Primary Care Commons^™

Beyond The Waiver Training: Practical Tips You May Not Have Learned, Lara Weinstein, Md, Mph, Drph, Erica Li, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Understand the critical importance of philosophy, structure, and access in MAT
• Share practical tips for starting MAT in your practice
• Discuss lessons learned with developing a MAT program

Journal Club: Emergency Department–Initiated Buprenorphine/Naloxone Treatment For Opioid Dependence, Simon Newsom

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Briefly highlight OUD
• Current ED practices
• Review study
• Future directions

Preventive Care And Chronic Disease Management: Comparison Of Appalachian And Non-Appalachian Community Health Centers In The United States, Julie P. Marcinek, Alek Sripipatana, Sue C. Lin

Journal of Appalachian Health

Introduction: The Appalachian region is often characterized by poor health outcomes and economic depression. Health centers (HCs) are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary healthcare services in high need areas, including Appalachia, where economic, geographic, or cultural factors can hinder access to healthcare services.

Purpose: The study compares the clinical quality performance in preventive care and chronic disease management between Appalachian HCs and their non-Appalachian counterparts.

Methods: Using 2015 Uniform Data System (UDS) health center data, bivariate and multivariate linear regression analyses examine the association of Appalachian HC with performance on preventive and chronic care …

Review Of Treatment Options For Pneumonia In The Inpatient Setting, Shirley B Bonanni

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Management Of Neonatal Hyperbilirubinemia, David Schutzman

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Refugee Health In Philadelphia, Marc Altshuler

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Define the U.S. refugee resettlement process
2. Discuss the history of refugee health in Philadelphia and the creation of the Jefferson Center for Refugee Health
3. Review selected data on our patients
4. Learn how to utilize new resources to care for refugees

Integrative Medicine In Health And Well-Being, Andrew Newberg, Madeline Becker

Department of Family & Community Medicine Presentations and Grand Rounds

For integrative approaches to become part of standard care, research is required to understand clinical effects. Clinical data needs to be supplemented by mechanistic studies. Integrative medicine and general medicine have multiple areas of intersection. Studies can evaluate mental and physical disorders such as depression or anxiety or chronic pain and fatigue. Studies can evaluate psychological symptoms associated with other medical and neurological disorders. It is important to establish efficacy and also mechanism. Future collaborations are very welcome!

Resident Ume Updates, Fred Markham, Marisyl Delacruz

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

1. Guidelines for Students in Clinical Spaces
2. Grading and feedback
3. RIME scheme
4. Telehealth, QI curriculum
5. Phase 3 Updates and JeffDOT
6. Q&A

The Other Epidemic, Bruce Deighton

HCA Healthcare Journal of Medicine

The epidemic level of opioid abuse in the U.S. population continues to present a major challenge to our society and to the medical profession. Medical education has a significant role in improving screening, diagnosis, appropriate treatment and management of opioid use disorder. Addressing the problem of overprescribing opioids through physician education, surveillance and opioid management has resulted in significant improvement, translating to fewer overdose deaths from prescription opioids. Graduate medical education can increase access to care by training more addiction medicine specialists, and training other physicians to prescribe buprenorphine and provide access to medically assisted care.

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

Awareness Of And Willingness To Use Prep Among Black And Latinx Adolescents Residing In Higher Prevalence Areas In The United States, Tamara Taggart, Yilin Liang, Paolo Pina, Tashuna Albritton

Publications and Research

This mixed-methods study examined awareness of and willingness to use pre-exposure prophylaxis (PrEP) among sexually active Black and Latinx adolescents (13–17 years) residing in five cities in the United States with some of the highest burden of HIV. Data are from adolescents who participated in a cross-sectional survey (n = 208) and one-on-one interviews and focus groups (n = 26) conducted from September 2017—August 2019. Approximately 50% of the sample were recruited through community efforts, and the other half through a panel. Logistic regression with covariates including sexual orientation, relationship status, socioeconomic status, and race/ethnicity were used to assess factors …

Social Services Cases, Maria Hervada-Page, Mms

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Understand common Social Work referrals and possible solutions
• Understand the roles of the members of our team
• Understand the basics of insurance
• Basic community resources

Incidental Findings On Brain Mri In People With Hiv Infection, Kevin F. Hanna, Harlan R. Sayles, Jennifer O'Neill, Matthew L. White, Tony W. Wilson, Susan Swindells

Journal Articles: Internal Medicine

BACKGROUND: Incidental findings are a well-known complication of imaging studies done for both diagnostic and research purposes. Little is known about the rates and types of incidental findings found on brain MRI in patients with HIV infection, who may be at risk for HIV-Associated Neurocognitive Disorders (HAND).

METHODS: The parent study included 108 adults with HIV infection and 125 demographically-matched uninfected controls who completed MRI and neuropsychological testing. Incidental findings were classified by the study team as vascular, neoplastic, congenital, other neurologic, or non-neurologic. Categorical measures were compared using Pearson chi-square tests; continuous measures were compared using t-tests.

RESULTS: Among …

Today's Cigarette And E-Cigarette Landscape, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

E-cigarettes are one of the most difficult and complex public health issues most of us have confronted.

Most anti-tobacco experts and advocates line up on a spectrum from embracing e-cigarettes as a promising way to reduce the harm of tobacco products all the way to being the greatest threat to progress in our 60 year war on big tobacco.

Journal Club, Zeynep Uzumcu, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

• Review coronavirus life-cycle
• Review mechanism of action of remdesivir
• Review previous research on remdesivir
• Close reading of article - Methods - Results - Discussion
• Future research
• Implications for our practice

Breast Cancer Treatment: Basics For The Primary Care Provider, Sarah Hirsh, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. To review the prevalence of breast cancer and the mortality rate of breast cancer in the United States.
2. To understand breast cancer staging and its role in prognostication.
3. To understand the therapies offered for the treatment of non-metastatic, invasive breast cancer and their side effects.
4. To review the role of the PCP in caring for patients undergoing treatment for breast cancer and those in remission.

The Impact Of An International Interprofessional Experience On Perceptions Of Pharmacist-Physician Relationships, Miranda R. Andrus, Emily A. Powell, Katherine Moody, Taylor D. Steuber

International Journal of Health Sciences Education

Objective. To assess the impact of this international interprofessional learning experience on perceptions of pharmacist-physician relationships and interprofessional teams.

Methods. Medical and pharmacy students completed a one-week interprofessional medical mission experience in the Dominican Republic. Anonymous surveys were administered to 17 students before and after completion to measure perceptions of pharmacist-physician relationships and interprofessional teams. Responses were matched and changes in perceptions were analyzed using the Wilcoxon Signed Rank test. The SPICE-R2 instrument was administered after the experience to measure attitudes toward interprofessional teams.

Results. Of the 17 participants, 100% responded to all surveys. Significant improvements were seen in the …

Occupational Therapy As Part Of A Team-Based Approach In Primary Care Settings, Lydia Royeen

Dissertations

The purpose of this project was to study issues related to occupational therapists integrating into primary care settings, as part of a team-based approach and to best meet the needs of the clients.

This is a mixed methods study that examined quantitative and qualitative data for members of the primary care team and occupational therapists working in primary care clinics. The Team Climate Inventory-14 (Kivimaki & Elovainio, 1999) was selected as the quantitative measure because it examines themes related to team functioning, which include vision, participative safety, task orientation, and mutual support. Participants completed a semi-structured interview that examined themes …

Improving Osteoporosis Screening Rates In A Primary Care Practice Using An Emr-Based Intervention, Conor Murphy, Ashley Barnes, Rukaiya Bashir, Peter Block

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Osteoporosis is defined as a T-score ≤ -2.5 on DEXA or history of fragility fracture
• Affects a significant proportion of our population over 65 with an estimated annual cost burden of $22 billion
• Only 46% of females over 65 years of age had been screened for osteoporosis at JHAP
• Our study aims to increase that percentage between July 2019 and July 2020 from 46% to 60%

Identifying Barriers To Statin Therapy In Diabetic Patients In A Large Ambulatory Practice, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mitchell, Md, Sarah Hirsh, Md, Madeline Taskier, Md, Robert Wiley, Md, Lilli Flink, Md, Greta Bires, Md, Geoffrey Mills, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice.

Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines.

Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy.