Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis.

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis.

Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health record (EHR) reminding providers of the recommended treatment of sinusitis.

Feasibility study of family planning services screening as clinical decision support at an urban Federally Qualified Health Center network.

Objective: The objective was to assess the feasibility of an intervention introducing family planning services screening clinical decision support to improve provision of contraception and/or preconception services for women of reproductive age in our primary care Federally Qualified Health Center (FQHC) network.

Study Design: We implemented a family planning services screening prompt for support staff to ask women 13-44 years at nonobstetric visits at specified time intervals. The response was displayed in the electronic medical record for the provider to review, linked to a documentation tool.

A Randomized Trial of a Group-Based Integrative Medicine Approach Compared to Waitlist Control on Irritable Bowel Syndrome Symptoms in Adults.

Introduction: Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder that affects a large proportion of the general population. Dietary and mind-body approaches have shown some effectiveness in reducing IBS symptoms.

Objectives: The purpose of this project was to test the feasibility of a low cost, group-oriented integrative medicine approach to IBS, and to explore whether such an approach improves participant outcomes.

Assessing and Improving Zoster Vaccine Uptake in a Homeless Population.

The herpes zoster (shingles) vaccine is recommended for all adults aged ≥ 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults.

Acupuncture Therapy in a Group Setting for Chronic Pain.

Objective: This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain.

Design: Nonrandomized, repeated measures quasi-experimental trial.

Setting: Care was delivered in a primary care clinic waiting area after clinic hours.

Patient Beliefs Have a Greater Impact Than Barriers on Medication Adherence in a Community Health Center.

Purpose: Nonadherence to medicines contributes to poor health outcomes, especially for patients with complicated medicine regimens. We examined adherence among patients at a family health center and the impact that barriers to getting medicines and negative beliefs about medicines have on adherence.

Methods: A survey was administered incorporating the 8-item Morisky Medication Adherence Scale, questions from the Beliefs about Medicine Questionnaire, and questions about patients' external barriers to getting medicines.

Intrauterine devices at six months: does patient age matter? Results from an urban family medicine federally qualified health center (FQHC) network.

Background: Federally qualified health centers (FQHCs) can address high rates of unintended pregnancy among adolescents in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing adolescent use of IUDs, some physicians remain concerned about IUD tolerance and safety in adolescents. Therefore we compared adolescents and adults in a family physician staffed FQHC network with regard to (1) IUD postinsertion experience, (2) device discontinuation, and (3) sexually transmitted infection (STI) rates.

An examination of domestic partner violence and its justification in the Republic of Georgia.

Background: Little research on Intimate Partner Violence (IPV) and social perceptions toward this behavior has been disseminated from Eastern Europe. This study explores the prevalence and risk factors of IPV and the justification of this behavior among women in the Republic of Georgia. It seeks to better understand how IPV and IPV justification relate and how social justification of IPV differs across socio-economic measures among this population of women.

Becoming a patient-centered medical home: a 9-year transition for a network of Federally Qualified Health Centers.

Purpose: The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes.

Methods: We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes.

Emergency contraception considerations and use among college women.

Background: Emergency contraception (EC) has been available behind the counter without a prescription since 2006. Evidence has shown increased use of EC among young women, but no recent findings have been published to date of current use.

Methods: This cross-sectional study surveyed 482 college heterosexually active college women attending a large public university who either visited the college-based health clinic or were enrolled in selected undergraduate classes.

Public justification of intimate partner violence: a review of the literature.

Understanding the extent to which the general public justifies intimate partner violence (IPV) is necessarily to explain perpetration, victimization, and response to this behavior. This article provides a literature review of quantitative studies measuring IPV justification among the general population. Key word searching of two databases plus bibliographies, and the web yielded 23 studies that provided comparable measures of IPV justification.

Are We Misjudging How Well Informed Consent Forms are Read?

UNDERSTANDING THAT INFORMED CONSENT forms are provided to be read and comprehended, this study compares the research assistant's perception of comprehension with the actual time potential participants spend reading their consent form. After providing information verbally to two samples of women, research assistants observed as the women reviewed and signed the consent form recording the time spent reading and the assistant's impression of reading behavior. Over half of the women "read" their consent forms in thirty seconds or less before signing.

Understanding intimate partner violence against women in the rural South.

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative.

Computer-administered screening of reproductive-aged women for diabetes risk in primary care settings, feasibility and acceptability of such screening, and validity of risk assessments based on self-reported weight.

Introduction: Obesity, a major public health problem, is the key modifiable component of diabetes risk. Addressing obesity and diabetes risk during primary care visits is recommended but, because of time constraints, is often difficult for health care providers to do. The purpose of this study was to determine whether technology can streamline risk assessment and leave more time to educate patients.

Black women's health: the effect of perceived racism and intimate partner violence.

This study provides preliminary evidence of the relationship between perceived racial discrimination and intimate partner violence (IPV) and how these exposures interact to affect the mental and physical health of Black women. The exposures of lifetime perceived racial discrimination and IPV were found to be highly associated. Furthermore, women who reported both exposures showed a notably higher prevalence of anxiety and nonspecific physical health symptoms compared with women who reported either or neither exposure.

Measuring intimate partner violence (IPV): you may only get what you ask for.

With the goal of understanding the true extent of intimate partner violence (IPV), researchers have put tremendous effort over the past 20 years developing, revising, and assessing IPV screening instruments. The enhancements made in IPV instrumentation reflect our improved understanding of the nature of IPV. Unfortunately, as is often the case with progress, we are presently at the stage where IPV researchers have an arsenal of multiple IPV screens that are, in some cases, slightly different, whereas in others, the differences are sizeable.

Issues in estimating the prevalence of intimate partner violence: assessing the impact of abuse status on participation bias.

This study examines the potential implications of household interviews on participation bias for estimates of intimate partner violence (IPV). Using a variety of scales, IPV prevalence for the 135 women interviewed in a street-intercept survey was compared with the IPV prevalence of a subsample of these women who reported willingness to participate in a household survey with their partner in another room or when their partner also would be interviewed. A potential self-selection bias showed an 8% to 13% deflated prevalence of moderate to highly abused women and a 8% to 11% inflated prevalence of nonabused women among this subsample who would willingly participate in a household survey.