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Rationale: Prescription drug abuse and misuse (PDA/M) is a significant problem in Central Appalachia and continues to grow. Since 2000, Tennessee has seen a 250% increase in prescription overdose deaths. Nationally, most prescription painkillers are prescribed by primary care doctors and dentists, rather than specialists. Objective: To develop and test a survey instrument aimed at understanding family physician knowledge, attitudes, and beliefs about opioid therapy prescribing. Design: Survey development. Setting: Survey questions were developed based on results of five focus groups held in primary care clinics in Northeast Tennessee and Southwest Virginia. Surveys were validated and tested by faculty and residents in three family medicine residency clinics in Northeast Tennessee. Participants: Survey questions were face validated for clarity and relevance by family physician attendings and third year residents (N=29). All faculty attendings and residents (N≈85) at the same family medicine residency clinics will be invited to complete the survey for psychometric testing. Main and Secondary Outcome Measures: Survey questions have been face validated for clarity and relevance. Data from the psychometric testing phase will be analyzed for internal consistency and inter-item correlations. Exploratory factor analysis will be used to identify underlying constructs. Results: Based on the results of the focus groups and physician expertise, a 51-item instrument was developed. Following face validation, wording was clarified on 25 questions, 3 questions were removed, and 5 questions were added, resulting in a 53-item instrument. Psychometric testing has not been completed at this time, but will be completed at the time of presentation. Conclusions: Researchers intend to use the findings to improve policies and practice guidelines for primary care clinics in the Appalachian region. Results will be used to design CME activities to decrease PDA/M and to help foster more effective and responsible prescribing of pain medication.

BACKGROUND: The Appalachian Research Network (AppNET) was established in the Department of Family Medicine at East Tennessee State University (ETSU) as a network of community primary care preceptors focused on Quality Improvement (QI) in rural Appalachia. As the network has moved forward, following our established aims and priorities to improve the quality of healthcare in rural Appalachia, the importance of transitioning to an interdisciplinary network has emerged. METHOD: AppNET QI projects related to medication reconciliation and prescription drug monitoring led to the development of an AAFP Foundation grant focused on prescription drug abuse/misuse (PDA/M). AppNET approached two ETSU pharmacy faculty experienced in PDA/M research to join the team. Soon after, we were invited to collaborate on an NIH NIDA R-24 submission with the ETSU Bill Gatton College of Pharmacy (GCOP) and the ETSU College of Public Health: Diversity-promoting Institutional Drug Abuse Research Program (DIDARP). This colllaboration has contributed to a variety of AppNET interdisciplinary partnerships resulting in an expanding scope. RESULTS: AppNET’s interdisciplinary partnerships have resulted in several funded projects. In June 2013, we received funding from the AAFP Foundation to assess family physician knowledge, attitudes, and methods for effective and responsible prescribing of pain medication. The ETSU DIDARP grant was awarded in September 2013 with AppNET’s Network Director serving as CoInvestigator on one of three funded projects as well as an AppNET PEA joining the DIDARP team. AppNET is serving as the laboratory for the project, which requires input from providers and pharmacists, leading to the recruitment of pharmacists to the PBRN. In April 2014, through an interdisciplinary partnership of AppNET and GCOP, ETSU was awarded a contract from the Tennessee Department of Health to help combat the Neonatal Abstinence Syndrome (NAS) epidemic in the State. AppNET’s Research Director and a Pharmacy faculty member are leading a project to study the knowledge, attitudes, beliefs, and behaviors of prescribers and dispensers specific to substance use in pregnancy and NAS and evaluate the impact of a NAS primary prevention academic detailing intervention. CONCLUSION: Research in the major health issues facing rural Appalachia, such as PDA/M and NAS, has required an expansion of the research team to include other key professions such as pharmacy and public health. AppNET evolving into an interdisciplinary network has expanded our research scope, our success with obtaining funding, and increased the potential for future funding.

It is estimated that the divorce rate for marriages in which at least one party is a physician is 10-20% higher than the general population. Predicting the variables that contribute to marital satisfaction, identifying the skills associated with those behaviors and developing a residency curriculum to teach the skills to resident physicians is the focus of this study. Intimacy, conflict resolution and emotional expressiveness have all been identified as important aspects of marital satisfaction. We will determine how each of these variables contributes to marital satisfaction using multilevel logistic regression. The results will be used to develop a skills based training curriculum for residency to improve the lives and well-being of physicians and their families.

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