RESEARCH & SCHOLARLY ACTIVITY

Resident Research

Adult Vaccination Delivery and Acceptance Study

Resident Principal Investigator

Dr. Joseph Brewer

Faculty Advisors

Dr. Tamer Elsayed and Dr. Melanie Tucker

Abstract

Purpose: The purpose of this study is to assess if the use of the CDC website vaccination quiz with patients, during their regularly scheduled appointment, increases the delivery and acceptance of adult vaccinations. Methods: This intervention study uses a retrospective chart review to assess any change in the delivery and acceptance of adult vaccinations. Family medicine residents and one faculty member will participate in the study. The intervention includes an educational session delivered to the residents during their academic afternoon. The session discussed the vaccine schedule and the CDC website vaccination quiz. The CDC quiz is an 11-item, two-part quiz that asks patients about their age, pregnancy status, and sex, work, travel, and health/high risk behaviors. Arm 1: All residents were encouraged, but not required, to use the CDC quiz with each of their patients. Arm 2: One faculty member and one resident will use the CDC quiz with each patient. A retrospective chart review will be conducted for each resident (Arm 1) and for the faculty and resident (Arm 2) to assess the vaccine delivery and acceptance for 6 months prior to the intervention and 6 months post intervention. The groups will be compared to assess for differences. Results: Final study results are pending based on the final retrospective chart review. The intervention took place in August 2015 and 27/45 (60%) of the residents attended. The retrospective chart reviews took place in August 2015 and schedule for February 2016. Conclusion: Vaccination delivery and acceptance is a vital component of overall individual and public health. Understanding the reasons an individual chooses to receive, refuse, or delay a vaccination can assist in the development of timely interventions during the appointment. The use of specialized interventions could potentially improve vaccination delivery and acceptance.

Poster Presentation

STFM Annual Conference May 2016

Patient’s Knowledge of Diabetes Mellitus

Resident Principal Investigators

 Dr. Jerry Shen and Dr. Sirisha Chada

Faculty Advisor

Dr. Melanie Tucker

Abstract

Diabetes is one of the fastest growing diseases in the United States. According to the American Diabetes Association, 11.3 percent of all people ages 20 years or older are diagnosed with diabetes in the United States. The cost of care for person with diabetes is 2.3 times higher than a person without the disease, which adds up to over $174 billion spent on healthcare for diabetics alone. Diabetes is the 7th leading cause of death and can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Despite the use of clinical educational tools, classes, workshops, and other information available to the public, these numbers continue to rise each year. Thus, individually tailored health education could have an impact on their level of knowledge. Purpose: The purpose of this study was to assess the knowledge of CCHS family medicine patients who are diagnosed with diabetes. This project will assist in the development of individualized diabetes education, which may lead to increasing the knowledge and compliance of patients with diabetes.\Methods: This study was conducted with UMC patients who have been diagnosed with type-2 diabetes. The survey was administered in the CCHS Family medicine Blue and Red Suite clinic during a two-month period. Results: Seventy-five participants completed the survey. Of the participants 39% report controlling their diabetes with diet and exercise; 68% with oral medicine and 49% with insulin; 66% have knowledge of fasting blood glucose and 69% have knowledge of A1c levels. Forty percent are interested in attending a diabetes education class. Discussion: While the majority of the participants report appropriate knowledge of diabetes, no assessment of knowledge was completed. Future studies modify the survey and collect such data. While the majority of patients did not want diabetes education, it is encouraging that 40% of patients are interested in additional education.

Poster Presentations

AAFP December Meeting (Birmingham); Rural Health Conference; CCHS Research Day

Student and Resident Effectiveness on Dietary Modifications

Resident Principal Investigators

Dr. Bhavika Patel, Dr. Brooke Robinson, and Dr. Keirsten Smith

Faculty Advisors

Dr. Jennifer Clem, Dr. Linda Knol, and Dr. Melanie Tucker

Abstract

Background: Physicians are viewed as credible sources of health information, and the office an opportunity to share information about dietary modification. Due to the number of routine health visits for chronic conditions, a physician may play a pivotal role in the dietary health of their patients.  The perceived expertise of the primary care physician is a variable in where patients obtain their nutritional guidance. However, physicians report that they have not received adequate training to in nutrition counseling. Methods: UA medical students and family medicine residents survey responses were used to answer: How often do your patients make the following dietary changes after you provide nutrition advice? The answer components addressed adherence to: the Mediterranean diet, the DASH diet, a low fat diet, MyPlate recommendations, dietary patterns for type two diabetes, and evidence-based weight loss strategies. The answer choices ranged from 1-6 to correspond to the following options respectively: don’t know, never, rarely, sometimes, often, and always. Results: Upon analysis, the mean was 2 which corresponds to “rarely”.  Eight residents and 15 students completed the survey. Of the residents, 25%-50% marked “don’t know” if their patients adopted any of the recommended diets and 38%-50% reported their patients “rarely or never” adopt any of the recommended diets. The only diet reported being adopted “often” was the Dash diet at 12.5%. Of the students, 53%-80% marked “don’t know” if their patients adopted any of the recommended diets and 6%-33% reported their patients “rarely or never” adopt any of the recommended diets. The low fat diet was “sometime” adhered to at 33% and the Dash diet was “sometimes” adhered to at 27%. Conclusion: The UA students and residents feel that their patients rarely make dietary modifications after having discussion on any of the six components of the posed question.  Research shows that culinary medicine helps address this.

Presentations

Poster Presentations: AAFP December Meeting (Birmingham), Rural Health Conference, and Research Day

Oral Presentations: Rural Health Conference and University Research Breakfast

A Febrile Journey

Resident Principal Investigator

Dr. Keri Merschman

Faculty Advisor

Dr. Karen Burgess

Presentations

Poster Presentations: Rural Health Conference, CCHS Research Day

Oral Presentations: Rural Health Conference and AFMR Southern Regional Meeting

Abstract

A 4- year old black female presented with 5 days fever, abdominal pain, and decreased intake/ activity. Past medical and social history noncontributory. Vaccines up to date. On admission, temp 102.4 with physical exam remarkable for mild abdominal tenderness.Labs: WBC 30, 92% neutrophils. CRP 12. UA: 1+ protein, WBC 5. Influenza and strep negative. Abdominal series negative. Stool studies negative. Given supportive care. On day 1, developed diarrhea and vomiting. On day 2, chest XR, pelvic ultrasound, and EBV titers negative. Renal US showed possible pyelonephritis. UA trace leukocyte esterase and 7 WBC. Due to recurrent fever and renal US, ceftriaxone 100mg/kg/d started. Day 3, continued to have abdominal pain with new back and vaginal pain but somewhat playful. Day 4, new headache and neck pain without meningismus. More active. WBC and CRP improved to 17.8 and 2.3 respectively. Temp was 101. Patient discharged with antibiotics for diagnosis of viral infection vs UTI. After discharge, patient had inability to bear weight. Admitted to COA. Next day developed decreased speech and bilateral clonus. Tests included negative head CT. LP with 247 WBC, 2 RBC, mild increased protein and normal glucose.  MBP normal, negative for NMO antibody, HSV, enterovirus, autoimmune encephalopathy and MS panels. Also negative ANA, enterovirus PCR, anticardiolipin, antiphosphatidylethanolamine, viral respiratory panel and stool enterovirus. On day 3 rocephin restarted. Patient lost ability to speak and eat. Neurology consultation recommended MRI which showed demyelination from thalami to spinal cord, raising concern for NMO (neuromyelitis optica). High-dose steroids started. Patient improved and LP findings resolved. Discharged with 6-week course steroids. This case demonstrates value of follow-up for treatment and diagnostic purposes. Most accurate diagnosis remains unknown, but differential diagnosis includes acute disseminated encephalomyelitis, NMO or other acute demyelinating process.

Streamlining Documentation and Coding of the Well Woman Exam

Resident Principal Investigators

Dr. Mary Margaret Clapp, Dr. Katie Gates, and Dr. Ambreen Mardhani

Faculty Advisors

Dr. Catherine Scarbrough and Dr. Melanie Tucker

Abstract

A Well Woman Exam (WWE) is an annual preventive screening for gynecological diseases and generally includes a breast and pelvic exam. Coding and billing for these exams is complex. Medicare, Medicaid, and private insurance carriers require different diagnosis codes. In addition, there are different pap collection fee codes for the different carriers. If a visit is incorrectly coded, reimbursement may be denied by insurance carriers. Greater than half the pap collection fees in 2013 at the University Medical Center were denied. According to a 2010 CDC survey, gynecologic exams are among the 20 leading principal reasons for outpatient visits in the United States. Consequently, a large number of these exams are performed each year by family physicians. Claim denials leading to non-payment or delayed payment represent lost revenue for a family medicine clinic. In addition to lost revenue, incorrect coding that leads to non-reimbursement of collection fees could represent an expense to a practice if the practice requires cash outlay in order to collect pap smears. The purpose of the WWE study was to determine whether the use of a concise, single-page coding reference improves reimbursement rates for well woman exams (WWEs) at the University Medical Center (UMC). The study hypothesized that the availability of a reference card that instructs resident physicians in proper coding of well woman exams would result in better reimbursement rates at UMC. The study improved the coding skills of resident physicians as well as improved the reimbursement rates for services performed at UMC. The denial rate for WWEs due to documentation issues decreased from 87% to 2% in the six months post-intervention.

Presentations

Poster Presentations: AAFP December Meeting (Birmingham), Rural Health Conference, and Research Day

Oral Presentation: STFM Practice Management Conference (national)

Interns’ Perceived Confidence Level

Resident Principal Investigator

Dr. Eric Curley

Faculty Advisors

Dr. Catherine Scarbrough and Dr. Melanie Tucker

Abstract

Background: The transition from medical student to intern can be a difficult one. In the course of one day, responsibilities go from making sure the triple sheet was complete on two hospital discharges to ordering medications for an entire inpatient medicine service. This can cause even the most seemingly prepared intern to question some of their decisions in patient care. Family medicine residents are required to demonstrate extensive knowledge on many areas of medical practice. Exposure to these varied topics might exacerbate an interns’ confidence regarding their ability to practice the broad range of family medicine. Although residents may have done well on their didactic exams, practical application of that information is not as clear-cut and may lead to family medicine interns doubting themselves. Just how confident are family medicine interns? Not much research has been done in order to effectively answer this question, and even less on what can be done to help improve interns’ perception and confidence in caring for patients. The answers to these questions will help residency programs better understand methods that assist interns in developing confidence in their abilities which will ultimately lead to better and more efficient patient care. Methods: An outpatient lecture series was developed on 22 topics most commonly encountered in family medicine clinics. Each intern was surveyed before and after each lecture, then six months after that. The topics chosen were not covered in other didactic lectures. Results/Discussion: We observed an increase in confidence among interns in independently diagnosing and treating patients diagnosed within one of the five topic areas (asthma, COPD, HTN, diabetes, geriatric care). Further research is needed to determine the practical relevance of these confidence changes to actual patient care.

Poster Presentations

AAFP December Meeting (Birmingham), Rural Health Conference, and CCHS Research Day​

Advanced Directives

Resident Principal Investigators

Dr. Michael Gabriel, Dr. Chandra Americhetty, Dr. George Petty, and Dr. Jason Clemons

Faculty Advisor

Dr. Anne Halli

Abstract

The purpose of the study was to learn more about the importance of advance directives (i.e. living will) in the UMC patient population and find out possible reasons for patients not having an advance directive. An advance directive is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for himself or herself. Approximately 100 patients in the Department of Family Medicine at the University Medical Center, over the age of 40 years were asked to complete a survey asking if they had an advance directive/living will and assess their perceptions toward advance directives.

Bisphosphonate Prescription Knowledge among Family Medicine Residents

Resident Principal Investigators

Dr. Timothy Eckford and Dr. Ross Summerford

Faculty Advisor

Dr. Melanie Tucker

Abstract

The purpose of this research study was to determine the knowledge and prescription of bisphosphonate for the prevention of hip fractures. Determining a resident’s knowledge of bisphosphonate prescription protocol and if the resident follows the protocol in clinic will guide us in tailoring educational session for hip fracture prevention.

Faculty Research

Cooking for Health Optimization with Patients (CHOP) – A UA Culinary Medicine Curriculum

Principal Investigator

Dr. Jennifer Clem

Collaborators

Dr. Linda Knol, Dr. Melanie Tucker, Dr. John Higginbotham, Dr. Bhavika Patel, Dr. Brooke Robinson, and Dr. Keirsten Smith

Abstract

Background: The rising obesity issue and nutrition-related chronic disease epidemics has challenged medical education. Obesity is a modifiable risk factor for three of the top four American mortality causes. However, only half of primary care physicians regularly track body mass index (BMI) or provide nutrition education for their patients. Insufficient early medical education is one potential cause of this education deficit. Only one in four American medical schools require the minimum 25 hours of nutrition education recommended by the National Academy of Sciences, and most graduating medical students continue to rate their nutrition preparation as inadequate. The UA Culinary Medicine program study will use the, Cooking for Health Optimization with Patients (CHOP) curriculum, developed The Goldring Center for Culinary Medicine at Tulane University.  Methods: The elective will take place over five weeks with participants meeting once per week for a three-hour educational session and ten hours of outside reading and module completion. Thirty were recruited to complete the UA Culinary Medicine course (10 UASOM medical students, 10 UA Family Medicine residents, and 10 UA nutrition students). Students who participate in the elective are considered the experimental group. Students who do not to participate in the program are considered the control group. Both groups will complete pre- and post- knowledge and attitudes surveys, and the team performance survey. Discussion: Incorporating an interprofessional culinary medicine elective in medical education could assist new medical professionals in providing nutrition education to their patients. Having an understanding of nutrition, dietary habits, attitudes and competencies can affect their patient’ss health and directly improve their own health.

Patient Satisfaction of a Medical Scribe Program

Principal Investigator

Dr. Melanie Tucker

Collaborator

Dr. Richard Friend

Abstract

Background: While benefits of EMR are acknowledged, the transition to electronic medical records (EMR) has created additional demands on a physician’s time. Many providers find the EMR difficult to navigate and feel as if they are spending more time with the EMR than with the patient. Primary physician complaints include, “too long to write a progress note” and “too many clicks to navigate the EMR”. An approach used to increase efficiency and quality of care is to implement the use of scribes in an outpatient setting. A scribe is an individual who is present during the provider’s performance of a clinical service and documents everything said during the course of the service and other information as directed by the provider. While many physicians enjoy having a scribe in their practice this study seeks to assess how the patient feels about the scribe being in the room during the physical examination.  Methods: In order to evaluate the patient’s satisfaction with the medical scribe program, patient participants completed a 9-question survey assessing their overall satisfaction with the visit and comfort with having a scribe in the exam room.   Results: Forty-three patients participated in the research study.  The majority of the patients (70%-86%) answered “Very Good” to “Excellent” to questions about their doctor’s willingness to listen carefully, answer questions, spending adequate time with you, explaining things in ways that are understandable, giving instructions about medications, thoroughness of exam and advice on ways to stay healthy. When asked about having the scribe in the room 70% agreed to strongly agreed to feeling comfortable compared to 9.4% that strongly disagreed to disagreed. 5% reported strongly agreed to agree to rather not having a scribe in the room.  Discussion: The presence of a scribe in the exam room does not interfere with the patient’s perception of care and can possibly enhance the physician’s ability to function as an active listener.

Critical Care Interprofessional Education: Perceptions among Nursing and Medical Students: A Mixed- Methods Pilot Study

Principal Investigator

Dr. Louanne Friend

Collaborator

Dr. Richard Friend

Abstract

Background: It has been suggested that physicians do not respect critical care nurses’ assessments (Stein-Parbury & Liaschenko, 2007) and interprofessional tensions and poor communication in critical care units persist (Rose, 2011). In 2008, The Joint Commission became so concerned about behaviors that undermine a culture of safety that it issued a Sentinel Event Alert on the topic. Potential negative effects of hostile relations include increased patient mortality, wrong- site surgery, medication errors and decreased patient safety (Rosenstein & ODaniel, 2006). Educators have a responsibility to provide interprofessional activities where students have opportunities to discuss the antecedents of conflict as well as strategies to resolve interprofessional conflict. Methods: A nonequivalent control group design with pretest and posttest and focus group interviews were utilized. Students in the experimental group completed the critical care elective during spring semester 2015. Surveys utilized included an adapted 14 item version of the Attitudes toward Interprofessional Healthcare Teams Scale (ATHCT) (Curran, Heath, Kearney, & Button, 2010), the 17 item Team Skills Scale (TSS) (Grymonpre et al., 2010), and the 18 item Interdisciplinary Education Perception Scale(IEPS) (Luecht, Madsen, Taugher &, Petterson,1990). Two heterogeneous focus groups were conducted at semester end.University institutional review board (IRB) approval was obtained prior to data collection in spring semester 2015.Results:No subscales or total scores were significantly different across time or between groups. Interview transcripts were read verbatim and four themes were identified: “learning in a non-judgmental, relaxed environment”, “changes in preconceived perception”, “camaraderie” and “increased awareness of interprofessional conflict”. Conclusion: Findings suggest that students experience conflict in clinical, yet lack the confidence and skills to effectively mitigate these behaviors.

The LEARNS Collaborative (Leading Education and Reducing No Shows): a Pathway to the Triple Aim

Principal Investigator

Dr. Catherine Scarbrough

Collaborators

Peter Lazzopina, Jewell Pauline Carr, Krystal Tamura, Steven Fox, Roy Lemaster; Maximos Attia; Alfred Reid, Sam Weir, and Ann Lefebvre

Abstract

Missed appointments affect the cost and quality of care as well as patient, provider, and staff satisfaction. The UNC Faculty Development Fellowship Quality Improvement Collaborative has undertaken a year-long effort to decrease the no-show rate in seven diverse, residency-based clinical practices. As a group we developed a change package to address clinic flow, practice policy (content and implementation), provider and staff behavior, and patient factors that impact no-show rates. Interventions developed from our change package were implemented within our individual residency practices based on needs or gaps that were identified during analysis of our various existing policies and procedures. We summarize evidence for the effect of missed appointments on cost, quality, and experience of care and share best practices developed to date as well as plans for future changes and further research. Upon completion of this session, participants should be able to: 1. Apply evidence of the effect of missed appointments on cost, quality, and experience of care to their own practices. 2. Effectively measure the no-show rate and identify the various factors that contribute to no-show rates in residency-based clinics. 3. Apply best practices to improve access to care through decreased no-show rates demonstrated in a variety of residency practice settings.

Alabama Coalition for Testing, Intervention and Engagement in Hepatitis C Care (ACTIVE-C)

Principal Investigator

Dr. Jane Weida

Collaborators

Bret Summerlin, Omar Massoud, Chastity McDavid, and Michael Saag

Abstract

Background: In the U.S., the overall prevalence of HCV is 1.6% with a higher prevalence among African-Americans, people born between 1945 and 1965, and those with a history of injection drug use. Left untreated, chronic HCV infection can cause liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). The risk of cirrhosis is 5-30% within 20 years of infection, and the risk of HCC in patients with cirrhosis is 2-4% per year. The Alabama Coalition for Testing, Interventions, and Engagement in HCV Care (ACTIVE-C), is a targeted collaboration among academic departments (UAB and UA), community clinics (FQHC and primary care clinics), emergency departments, and State and Public Health Departments in Alabama. ACTIVE-C is comprehensive network of university-based, community-based, and public health department-based testing, evaluation, and treatment faculty and providers who are collaborating to bring state-of-the-art care in primary care settings to those most in need of HCV treatment in Alabama. Methods: The project will be conducted in three phases, serving the target populations in Birmingham, Montgomery, Tuscaloosa, Huntsville and Mobile. In Phase 1, will expand treatment capacity within the regional partners, including education and training; establish data collection and management systems; and build capacity for HCV testing. In Phase 2, the implementation of HCV testing in primary care and ER settings will start. During this phase, building capacity for HCV treatment throughout the Network is a key priority. In Phase 3, treatment uptake and sustained virologic response (SVR) statewide will be tracked. Discussion: Over 1 year, it is anticipated that at least 18,000 people will be screened for HCV during the project period with over 1,300 HCV Ab reactive persons identified and with an estimated 750 persons with chronic HCV infection linked to care for potential curative treatment. Plans include ongoing expansion throughout Alabama in the future.

Innovative Utilization of Interprofessional Board Review in Family Medicine Resident Education: Perspectives in Active Learning for a Pharmacotherapy Curriculum in Academics

Principal Investigator

Dana Carroll, PharmD

Faculty Collaborators

Nathan Pinner PharmD; Catherine Scarbrough, MD; Katelin Lisenby, PharmD

Resident Collaborators

Holly McCaleb, MD; Raven Ladner, MD

Abstract

Background: Medical schools are unable to devote the necessary amount of the curriculum to pharmacotherapy to keep pace with the expanding drug market. By incorporating pharmacy faculty and residents into family medicine resident education, the residents have access to pharmacotherapy specialists who are able to enrich their drug therapy knowledge and help with practical application to clinical practice. In efforts to continue to improve patient care and interprofessional education, it is essential for pharmacy faculty to utilize interactive teaching methodologies and case-based content that is applicable to physicians’ daily clinical practice.

Purpose: To assess the perceptions of family medicine residents on how incorporation of active learning and board review questions into pharmacotherapy lectures impact their pharmacotherapy knowledge and board preparation during residency.

Methods: A one-time anonymous survey consisting of 16 questions regarding resident perceptions of pharmacotherapy lectures utilizing board review questions as an active learning component was administered to residents in the University of Alabama Family Medicine residency program.

Results/Discussion: Overall, there was no significant difference in the perceptions of pharmacotherapy preparedness among the residents in those who attended a medical school with a systems-based versus traditionally presented pharmacology curriculum. An area for future study would include investigating the perceptions of pharmacotherapy preparedness of U.S. versus non-U.S. medical school graduates.

Student Research

Clinical Health Coaching in a Diabetes and Hypertension Clinic

Student Principal Investigators

Kyle Jimerson, Malcom Webb, and Andrew Moss

Faculty Advisors

Dr. Melanie Tucker, Dr. Thomas Weida, Suzanne Henson, Angela Hammond, and Kimberley McMillan

Abstract

Background: In the U.S, 29 million people (9.3%) are diagnosed with diabetes and approximately 70 million American adults (1 of every 3 adults) have high blood pressure. Over one year period, the University Medical Center (UMC), Department of Family Medicine saw 4,836 unique patients over the age of 18 years. Of these patients, 55% were diagnosed with hypertension, 20% diagnosed with diabetes and 15% diagnosed with both. Primary care faces serious challenges in the face of the growing demand for diabetes and hypertension care. Clinical health coaching was developed to address a health care need and provide support for patient self-management and education. The health coach takes an active role in providing education and enhancing motivation in the difficult to treat patients. The UMC Diabetes and Hypertension Health Coaching program is a behavior-change, health education program offered to patients at the UMC. Methods: The purpose of this study is to determine the feasibility and efficacy of the UMC Diabetes and Hypertension Health-Coaching program. Approximately 75 patients diagnosed with uncontrolled hypertension and/or diabetes will be recruited. Participants will be in the study for 12 months and will meet with the health coach at Baseline, month 6 and month 12. Patient’s health literacy, knowledge of diabetes and hypertension, motivation and patient satisfaction will be assessed. Follow-up phone call will be made every two weeks for six months then monthly for six months to assess adherence to medication, blood sugar and blood pressure monitoring, participation in physical activity and diet management. Educational strategies will be delivered through one-on-one counseling and telephone-based education. Discussion: Hypertension and diabetes is prevalent among patients at the UMC. The implementation of a health-coaching program could promote knowledge, awareness, and health literacy among UMC patients to prevent hypertension and diabetes complications.

Impact of an Interdisciplinary Geriatric Clinic on Cognition, Depression, and Anxiety in Geriatric Patients

Student Principal Investigator

Brendan Meyer

Faculty Advisors

Aaron Garrett, Anne Halli-Tierney, Rebecca Allen, and Dana G Carroll

Abstract

Background: The interdisciplinary clinic utilizes the skills of multiple professions and psychological scales to help identify potentially inappropriate medications and identify patients with cognitive impairment, depression, and anxiety. The objective of this study is to assess the impact of care provided by an interdisciplinary team compared to usual care for cognition, depression, and anxiety in geriatric patients. Methods: This study has been approved by the Institutional Review Board. This is a retrospective cohort study. All patients with initial visits to the interdisciplinary geriatric clinic or the family medicine clinic in the years 2011 to 2014 were identified using the electronic medical record system. There are 253 available patients for review from the interdisciplinary geriatric clinic and 254 from the family medicine clinic during these periods. The following data will be collected: patient age, gender, ethnicity, health insurance, PMH, and current medications. If available, results of baseline screening tool scores and follow-up screening scores will be collected for: MOCA, SLUMs, MMSE, GDS, PDQ-9, and GAI scores. Provider documentation will be reviewed to identify pertinent therapy modifications and change in: depression, anxiety, or dementia status. All patient-specific data will be deidentified. Results: N/A Conclusion: N/A

Continued Behavioral Health Screenings in an Interdisciplinary Geriatric Clinic

Student Principal Investigator

Lisa Mieskowski

Faculty Advisors

Jordan C. Williams, Amy Albright, Anne D. Halli, Dana Carroll, Forrest Scogin, and Rebecca S. Allen

Abstract

Background: The interdisciplinary clinic utilizes the skills of multiple professions and psychological scales to help identify potentially inappropriate medications and identify patients with cognitive impairment, depression, and anxiety. The objective of this study is to assess the impact of care provided by an interdisciplinary team compared to usual care for cognition, depression, and anxiety in geriatric patients. Methods: This study has been approved by the Institutional Review Board. This is a retrospective cohort study. All patients with initial visits to the interdisciplinary geriatric clinic or the family medicine clinic in the years 2011 to 2014 were identified using the electronic medical record system. There are 253 available patients for review from the interdisciplinary geriatric clinic and 254 from the family medicine clinic during these periods. The following data will be collected: patient age, gender, ethnicity, health insurance, PMH, and current medications. If available, results of baseline screening tool scores and follow-up screening scores will be collected for: MOCA, SLUMs, MMSE, GDS, PDQ-9, and GAI scores. Provider documentation will be reviewed to identify pertinent therapy modifications and change in: depression, anxiety, or dementia status. All patient-specific data will be deidentified. Results: N/A Conclusion: N/A