1
|
Filippi MK, Nederveld A, Williams MD, Robertson E, Doubeni C, Waxmonsky JA, Hester CM. Integrated Behavioral Health Adaptations During the COVID-19 Pandemic. J Am Board Fam Med 2024; 36:1023-1028. [PMID: 38182424 DOI: 10.3122/jabfm.2023.230125r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to behavioral health (BH) access. METHODS Semistructured interviews were completed with clinicians from family medicine residency programs on the impact of the pandemic on IBH care delivery along with adaptations employed by care teams to ameliorate disruption. RESULTS Participants (n = 41) from 14 family medicine residency programs described the rapid shift to virtual care, creating challenges for IBH delivery and increased demand for BH services. With patients and care team members at home, virtual warm handoffs and increased attention to communication were necessary. Screening and measurement were more difficult, and referrals to appropriate services were challenging due to higher demand. Tele-BH facilitated continued access to BH services but was associated with logistic challenges. Participants described adaptations to stay connected with patients and care teams and discussed the need to increase capacity for both in-person and virtual care. DISCUSSION Most practices modified their workflows to use tele-BH as COVID-19 cases increased. Participants shared key learnings for successful implementation of tele-BH that could be applied in future health care crises. CONCLUSION Practices adapted readily to challenges posed by pandemic restrictions and their ability to sustain key elements of IBH during the COVID-19 pandemic demonstrates innovation in maintaining access when in-person care is not possible, informing strategies applicable to other scenarios.
Collapse
Affiliation(s)
- Melissa K Filippi
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW). )
| | - Andrea Nederveld
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Mark D Williams
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Elise Robertson
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Chyke Doubeni
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Jeanette A Waxmonsky
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Christina M Hester
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| |
Collapse
|
2
|
Filippi MK, Waxmonsky JA, Williams MD, Robertson E, Doubeni C, Hester CM, Nederveld A. Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study. J Am Board Fam Med 2024; 36:1008-1019. [PMID: 37857440 DOI: 10.3122/jabfm.2023.230067r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Integrating behavioral health services into primary care has a strong evidence base, but how primary care training programs incorporate integrated behavioral health (IBH) into care delivery and training has not been well described. The goal of this study was to evaluate factors related to successful IBH implementation in family medicine (FM) residency programs and assess perspectives and attitudes on IBH among program leaders. METHODS FM residency programs, all which are required to provide IBH training, were recruited from the American Academy of Family Physicians National Research Network. After completing eligibility screening that included the Integrated Practice Assessment Tool (IPAT) questionnaire, 14 training programs were included. Selected practices identified 3 staff in key roles to be interviewed: medical director or similar, behavioral health professional (BHP), and chief medical officer or similar. RESULTS Forty-one individuals from 14 FM training programs were interviewed. IPAT scores ranged from 4 (Close Collaboration Onsite) to 6 (Full Collaboration). Screening, outcome tracking, and treatment differed among and within practices. Use of curricula and trainee experience also varied with little standardization. Most participants described similar approaches to communication and collaboration between primary care clinicians and BHPs and believed that IBH should be standard practice. Participants reported space, staff, and billing support as critical for sustainability. CONCLUSIONS Delivery and training experiences in IBH varied widely despite recognition of the value and benefits to patients and care delivery processes. Standardizing resources and training and simplifying and assuring reimbursement for services may promote sustainable and high quality IBH implementation.
Collapse
Affiliation(s)
- Melissa K Filippi
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN). )
| | - Jeanette A Waxmonsky
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| | - Mark D Williams
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| | - Elise Robertson
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| | - Chyke Doubeni
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| | - Christina M Hester
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| | - Andrea Nederveld
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); University of Colorado Anschutz, Aurora, CO (AN)
| |
Collapse
|
3
|
Callen EF, Na'Allah R, Lewis A, Kerns J, Hester CM. Block Scheduling for LARC in a Family Medicine Residency Program. Fam Med 2023. [PMID: 38241742 DOI: 10.22454/fammed.2023.253918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Only 20% of family physicians report providing long-acting reversible contraception (LARC). Clinician-related barriers include confidence and comfort with LARC counseling and insertion/removal, and limited availability and uptake. Training during residency may address barriers and increase access/availability of LARC to support reproductive autonomy. We sought to determine the impact of block scheduling LARC clinics on resident comfort and confidence with LARC counseling and insertion/removal. METHODS LARC block schedules were established in a Midwest family medicine residency's primary clinic (FMC) and in a federally qualified health center rotation clinic. Baseline and end-of-study surveys, compared by Mann-Whitney U and Wilcoxon signed-rank tests, were used to assess comfort and confidence with counseling and inserting LARC. The number of LARC devices placed at the FMC were collected for the intervention year and the year prior. RESULTS Twenty of 30 residents completed the baseline survey; 13 completed the end-of-study survey. At the group and individual levels, comfort increased for counseling on Levonorgestrel (LNG) intrauterine devices (IUDs) and for inserting implants and LNG IUDs. Individual comfort increased for copper IUDs. Resident willingness to recommend LARC increased, and more devices were placed during the intervention year than the year prior in the FMC (all: P<.05). CONCLUSIONS Block scheduling of LARC clinics was associated with increased residents' comfort and confidence with counseling and placement of implants (LNG IUDs) and with an increase in LARCs placed at one clinic. Changes to scheduling may be an effective educational strategy that may increase access/availability to LARC.
Collapse
Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians National Research Network, Leawood, KS
- DARTNet Institute, Aurora, CO
| | - Rahmat Na'Allah
- Department of Family and Community Medicine, University of Illinois College of Medicine, Peoria, IL
| | - Artis Lewis
- Department of Family Medicine, Ascension St. Joseph Hospital Chicago, Chicago, IL
- John Fitzgibbon Memorial Hospital, Marshall, MO
| | - James Kerns
- Department of Family and Community Medicine, University of Illinois College of Medicine, Peoria, IL
- John Fitzgibbon Memorial Hospital, Marshall, MO
| | - Christina M Hester
- American Academy of Family Physicians, Leawood, KS
- DARTNet Institute, Aurora, CO
| |
Collapse
|
4
|
Carroll JK, Hester CM, Lutgen CB, Callen E, Hunt S, Lanigan AM, Bartlett-Esquilant G, Irwin G, Jones WA, Loskutova N, Mabachi NM, Okuyemi KS, Peterson LE, Smith RE, Tabel C, Weidner A. Research interests of family physicians applying for research training. BMC Med Educ 2023; 23:617. [PMID: 37644437 PMCID: PMC10466687 DOI: 10.1186/s12909-023-04562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND There is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020. METHODS Descriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant's career stage. RESULTS Sixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6-10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%). CONCLUSION Applicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives.
Collapse
Affiliation(s)
- Jennifer K Carroll
- Department of Family Medicine, University of Colorado, 12631 East 17th Ave Box F496, Aurora, CO, 80045, USA.
| | | | - Cory B Lutgen
- American Academy of Family Physicians, Leawood, KS, USA
| | | | - Sharon Hunt
- American Academy of Family Physicians, Leawood, KS, USA
| | | | | | - Gretchen Irwin
- University of Kansas School of Medicine, Wichita, KS, USA
| | - Warren A Jones
- University of Mississippi School of Medicine, Jackson, MS, USA
- The Jones Group of Mississippi, Jackson, MS, USA
| | | | | | - Kolawole S Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | - Cheri Tabel
- American Academy of Family Physicians, Leawood, KS, USA
| | - Amanda Weidner
- Association of Departments of Family Medicine, Leawood, KS, USA
| |
Collapse
|
5
|
Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
Collapse
Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
6
|
Fernald DH, Hester CM, Brown SR. "We've Really Built Something": Why Family Medicine Program Directors Stay in Their Positions-A Qualitative Study. J Grad Med Educ 2022; 14:451-457. [PMID: 35991101 PMCID: PMC9380624 DOI: 10.4300/jgme-d-21-01160.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Program directors (PDs) are essential to more than 12 000 residency and fellowship programs accredited in the United States. Short PD tenure may affect overall program quality. Reasons why PDs leave the position are multifactorial, and little is known about the reasons why PDs stay in the position. OBJECTIVE The authors explored factors related to retention and why family medicine PDs have stayed in their positions long term. METHODS This was a qualitative study of PDs in their roles for 12 or more years drawn from a national sample of family medicine residency PDs. Interviews with semi-structured and structured questions about long-term PD experience were conducted in October and November 2020. Multiple cycles of comparative coding and code network analysis produced constructs describing reasons why some PDs stay in the position long term. RESULTS Among 17 respondents with a mean tenure of 17.4 years, 3 interrelated constructs consistently emerged that supported PDs: developing the program, support systems, and job rewards. Program development reinforces internal and external support systems and enhances experiencing rewards of the job. Strong support systems enable further program development and job rewards. CONCLUSIONS Family medicine residency PDs who have been in the role 12 or more years continuously work to develop the program, benefit from strong internal and external support systems, and describe many important rewards of the position that help sustain them in the role.
Collapse
Affiliation(s)
- Douglas H. Fernald
- Douglas H. Fernald, MA, is Senior Instructor, Department of Family Medicine, University of Colorado
| | - Christina M. Hester
- Christina M. Hester, PhD, MPH, is Director, Practice-Based Research, Innovation, & Evaluation Division, American Academy of Family Physicians, National Research Network
| | - Steven R. Brown
- Steven R. Brown, MD, FAAFP, is Program Director, Phoenix Family Medicine Residency, University of Arizona College of Medicine
| |
Collapse
|
7
|
Abstract
BACKGROUND AND OBJECTIVES Family medicine residency program directors (PD) oversee the training of every new family physician in the United States. The median tenure of family medicine PDs is 4.5 years, and factors relating to length of tenure and reasons for departure are not well known. This exploratory study examined why family medicine PDs leave their position. METHODS We conducted in-depth interviews with family medicine PDs who recently left their director position. Semistructured and structured questions asked about their PD experience and factors contributing to stepping away from the PD role. We analyzed answers quantitatively and qualitatively. RESULTS When comparing cases with longer (>6 years) and shorter tenures (≤6 years), 25 PDs described differing pathways but few major differences in why they left the position. The two groups were distinguished more by their similarities than their differences. The majority left voluntarily due to a combination of factors, not a single factor. Most PDs left the position because of their desire and opportunities to move up, move over, or move on, and not because of dissatisfaction with the job. Succession plans helped with PD decisions to leave the position, knowing that the program was in good hands. CONCLUSIONS Family medicine PDs left the position due to multiple factors primarily related to career pathway choices and not solely due to demands of the job. Additional research with PDs of very short tenures and long tenures may yield further details about sustaining PDs in residency education to successfully train the next generation of family physicians.
Collapse
Affiliation(s)
- Douglas Fernald
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | | | - Steven R Brown
- University of Arizona College of Medicine - Phoenix Family Medicine Residency, Phoenix, AZ
| |
Collapse
|
8
|
Mullen R, Weidner A, Liaw W, Mainous AG, Hester CM, Goodyear-Smith F, Nease D, Schneider D, Ewigman B. Family medicine research capacity in the USA. Fam Pract 2021; 38:187-189. [PMID: 33159206 DOI: 10.1093/fampra/cmaa119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca Mullen
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Amanda Weidner
- Association of Department of Family Medicine, Leawood, KS, USA.,Family Medicine Residency Network, University of Washington School of Medicine, Seattle, WA, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine and Department of Health Services Research, Management and Policy University of Florida, Gainesville, FL, USA
| | | | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Donald Nease
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - David Schneider
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bernard Ewigman
- NorthShore University HealthSystem, Department of Family Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
9
|
Blosnich JR, Dichter ME, Gurewich D, Montgomery AE, Kressin NR, Lee R, Hester CM, Hausmann LRM. Health Services Research and Social Determinants of Health in the Nation's Largest Integrated Health Care System: Steps and Leaps in the Veterans Health Administration. Mil Med 2020; 185:e1353-e1356. [PMID: 32592393 DOI: 10.1093/milmed/usaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/16/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- John R Blosnich
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411
| | - Melissa E Dichter
- Corporal Michael J. Crescenz VA Medical Center, CHERP, 21 S University Ave, Philadelphia, PA 19104.,School of Social Work, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122
| | - Deborah Gurewich
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233.,School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233
| | - Nancy R Kressin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130.,Department of Medicine, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | - Richard Lee
- Veterans Rural Health Resource Center, 163 Veterans Dr, White River Junction, VT 05009
| | - Christina M Hester
- American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211
| | - Leslie R M Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411.,Division of General Internal Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 1526
| |
Collapse
|
10
|
Kovach KA, Lutgen CB, Callen EF, Hester CM. Informing the American Academy of family Physician's Health Equity strategy - an environmental scan using the Delphi technique. Int J Equity Health 2019; 18:97. [PMID: 31227001 PMCID: PMC6588858 DOI: 10.1186/s12939-019-1007-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many organizations have prioritized health equity and the social determinants of health (SDoH). These organizations need information to inform their planning, but, relatively few quantifiable measures exist. This study was conducted as an environmental scan to inform the American Academy of Family Physician's (AAFP's) health equity strategy. The objectives of the study were to identify and prioritize a comprehensive list of strategies in four focus areas: health equity leadership, policy, research, and diversity. METHODS A Delphi study was used to identify and prioritize the most important strategies for reducing health inequities among the four aforementioned focus areas. Health equity experts were purposefully sampled. Data were collected in three rounds for each focus area separately. A comprehensive list of strategy statements was identified for each focus area in round one. The strategy statements were prioritized in round two and reprioritized in a final third round. Quantitative and qualitative data were integrated for the final analysis. RESULTS Fifty strategies were identified across the four focus areas. Commitment to health equity, knowledge of health inequities, and knowledge of effective strategies to address the drivers of health inequities were ranked the highest for leadership. Universal access to health care and health in all policies were ranked highest for policy. Multi-level interventions, the effect of policy, governance, and politics, and translating and disseminating health equity interventions into practice were ranked the highest for research. Providing financial support to students from minority or low-socioeconomic backgrounds, commitment from undergraduate and medical school leadership for educational equity, providing opportunities for students from minority or low-socioeconomic backgrounds to prepare for standardized tests, and equitable primary and secondary school funding were ranked highest for diversity. CONCLUSIONS The AAFP and other medical specialty societies have an important opportunity to advance health equity. They should develop a health equity policy agenda, equip physicians and other stakeholders, use their connections with practice-based research networks to identify and translate practical solutions to address the SDoH, and advocate for a more diverse medical workforce. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Kevin A. Kovach
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Cory B. Lutgen
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Elisabeth F. Callen
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Christina M. Hester
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| |
Collapse
|
11
|
Hester CM, Jiang V, Bartlett-Esquilant G, Bazemore A, Carroll JK, DeVoe JE, Dickinson WP, Krist AH, Liaw W, New RD, Vansaghi T. Supporting Family Medicine Research Capacity: The Critical Role and Current Contributions of US Family Medicine Organizations. Fam Med 2019; 51:120-128. [PMID: 30736037 DOI: 10.22454/fammed.2019.318583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Family medicine is continuously advanced by a reinforcing research enterprise. In the United States, each national family medicine organization contributes to the discipline's research foundations. We sought to map the unique and interorganizational roles of the eight US family medicine professional organizations participating in Family Medicine for America's Health (FMAHealth) in supporting family medicine research. METHODS We interviewed leaders and reviewed supporting materials from organizations participating in FMAHealth. We explored existing activities, capacity, and collaboration. We identified areas of strength and opportunities for growth and synergy with respect to how the family of family medicine nurtures family medicine research. RESULTS The FMAHealth organizations support certain aspects of the family medicine research infrastructure. Six domains were identified through this work: showcasing scholarship, communication and dissemination, workforce development, data-driven initiatives, performing primary research, and advocacy for family medicine research. Each organization's areas of emphasis differ, but we found substantial collaboration on initiatives across organizations, possibly attributable to the fact that many members belong to more than one organization. CONCLUSIONS Deliberate contributions to each of the six domains identified herein will be important for the future success of family medicine research. Key opportunity areas described here include coordinated and strategic advocacy for increased funding for family medicine research, dedicated investment in training opportunities, protected effort to grow the next generation of family medicine researchers, pilot funding to build a research base for future high-impact research, and infrastructure to facilitate cross-institutional collaboration and data sharing.
Collapse
Affiliation(s)
| | - Vivian Jiang
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA
| | | | | | - Jennifer K Carroll
- Family Medicine for America's Health Research Tactic Team, and University of Colorado Department of Family Medicine
| | - Jennifer E DeVoe
- Family Medicine for America's Health Research Tactic Team, and Oregon Health & Science University Department of Family Medicine
| | - W Perry Dickinson
- Family Medicine for America's Health Research Tactic Team, and University of Colorado Department of Family Medicine
| | - Alex H Krist
- Family Medicine for America's Health Research Tactic Team, and Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, VA
| | - Winston Liaw
- Robert Graham Center, Washington, DC, and University of Houston College of Medicine, Department of Health Systems and Population Health Sciences
| | | | - Tom Vansaghi
- North American Primary Care Research Group, Leawood, KS
| |
Collapse
|
12
|
Hidaka BH, Hester CM, Bridges KM, Daley CM, Greiner KA. Fast food consumption is associated with higher education in women, but not men, among older adults in urban safety-net clinics: A cross-sectional survey. Prev Med Rep 2018; 12:148-151. [PMID: 30258763 PMCID: PMC6152808 DOI: 10.1016/j.pmedr.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/22/2018] [Accepted: 09/08/2018] [Indexed: 11/04/2022] Open
Abstract
Fast food consumption is linked to poor health, yet many older adults regularly consume fast food. Understanding factors contributing to fast food consumption is useful in the development of targeted interventions. The aim of this study was to characterize how fast food consumption relates to socio-demographic characteristics in a low-income sample of older adults. This study used cross-sectional survey data of 50 to79-year-olds (N-236) in urban safety-net clinics in 2010 in Kansas City, KS. Self-reported frequency of fast food consumption was modeled using ordinal logistic regression with socio-demographics as predictor variables. Participants were 56.8 ± 6.0 (mean ± SD) years old, 64% female, 45% non-Hispanic African American, and 26% Hispanic. Thirty-nine percent denied eating fast food in the past week, 36% ate once, and 25% ate fast food at least twice. Age was negatively correlated with fast food intake (r = −0.20, P = 0.003). After adjusting for age, race-ethnicity, employment, and marital status, the association between education and fast food consumption differed by sex (Pinteraction = 0.017). Among women, higher education was associated with greater fast food intake (Spearman's correlation; r = 0.28, P = 0.0005); the association was not significant in men (r = −0.14, P = 0.21). In this diverse, low-income population, high educational attainment (college graduate or higher) related to greater fast food intake among women but not men. Exploration of the factors contributing to this difference could inform interventions to curb fast food consumption or encourage healthy fast food choices among low-income, older adults.
Collapse
Affiliation(s)
- Brandon H Hidaka
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Department of Family Medicine, Kaiser Permanente Washington, Seattle, WA 98112, USA
| | - Christina M Hester
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA.,American Academy of Family Physicians, Leawood, KS 66211, USA
| | - Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Christine M Daley
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - K Allen Greiner
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA
| |
Collapse
|
13
|
Lumpkins CY, Filippi MK, Nazir N, Pacheco CM, Hester CM, Daley SM, Choi WS, Daley CM. It's not just about recruitment: An exploratory look at tobacco education sessions to increase participation into smoking cessation programs among American Indians. ACTA ACUST UNITED AC 2018; 3:1-4. [PMID: 34095515 PMCID: PMC8174104 DOI: 10.15761/hec.1000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
American Indians (AI) have the highest smoking rates and lowest quit rates of any racial/ethnic group in the U.S. Researchers and community members from the American Indian Health Research and Education Alliance (AIHREA) created and evaluated a culturally-tailored smoking cessation program, All Nations Breath of Life (ANBL) as a recruitment tool for smoking cessation programs among AI. To increase enrollment in ANBL, AI smokers were approached at cultural events and asked to attend a 30-minute educational session (in-person, n= 179; tele-video, n=97). Tele-video (30%) and in-person (9%) session participants were recruited into ANBL. Pre- and post-tests showed participants in both sessions demonstrated increased motivation and confidence to quit smoking but significant differences were present in both sessions (p < 0.0001). Results indicate that theoretically guided and culturally tailored education sessions are viable approaches to educate and recruit underserved populations into programs that promote smoking cessation.
Collapse
Affiliation(s)
- C Y Lumpkins
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - N Nazir
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - C M Hester
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - S M Daley
- Center for American Indian Studies, Johnson County Community College, Kansas City, KS, 66210, USA
| | - W S Choi
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - C M Daley
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| |
Collapse
|
14
|
Bridges KM, Diaz FJ, Wang Z, Ahmed I, Sullivan DK, Umar S, Buckles DC, Greiner KA, Hester CM. Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population. Genes (Basel) 2018; 9:genes9030119. [PMID: 29495356 PMCID: PMC5867840 DOI: 10.3390/genes9030119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the United States, yet it is treatable and preventable. African Americans have higher incidence of CRC than other racial/ethnic groups, however, it is unclear whether this disparity is primarily due to environmental or biological factors. Short chain fatty acids (SCFAs) are metabolites produced by bacteria in the colon and are known to be inversely related to CRC progression. The aim of this study is to investigate how stool SCFA levels, markers of inflammation in stool and dietary intake relate to colonoscopy findings in a diverse patient population. Stool samples from forty-eight participants were analyzed for SCFA levels and inflammatory markers (lysozyme, secretory IgA, lactoferrin). Additionally, participants completed the National Cancer Institute's Diet History Questionnaire II (DHQ II) to report dietary intake over the past year. Subsequently, the majority of participants underwent screening colonoscopy. Our results showed that African Americans had higher total levels of SCFAs in stool than other racial/ethnic groups, significantly lower intake of non-starchy vegetables and similar inflammatory marker expression and colonoscopy outcomes, compared to others. This work is an initial exploration into the biological and clinical factors that may ultimately inform personalized screening approaches and clinical decision-making to improve colorectal cancer disparities for African Americans.
Collapse
Affiliation(s)
- Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Francisco J Diaz
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Zhiwen Wang
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Ishfaq Ahmed
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Shahid Umar
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Daniel C Buckles
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - K Allen Greiner
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Christina M Hester
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| |
Collapse
|
15
|
Hester CM, Born WK, Yeh HW, Young KL, James AS, Daley CM, Greiner KA. Decisional stage distribution for colorectal cancer screening among diverse, low-income study participants. Health Educ Res 2015; 30:400-11. [PMID: 25721254 PMCID: PMC4434950 DOI: 10.1093/her/cyv006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/13/2015] [Indexed: 05/03/2023]
Abstract
Colorectal cancer (CRC) screening uptake among minorities and those with lower incomes is suboptimal. Behavioral interventions specifically tailored to these populations can increase screening rates and save lives. The Precaution Adoption Process Model (PAPM) allows assignment of a decisional stage for adoption of a behavior such as CRC screening. Here, we characterize the PAPM decisional stage distribution among 470 low income, racially and ethnically diverse study participants at intake into a behavioral intervention study designed to increase CRC screening uptake. We staged participants for stool blood test (SBT) and colonoscopy separately and used the highest stage for the two tests as the 'overall' stage for CRC screening. For SBT, sex, language (English versus Spanish) and doctor recommendation were significantly related to PAPM stage for CRC screening. For colonoscopy, language, education level, doctor recommendation and self-efficacy were related to stage. For overall CRC screening stage, all the variables associated with either SBT or colonoscopy, with the exception of language were significant. This study suggests attending to these key variables in designing interventions to promote CRC screening, particularly with respect to medically underserved populations.
Collapse
Affiliation(s)
- C M Hester
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - W K Born
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - H W Yeh
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - K L Young
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - A S James
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - C M Daley
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - K A Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| |
Collapse
|
16
|
Hester CM, Jala VR, Langille MGI, Umar S, Greiner KA, Haribabu B. Fecal microbes, short chain fatty acids, and colorectal cancer across racial/ethnic groups. World J Gastroenterol 2015; 21:2759-2769. [PMID: 25759547 PMCID: PMC4351229 DOI: 10.3748/wjg.v21.i9.2759] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/12/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate differences in microbes and short chain fatty acid (SCFA) levels in stool samples from Hispanic and non-Hispanic African American, American Indian, and White participants.
METHODS: Stool samples from twenty participants were subjected to analysis for relative levels of viable bacteria and for SCFA levels. Additionally, the samples were subjected to 16S rRNA gene pyrosequencing for identification of bacteria present in the stool. We used a metagenome functional prediction technique to analyze genome copy numbers and estimate the abundance of butyrate kinase in all samples.
RESULTS: We found that African Americans had significantly lower levels of acetate, butyrate, and total SCFAs than all other racial/ethnic groups. We also found that participant microbial profiles differed by racial/ethnic group. African Americans had significantly more Firmicutes than Whites, with enriched Ruminococcaceae. The Firmicutes/Bacteroidetes ratio was also significantly higher for African Americans than for Whites (P = 0.049). We found Clostridium levels to be significantly and inversely related to total SCFA levels (P = 0.019) and we found Bacteroides to be positively associated (P = 0.027) and Clostridium to be negatively associated (P = 0.012) with levels of butyrate. We also identified a correlation between copy number for a butyrate kinase predicted from 16S rRNA gene abundance and levels of butyrate in stool.
CONCLUSION: The identified differences in gut flora and SCFA levels may relate to colorectal cancer mortality differentials and may be useful as targets for future clinical and behavioral interventions.
Collapse
|
17
|
Roy BC, Subramaniam D, Ahmed I, Jala VR, Hester CM, Greiner KA, Haribabu B, Anant S, Umar S. Role of bacterial infection in the epigenetic regulation of Wnt antagonist WIF1 by PRC2 protein EZH2. Oncogene 2014; 34:4519-30. [PMID: 25486432 PMCID: PMC4459936 DOI: 10.1038/onc.2014.386] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/19/2022]
Abstract
The Enhancer of Zeste Homolog-2 (EZH2) represses gene transcription through histone H3 lysine-27-trimethylation (H3K27me3). Citrobacter rodentium (CR) promotes crypt hyperplasia and tumorigenesis by aberrantly regulating Wnt/β-catenin signaling. We aimed at investigating EZH2’s role in epigenetically regulating Wnt/β-catenin signaling following bacterial infection. NIH:Swiss outbred and ApcMin/+ mice were infected with CR (108cfu); BLT1−/−ApcMin/+ mice, AOM/DSS-treated mice and de-identified human adenocarcinoma samples were models of colon cancer. Following infection with wild type but not mutant CR, elevated EZH2 levels in the crypt at days-6 and 12 (peak hyperplasia) coincided with increases in H3K27me3 and β-catenin levels, respectively. Chromatin immunoprecipitation revealed EZH2 and H3K27me3’s occupancy on WIF1 (Wnt Inhibitory Factor-1) promoter resulting in reduced WIF1 mRNA and protein expression. Following EZH2 knockdown via siRNA or EZH2-inhibitor DZNep either alone or in combination with HDAC inhibitor SAHA, WIF1 promoter activity increased significantly while overexpression of EZH2 attenuated WIF1-reporter activity. Ectopic overexpression of SET domain mutant (F681Y) almost completely rescued WIF1 reporter activity and partially rescued WIF1 protein levels while H3K27me3 levels were significantly attenuated suggesting that an intact methyltransferases activity is required for EZH2-dependent effects. Interestingly, while β-catenin levels were lower in EZH2-knocked-down cells, F681Y mutants exhibited only partial reduction in β-catenin levels. Besides EZH2, increases in miR-203 expression in the crypts at days-6 and 12 post-infection correlated with reduced levels of its target WIF1; overexpression of miR-203 in primary colonocytes decreased WIF1 mRNA and protein levels. Elevated levels of EZH2 and β-catenin with concomitant decrease in WIF1 expression in the polyps of CR-infected ApcMin/+ mice paralleled changes recorded in BLT1−/−ApcMin/+, AOM/DSS and human adenocarcinomas. Thus, EZH2-induced downregulation of WIF1 expression may partially regulate Wnt/β-catenin-dependent crypt hyperplasia in response to CR infection.
Collapse
Affiliation(s)
- B C Roy
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA
| | - D Subramaniam
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA
| | - I Ahmed
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA
| | - V R Jala
- James Graham Brown Cancer Center and Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - C M Hester
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA
| | - K A Greiner
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA
| | - B Haribabu
- James Graham Brown Cancer Center and Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - S Anant
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Cancer Center, Kansas City, KS, USA
| | - S Umar
- Departments of Molecular and Integrative Physiology and Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Cancer Center, Kansas City, KS, USA
| |
Collapse
|
18
|
Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
Collapse
Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
| | | |
Collapse
|
19
|
Quick BW, Hester CM, Young KL, Greiner KA. Self-reported barriers to colorectal cancer screening in a racially diverse, low-income study population. J Community Health 2013; 38:285-92. [PMID: 22976770 DOI: 10.1007/s10900-012-9612-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what "switch" patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.
Collapse
Affiliation(s)
- Benjamin W Quick
- Research Division, Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | | | | | | |
Collapse
|