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Article ; Online: Quantifying diagnosis and treatment practices of opioid use disorder in primary care practices using chart review data.

Callen, Elisabeth F / Clay, Tarin / Lutgen, Cory / Robertson, Elise / Staton, Elizabeth W / Filippi, Melissa K

2024 , Page(s) 1–8

Abstract: Background: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices.: Methods: American Academy of Family Physicians (AAFP) offered a monthly online educational series to ...

Abstract	Background: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. Methods: American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February-April, 2019, and February-April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used. Results: Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. Discussion: Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. Conclusions: Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.
Language	English
Publishing date	2024-04-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1077616-3
ISSN	1545-0848 ; 1055-0887
ISSN (online)	1545-0848
ISSN	1055-0887
DOI	10.1080/10550887.2024.2327728
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Article ; Online: A Team-Based Training for Continuous Glucose Monitoring in Diabetes Care: Mixed Methods Pilot Implementation Study in Primary Care Practices.

Filippi, Melissa K / Oser, Sean M / Alai, Jillian / Brooks-Greisen, Alicia / Oser, Tamara K

JMIR formative research

2023 Volume 7, Page(s) e45189

Abstract: Background: The American Academy of Family Physicians (AAFP) develops and maintains continuing medical education that is relevant to modern primary care practices. One continuing medical education modality is AAFP TIPS, which are comprised of resources ... ...

Abstract	Background: The American Academy of Family Physicians (AAFP) develops and maintains continuing medical education that is relevant to modern primary care practices. One continuing medical education modality is AAFP TIPS, which are comprised of resources designed for family medicine physicians and their care teams that aid in quick and accessible practice improvement strategies, with actionable steps. Evaluating physicians' use of and satisfaction with this modality's content and implementation strategies has not been prioritized previously. Continuous glucose monitoring (CGM) plays an increasing role in the treatment of diabetes; uptake occurs more rapidly in endocrinology settings than in primary care settings. To help address such differences in CGM uptake and diabetes care, AAFP TIPS on Continuous Glucose Monitoring (AAFP TIPS CGM) was developed, using published evidence and input from content experts (family medicine faculty; AAFP staff; and an advisory group comprised of other primary care physicians, patients, a pharmacist, and a primary care practice facilitator). A pilot implementation project was conducted in 3 primary care practices. Objective: To evaluate AAFP TIPS CGM in primary care practices, the research team assessed use of and satisfaction with the content and assessed barriers to and facilitators for strategy and workflow implementation. Methods: In total, 3 primary care practices participated in a mixed methods pilot implementation of AAFP TIPS CGM between June and October 2021. Practice champions at each site completed AAFP TIPS CGM and baseline practice surveys to evaluate practice characteristics and CGM prescribing. They conducted team trainings (via webinars or in person), with the goals of implementing CGM into practice and establishing or improving CGM workflows. Practice champions and team training participants completed posttraining surveys to evaluate the training, AAFP TIPS materials, and likelihood of implementing CGM. Interviews were conducted with 6 physicians, including practice champions, 2 months after team training. Satisfaction surveys were also distributed to those who completed the AAFP TIPS CGM course via the internet during the study period. Results: Of the 3 practices, 2 conducted team trainings. The team training evaluation survey showed that practice staff understood their role in implementing CGM in practice (19/20, 95%), and most (11/20, 55%) did not have questions after the training. Insurance coverage for CGM was a remaining knowledge gap and potential barrier to implementing CGM in practice. Physicians and interdisciplinary care team members who took the AAFP TIPS CGM course via the internet, as well as those who attended in-person team training, expressed a high degree of satisfaction with the education, content, and applicability of the course. Conclusions: This pilot implementation of AAFP TIPS CGM offers pertinent and timely information for primary care practices that desire to initiate or expand CGM use to best meet the needs of their patients with diabetes.
Language	English
Publishing date	2023-04-24
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/45189
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Article ; Online: Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions.

Lutgen, Cory / Callen, Elisabeth / Robertson, Elise / Clay, Tarin / Filippi, Melissa K

Substance abuse

2023 Volume 44, Issue 1, Page(s) 51–61

Abstract: Introduction: Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e. ...

Abstract	Introduction: Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions. Methods: The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups. Results: All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion ( Conclusion: Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.
MeSH term(s)	Humans ; Learning ; Physicians, Family ; Opioid-Related Disorders/therapy ; Primary Health Care
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1177/08897077231174675
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Article ; Online: Integrated Behavioral Health Adaptations During the COVID-19 Pandemic.

Filippi, Melissa K / Nederveld, Andrea / Williams, Mark D / Robertson, Elise / Doubeni, Chyke / Waxmonsky, Jeanette A / Hester, Christina M

Journal of the American Board of Family Medicine : JABFM

2024 Volume 36, Issue 6, Page(s) 1023–1028

Abstract: Introduction: COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to ... ...

Abstract	Introduction: COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to behavioral health (BH) access. Methods: Semistructured interviews were completed with clinicians from family medicine residency programs on the impact of the pandemic on IBH care delivery along with adaptations employed by care teams to ameliorate disruption. Results: Participants (n = 41) from 14 family medicine residency programs described the rapid shift to virtual care, creating challenges for IBH delivery and increased demand for BH services. With patients and care team members at home, virtual warm handoffs and increased attention to communication were necessary. Screening and measurement were more difficult, and referrals to appropriate services were challenging due to higher demand. Tele-BH facilitated continued access to BH services but was associated with logistic challenges. Participants described adaptations to stay connected with patients and care teams and discussed the need to increase capacity for both in-person and virtual care. Discussion: Most practices modified their workflows to use tele-BH as COVID-19 cases increased. Participants shared key learnings for successful implementation of tele-BH that could be applied in future health care crises. Conclusion: Practices adapted readily to challenges posed by pandemic restrictions and their ability to sustain key elements of IBH during the COVID-19 pandemic demonstrates innovation in maintaining access when in-person care is not possible, informing strategies applicable to other scenarios.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Communicable Disease Control ; Pandemics ; Communication ; Delivery of Health Care, Integrated
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2023.230125R2
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Zs.A 2626: Show issues

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Article ; Online: Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study.

Filippi, Melissa K / Waxmonsky, Jeanette A / Williams, Mark D / Robertson, Elise / Doubeni, Chyke / Hester, Christina M / Nederveld, Andrea

Journal of the American Board of Family Medicine : JABFM

2024 Volume 36, Issue 6, Page(s) 1008–1019

Abstract: Introduction: Integrating behavioral health services into primary care has a strong evidence base, but how primary care training programs incorporate integrated behavioral health (IBH) into care delivery and training has not been well described. The ... ...

Abstract	Introduction: Integrating behavioral health services into primary care has a strong evidence base, but how primary care training programs incorporate integrated behavioral health (IBH) into care delivery and training has not been well described. The goal of this study was to evaluate factors related to successful IBH implementation in family medicine (FM) residency programs and assess perspectives and attitudes on IBH among program leaders. Methods: FM residency programs, all which are required to provide IBH training, were recruited from the American Academy of Family Physicians National Research Network. After completing eligibility screening that included the Integrated Practice Assessment Tool (IPAT) questionnaire, 14 training programs were included. Selected practices identified 3 staff in key roles to be interviewed: medical director or similar, behavioral health professional (BHP), and chief medical officer or similar. Results: Forty-one individuals from 14 FM training programs were interviewed. IPAT scores ranged from 4 (Close Collaboration Onsite) to 6 (Full Collaboration). Screening, outcome tracking, and treatment differed among and within practices. Use of curricula and trainee experience also varied with little standardization. Most participants described similar approaches to communication and collaboration between primary care clinicians and BHPs and believed that IBH should be standard practice. Participants reported space, staff, and billing support as critical for sustainability. Conclusions: Delivery and training experiences in IBH varied widely despite recognition of the value and benefits to patients and care delivery processes. Standardizing resources and training and simplifying and assuring reimbursement for services may promote sustainable and high quality IBH implementation.
MeSH term(s)	Humans ; Primary Health Care ; Delivery of Health Care, Integrated ; Psychiatry ; Physicians, Family ; Health Personnel
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2023.230067R2
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Article ; Online: Evaluating a Web-Based Adult ADHD Toolkit for Primary Care Clinicians.

Loskutova, Natalia Y / Lutgen, Cory B / Callen, Elisabeth F / Filippi, Melissa K / Robertson, Elise A

Journal of the American Board of Family Medicine : JABFM

2021 Volume 34, Issue 4, Page(s) 741–752

Abstract: Introduction: Approximately 5% of the US adult population has Attention Deficient Hyperactivity Disorder (ADHD) that can negatively impact quality of life. Health care professionals report a need to increase their knowledge of and confidence in treating ...

Abstract	Introduction: Approximately 5% of the US adult population has Attention Deficient Hyperactivity Disorder (ADHD) that can negatively impact quality of life. Health care professionals report a need to increase their knowledge of and confidence in treating adult ADHD. The American Academy of Family Physicians National Research Network (AAFP NRN) collaborated with a panel of experts to create a web-based AAFP Adult ADHD Toolkit composed of resources to aid in the diagnosis, management, and treatment of adults with ADHD. Objectives: Assess the impact of using an AAFP Adult ADHD Toolkit in a practice setting. Methods: Ninety-seven primary and behavioral health care professionals from AAFP NRN practices (n=6) used the Toolkit for 17 weeks. Data on Toolkit use, usefulness, implementation, impact, and changes in knowledge and confidence were collected via pre-post and weekly surveys. Mixed methods, regression analyses, Results: Use of the Toolkit improved health care providers' knowledge by midpoint relative to baseline in areas related to treatment effects, side effects, and outcomes (3.6 vs 3.0; Conclusion: Availability and adoption of the Toolkit into the routine care of adults with ADHD measurably increased health care professionals' knowledge especially in those providers who regularly see adult patients with ADHD.
MeSH term(s)	Adult ; Attention ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Attention Deficit Disorder with Hyperactivity/therapy ; Humans ; Internet ; Primary Health Care ; Quality of Life
Language	English
Publishing date	2021-07-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2021.04.200606
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Article ; Online: COVID-19's Financial Impact on Primary Care Clinicians and Practices.

Filippi, Melissa K / Callen, Elisabeth / Wade, Ann / Coffman, Megan / Westfall, John M / Jabbarpour, Yalda / Hester, Christina M / Carroll, Jennifer

Journal of the American Board of Family Medicine : JABFM

2021 Volume 34, Issue 3, Page(s) 489–497

Abstract: Introduction: Coronavirus disease 2019 (COVID-19) disrupted and undermined primary care delivery. The goal of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices.: Methods: The American ... ...

Abstract	Introduction: Coronavirus disease 2019 (COVID-19) disrupted and undermined primary care delivery. The goal of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices. Methods: The American Academy of Family Physicians National Research Network and the Robert Graham Center distributed weekly surveys from March 27, 2020, through June 15, 2020, to a network of more than 1960 physicians. Responses to the question, "Could you please tell us about any financial impact the COVID-19 pandemic has had on your practice, if any?" were analyzed using a grounded theory approach of qualitative analysis. The number of unique respondents who answered the financial impact question totaled 461 over the 12 weeks. Results: Severe declines in patient visits, causing drastic revenue reductions, greatly impacted the ability to serve patients. Primary care clinicians and practices experienced significant changes in several areas about financial implications: patient visits, financial strain, staffing and telehealth. Discussion: Preliminary findings revealed that even with Coronavirus Aid, Relief, and Economic Security Act, also known as CARES Act, funding, business viability remains questionable for some primary care practices. Conclusions: Low patient visits directly resulted in decreased revenues, which in turn, impacted staffing decisions and fueled telehealth implementation. It is difficult to predict whether patient visits will increase after June. Alternate payment models could provide some financial stability and address business viability.
Language	English
Publishing date	2021-06-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2021.03.200502
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Article ; Online: Barriers to autism screening in family medicine practice: a qualitative study.

Fenikilé, Tsehaiwork Sunny / Ellerbeck, Kathryn / Filippi, Melissa K / Daley, Christine M

Primary health care research & development

2015 Volume 16, Issue 4, Page(s) 356–366

Abstract: Aim: We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.: Background: The American Academy of Pediatrics recommends early detection and intervention of autism ... ...

Abstract	Aim: We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits. Background: The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism. Methods: Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis. Findings: Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.
MeSH term(s)	Autistic Disorder/diagnosis ; Child, Preschool ; Family Practice/statistics & numerical data ; Female ; Focus Groups ; Health Services Accessibility/statistics & numerical data ; Humans ; Infant ; Interviews as Topic ; Kansas ; Male ; Mass Screening/statistics & numerical data ; Pediatrics/statistics & numerical data ; Physicians, Family/statistics & numerical data ; Practice Guidelines as Topic ; Qualitative Research ; Surveys and Questionnaires
Language	English
Publishing date	2015-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2027892-5
ISSN	1477-1128 ; 1463-4236
ISSN (online)	1477-1128
ISSN	1463-4236
DOI	10.1017/S1463423614000449
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Article ; Online: Health status among black African-born women in Kansas City: a preliminary assessment.

Ndikum-Moffor, Florence M / Faseru, Babalola / Filippi, Melissa K / Wei, Hou / Engelman, Kimberly K

BMC research notes

2015 Volume 8, Page(s) 540

Abstract: Background: Health information and statistics for Black foreign-born women in the United States are under-reported or not available. Black foreign-born women typically are classified under the general category of African American, ignoring the ... ...

Abstract	Background: Health information and statistics for Black foreign-born women in the United States are under-reported or not available. Black foreign-born women typically are classified under the general category of African American, ignoring the heterogeneity that exists in the United States Black population. It is important to identify health issues and behaviors of African-born women to effectively address health disparities. Methods: Black African-born women (N = 29), 20 years or older completed a survey about general and women's health, health history, acculturation, lifestyle, social and health challenges, beliefs about breast cancer. Data were analyzed using SPSS 14.0 software. Categorical variables were summarized with frequencies and percentages and continuous variables were summarized with means and standard variation. A Likert scale (strongly agree, agree, disagree, and strongly disagree) was used to assess beliefs about breast cancer. Results: Most (71.4%) participants had a high school education or more, 70% were employed, and 50% had health insurance. Two-thirds received health care from primary care doctors, 20.7% from health departments, and 39.3% got annual checkups. Lack of jobs, healthcare cost, language barrier, discrimination, and child care were the top social issues faced by participants. High blood pressure, obesity, oral health, HIV/AIDS, and diabetes were indicated as the most common health problems. The percent of participants (60%) that had not had a mammogram within the previous 2 years was more than the state average (24%) for women 40 years and older reported by the Kansas Department of Health and Environment. The percent of participants (40%) that had a mammogram within the previous 2 years was lower than the national average (73.2%) for African American women. Conclusions: Study provides a snapshot of social concerns and health issues in an African population residing in Midwestern United States. Understanding the socio-cultural characteristics of this population is necessary to address health disparities.
MeSH term(s)	Acculturation ; Adult ; Africa/ethnology ; African Americans ; African Continental Ancestry Group ; Breast Neoplasms/prevention & control ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/ethnology ; Employment/statistics & numerical data ; Female ; HIV Infections/epidemiology ; HIV Infections/ethnology ; Health Knowledge, Attitudes, Practice ; Health Status ; Healthcare Disparities/statistics & numerical data ; Humans ; Hypertension/epidemiology ; Hypertension/ethnology ; Insurance, Health/statistics & numerical data ; Kansas/epidemiology ; Mammography/statistics & numerical data ; Middle Aged ; Obesity/epidemiology ; Obesity/ethnology ; Primary Health Care/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2015-10-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2413336-X
ISSN	1756-0500 ; 1756-0500
ISSN (online)	1756-0500
ISSN	1756-0500
DOI	10.1186/s13104-015-1469-1
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Article: COLORECTAL CANCER SCREENING PRACTICES AMONG THREE AMERICAN INDIAN COMMUNITIES IN MINNESOTA.

Filippi, Melissa K / Perdue, David G / Hester, Christina / Cully, Angelia / Cully, Lance / Greiner, K Allen / Daley, Christine M

Journal of cultural diversity

2016 Volume 23, Issue 1, Page(s) 21–27

Abstract: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. Effective prevention and early detection may be achieved through screening, but screening rates are low, especially in American Indian (AI) populations. We wanted to understand ...

Abstract	Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. Effective prevention and early detection may be achieved through screening, but screening rates are low, especially in American Indian (AI) populations. We wanted to understand perceptions of CRC screening among AI located in the Great Lakes region. Focus groups were recorded and transcribed verbatim (N = 45). Data were analyzed using qualitative text analysis. Themes that deterred CRC screening were low CRC knowledge, fear of the procedure and results, cost and transportation issues, and a lack of quality and competent care. Suggestions for improvement included outreach efforts and culturally-tailored teaching materials.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Attitude to Health/ethnology ; Colonoscopy/psychology ; Colonoscopy/statistics & numerical data ; Colorectal Neoplasms/prevention & control ; Cultural Characteristics ; Early Detection of Cancer/psychology ; Early Detection of Cancer/statistics & numerical data ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Humans ; Indians, North American/psychology ; Indians, North American/statistics & numerical data ; Male ; Middle Aged ; Minnesota
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1469804-3
ISSN	1071-5568
ISSN	1071-5568
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