care Commons^™

Priority Competencies For Designated Education Officers In The Veterans Health Administration, Duane R. Bidwell, Anita Samuel, Ronald M. Cervero, Steven J. Durning, Sherri L. Stephan, Erin L. Patel, Marjorie A. Bowman, Holly S. Meyer

Population and Public Health Sciences Faculty Publications

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that …

Prospective Receptivity And Acceptability Of Brief Alcohol Interventions Among Women And Racial/Ethnic Minority Veterans In Primary Care, Jacob L. Scharer, Robyn Shepardson, Brandi Roelk, Julie C. Gass, Laura Wray, Stephen A. Maisto, Jennifer Funderburk

The Journal of Integrated Primary Care

Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous drinking among primary care patients, yet implementation of BAIs in practice has been difficult and disparities have been identified regarding implementing BAIs with women and racial/ethnic minority patients. Further, patient engagement is a commonly identified barrier to BAI implementation. This mixed methods study aimed to assess acceptability of BAIs among women and racial/ethnic minority primary care patients and to identify factors that may impact their receptivity to engaging in a BAI. Qualitative interviews were conducted with 17 patients who had screened positive for hazardous alcohol use. Patients reported neutral …

Improving Patient Engagement Through Whole Health: Veteran Perspectives On A Values Assessment Tool, Luke D. Mitzel, Robyn Shepardson, Emily M. Johnson, Jennifer Funderburk

The Journal of Integrated Primary Care

Amidst rising rates of costly chronic diseases, a growing emphasis for integrated primary care settings is offering proactive, person-centered, and whole-person care. Through its Whole Health approach, the Veterans Health Administration (VA) is a leading force in this movement. VA’s Whole Health focuses on delivering patient-centered care that engages and empowers Veterans to improve health outcomes. The Personal Health Inventory (PHI) is a brief, whole-person focused, values assessment of what matters most that can lead to personalized health planning. Using a concurrent triangulation (convergent) mixed methods design, we examined the perspectives of 25 post-9/11 Veterans using semi-structured telephone interviews. Qualitative …

Use Of Ai In Family Medicine Publications: A Joint Editorial From Journal Editors, Sarina Schrager, Dean A. Seehusen, Sumi M. Sexton, Caroline Richardson, Jon Neher, Nicholas Pimlott, Marjorie A. Bowman, José E. Rodríguez, Christopher P. Morley, Li Li, James Domdera

Population and Public Health Sciences Faculty Publications

There are multiple guidelines from publishers and organizations on the use of Artificial Intelligence (AI) in publishing.1–5 However, none are specific to family medicine. Most journals have some basic AI use recommendations for authors, but more explicit direction is needed, as not all AI tools are the same.

How Are You Doing… Really? A Review Of Whole Person Health Assessments, Kurt C. Stange

Faculty Scholarship

Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include …

Mental Health Stigma As A Barrier To Care, Whitney Grant

Regis University Student Publications (comprehensive collection)

Abstract

Mental health stigma is a major barrier to care. The mental health stigma as a problem is relevant due to its influence on increasing the burden of mental health issues due to a lack of help-seeking, contributing to increased healthcare costs, and increasing adverse health outcomes. Currently there is no action consistently taken to assess or address this stigma in the primary care setting. Healthcare professionals can help to reduce the perceptions of stigma and lessen stigma as a barrier to care. A quality improvement project was implemented to evaluate if an education intervention by a primary care provider …

Working With Foster Families: What Providers Should Know, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Foster parents play a vital, yet often challenging role in the lives of children who have experienced trauma and instability. Navigating the healthcare system for children in foster care can be particularly complex and overwhelming, requiring understanding, collaboration, and a unique approach from healthcare professionals. This page offers insights and practical ideas for healthcare professionals to effectively support foster parents, ultimately contributing to the well-being of the children in their care.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

Ensuring The Health And Well-Being Of Children After Adoption, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children in foster care have higher rates of health concerns and healthcare utilization than their peers who have not experienced foster care. For example, one study found that children in foster care had 2.5- and 2.3-times higher odds of having a mental health diagnosis and developmental disability diagnosis, respectively. Data on our patient population supports these findings, revealing that 70.4% of our patients had chronic or complex chronic health conditions.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Perspective On Alcohol-Induced Organ Damage Via Autophagy-Dependent Cellular Changes, Ahmed Bakheet, Murugadas Anbazhagan, Shirish Barve, Srinivasan Dasarathy, John Dickinson, Wen-Xing Ding, Terrence Donohue, Thiyagarajan Gopal, Anna Gukovskaya, Kusum K. Kharbanda, John J. Lemasters, Natalia A. Osna, Pal Pacher, Lucy Sloan, Luis F. Vilches, Viswanathan Saraswathi, Xiao-Ming Yin, Zhi Zhong, Paul G. Thomes

Journal Articles: Internal Medicine

Alcohol-induced organ damage is a major global health concern and a leading cause of disability and mortality. In addition to the liver, chronic alcohol consumption adversely affects multiple organ systems, including the cardiovascular and neuromuscular systems, the gastrointestinal tract, adipose tissue, kidneys, pancreas, and the brain. Organ damage begins with necrosis (cell death) followed by tissue injury, which triggers immune responses aimed at tissue repair. However, with continued heavy drinking, these reparative responses transition into inflammatory responses which exacerbate tissue injury and accelerate disease progression. Macroautophagy, commonly referred to as autophagy, is a vital and evolutionarily-conserved digestive process in eukaryotic …

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 …

The Hybrid General Internist: A Novel Solution To Declining Interest In Primary Care, Rae Witt, Jana L. Wardian, Victoria Kennel, Jennifer Parker, Chelsea Navarrette

Journal Articles: Internal Medicine

No abstract provided.

Financial Health Literacy Of Community-Dwelling Older Adults: A Qualitative Research Study, Kimberly Davis

Theses and Dissertations

Background: Financial health literacy (FHL) is an emerging concept with unique application to older adults. Multiple complexities converge in older age that create increased financial vulnerability (e.g., retirement, chronic disease). However, low financial and health literacy are common in older adults, impacting their ability to self-manage. The AWV’s focus on prevention offers an opportunity to incorporate a proactive approach to financial-related assessment. This study will explore the perceived value of assessing FHL in primary care settings and the financial-related barriers and facilitators to implementing the personalized prevention plan.

Methods: The conceptual framework was guided by the Individual and Family Self-Management …

The Potential Of Vitamin D As An Adjunct Therapy For Eczema, Kimberly Hill

Graduate Research Projects

No abstract provided.

Shifting Patterns In Primary Care Telehealth Utilization Among Medicare Beneficiaries And Providers, Yunxi Zhang, Lincy S Lal, Saurabh Chandra, John Michael Swint

Faculty, Staff and Student Publications

Introduction: The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.

Methods: A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.

Results: Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to …

Second Generation Antipsychotics And Cardiovascular Adverse Effects: Developing Evidence-Based Recommendations For Primary Care Medicine, Sana Borda, Ahn-Dao Lee, Paul F. Bell

HCA Healthcare Journal of Medicine

Background

Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Methods

Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was …

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 …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Gender Segregation In Caring Labor: The Impact Of Social Norms On Career Choices, Evelyn Xinhui Cheng

CBER Conference

Women engage in work stereotypically seen as "women's work," or work based on the perceived "natural" female tendency towards caring and relational thinking (Tung 2000). In pre-reform China, Shu (2005) found that women were more concentrated in the lowerpaying collective sector compared to men in the state-owned sector, contributing to the gender wage gap. China's horizontal occupational segregation by gender has significant implications for gender pay gaps, workforce attachment, and the perceived value of caring labor in society. Feminist scholars argue that gendered norms around caring originate that conflate womanhood with nurturing (England 2005; Litt & Zimmerman 2003). The main …

Understanding Provider Competency In Gender Affirming Care, Vanessa Castle, Lindsay Gietzen

Pacific Journal of Health

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual plus (LGBTQ+) individuals, especially transgender patients, face many healthcare disparities. It is extremely important for them to have access to high-quality healthcare, particularly Gender Affirming Care (GAC), to support their well-being and mental health. However, many healthcare providers, including clinical social workers, NPs, PAs, and MDs lack proper training to offer GAC. The current training opportunities available are often basic and lack comprehensive, detailed information. To reduce healthcare barriers for the transgender and gender-diverse community, we must have comprehensive training on GAC available for providers so they can treat their patients with …

Biodata Drives Treatment Success, Steve Carstensen Dds

Metro Denver Dental Society Articulator Magazine

This article explores the growing role of biosignals and digital health technologies in dentistry, emphasizing how devices like wearable rings and sensors are enhancing the diagnosis and management of conditions such as obstructive sleep apnea, periodontal disease and chronic pain. By integrating biosignal data into patient care, dentists can provide more precise, personalized treatments, improving outcomes and supporting collaboration with primary care providers in managing chronic diseases.

Association Between Teaching Clinic Structure And The Readiness Of Ophthalmology Residents To Enter Independent Practice, T. Michael Kashner, Marjorie A. Bowman, Catherine P. Kaminetzky, Andrea D. Birnbaum, John M. Byrne, Paul B. Greenberg, Steven S. Henley, Karen M. Sanders

Population and Public Health Sciences Faculty Publications

Our objective is to determine if the structure of Graduate Medical Education teaching clinics is associated with how well ophthalmology residents are prepared to meet the workload demands of independent clinical practice. Resident preparedness to enter independent practice was measured by the Readiness Index. Part of the Department of Veterans Affairs’ new Workload-based Resident Academic Performance measures (WRAP), resident readiness is computed from electronic health records for residents by clinic and service-date. The index compares resident productivity net of supervision and adjusted for care quality to the average productivity of non-supervising ophthalmologists. Readiness comprises a Workload component (ratio of resident …

Comprehensive Community Medicine, Alexander Walther

Capstone Projects and Master's Theses

Comprehensive Community Medicine (CCM) is a theoretical framework designed to address the complex needs of individuals with dual diagnoses of mental illness and substance use disorders (SUDs). Dual diagnosis is highly prevalent, particularly among populations experiencing homelessness, and is associated with poorer health outcomes and increased healthcare service utilization. Structural inequities, including a fractured healthcare system, exacerbate the challenges faced by this vulnerable group. Research indicates that effective care for dually diagnosed individuals requires a layered approach addressing clinical, systemic, legal, and housing barriers.

The development of CCM has been informed by interviews with local stakeholders, including County EMS board …

How Low Can We Go: Evaluation Of A Pharmacist-Led Weight Loss Management Program, Kelly Rubi, Elaina Rosario, Sara Panella, Jacqualine Igwe, Maria Pulido, Faaria Quadri

Nursing & Health Sciences Research Journal

Background: Obesity is a major health challenge that is associated with several health risks, including diabetes and hypertension. The purpose of this project was to evaluate the impact of clinical pharmacists on the therapy optimization of GLP-1 receptor agonists (GLP-1RAs) in a weight management program. Methods: This project evaluated a quality improvement initiative through a retrospective chart review that included patients who were treated with semaglutide or liraglutide between October 2022 and July 2023, with body mass indices (BMI) of 27 kg/m2 or greater with at least one weight-related comorbidity or a BMI greater than or equal to 30 kg/m2. …

Laboratory Literacy: Surveying Lab Result Interpretations Of A Local Patient Population, Jordan Franco, Mark K. Fung

Patient Experience Journal

A patient's independent interpretation of their medical laboratory data has become an unspoken prerequisite in the current age of medicine. In the outpatient setting, it is anecdotally commonplace for patients to receive their lab results before their physicians, resulting in patients often relying on self-interpretations of their results. This study analyzed the degree to which patients are comfortable interpreting lab results and sought to shed light on the question: How are patients interpreting their laboratory reports? A survey was constructed to include the items from a validated health literacy screening tool, followed by items inquiring about the respondent's experience and …

Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu

Journal of Mind and Medical Sciences

Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …

The Telehealth Shared Decision-Making Coaching And Navigation In Primary Care (Telescope) Intervention: A Study Protocol For Delivering Shared Decision-Making For Lung Cancer Screening By Patient Navigators, Naomi Q P Tan, Lisa M Lowenstein, Elisa E Douglas, Jeanne Silva, Joshua M Bershad, Jinghua An, Sanjay S Shete, Michael B Steinberg, Jeanne M Ferrante, Elizabeth C Clark, Ana Natale-Pereira, Novneet N Sahu, Shirin E Hastings, Richard M Hoffman, Robert J Volk, Anita Y Kinney

Faculty, Staff and Student Publications

BACKGROUND: Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigation intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm.

METHODS: Patients (n = 420) of primary care clinicians (n …

Churning The Tides Of Care: When Nurse Turnover Makes Waves In Patient Access To Primary Care, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Trang N D Pham, Laura A Petersen, Lechauncy Woodard, Richard Sorelle, Cheng Rebecca Jiang, Frederick L Oswald, Daniel R Murphy, Hilary N Touchett, Joshua Hamer, Sylvia J Hysong

Faculty, Staff and Students Publications

BACKGROUND: Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

OBJECTIVE: This study aims to empirically assess how the stability of RN staffing within …

Child Maltreatment And Behavioral Health Outcomes In Child Welfare: Exploring The Roles Of Severity And Polyvictimization, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

For questions about this study or others, please email [email protected]

childrens.com/fostercare