Family Medicine Research at SUNY Upstate Medical University

2011-09-29T14:29:00.000-07:00

22011 NAPCRG
Annual Meeting

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SUNY Upstate Medical University

Department of Family Medicine

Presentations Accepted and
Scheduled for the 2011 Annual Meeting of NAPCRG

Saturday, November
12, 2011 6:00 PM

P046 R U 4 PC?:
Texting and Feedback on Primary Care During Medical School

Andrea Wudyka, MD, William
Beaumont Hospital; Diane Levine, MD; Joel Heidelbaugh,
MD; Elie Mulhem, MD;
Victoria Neale, PhD; Andrea Wendling, MD;
Christopher Morley, PhD; Julie Phillips, MD, MPH

Context: Medical students are often asked which field they plan to enter, and teaching physicians routinely offer feedback on this complex and important decision. Additional data regarding this aspect of the “hidden curriculum” are needed to increase knowledge to be used to attract and retain student interest in primary care. Objective: To gain understanding of incidence and balance of positive and negative feedback on primary care as a career choice, and secondarily, to determine efficacy of texting as a data collection method for medical students. Human Subjects Review: WSU IRB approval for pilot portion (10/2010); expecting multicenter IRB approval before 11/2011. Design: Multicenter observational prospective trial. Cohorts of medical students from 4 universities will collect data for a 30-day period by sending a text message whenever a comment regarding primary care is heard in the context of formal educational activities, and will complete pre/post surveys regarding demographics, career plans, and attitudes toward primary care. Setting: Pre-doctoral curriculum at four medical schools. Participants: Medical students at participating universities (Wayne State, Michigan State, University of Michigan, SUNY). Main and Secondary Outcome Measures: Raw number of negative and positive messages heard; ratio of positive-to-negative comments; effects of student characteristics upon messages received; themes derived from qualitative content of messages; compliance/satisfaction with text messaging. Anticipated Results: Based upon pilot data, we anticipate most feedback to be reported during third year; balance of positive to negative feedback will vary by several factors. Conclusions: Attracting and retaining interest in primary care is essential in medical education today. Aspects of the “hidden curriculum” have been described as important in shaping career decisions of medical students, and feedback from teaching physicians has been named as an area in need of further work. This study aims to contribute concrete data to increase understanding of this piece of medical education.

Saturday, November
12, 2011 6:00 PM

P064 Factors
Influencing Participation in Ilinet: A Public
Health/Primary Care Surveillance Program for Influenza

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Buckley Brian; Natalie Jones, BS; John Epling, MD, MSEd; Donna Gowie, AAS

Context: The U.S. Centers for Disease Control (CDC) operates the Outpatient Influenza-like Illness Surveillance Network (ILINet), a collaborative effort with states and primary care providers who regularly report cases of influenze-like illness on a weekly basis. While ILINet in New York State has always maintained an adequate proportion of ILINet providers to population, gaps in geographic and demographic coverage are present. Human Subjects Review: The study was granted an exemption from review by the SUNY Upstate Medical University IRB. Design: Cross-sectional survey of physicians. Setting: Statewide influenza surveillance program, relying upon physician volunteers. Patients or Other Participants: Initial cohort of physician respondents recruited SALT-Net practice-based research network and through the ILINet provider roster.Additional respondents will be sought through partnerships with other practice-based research networks. Main and Secondary Outcome Measures: Initial results were analyzed descriptively, and a bivariate logistic regression model was created with “Participation in ILINet” serving as the outcome variable. Qualitative comments were also collected. Anticipated Results: We expect additional responses to increase the significance of our findings from the initial survey dissemination, to which 86 providers responded. Endorsement of the validity of ILI surveillance was the most significant predictor of participation (O.R.=9.926, p=.004). Years in practice (O.R.=1.097, p=.018) and possession of a master’s degree (O.R.=4.346, p=.049) were also significant factors. A time usage and compensation factor was nominally significant (O.R.=1.868, p=.051). Qualitative comments generally endorsed ILI surveillance as a good method of influenza monitoring, with some citing ease of use as an incentive. Conclusions: We expect to identify factors which incentivize participation in surveillance programs like ILINet, as well as barriers to physician participation.

Sunday, November 13,
2011 9:30 AM

P187 Antepartum Depression Screening Effectiveness in
Indentifying At-risk Women

Kristin Rutherford, MS, FNP-C; Christopher Morley, PhD,
MA, CAS, SUNY Upstate Medical University; Abigail Beaudette; Virginia Young, MLS

Objective: To determine the effectiveness of antepartum depression screening of pregnant women in identifying those at risk for postpartum depression. Design: A systematic search of the current literature on antepartum screening for postpartum depression. A medical librarian conducted searches in Medline, PubMed CINAHL, Cochrane, PsycINFO, and Scopus. Search terms in the databases which utilize MeSH subject headings (Cochrane, Medline, PubMed, PsycINFO) were "Depression, Postpartum" [Mesh], "Depression, Postpartum/prevention and control" [Mesh], "Prenatal care" [Mesh] combined with the keywords "screening" or "diagnosis." In the databases which do not use MeSH subject headings (CINAHL and Scopus) the keywords used were "prenatal care" and "postpartum depression" and "screening." Only English language studies were selected. Outcomes: ROC curve and summary statistics (AUC) for sensitivity & specificity of tests, particulary Edinburgh Postnatal Depression Scale. Qualitative assessment of the findings will be presented as well. Early/Expected Results: Preliminary findings suggest antepartum depression screening does in fact identify women at risk for developing postpartum depression. Multiple studies showed that screening women in the antepartum period is effective in detecting depression during pregnancy. Screening women during the antepartum period leads to early identification and treatment which in turn leads to less postpartum depression. Preliminary Conclusions: Antepartum depression screening of women to identify risk for postpartum depression appears to be effective and relatively efficient and easy to conduct, when using standardized instruments such as the Edinburgh Postnatal Depression Scale.

Sunday, November 13,
2011 2:00 PM Room: DC Coleman

OP17 Impact of Prior
Authorization Requirements in Primacy Care: A Salt-net Study

John Epling, MD, MSEd, SUNY Upstate Medical University;
Christopher Morley, PhD; Kathleen Barzee, MPH

Context: Insurance companies increasingly require prior authorization for various health-related services prescribed by primary care providers. Objective: What is the economic burden of insurance company prior authorization requirements on primary care practices in New York? Design: Pilot concurrent self-report single cohort observational study. Setting: Primary care practices in the Central and Northern New York region who are members of SALT-Net, a practice-based research network. Participants: Providers, nurses, and clerical staff in nine primary care practices. Methods: Baseline practice characteristics (setting, size, staffing, payer mix) were obtained from each practice. Each participant (provider, nurse, clerical) completed a data card for 25 consecutive prior authorization requests, or consecutive requests for one month, whichever occurred sooner, from insurance companies for a range of services. Data items collected include object of request, provider type, category of insurance, and total number of minutes spent on that request. Where ingle requests required activity by multiple participants, each participant recorded their time individually. Data collection occurred during Fall, 2010. Outcome Measures: Average hours per week for prior authorization requests were calculated for all practices, and stratified by recorder type, request type and insurance type. These figures were combined with US Bureau of Labor Statistics data for New York State to generate an average staffing cost per practice required to deal with prior authorization requests. Results: Roughly 434 individual authorization requests were recorded by participants in nine practices. Initial analyses indicate that practices spent an average of 2.8 staff hours per week with prior authorization requests, at an average staffing cost to the practice of $71 per week. Clerical staff and RNs spent the most time on these requests (1.3 and 0.7 hours/week respectively). Most time was spent on radiologic studies (1.4 hours/week), and medications (1.0 hours/week). Commercial insurance company requirements took the most time (1.7 hours/week), followed by Medicaid (0.4 hours/week) and commercial Pharmacy Benefits Managers (0.3 hours/week). Limitations to these results include incomplete reporting, estimations based on average cost data and relatively short data collection windows. Conclusions: Prior authorization requirements have definable monetary costs to primary care practices.

Monday, November 14,
2011 9:00 AM

P220 Predictors of
Interest in Future Global Health Practice Among First and Second Year Medical
Students

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Ana Villarreal, BA; Carrie Roseamelia,
MA

Objective: To identify predictive factors for interest in global health practice among early medical students. Design: Exploratory, descriptive study using a prospective survey. Setting: Year 1-2 Clinical Skills course at an allopathic medical school. Participants: We surveyed all first- and second-year students at the beginning of the 2010 academic year, as they entered a required two-year clinical skills course to measure attitudes toward careers in global health, rural practice, in primary care, and in other settings. The survey included Likert-scaled questions asking about future specialty and practice context preferences, attitudes toward global health practice, primary care, care for the underserved, and geographical location (i.e. rural vs. urban, etc.) of future practice, along with basic demographics. Outcome Measures: Principal Components Analysis (PCA) was utilized to identify 15 factors within the survey. Factor loadings were then modeled via stepwise OLS regression as predictors of interest in future global health practice. All statistical analyses were conducted in SPSS v.18.0.3. Results: We obtained a strong response rate (155/160 MSIs, and 141/160 MSIIs; 92.5% response rate overall). Interest in Urban Care (?=0.32 p<.001), Underserved Care (?=0.32 p<.001), Surgery (?=0.2 p<.001), Patient Communication (?=0.17 p=.002), Preventive Medicine (?=0.16 p=.003), Primary Care (?=0.15 p=.007), and in Advanced Training Opportunities (?=0.14 p=.013) each were significantly predictive of interest in future global health practice. Conversely, concerns about job security and income (?=-0.24 p<.001), as well as interest in Neurology and Psychiatry (?=-0.21 p<.001), were negatively associated with interest in future global health practice. Conclusions: Administrators of global health electives and educational programs may consider these factors in targeting students for recruitment. Conversely, programs may consider introducing global health curricular elements in order to attract students who are interested in primary care, preventive medicine, and in various other forms of underserved care.

Monday, November 14,
2011 9:00 AM

P221 Predictors of
Medical Student Interest in Rural Practice

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Carrie Roseamelia, MA;
Andrea Manyon, MD

INTRODUCTION: Interest in a primary care career and rural upbringing have been shown to be predictors of future medical practice in rural areas. As part of a dedicated expansion of a Family Medicine-Based Rural Medical Scholars Program, we explored these factors and others in a cohort of MSIs and MSIIs as they began a clinical skills training program at SUNY Upstate Medical Unvierisity. Methods: We surveyed all first- and second-year students at SUNY Upstate Medical University at the beginning of academic year 2010, as they entered a required two-year clinical skills course to measure attitudes toward careers in rural practice, in primary care, and in other settings. The survey included Likert-scaled questions asking about future specialty and practice context preferences, attitudes toward primary care, care for the underserved, and geographical location (i.e. rural vs. urban, etc.) of future practice, along with basic demographics. We examined associations between interest in rural practice and predictor variables via OLS regression in SPSS v.18. RESULTS: We obtained a strong response rate (155/160 MSIs, and 141/160 MSIIs; 92.5% response rate overall). Rural origin measured by RUCA code (?=.105, p=.001) and early interest in a primary care career (Beta=.224, p<.001) were strongly associated with interest in rural practice. Additionally, African-American race (Beta=-.095, p=.016), concern about educational debt (Beta=.105, p=.001), and level of concern about the prestige of chosen specialty were inversely associated with interest in eventual rural practice (Beta=-.141, p=.003). Discussion: Consistent with existing literature, rural origin and interest in primary care were associated with eventual rural practice. These interests may be mitigated by concern over concerns about debt load and prestige.

Monday, November 14,
2011 9:00 AM

P225 Evaluation of a
Curriculum on Care for Patients With Disabilities: Effects on Medical Student
Attitudes and Comfort Levels

Andrew Symons, MD, MS; Christopher Morley, PhD, MA,
CAS, SUNY Upstate Medical University; Denise McGuigan, MSEd; Elie Akl, MD, PhD

Objective: To evaluate the effect of a new curriculum teaching medical students to care for patients with disabilities. Design: Comparable cohort design, pre/post test. Setting: Two regionally proximal, comparable medical schools. School A implemented the new curriculum, incorporating it into required clinical skills training in the first two years of medical school, and School B maintained an existing curriculum. Participants: Medical students enrolled in required clinical skills courses in Fall, 2008 (pre-test). Students participating in Family Medicine clerkships were invited to respond to the post-test in the AY 2010-2011. Data were collected anonymously. Outcomes: Pre-test was used to establish group similarities, and post-test means were compared between groups via one-way Analysis of Variance (ANOVA). Results: There were virtually no statistical differences between the two student cohorts, in terms of age, gender distribution, or in responses to 18 pre-test and vignette-reaction questions, with two exceptions: students at the School B were in slightly higher agreement that they would “feel comfortable living next door to a person with an intellectual disability that lives by himself” (p=.049); and students at School A indicated that they had experiences similar to a clinical vignette presented in the survey and a slightly higher rate of agreement (p<.001). However, mean responses were statistically different on 15 items, including 13 at a p value of .001 or below. Out of the 15 categories where statistical differences were observed, 13 indicated an improvement in the intervention group relative to the control group, whereas 2 items seemed to be rated more favorably by controls. Conclusions: The intervention appears to have dramatically improved the attitudes and comfort levels of medical students in the provision of care for patients with disabilities. Additional follow-up studies include implementation of the curriculum at a second institution, and factor analysis of the instruments used.

Monday, November 14,
2011 10:15 AM Room: New Brunswick

BP24 Analysis of
Narrative Responses to a Post-ISPE Self-assessment Completed by Family
Medicine Clerkship Students

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Carin McAbee,
BS; Andrea Manyon, MD

Objective: To assess psychometric, linguistic and qualitative differences in self-assessment comments between high and low scorers on a biopsychosocial Integrated Standardized Patient Examination (ISPE) that combined assessment of medical knowledge with communication, counseling, and clinical interviewing skills. Design: Descriptive, exploratory, mixed qualitative/quantitative study. Setting: Standardized Patient (SP) examination within a Family Medicine Clerkship. Participants: Third and fourth year medical students. Instruments: 1) A self-assessment module completed by students upon completion of their ISPE session containing qualitative comments about what they did well with, what they could improve upon, and an overall assessment of the SP’s understanding. 2) The text of these comments were analyzed using the Linguistic Information and Word Count 007 (LIWC2007) software package, which utilizes a validated dictionary to assess narrative passages on 65 linguistic and psychological domains, based upon percentage of words used that are identified with each domain. 3) Students were graded using a 27-question instrument scoring instrument. 4) Group means on the 65 LIWC-inferred dimensions were compared between high scorers (+1 SD from mean; n=49) and low scorers (-1 SD from mean; n=45) via t-tests in SPSS v18.0.3. Outcomes: Statistically significant difference between high and low scorers on any of 65 measured domains. Results: High scorers had statistically significant larger scores in 11 domains, including overall word count (p=.009) and six other linguistic measures, as well as in four psychological domains: Anxiety (p=.043), words that ascribe causality (p=.010), words that indicate inhibition (p=.045), and words that are indicative of perceptual processes in action (p=.050). Conclusions: High and low scorers appear to be systematically different in a number of ways. Further research into whether such differences are due to temporary factors, such as differential responses towards tests or towards the FM clerkship, or whether such differences are more embedded, is warranted.

Tuesday, November
15, 2011 8:30 AM Room: Cascade

ET32 Medical Student
Experiences With a New Integrated Standardized Patient Examination:
Qualitative Analysis of Focus Group Data

Jennifer R. Flad, PhD;
Christopher Morley, PhD, MA, CAS, SUNY Upstate Medical University

Objective: To qualitatively gauge student reactions to a new, complex standardized patient examination as a follow-up to previously-reported mixed method evaluation results. Design: Focus groups held before and after SP examination. Transcripts of FG interviews were analyzed using immersion/crystallization methods. Setting: Single-station standardized patient examination featuring a complex patient, integrating biological, psychological, and social factors into one encounter, at the end of a Family Medicine Clerkship. Participants: Medical Students (MSIII’s & IV’s) enrolled in FM clerkship (N=41). Outcome Measures: Emerging themes from student/research focus group dialogues. Results: Three primary themes emerged from the focus group transcripts. 1. “Readiness for the SP encounter” (highly variable prior clinical experiences; lack of training in translating medical jargon into vernacular speech; a feeling among some but not all that the examination did not resemble experiences in the preceptor’s office). 2. “Focus on the Grade” was evident (anxiety about video recording of the encounter, and about unpredictable SP’s). Frustration about lack of feedback was also apparent. 3. “Scope of Practice.” Some students challenged conceptions of physician roles in helping patients address psychological and social confounders of health status. In spite of these challenges, many student comments served to validate and endorse the experience. Conclusions: Student responses indicate a lack of focus on biopsychosocial elements in their medical school training. A lack of opportunities to learn to explain diagnoses to patients in nontechnical language was noted as a deficiency in prior training. When students were asked how they learned to give a diagnosis and communicate with patients, many claimed this was done by observing a physician, and revealed a lack of standardization in their understanding of the role of physicians in these encounters. Also, communication-intensive SP-based examinations would benefit by the addition of prompt feedback with each student on strengths and weaknesses, create a learning opportunity.

Tuesday, November
15, 2011 10:45 AM

P384 Health
Ramifications of Displacement: Undocumented Migrants, Refugees, IDP's, and
Stateless Persons

Lindsey Kingston, PhD; Christopher Morley, PhD, MA,
CAS, SUNY Upstate Medical University

Objective: To expand upon previous work focused upon stateless populations and health. Because globalized factors related to migration and health rights are often interconnected, this review addresses the following: (1) Undocumented immigrants, who are sometimes referred to as “economic refugees”; (2) Refugees, or people who have been forced to flee their homes and cross international borders; (3) Internally-displaced persons (IDPs), or people who have fled their homes but remain in their home country; and (4) Stateless persons who do not have legal nationality in any nation-state. In addition to providing a definitional background and illustrative examples for each group, this review also outlines the health challenges associated with each case and provides recommendations for protecting the “right to health.” Design: Narrative Review of the Literature. Results: International human rights frameworks outline a universal “right to health,” yet undocumented immigrants and displaced persons face unique health challenges that threaten this basic right. This threat is twofold: First, many are exposed to health risks due to their particular circumstances. Trauma associated with forced displacement and prolonged periods spent in camps, for instance, have negative impacts on the physical and mental health of refugees and internally displaced persons (IDPs). Second, these groups are often denied the medical services necessary for prevention and treatment. For example, undocumented immigrants and the stateless are often denied access to health care such as essential medicines and reproductive services. Conclusions: In order to protect the “right to health” of undocumented immigrants and the displaced, the medical community must be more aware of the specific needs and challenges associated with these groups. This is particularly important for those who interact with such groups, including primary, emergency, and public health practitioners.

Tuesday, November
15, 2011 2:30 PM Room: DC Coleman

PD33 Long Term Effects of Cow's Milk Feeding in Infancy on BMI, Blood Pressure and Insulin Resistance

Alevtina Durmashkina,
MD, PhD; Christopher Morley, PhD, MA, CAS, SUNY Upstate Medical University;
Elena Lukushkina, MD, PhD; Olga Netrebenko,
MD, PhD

CONTEXT: The results of a survey conducted in Nizhny Novgorod, Russia in 2001 had revealed a low prevalence of exclusive breastfeeding and high incidence of whole cow’s milk feeding in infants. OBJECTIVE: To evaluate consequences of whole cow’s milk feeding in infancy on BMI, blood pressure and insulin resistance. DESIGN: Case-control cohort analysis. PATIENTS: 79 children, aged 4-9 years, recruited from a clinical population (n=436) who had previously participated at infant feeding practice survey, and who had been assessed by a pediatrician at 12 months at a pediatric clinic in Nizhny Novgorod, Russia. MAIN OUTCOME MEASURES: BMI, blood pressure, and insulin resistance. Participants were divided into 2 groups according to type of feeding in infancy: those breastfed for a minimum of 9 months (BF; n=36), and those who had a high daily volume of cow’s milk during the first year (CM; n=43). Group differences in BMI, blood pressure, and 2-hour insulin were initially analyzed by Student’s t-test; multivariate testing was conducted using forward stepwise OLS regression. All analyses were performed in SPSS v. 18.03. RESULTS: CM Children showed higher systolic and diastolic blood pressure (99.58 vs 93.39 mm Hg, p less than 0.001; 68.23 vs 63.67 mm Hg, p=0.003, respectively), and a marginally significant upward trend in 2-hour insulin (18.5 vs 9.52 mcIU, p=0.049). Forward stepwise regression revealed the only significant independent variable to be a grouping (1,0) variable for BF vs CM. BMI at first visit was slightly but significantly higher (Beta=1.013, p=.026) for the CM group, with a clear trend separating the groups beginning at 6 months, and persisting through last measurement at 18 months, where the difference in BMI becomes 1.6 times higher (Beta=1.697, p=.003), despite having lost roughly half the sample to follow-up by this point (n=40). CONCLUSIONS: These findings suggest that dietary patterns in infancy have immediate effects into toddlerhood and through age 9.

Tuesday, November
15, 2011 3:45 PM Room: Cascade

DB34 Evaluation of a
Chronic Care Model for Diabetes in a Rural Family Practice Network

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Alevtina Durmashkina, MD, PhD; Douglas Rahner,
MD; Tricia Lyman, BA; Mary Alm, BS

Objective: Evaluation of clinical outcomes in diabetes patients following implementation of a chronic care treatment model in a 5-practice network. Design: Single-arm pre/post evaluation. Setting: Five-practice family medicine network in rural New York State. Participants: Patients with Diabetes Type I and Type II (N=432). Outcomes: Change in HbA1c, glucose, lipids, creatinine levels, BMI and BP measurements. Data were analyzed using the Statistical Package for Social Sciences (SPSS 18.0.0). Descriptive statistics, including means, standard deviations, and frequencies were calculated. Non-parametric paired t-tests were used to evaluate the differences between pre-test scores and post-test scores following the intervention. Spearman correlations were used to evaluate relationships of changes in HbA1c, glucose, lipids and creatinine levels as well as BMI and BP measurements following the intervention. Results: 392 individuals completed all pre-tests and 401 individual completed all post-tests, providing anthropometric measurements, blood samples for HbA1c, glucose and lipid profile. At pre-test, 161 participants (38.7%) had a higher than recommended HbA1c level (7.0%). There was no significant decrease in BMI, mean glucose and HbA1c levels in the general cohort. However, the subset of participants who had the pre-test HbA1c >7% had significant decreases in mean HbA1c from 8.72% to 8.3%, (P = 0.007), and those with high glucose (>126 mg/dL) had a mean decrease in glucose from 189 to 167.9 mg/dL (p less than 0.001). There was also significant improvement in lipid parameters of individuals who had clinically high cholesterol, triglycerides, and low HDL as well as improvements in BP. Conclusions: Although there was no control arm in this evaluation, the pre-test measurements were taken in patients who were already diagnosed and under a usual care standard of treatment. The improvements seen following implementation of the Chronic Care Model intervention at each site are therefore indicative of efficacy of this approach.

Wednesday, November
16, 2011 11:00 AM Room: Cascade Ballroom

WS44 Qualitative
Research Methods and Design: A Basic Primer/Review

Christopher Morley, PhD, MA, CAS, SUNY Upstate
Medical University; Jennifer Flad, PhD; Lindsey
Kingston, PhD; Carrie Roseamelia, MA

Objectives of the session: When conducting and reporting primary care qualitative research, essential methodological concepts like sampling strategy, validity, sample characteristics, and coding methods are just as important to consider and address as in quantitative work. However, many qualitatively-based conference and journal submissions suffer from a lack of rigor. Issues include nebulous results, failure to present clear research questions, or disconnectedness between research questions, methods, and results. Content of the Session: This session will cover the basic elements of research design and reporting from a qualitative perspective, including: 1) Hypothesis generation and testing in qualitative research ; 2) Forming a Research Question, and selection of an appropriate method to answer it ; 3) Sampling - methods, sample characteristics, representativeness; 4) Methodological approach - Grounded Theory, Phenomenology, Institutional Ethnography, etc.; 5) Evaluating and analyzing the data - coding/theming 6) Reporting findings; 7) A quick review of software that can make analysis easier, or which allows for novel mixing of methods. Method and Extent of Audience Participation: The format will include a brief panel presentation, hand-out of take-home materials, a break-out session with participants practicing interviewing and coding techniques in small groups, and an open question-and-answer session with the four panel members. Prerequisite Knowledge: Participants should have a basic understanding of what qualitative research is. It may be beneficial for participants to have a project in mind, but this is not required.

An interesting blog by a noted Family Medicine research

2011-07-27T06:23:00.001-07:00

http://www.medicinesocialjustice.blogspot.com/

2010-09-16T10:15:00.000-07:00

2010 North American Primary Care Research Group (NAPCRG)
Annual Meeting

Seattle, Washington

Nov. 13-17, 2010

http://www.napcrg.org

Presentations to be made by faculty affiliates of the
Division of Research & Academic Development,
Department of Family Medicine,
SUNY Upstate Medical University

Sunday, November 14, 2010 9:30 AM Room: Grand Ballroom III
P138 Development Process of an Integrated Standardized Patient Evaluation of Biopsychosocial Skills In a Complex Patient: Analysis of Participant Observation Data
Jennifer R. Flad, PhD; Christopher Morley, PhD, MA, CAS, Department of Family Medicine, SUNY Upstate Medical University; Andrea T. Manyon, MD

Sunday, November 14, 2010 9:30 AM Room: Grand Ballroom III
P154 Impact of Prior Authorization Requirements In Primary Care
John Epling, MD, MSEd, SUNY Upstate Medical University; Christopher Morley, PhD; Kathleen Barzee, MPH

Sunday, November 14, 2010 4:15 PM Room: Orcas
WS24 Qualitative Research Methods And Design: A Basic Primer/Review
Christopher Morley, PhD, MA, CAS, SUNY Upstate Medical University; Jennifer Flad, PhD; Carrie Roseamelia, MA; Lindsey Kingston, PhD

Monday, November 15, 2010 9:30 AM Room: Grand Ballroom III
P209 A Meta-analysis of Competitive Level And Upper-extremity Bone Mass Density In Female Athletes
Armin Arasheben, MD; Christopher Morley, PhD, MA, CAS, Department of Family Medicine, SUNY Upstate Medical University; Kathleen Barzee, MPH

Monday, November 15, 2010 9:30 AM Room: Grand Ballroom III
P256 Primary Care Diagnosis And Management of Vitamin D Deficiency
John Epling, MD, MSEd, SUNY Upstate Medical University; Christopher Morley, PhD; Kathleen Barzee, MPH

Tuesday, November 16, 2010 1:30 PM Room: Cascade 2
VP32 Statelessness, The Right to Health, And The Necessity of Legal Nationality
Lindsey Kingston, PhD; Christopher Morley, PhD, MA, CAS, SUNY Upstate Medical University; Elizabeth F. Cohen, PhD

Tuesday, November 16, 2010 3:45 PM Room: Elliot Bay
MI47 Health Status, Health Care Utilization, And Health Information Sharing Patterns Of Adult Patients At A Regional Spina Bifida Center
Nienke Dosa, MD, MPH; Christopher Morley, PhD, MA, CAS, SUNY Upstate Medical University; Rebecca Lavalley; Kimberly Garver, MSW; Gregory S. Liptak, MD; Marygrace Flaherty, MLS; Carsten Oesterlund, PhD

Wednesday, November 17, 2010 10:45 AM Room: Cascade 1-C
OE51 A Retrospective Chart Study of Juvenile Program Completers And Participants Vs. Drop-outs In a Medical Weight Loss Program.
Wendy Scinta, MD; Christopher Morley, PhD, MA, CAS, Department of Family Medicine, SUNY Upstate Medical University

Recent Publications by Family Medicine Faculty

2010-06-08T07:54:00.000-07:00

Kingston LN, Cohen EF, Morley CP.Limitations on universality: the "right to health" and the necessity of legal nationality. BMC Int Health Hum Rights. 2010 Jun 4;10(1):11.

View PubMed record here

ABSTRACT
BACKGROUND: The "right to health," including access to basic healthcare, has been recognized as a universal human right through a number of international agreements. Attempts to protect this ideal, however, have relied on states as the guarantor of rights and have subsequently ignored stateless individuals, or those lacking legal nationality in any nation-state. While a legal nationality alone is not sufficient to guarantee that a right to healthcare is accessible, an absence of any legal nationality is almost certainly an obstacle in most cases. There are millions of so-called stateless individuals around the globe who are, in effect, denied medical citizenship in their countries of residence. A central motivating factor for this essay is the fact that statelessness as a concept is largely absent from the medical literature. The goal for this discussion, therefore, is primarily to illustrate the need for further monitoring of health access issues by the medical community, and for a great deal more research into the effects of statelessness upon access to healthcare. This is important both as a theoretical issue, in light of the recognition by many of healthcare as a universal right, as well as an empirical fact that requires further exploration and amelioration. DISCUSSION: Most discussions of the human right to health assume that every human being has legal nationality, but in reality there are at least 11 to 12 million stateless individuals worldwide who are often unable to access basic healthcare. The examples of the Roma in Europe, the hill tribes of Thailand, and many Palestinians in Israel highlight the negative health impacts associated with statelessness. SUMMARY: Stateless individuals often face an inability to access the most basic healthcare, much less the "highest attainable standard of health" outlined by international agreements. Rather than presuming nationality, statelessness must be recognized by the medical community. Additionally, it is imperative that stateless populations be recognized, the health of these populations be tracked, and more research conducted to further elaborate upon the connection between statelessness and access to healthcare services, and hence a universal right to health.

Morley CP. The effects of patient characteristics on ADHD diagnosis and treatment: a factorial study of family physicians. BMC Fam Pract. 2010 Feb 8;11:11.

View PubMed record here
ABSTRACT
BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a costly and prevalent disorder in the U.S., especially among youth. However, significant disparities in diagnosis and treatment appear to be predicted by the race and insurance status of patients. METHODS: This study employed a web-based factorial survey with four ADHD cases derived from an ADHD clinic, two diagnosed with ADHD in actual evaluation, and two not. Randomized measures included race and insurance status of the patients. Participants N = (187) included clinician members of regional and national practice-based research networks and the U.S. clinical membership of the Society of Teachers of Family Medicine. The main outcomes were decisions to 1) diagnose and 2) treat the cases, based upon the information presented, analyzed via binary logistic regression of the randomized factors and case indicators on diagnosis and treatment. RESULTS: ADHD-positive cases were 8 times more likely to be diagnosed and 12 times more likely to be treated, and the male ADHD positive case was more likely to be diagnosed and treated than the female ADHD positive case. Uninsured cases were significantly more likely to be treated overall, but male cases that were uninsured were about half as likely to be diagnosed and treated with ADHD. Additionally, African-American race appears to increase the likelihood of medicinal treatment for ADHD and being both African-American and uninsured appears to cut the odds of medicinal treatment in half, but not significantly. CONCLUSIONS: Family physicians were competent at discerning between near-threshold ADHD-negative and ADHD positive cases. However, insurance status and race, as well as gender, appear to affect the likelihood of diagnosis and treatment for ADHD in Family Medicine settings.

Scholarly Pairings for Academic and Research Collaboration - the SPARC program

2009-11-16T19:41:00.000-08:00

The SPARC program invites regional students at all levels from education, the social sciences, and other disciplines to explore opportunities to collaborate with faculty in the Department of Family Medicine (DFM) at SUNY Upstate Medical University. The primary goal for this program is to allow students and DFM faculty to produce scholarly papers, presentations, and other academic output, together as collaborators. This allows the student to access populations, data, pre-doctoral publication opportunities, and potentially unique research opportunities that would not otherwise be available to them. At the same time, it allows DFM faculty and collaborators to tap into the skills, knoweldge, and expertise that many students already have.

Projects completed or in progress that have involved SPARC associates include a mixed methods evaluation of the Department's standardized patient program, evaluation activities associated with the Transitions Institute (a collaboration with the Department of Pediatrics at SUNY Upstate), an exploration of the role of legal nationality on access to the right to health, and a newly-instituted program, the "Research Experience in Ethics and Health" (http://www.upstate.edu/fmed/reeh.php).

This project has been made possible by intra-departmental funding and commitment of effort, as well as by a federal grant award from the Health Resources and Services Administration (HRSA grant D54HP05462, Andrea T. Manyon, PI).

North American Primary Care Research Group

2009-11-16T19:36:00.001-08:00

Members of the Department of Family Medicine are giving three podium presentations at this year's NAPCRG annual meeting, including two presentations on work derived from the development of a standardized patient examination that evaluates FM clerkship students on their ability to address the psychological and social needs of a patient with an impending diagnosis of Diabetes. Additionally, an analysis of data from a vignette study of the influences of race and insurance status on ADHD diagnosis and treatment preferences is also being presented.

See the NAPCRG website for more information.

SALT-Net, a Practice-Based Research Network

2009-11-16T18:55:00.001-08:00

Faculty in the Department of Family Medicine are developing a practice-based research network (PBRN) from the ranks of its community faculty preceptors and other associates. The primary aim of the PBRN - entitled the "Studying, Acting, Learning, Teaching Network" - or SALT-Net - is to serve as an incubator for new ideas to improve primary care practice in the Central New York region.

The first two studies conducted through SALT-Net were survey-based. The initial study was a survey of physician attitudes about obesity and obese patients. The data from this study are presently under analysis. The second study was a rapid look at the effect of news coverage of MRSA outbreaks on phsyician practices in our region, and was published in the Journal of Public Health Practice and Management in March, 2009.

PBRN studies currently in the planning stages include:

Moving regional primary care practices toward the Patient-Centered Medical Home model of care;
A study examining regular approaches to identifying and treating Vitamin D Deficiency;
A study examining the time spent on Prior Authorization procedures in primary care practices;
A study examining the effects of waiting time on patient satisfaction;

Additional study ideas are always welcome!

Medical Education

2009-09-29T11:02:00.000-07:00

The Department of Family Medicine regularly evaluates it's own educational endeavors, and has:

Developed a BioPsychoSocial Integrated Standardized Patient Examination (ISPE) for the Family Medicine clerkship;

Conducts periodic evaluations of its Rural Medical Education Program (RMED).
See, for example: Smucny J, Beatty P, Grant W, Dennison T, Wolff LT. An evaluation of the Rural Medical Education Program of the State University Of New York Upstate Medical University, 1990-2003. Academic Medicine. 2005 Aug;80(8):733-8.

Conducted a literature review to inform the development of practice management competency guidelines for Family Medicine residencies: Kolva DE, Barzee KA, Morley CP. Practice management residency curricula: a systematic literature review. Family Medicine. 2009 Jun;41(6):411-9.

Health, Human Rights, Medical Citizenship & Ethics

2009-09-29T10:36:00.000-07:00

Faculty in the Department of Family Medicine are currently working on several projects that examine ethical issues related to healthcare,social justice & health, and the bidirectional relationship between citizenship and health. Some examples include:

Genetics of Schizophrenia

2009-09-14T08:50:00.000-07:00

The Department of Family Medicine and the Department of Psychiatry at SUNY Upstate are collaborating to collect genetic material and data from 1000 patients with schizophrenia, and 1000 healthy control subjects, as part of a larger international, multi-site, NIMH-funded effort.

We are now entering our second year of collection, and welcome patient referrals. Schizophrenia patients are offered $50 for their participation for a blood draw and a one-hour interview. We are also happy to accept those who wish to volunteer as healthy control subjects! Healthy controls also give a sample of blood, but answer only a brief screening questionnaire, and are offered $25 for their participation.

More information about this project is available here:
http://www.upstate.edu/fmed/research/gpc.php