Family & Community Medicine Research Opportunities

Sara Dugan, Pharm.D., BCPP, BCPS and Stacey Gardner-Buckshaw, Ph.D., MPA

Cannabis and Pain Management Advice for Pregnant Women – Exploratory Study

Cannabis is the most widely used illicit substance among pregnant individuals, with reported use ranging from 3.9% to 16% in the U.S. and even higher among young adults or those using cannabis to alleviate nausea. Further, recent negative political and media attention towards Acetaminophen may motivate pregnant individuals to use cannabis as an alternative to treat pain. And as recreational cannabis legalization is growing across states, perceived risk of harm during pregnancy is declining among patients. Since THC and CBD cross the placenta—and possibly accumulate in fetal tissues—the American College of Obstetricians & Gynecologists (ACOG), CDC, and American Academy of Family Physicians (AAFP) strongly advise against cannabis use during pregnancy and lactation to protect the fetus and infant from harm and death. Yet, per patient report, dispensaries claim cannabis is safe for use during pregnancy, post-partum, and when lactating.

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Stacey Gardner-Buckshaw, Ph.D., MPA

Developing a Private Practice Elective for Undergraduate Medical Education

Currently, there are only three known programs that include business, management, and financial training to prepare undergraduate medical students for a career in private practice (Toledo, Thomas Jefferson, Indiana). The format for each varies greatly, ranging from a brief online elective to a 24-credit Certificate. There’s strong evidence that limited business and management skills among physicians contribute to challenges in establishing and sustaining rural practices—and this deficiency is a recognized factor affecting recruitment and retention in those areas.

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Paul LeCat, M.D. – 1

Dietary sugar intake: assessment and intervention for metabolic syndrome in primary care

Dietary sugar is clearly linked with every aspect of metabolic syndrome (obesity, hypertension, hypercholesterolemia, type 2 diabetes, and others). It has been shown to be causative in obesity, coronary artery disease, and diabetes. 50% of Americans consume 4-fold the maximum sugar intake recommended by the American Heart Association. The World Health Organization (WHO), American Academy of Pediatrics (AAP), and others have set similar limits. Some estimate that sugar related diseases could account for as much as 75% of current US medical expenditures.

There is currently no standardized method of measuring a patient’s sugar intake in a primary care setting in the way that alcohol or smoking is. There is also no standardized method of intervening through education for patients who overconsume sugar. We hope to find a simple, fast, and effective way to measure sugar intake and behaviors related to sugar consumption in the outpatient setting and intervene with a simple and brief educational piece. Impacts of the education will be measured and evaluated using biometric data and labwork which is already on the patient’s medical record with the patient’s consent.

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Paul LeCat, M.D. – 2

Physical Exam Skills: An “invisible” fracture in the patient safety/ QI loop?

Physical exam is a cornerstone of medicine and provides unique information, not provided by history or even technology in many instances. It has been shown to speed intervention in crucial situations, and streamline workups, saving resources.

Conversely, it could then be expected that gaps in physical exam skill contribute significantly to poor patient outcomes. Studies have shown that little improvement in exam skills occurs in graduate medical education, nor afterward and many would argue there is decay in these skills, without intentionality to improve.

Complicating matters, physical exam errors are often “invisible”. When a finding is missed, the exam is reported as “normal”. One can argue that the finding was absent at the time of exam, but was it? How is this phenomenon being addressed?

Historically, these gaps were addressed at the bedside during rounds or at Grand Rounds, involving actual patients for exam skill demonstration. Today these activities do not usually involve the patient and more commonly involve analyzing data generated by the patient (e.g. labwork, radiology studies, etc.)

Admitting residents are often unaware of any differences in their initial diagnosis and the patient’s final diagnosis, thereby cutting them out of the improvement loop, missing opportunities to learn and improve.

How can we identify poor or absent physical exam skills and address these gaps in postgraduate training? (practicing physicians?) This topic presents fertile ground for Quality and patient safety Improvement.

We aim to provide physical exam feedback and education to residents involved in the care of identified groups of patients, using physical exam documentation in the patient’s chart

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Amy Lee, M.D., MPH

Increasing Breast Cancer Screening Rates at the International Community Health Center

International Community Health Center is a Federally Qualified Health Center (ICHC) that has seen a decline in breast cancer screening in the past year. To increase their screening rates, quality improvement project planning will be conducted this summer, which will include a root cause analysis, impact/effort matrix, and continued tracking of breast cancer screening rates.

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