Family Medicine Research Day

The University of California San Diego (UCSD) School of Medicine (SOM) is transitioning its third-year primary care curriculum from a year-long longitudinal primary care course to a three-week clerkship in Family Medicine (FM). Additionally, there is a lack of FM physicians in the US, and limited information on what factors affect students’ decisions to enter FM. The aim of this pilot study is to analyze the effects of introducing sub-specialty tracks within an FM clerkship on student attitudes towards FM. A limiting factor for students within FM clerkships is that often they are not exposed to the full spectrum of FM. The aim of the tracks is to demonstrate that there are many FM clinicians practicing what may be considered more specialized aspects of primary care, including sports, sexual and reproductive health, and lifestyle and integrative medicine. There is a pre-existing family medicine clerkship for fourth-year medical students (FPM 426), which will serve as the pilot program. Three subspecialty tracks (sports medicine, sexual and reproductive health, and lifestyle and integrative medicine) will be introduced. Students will be assigned a track based on interest. A student will not be assigned a track if they did not express interest or if there was insufficient space to accommodate. Students not assigned a track will serve as the control group for this study. At the end of the clerkship, students will be emailed an anonymous survey to complete, and time will be provided during the course to complete the survey. The post-clerkship survey will collect data on students’ experience of the clerkship and perceptions of FM. We hypothesize that students placed in the subspecialty tracks will report a better experience during their clerkship and an expanded understanding of the scope of practice of family physicians. Comparisons will be made between students within tracks and those not in a track, who will serve as the control.

Research Question: The goal of this study is to assess the impact of a required, quarter-long preparatory course on medical students’ ability to effectively participate in a student-run free clinic and grapple with its ethical nuances. Methods: A one-time, cross-sectional survey was administered to all 55 students in the UCSD Student-Run Free Clinic Project’s (SRFCP) quarter-long introductory course. A Linkert 5-point scale was used to survey student’s impressions of how the course impacted 1) clinical skills, 2) understanding of ethics, 3) social and community issues, 4) sense of community, and 5) future motivation to work with the underserved. Mean scores (with standard deviations) were generated for each topic. Results: Students found the course useful for building a variety of clinical skills (3.97), including newly designed sessions such as working with interpreters (4.18) or effectively pre-charting (3.95). The course also deepened students’ awareness of social issues (4.08) and connectedness to peers (3.76), particularly through an MS1-MS4 teaching model (4.38). Students had mixed perceptions (3.55) on the ethical nuances of SRFCP. A majority felt prepared to work with SRFCP (4.16) and underserved groups (4.29) in the future. Significance: This required didactic helped students feel more prepared to work in SRFCP and strengthened long-term motivation to work with the underserved. A breadth of discussion on ethics, community resources, and health equity helped students define their role in an imperfect system. This study is a call to thoughtfully prepare students to work in free clinics in order to provide the highest quality patient care.

The COVID-19 pandemic has introduced and worsened many barriers to accessing healthcare, especially in the management of diabetes. To no surprise, this resulted in poorer glycemic control and delays in routine screening in patients with diabetes. While a prior study has shown the high-quality diabetes care that patients receive at the UC San Diego Student Run Free Clinic Project (SRFCP), this project examined the effects of the COVID-19 pandemic on diabetes management in this unique population. Diabetes outcome measures were analyzed within the two years prior to, and the two years immediately following the start of the pandemic and compared to previously published outcomes of the SRFCP. For many of the process measures and diabetes clinical outcome measures, there was no difference to or even an improvement during the pandemic. During the pandemic, patients with diabetes recorded higher systolic blood pressures and lower triglyceride values. Female patients with diabetes also saw improvements in their HDL levels. Unsurprisingly, the pandemic saw fewer patients receiving blood pressure measurements compared to prior to the pandemic. The maintenance of high-quality diabetes care for SRFCP patients despite barriers erected during the pandemic is a reflection of the tireless efforts of the providers and staff at the SRFCP.

Care of the female athlete has come to the forefront of the Sports Medicine Field as of late for many reasons. One of the areas is related to the impact the menstrual cycle has on athletic performance in the biologically female athlete. The Sports Performance team at a Division I University organized a Female Athlete Summit aimed at educating their scholar athletes about the female specific physical and mental aspects of sport. Our goal was to establish a baseline of knowledge in the body of female athletes about the effects of the menstrual cycle has on athletic performance. 46 completed the pre-summit survey, and 37 completed the post-summit. De-identified data was reviewed and demonstrated an average pre-summit knowledge base of 5.065, and a post-summit knowledge base of 8.838 out of a scale of 0 to 10, 0 being having no knowledge, and 10 being having all the knowledge. Another survey demonstrated an average period length of 4.069 days, the most common symptoms experienced during menses to be cramping (31/41) and mood changes (27/41), and a concern of the menstrual cycle effecting energy level (30/41) and strength (20/41) as the top two concerns about the effect the menstrual cycle has on athletic performance. The significance of this study lies in identifying the knowledge gaps in understanding the needs of female athletes. By identifying the gaps this study aims to pave the way for evidence-based interventions that can enhance performance, mitigate potential challenges, and promote optimal health outcomes for the female athlete.

Introduction: Urinary incontinence (UI) affects an estimated 51% of US adult women. This is a comparative effectiveness study of practice-based interventions to improve UI care quality and reduce health disparities.

Objectives: Compare the effectiveness of two nonsurgical UI interventions on care quality, shared decision making (SDM), patient-centered outcomes and knowledge. Determine if interventions reduce care disparities and knowledge gaps in underserved Spanish-speaking Latinas.

Methods: Sixty primary care physicians (PCPs) from 3 health systems will be randomized into two arms. In Arm 1,patients are co-managed by urology advanced practice provider (APP) and PCP. APP provides UI care, education, and self-management by telemedicine. In Arm 2, patients are co-managed by PCP and urologist. Urologist electronically reviews referral for appropriate primary UI care and provide recommendations if indicated. In both arms, PCPs receive academic detailing and electronic clinical decision support. Shared decision making, patient-reported UI outcomes and knowledge will be assessed using validated questionnaires. Will compare the care quality by site, provider characteristics (sex and years in practice), and racial/ethnic patient groups.

Results: Study funding began in October 2022. 181 primary care clinics are eligible for participation. Recruitment began April 2023. Preliminary analysis found 21.1% of women who screened positive for UI discussed UI with PCP. EHR clinical decision support tools are implemented to prompt PCPs to discuss UI patients who screen positive.

Conclusions: Successful intervention(s) may lead to wide-scale implementation of effective, cost-saving, quality improvement methods to improve patient satisfaction and streamline UI care.

Background: Clinical practice for detection, evaluation, management and support of patients and families dealing with Mild Cognitive Impairment/Dementia is not well standardized. Earlier detection affords patients and their family caregivers greater opportunity to come to terms with the challenge of MCI and to arrange coping plans for the present and future. Methods: We undertook an intervention to improve standardization of MCI care that included clinician education, experiential learning of mindful self-compassion skills and EPIC-based supportive tools for clinical decision support, documentation, orders and patient education. These interventions were carried out in a step-wedge approach with two of our FM clinics (SR first followed by GEN) in 6 month time periods. 6-9 clinicians in each clinic participated. Results: Educational and experiential mindful self-compassion experience interventions were well received and resulted in improvements in self-reported comfort and skill in dementia-related clinical skills. Screening improved from 51-79% of those eligible who were up-to-date with screening, comparing pre-and post data in the first clinic. Initial use of recommended follow up evaluation tools appears to be low. Conclusion: While this is a mid-study preliminary report the results indicate that education is effective as assessed by self-report among participating clinicians. While preliminary, the first comparisons of before and after intervention at the first clinic indicate that screening improved substantially. Further analysis comparing control clinic with first intervention clinic and 2nd clinic before and after will be completed soon. Further analysis comparing performance of study clinicians vs. non-study clinicians will also be carried out. Further evaluation of use of recommended evaluation tools will also be done.

Background Artificial intelligence (AI) is a rapidly advancing field that is beginning to enter the practice of medicine. Primary care is a cornerstone of medicine and deals with challenges such as physician shortage and burnout which impact patient care. AI and its application via digital health is increasingly presented as a possible solution. However, there is a scarcity of research focusing on primary care physician (PCP) attitudes toward AI. This study examines PCP views on AI in primary care. We explore its potential impact on topics pertinent to primary care such as the doctor-patient relationship and clinical workflow. By doing so, we aim to inform primary care stakeholders to encourage successful, equitable uptake of future AI tools. Our study is the first to our knowledge to explore PCP attitudes using specific primary care AI use cases rather than discussing AI in medicine in general terms. Methods From June to August 2023, we conducted a survey among 47 primary care physicians affiliated with a large academic health system in Southern California. The survey quantified attitudes toward AI in general as well as concerning two specific AI use cases. Additionally, we conducted interviews with 15 survey respondents. Results Our findings suggest that PCPs have largely positive views of AI. However, attitudes often hinged on the context of adoption. While some concerns reported by PCPs regarding AI in primary care focused on technology (accuracy, safety, bias), many focused on people-and-process factors (workflow, equity, reimbursement, doctor-patient relationship). Conclusion Our study offers nuanced insights into PCP attitudes towards AI in primary care and highlights the need for primary care stakeholder alignment on key issues raised by PCPs. AI initiatives that fail to address both the technological and people-and-process concerns raised by PCPs may struggle to make an impact.

Background: Over 100,000 people are currently waiting for organ transplants in the United States, and tragically 17 people die each day while waiting for an organ. Efforts to reduce these deaths have been made at many levels along the donation pathway, from increasing organ donation registration, to improving surgical techniques that optimize organ procurement. Objective: Our goal is to implement interventions in Primary Care to reduce deaths of those awaiting transplant. Methods: The first step will be a review of the existing literature on transplant-related interventions in the Primary Care setting. Multiple databases including PubMed, MedLine, and Google Scholar will be systematically searched. Results of these efforts will be synthesized and presented in a poster for the UC San Diego Family Medicine Department Research symposium. Results: Preliminary results show a wealth of data on a wide spectrum of efforts to reduce deaths on the transplant list. However, as searches are narrowed to include only Primary Care interventions, the number of applicable, high-quality studies decreases. There have been at least two published literature reviews on this subject and both conclude that although the data are limited, some interventions may confer benefit. Conclusions: While the data on this subject appears limited, it provides enough guidance to inform the development of a Primary Care intervention. The existing evidence and our conclusions therefrom will be documented in this poster. The limited available data highlights the opportunity that exists to study, and publish on, potential future interventions in our clinic.

Family Medicine physicians provide contraceptive, prenatal, and obstetric care; however, within our department physicians had not historically prescribed abortion medications to clinic patients. Early abortion care is within the scope of family medicine and is considered part of full reproductive health care for our patients. Research shows patients are open to and prefer to have abortion care from their primary care physician1 . It is estimated that one in four women will have an abortion by 45 years old2. This quality improvement project aims to improve health and healthcare access to persons seeking pregnancy termination or needing early pregnancy loss medication management. Following the PDSA cycle, planning included partnering with department leadership for approval, collaborating with MedStaff for physician privileging and malpractice coverage, building templates for the electronic medical record (EMR) with clinical informatics, training support staff at all three clinics, and educating our triage team and call center on triage management and patient support. We are developing a dedicated monthly procedure clinic specifically to access medication abortion for patients established within our family medicine clinics. Additionally, we will continue to offer training for interested faculty through yearly or twice-yearly presentations at department meetings and collaborate with residency leadership to provide ongoing residency education around medication abortion care. Six months post implementation of the procedure clinic, we will analyze if this dedicated clinical space is an appropriate method to increase access for medication abortion. After reviewing the results, we will revise and improve work processes as needed.

Research Question / QI Topic: Multimodal lifestyle interventions are the first line for obesity treatment with the Shared Medical Appointment (SMA) model offering a framework for educating groups of patients sharing common diagnoses, combined with individualized medication management. Despite their effectiveness in promoting weight loss and improving metabolic outcomes, the influence of lifestyle medicine SMAs on psychosocial and lifestyle outcomes remains underexamined. This study investigates the extent to which participation in a virtual, lifestyle medicine-focused SMA program affects these important factors. Data and Methods: Data comes from a retrospective chart review of 172 patients enrolled in the Supervised Lifestyle and Integrative Medicine (SLIM) program, a virtual, lifestyle medicine-focused, SMA program for weight management. Eligible patients included individuals 18 years of age or older and with a body mass index (BMI) of at least 30 kg/m2 or 27 kg/m2 with at least one weight-related comorbidity. Patients completed self-reported questionnaires at baseline and after the clinical program that assessed psychosocial, lifestyle, and behavioral outcomes. Paired sample analysis will be utilized to describe differences in self-efficacy (Self-efficacy to Manage Chronic Disease Questionnaire), perceived stress levels (Perceived Stress Scale-4 Questionnaire (PSS-4)), and mindfulness (Five Facet Mindfulness Questionnaire (FFMQ). Changes in patients’ dietary quality pre and post-clinical intervention will also be analyzed. Results: We hypothesize that participants will show enhanced self-efficacy, stress management, and mindfulness, along with healthier eating habits post-program. Significance: Our study elucidates the impact of a lifestyle-medicine-focused virtual SMA program on psychosocial and lifestyle factors. This study makes a meaningful contribution to the growing body of literature on SMAs for obesity management.