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2017 Annual Spring Conference

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Group Medical Visit Training: "It takes a village to cure a patient"

Melissa Prado, MD; Colleen T. Fogarty, MD, MSc; Tony Magno

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Purpose: Group medical visits (GMVs) have been shown to benefit participants by improving quality of life and biomedical measures and increasing patient knowledge of condition and overall satisfaction. We sought to examine how a GMV curriculum might influence residents’ views, in hopes of understanding factors that may promote or inhibit their use of GMVs in future practice. Methods: We conducted focus groups for second and third year residents of the University of Rochester Family Medicine Residency Program (URFMRP), to learn more about the following: 1) resident perception on the value of GMVs in general, 2) resident confidence in using the facilitation skills taught, and 3) resident desire to implement group care in their practice after graduation. Analysis was conducted by two separate coders and organized into the Kirkpatrick Model of Evaluation for ease of understanding. Results: We found that although residents saw value in GMVs, and felt confident in facilitating them, residents maintained multiple reservations that would prevent them from implementing GMVs in their future practices. Barriers included financial feasibility, lack of resources, belief that other clinicians could provide similar (if not, better) patient education. Conclusions: The GMV curriculum at URFMRP teaches residents that GMVs are valuable and gives them the confidence to create and run GMVs in practice. This, however, does not translate to intentions of implementing GMVs in their post-residency practice. It will require curriculum changes on our part to address the associated barriers and help promote GMV use in future practice.

Family Physicians’ Knowledge and Beliefs Regarding the Health Effects of Added Sugar

Marian Deames; Tammy Chang, MD, MPH, MS; Matthew Kittle; Christian Mackey; Melissa Plegue, MA

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Purpose: Added sugar consumption is a major risk factor for negative health outcomes including an increased risk of obesity, diabetes, and death from cardiovascular causes. In the setting of these risks and the easy availability of sugary foods, primary care physicians play an important role in educating patients regarding nutrition and health behaviors. The aim of this study was to describe the knowledge and beliefs of family physicians regarding the health effects of sugar. Methods: A 10-item questionnaire was administered to family physicians via an omnibus survey distributed by the CAFM Educational Research Alliance (CERA). Descriptive statistics were performed to characterize each survey response. Pearson’s chi-square test was used to test the association between practice and beliefs on effectiveness of dietary counseling for overweight and obese patients. Results: The overall survey had a 35% response rate (n=1248). Physicians who reported seeing patients for at least 3 half days were included in our sample (n=630). Among this sample, only 16% of family physicians reported providing dietary counselling to all of their overweight and obese patients. Most (89%) believed their counseling was ineffective for the majority of these patients and frequency of counseling was significantly associated with family physicians’ beliefs about counseling effectiveness (p-value<0.001). Less than one third (30%) of family physicians were familiar with accepted guidelines pertaining to added sugar consumption, despite two thirds (69%) reporting familiarity with added sugar research. Nearly all (97%) advised patients against consuming sugar in beverages, while advising patients to limit foods with added sugar was less common (82%). Conclusions: These findings suggest that in our sample, most family physicians do not provide dietary counseling on added sugars to their overweight and obese patients, possibly due to their belief that this counseling is ineffective. Family physicians in our sample were generally unaware of the guidelines pertaining to added sugar and were less likely to counsel their at-risk patients about added sugars in food compared to in beverages.

Impact of a Physician Wellness Curriculum on Burnout Rates of Residents and Faculty in a Community Based, University Affiliated Urban Family Medicine Residency

Emily Gutgsell; Laura M Webster, MD; Vanessa Rollins, PhD; Chandra Hartman MD; Matthew James Simpson, MD, MPH; Amy Tubay MD

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Background: Physician burnout is a common issue during residency training. It has been estimated that up to 70% of family medicine residents experience burnout at some point during their training. Purpose: Create a physician wellness curriculum and culture of wellness in a residency program and evaluate its effect on symptoms of burnout. Methods: The Maslach Burnout Inventory was administered at the beginning and end of the academic year to both residents and faculty. This instrument evaluates symptoms of physical burnout (depressive anxiety syndrome), depersonalization (loss of empathy), and personal achievement. For the 2015-2016 academic year, a series of didactics focusing on mindfulness, resiliency, and purpose was implemented to decrease burnout symptoms. An additional feature of the curriculum was an exclusive resident retreat focused on fostering a culture of wellness in the program. Results: Preprogram implementation: The proportion of physicians scoring moderate or high level of burnout in at least one of the three sections of the Maslach Burnout Inventory was 0.92, and in at least two sections was 0.79. Following the intervention, the survey revealed the proportion of physicians scoring moderate or high level of burnout in at least one section of the Inventory was 0.85, and in at least two sections was 0.58. At the beginning of the 2016 residency year, the proportion of physicians scoring moderate or high level of burnout in at least one section of the Inventory was again 0.92, and in at least two sections was 0.54. End of the current year survey pending. Conclusions: At the start of the residency year and prior to the physician wellness curriculum, moderate or high levels of burnout were reported by the majority of residents and faculty. The raw data shows some improvement, but without statistical significance. It is unclear whether the scores will continue to change as more residents participate in this novel curriculum. Limitations of this study include fatigue at the end of the academic year possibly contributing to the increase in burnout, as well as varying rates of incoming burnout form medical school.

Factors that influence pregnancy weight gain among adolescents: A mixed methods study using text messaging

Leigh Morrison, MD; Melissa Plegue, MA; Lauren Nichols; Tammy Chang, MD, MPH, MS

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Excess weight gain during pregnancy is a strong risk-factor for long-term obesity among mothers and infants, especially among adolescent mothers. The objective of the study is to understand the knowledge, beliefs, and factors that influence weight gain among pregnant adolescents. In this mixed method study, pregnant adolescents age 14-24 with access to cell phones were asked a series of structured and open-ended questions using text messaging. The text message questions were sent after 20 weeks gestational age and focused on adolescents’ ideas regarding diet, exercise, body, image, and health during pregnancy. Descriptive statistics were performed on quantitative responses and open-ended text message responses will be qualitatively analyzed using a grounded theory approach to identify the knowledge, beliefs, and factors that influence weight gain among adolescents during pregnancy. Among our sample (n=54), the mean age was 21 (SD=2.2), with 52% identifying as Black or African American, 30% White, 13% multiracial, and 13% identified as Hispanic or Latino. Fifteen percent did not graduate from high school, 42% were high school graduates, 9% attended at least some vocational school, and 20% attended some college. In preliminary analysis of responses to date, three main findings have emerged. First, participants show insight into healthy lifestyle changes, including "cutting out candy", "do more exercising", and "not stressing so much." However, many women report barriers to engaging in these healthy behaviors ("No I have not been working out. I work a job 8 hours a day 5 days a week. I chill on my off days, I feel like that is enough"). The most common educational resources reported were the Internet, their physicians and midwives, and their mothers. Many young women also report frequently drinking sugar sweetened beverages ("I drink juice the most") and may benefit from skills to cope with managing unhealthy cravings ("Sometimes I have [cravings] and I deal with them by getting what I’m craving for" "I crave hot wings this week and I got hot wings"). Pregnant adolescents face significant barriers to engaging in healthy behaviors during pregnancy including limited knowledge and resources. Adolescent-centered interventions that address both social and educational gaps, and focus on appropriate diet, exercise, and stress management may help to improve health outcomes among adolescent mothers and their infants.

Utilization of the Pooled Cohort Equations in Diabetic Patients at Hinsdale Family Medicine Clinic

Janet Bilder

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Purpose: Guidelines published by the American College of Cardiology/American Heart Association in 2013 recommend statin therapy as primary prevention for diabetics; the Pooled Cohort Equations outlined in these guidelines can be used to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy. As familiarity with primary prevention guidelines is a priority for family practice residents, this study sought to establish what percentage of diabetic patients at Hinsdale Family Medicine Clinic (HFMC) are on a statin and further on the correct dose (high or moderate) according to their 10-year ASCVD risk. Methods: This retrospective analysis included diabetic HFMC patients between the ages of 40 and 75 seen between 1/1/2014 and 12/31/2015. Exclusion criteria consisted of age <40 or >75, total cholesterol <130 or >320, HDL <20 or >100, systolic blood pressure (SBP) <90 or >200, and lipid panel more than one year prior to appointment in study timeframe. 264 patient charts were reviewed for gender, race, age, total cholesterol, HDL, SBP at most recent visit, use of antihypertensive, and smoking status. Patients’ 10-year ASCVD risk was calculated to determine recommended statin dose and then compared to actual statin dose. Results: Only 77.3% of diabetic patients were found to be on a statin. For those patients for whom a high-dose statin was recommended, only 26% were actually on a high-dose. For those patients for whom a moderate-dose was recommended, 49% were on a moderate dose. Data was further examined to evaluate male and female, African American and non-African American patients. Conclusions: Of those HFMC diabetic patients who qualified for high- and moderate-intensity statin therapy based on their 10-year atherosclerotic cardiovascular disease risk, only 26% and 49% were on high- and moderate dosing, respectively. This leaves room for improvement in resident adherence to guidelines such as the 2013 ACC/AHA guidelines which might be implemented through teaching or quality improvement projects in the residency clinic.

Comparison of botulinum toxin to fasciotomy in the treatment of chronic exertional compartment syndrome of the lower leg

Jordan Ryan, MD; Brett Boyce

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Purpose: Chronic exertional compartment syndrome is debilitating disease affecting primarily the lower extremity of physically active adults and current management is by surgical fasciotomy which fails in over 33% of patients while putting them at risk of surgical complications. The long term objective of this project is to validate botulinum toxin (Botox) injections as a non-inferior treatment option for pain control and ability to return to full activity for adult military members suffering from lower extremity CECS, when compared to surgical fasciotomy. Methods: The study will be a prospective cohort evaluation of patients with CECS of the lower extremity that will compare relief of pain and return to activity after Botox injections with surgical fasciotomy. Patients will be identified from the pool of patients referred to our sports medicine clinic at Scott Air Force base. Participants will be active duty adults, be unable to run 1.5 miles without producing symptoms, have failed conservative therapy, and meet diagnostic criteria for CECS based on standardized intramuscular pressure testing. We expect to have 10 to 15 patients after one year. After being diagnosed with CECS and failing conservative management, participants will be educated on Botox injections and surgical fasciotomy with an option to choose between either therapy. Patients who choose injections will receive 100 units Botox into affected compartment. Patients who choose surgery will be referred to an orthopedic surgeon for surgery. All patients will be asked to complete the universal pain assessment and lower extremity functional index at the initial visit and the one, three, and six month follow-up visits. A secondary outcome will be the ability to return to full activity. Return to full activity will be defined as running 1.5 miles without symptoms and being able to complete official duties without taking breaks during the day due to pain. Results: After receiving IRB approval, we will begin enrolling patients into the study as soon as December 2016. We expect to have initial results May 2017 with full results December 2018. Conclusions (Anticipated): In a small sample size, adult military patients with confirmed CECS treated with Botox injections had similar or better outcomes to patients treated with surgical fasciotomy. Therefore, Botox injections may be a non-inferior, safer option for patients with CECS and should be evaluated by higher-powered studies.

Retrospective Analysis of Pharmacist Pre-visit Engagement with Primary Care Providers for Patients with Non-cancer Pain on Chronic Opioid Therapy at a Family Medicine Residency Clinic

Nicholas Cox, PharmD; Susan E. W. Cochella, MD, MPH; Casey Tak; Karen M. Gunning, PharmD, BCPS, FCCP

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PURPOSE: The purpose of this study is to evaluate the impact of a pre-visit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to CDC recommendations at a family medicine residency clinic. METHODS: This is a retrospective analysis of patient-visit data before and after implementation of a pre-visit pharmacist review focused on pain management. All adult patients with an appointment for chronic pain management currently prescribed greater than 50 mg morphine milligram equivalents (MME) per day will have charts reviewed by a pharmacist prior to each appointment, with recommendations electronically sent and communicated verbally to the provider the day before or of the appointment. After the intervention period, a manual chart review of each individual patient will be completed to gather outcome variables. The specific objectives of this study are to compare the following among patients prescribed greater than 50 mg morphine milligram equivalents (MME) per day for chronic pain before and after implementation of a pre-visit pharmacist review: 1) Proportion of patients prescribed opiates concurrently with benzodiazepines and other potentially inappropriate medications; 2) MME per day and pain scores; 3) Proportion of patients prescribed non-opiate analgesics; 4) Proportion of patients prescribed naloxone. The analysis of outcomes will be made by comparing all patients seen during the comparator time period (Jun 2016 to Sep 2016) to all patients seen during the intervention time period (Oct 2016 to Jan 2017). RESULTS: Results are pending completion of the intervention time period (Oct 2016 to Jan 2017), chart review, and analysis. CONCLUSIONS (Anticipated): If a pharmacist review improves compliance to opioid prescribing guidelines at the pilot site, pharmacists at other primary care clinics may look to implement similar initiatives. Additionally, this study will enhance understanding of current pain management practices in a family medicine residency setting and allow for comparison of those practices to current guidelines.

The Impact of Wearable Fitness Monitors on Physical Activity in Diabetic Group Visits: A Pilot Study

Tara Kennedy, MD; Ayesha Abid; Shahla Ahmad, MD; Michael Timothy Partin; Timothy D Riley, MD

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Purpose: Past studies have shown that group visits can be effective in the care of the diabetic patient and many studies have also examined a potential role for wearable fitness monitoring devices in the medical setting; however, to the best of our knowledge, no study has examined the use of wearable fitness technology in the setting of a diabetic group visit. The aim of our study is to combine these two features with a series of educational group visits and assess activity level and diabetic control. Methods: An IRB approved study is underway. All diabetic patients managed by a Penn State Family Medicine Provider are eligible for enrollment in the study. Participants must be willing to attend six evening sessions to complete the study; they will be notified of the dates at enrollment. Once enrolled all participants will be given a FitBit wearable fitness monitor for the duration of the study. Members of the research team will help each participant create a private online FitBit account. At each visit members of the research team will help each participant sync his or her FitBit device and record step counts. In addition the first and the last visit will be billed to the participant’s insurance company as a clinic visit where they will meet individually with a provider; at each clinic visit weight and blood pressure will be checked, vaccinations will be reviewed and necessary lab tests will be ordered. Educational sessions and group discussions will be conducted at each visit. Results: All standard diabetic monitoring values, such as A1c, weight, blood pressure, urine microalbumin to creatinine ratio, will be compared from the beginning and the end of the study. Activity level and step counts in the Fitbit website will also be reviewed for each participant. The study is ongoing and no results have been obtained yet. Anticipated Conclusions: It is our hope that the use of the Fitbit in combination with a diabetic group visit will yield encouraging results in terms of improving diabetic control and physical activity level. The study was designed as a pilot study to set the stage for a larger scale investigation of group visits and/or wearable fitness monitoring devices and their role in chronic disease management.

Are patients with CKD Stage 2 and 3 at a higher risk of developing AKI?

Maureen Grissom, PhD; Ani A Bodoutchian, MD, MBA; Prabhjot Chahal; Revathy Nair, MD; Donique Jones; Farideh Zonouzi-Zadeh, MD

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Purpose: To follow up on a previous project which assessed risk factors for the development of Acute Kidney Injury (AKI) in patients with an existing diagnosis of Congestive Heart Failure (CHF). Our initial findings suggested that underlying chronic kidney disease (CKD) was the strongest risk factor for developing AKI in patients with CHF. Our current objective is to determine the likelihood of developing AKI in our hospital and to determine factors that place patients at additional risk for developing AKI during an inpatient hospital stay. Methods: We will conduct a retrospective chart review of 200 patients at a tertiary care center in a suburb of New York City to determine the rate of AKI in the population of patients with CKD. Characteristics of the sample that we plan to consider include: age, gender, anemia severity, hypertension, diabetes, CHF, medications, CKD stage, GFR, imaging studies and contrast exposure. Results: We expect to find a strong association with patients developing AKI and mild to moderate underlying kidney disease. We further expect that in comparing the group of patients with CKD who did and did not develop AKI, those who did develop AKI may have modifiable and early identifiable risk factors. Conclusion: We hope to shed provide helpful information about specific risk factors for AKI in patients with CKD with the aim of decreasing the occurrence of this complication. In Future studies we could use our data to create prognostic criteria and possible better targeted preventive measures.

Walk with Your Doctor: Physician Led Group-Based Exercise and Education Using Evidence Based Information for Sustained Weight Reduction and Patient Empowerment

Timothy James Musick; Sarah Astorga

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Title: Walk with Your Doctor: Physician Led Group-Based Exercise and Education Using Evidence Based Information for Sustained Weight Reduction and Patient Empowerment Purpose: Obesity is a well-known contributor to chronic disease and it is difficult to adequately address the complex interplay of multiple associated biopsychosocial factors in the typical primary care office visit. This study is a pilot, non-randomized, non-controlled behavioral group therapy model to educate and empower patients to make long-term lifestyle changes to lose weight. The purpose of the study is to compare the pilot group to standard office based interventions to determine if this more comprehensive model is beneficial for weight loss and patient empowerment. Methods: Adults with a BMI >30, no limitations in exercise and motivation for weight loss were recruited for the study group. A survey was given prior to participation and again at the end of the intervention to gauge health knowledge and motivation. The intervention offered two meetings per week for six weeks with participants required to attend at least once per week. The first half of each session, participants exercised with providers. The second half was spent educating on health-related topics. Participants were weighed during the study and two months later. Standard care group patients received nutrition and exercise education from their primary care provider. Standard care group weights and survey answers were compared to the study groups’ weights and answers. Final analysis is pending. Results/Conclusions: With statistical analysis still in progress, based on observation it appears this intervention did not lead to a statistically significant improvement in weight loss but did improve perceived empowerment for group participants compared to those receiving standard care.

The Continuing Impact of ACOG’s 2014 Labor Management Guidelines on Cesarean Section Rates at a Community-Based Hospital

Dillon Cleary, MD; Leo Bay, DO; Gretta Carroll; Dylan Tracy; Anne Nash, MD

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1. Purpose: There has been an alarming increase in the rate of cesarean section deliveries (C/S) without any corresponding decrease in maternal or neonatal morbidity and mortality between 1996 and 2011 which has raised concern that, perhaps, C/S were being implemented too soon. We wanted to know if there was a correlation between the new 2014 ACOG guidelines changing the definition of onset of active labor from 4 to 6 centimeters (cm) and occurrence of the C/S rate due to arrest of dilation at a community-based hospital. 2. Methods: A retrospective chart review was performed on a patient population database at St. Elizabeth’s hospital in Belleville, IL and was accessed to identify deliveries of pregnant women, aged 16–41, with EGA 34-42 weeks’ gestation including any parity, complications, and prenatal history. Deliveries were analyzed at one year before (n = 985) and one year after (n = 1128) the guideline implementation to evaluate the C/S rate occurring prior to 6 cm cervical dilation for arrest of dilation. Using Chi-square analysis, the primary outcome evaluated was the C/S rate at cervical dilation <6 cm compared to >6 cm at one year prior and one and two years after the publication of the new ACOG guidelines. Secondary outcomes evaluated overall C/S rate, vaginal vs C/S deliveries, and C/S indications at one year prior and one and two years after the publication of the new ACOG guidelines. Year two data is currently being analyzed. 3. Results: Using a p-value <0.05 as denoting a statistical difference, no statistical change was observed in the percentage of C/S occurring prior to 6 cm cervical dilation due to arrest of dilation at year one. The overall C/S rate percentage increased 4 percentage points (21% and 25 %, before and after, respectively) but likewise, no statistical difference was measured. 4. Conclusions (Anticipated): Year one data suggest the new ACOG guidelines may require either more time, education, or both before a reduction in the number of C/S occurring before a cervical dilation of 6 cm is observed. More research is needed in this area specifically to determine if other interventions (e.g. CME) are needed to implement labor management change other than ACOG national guidelines; another consideration would be altering an ACOG guideline that would directly influence the management of a higher proportion of the C/S rate in hopes of limiting overuse, considering that arrest of dilation accounts for a small number of C/S.

Linking Patients with Obesity at an Urban Federally Qualified Health Center (FQHC) to Existing Community-based Weight Loss Resources: A Quality Improvement Project

Megan Rocchio Waterman, MD, MPH

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Purpose: Patients with obesity are more likely to improve their nutrition and exercise habits if connected to community resources for lifestyle change, and these programs exist in urban community settings; however, urban underserved clinics may not link their obese patients to weight loss resources sufficiently. This project seeks to (1) identify local urban community resources for weight loss surrounding a FQHC in Chicago; (2) assess how weight loss is currently discussed with obese patients, and how these patients are currently referred to weight loss resources by the clinic; (3) improve the clinic’s referral process to community weight loss resources. Methods: The project will use a "Plan-Do-Study-Act" quality improvement method. At an urban FQHC, it will translate an approach from a toolkit prepared by the Agency for Healthcare Research and Quality to link rural primary care practices and community-based weight loss resources. An initial needs assessment of utilization of and linkage to community weight loss resources will include patient surveys and staff/provider focus groups. Additional resources will be identified using Internet searches and a community services web application (Purple Binder). A resource inventory will then be compiled, and primary care providers at the clinic will be trained on its use in a dissemination session. Survey measurements of provider pre- and post-session comfort with referrals and knowledge of available resources will be obtained. Results: Anticipated findings of the needs assessment component will include: (1) qualitative synthesis of staff/provider beliefs and behaviors around weight loss referral practices; (2) baseline patient data about knowledge of community resources and frequency of referrals to resources made in the clinic. Anticipated findings of the inventory training intervention will include pre- and post-session survey data to demonstrate the impact of training on providers’ comfort with and knowledge of weight loss referral. Conclusions: This project will potentially result in improved understanding of an urban FQHC’s current practice in linking obese patients with community weight loss resources, and demonstrate the utility of locally-driven inventory development in improving linkages. If successful, it will be a positive example of care coordination and community-based quality improvement methods.

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

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Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).

Prevalence of adverse life experiences in an urban primary care clinic

Morgan Briggs; Jennifer Moore; Courtney Barry, PsyD

-

Purpose: Traumatic experiences are associated with adverse mental and physical health outcomes in primary care patients. This study developed and distributed a survey to assess the prevalence of traumatic events experienced by patients at an urban primary care clinic in a Midwestern city, and to investigate the relationship between trauma and health outcomes. Methods: The study was a single site cross-sectional, retrospective survey distributed at an urban primary care clinic in a Midwestern city. Research team members distributed 200 surveys to English-speaking patients, ages 18 or older. The 27 item survey was based on the Adverse Childhood Event (ACE) study and other trauma instruments. Respondents indicated on the survey whether or not they experienced 12 trauma types, including emotional abuse, physical abuse, sexual abuse, neglect, intimate partner violence, household challenges, exposure to violence, unintentional traumatic events, and military trauma. Preliminary frequency statistics were analyzed. This research was approved by the Institutional Review Board (IRB) of the sponsoring hospital and medical school. Results: Preliminary analyses show, among respondents, 92% reported at least 1 traumatic experience before age 18 and 40% reported at least 5 unique trauma types prior to age 18. After the age of 18, 94% reported at 1 unique type of trauma and 25% reported at least 5 unique trauma types. Descriptive and correlation statistics will be analyzed and presented. Health outcomes data (i.e. medical diagnoses, medications, and body mass index (BMI)) are being analyzed with regression analysis. Conclusions: Preliminary results demonstrate a high prevalence of traumatic experiences among patients at an urban primary care clinic. Future data analysis will provide further insight into the relationship between traumatic experiences and health outcomes. We hypothesize there will be a positive correlation between number of unique types of trauma experiences and adverse health outcome measures. This study provides a foundation for the development of a trauma-informed care model at the urban clinic and for future research regarding trauma-informed care (i.e. educating healthcare providers, implementing trauma-informed practices, and creating trauma-informed patient programs).


Copyright 2017 by Society of Teachers of Family Medicine