Continuity of Care has long been known to be of critical importance in primary care and is a major component in the Patient Centered Medical Home. With the increasing importance of scheduling availability and Patient Centered Medical Home access requirements, it is important to determine to what degree patients are able to schedule appointments with Primary Care Providers (PCPs) - Family Physicians and Nurse Practioners - and what moveable barriers restrict access. Objectives: 1. Determine the frequency appointments are initially scheduled with Primary Care Provider. 2. Determine any systematic difference for patients unable to schedule with identified Primary Care Provider. 3. Use the findings of the study to plan a future intervention to increase access to PCPs. Human Subjects Review: Database analysis only, not considered human subjects research. Design: Clinic Electronic Health Record (EHR) review. Setting: appointments made in four rural South-Central Appalachian primary care clinics. Patients or Other Participants: all appointments recorded in clinic EHR databases for 2010 and 2011. Intervention/Instrument: database analysis from eClinical works, AllScripts, and Centricity EHRs. Outcome Measures: Summary assessment of Primary Care Provider accessibility. Anticipated Results: 1. It is expected that the frequency of appointments initially scheduled with PCP will be under 60% based upon preliminary data from one clinic. 2. It is anticipated that patients may have been unable to schedule with a PCP because appointments were not available or because there was no PCP identified. 3. Identification of systematic barriers to Primary Care Provider Access in order to improve same day appointment availability. Conclusions- An accurate picture of ability to schedule appointments with Primary Care Providers would be useful in ensuring continuity of care and success of a Patient Centered Medical Home.

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This study was designed to investigate the effects of acute eticlopride (0.02 mg/kg, D2 antagonist) treatment, given immediately before training, in rats neonatally treated with quinpirole, which has been shown to produce long-term D2 receptor supersensitization. Rats were given quinpirole (1mg/kg) or saline treatment from P1-21. Beginning on P22, rats were administered eticlopride or saline (i.p.) fifteen mins before each of seven days of training. Rats were tested on the Morris water task (MWT). For the first three consecutive days, rats were tested on the place version of the MWT with a stationary platform. Animals were given 24 training trials followed by a probe trial, and swim patterns were analyzed with platform removed. The next day, animals began testing on the match-to-place version for four consecutive days and two daily trials were given with the platform moved to a new location each day. On both the search time and target visit measures of the probe trial, animals neonatally treated with quinpirole demonstrated a deficit, and eticlopride eliminated this deficit. Interestingly, animals neonatally treated with saline but given eticlopride before training also demonstrated a deficit on both measures. On the match-to-place version, the difference in latency to locate the platform between the two daily trials served as the dependent measure. Similar to the MWT place version, eticlopride treatment eliminated deficits produced by neonatal quinpirole treatment on this task, and eticlopride produced a deficit in saline controls. This study demonstrates that in a model of dopamine D2 supersensitivity, it appears that the increased sensitivity of the D2 receptor is important for cognitive function.

In this experiment, rats were administered nicotine (0.3 mg/kg) for 11 consecutive days before and after an electrolytic medial frontal cortex lesion. After drug administration ceased, rats were tested on two spatial memory tasks, the radial arm maze (RAM) and the Morris water task (MWT). Behavioral testing was arranged so that rats were tested on the RAM 1 day after drug administration followed by behavioral testing on the MWT 19 days after drug treatment, or tested on the MWT 1 day after drug administration followed by testing on the RAM 4 days after drug treatment. Results of MWT testing showed that regardless of the drug/behavioral testing interval, lesioned rats given nicotine demonstrated enhancement relative to saline-treated lesioned animals, but the effects were more robust 1 day after drug treatment had ceased. Nicotine-induced behavioral compensation after medial frontal cortex lesions appears to be time-dependent in animals behaviorally tested on the MWT. Results of RAM testing showed that there were no significant differences between lesioned groups at the 1-day drug/testing interval, although nicotine improved performance in non-lesioned rats compared to non-lesioned rats given saline. Four days after drug administration, nicotine improved performance in lesioned rats to the levels of non-lesioned rats given saline or nicotine. This result suggests that previous training on the MWT may have primed behavioral compensation produced by nicotine in medial frontal cortex lesioned rats behaviorally tested on the RAM.

INTRODUCTION: Intrauterine devices (IUDs) and implants have been shown to decrease the rate of unintended pregnancies. These methods also known as Long Acting Reversible Contraceptives (LARCs) are considered the birth control of choice for women of childbearing age, including adolescents, from multiple professional medical associations. However, even with strong recommendations, LARCs are widely underused in the United States, especially in rural areas. This research is based in the Rural Health Services Consortium (RHSC) clinic in Rogersville, Tennessee. This research looks at knowledge and use of LARCs in this clinic before and after receiving training in IUD and implant insertion and removal. METHODS: The physicians, nurse practitioners and physician assistants affiliated with the Rural Health Services Consortium were invited to attend both an IUD and an Implant training. Those who agreed to participate in the study were asked to complete a survey, which addressed current knowledge of LARCs, contraceptive counseling practice and LARC referral practice. Surveys were de-identified and linked to each individual provider through a person specific randomized code. Providers were then trained and certified in the insertion and removal of both IUDs and Implants. Following training the providers provided a survey assessing any change in knowledge and intended practice. At three and six months the same providers will be given an additional surveys with their individualized codes. These surveys assessed the providers' knowledge of LARCs and current practice regarding contraceptive counseling and LARC referral. All survey data was compiled and analyzed for statistical significance using paired T tests. Data was analyzed to identify significant changes in knowledge or practice following training. RESULTS: A t-test revealed a statistically significant increase in provider comfort level with discussing the risks and benefits associated with both IUDs (pretest M=1.92, posttest M=2.92, t = -3.09, p<.01) and implants (pretest M = 1.83, posttest M = 2.83, t = -2.76, p< .05). Regarding practice behavior, a t-test found a statistically significant increase in provider recommendation/discussion of Mirena/Skyla (pretest M= 2.09, posttest M= 3.08, t = -2.14, p<.05) and implants (pretest M = 2.25,

INTRODUCTION: The importance of prenatal care is a well-established principle in the field of obstetric care. Inconsistent, poor and/or inadequate prenatal care is associated with a wide range of poor health outcomes including, pre-term labor, low-birth weight infants and maternal mortality. Hispanic women, specifically migrant/seasonal farmworkers, face a variety of barriers to early and effective prenatal care including: language barriers, poverty, transportation and frequent mobility. Northeast Tennessee has grown to include a robust Hispanic community. Rural Medical Services (RMS), a provider of primary care in rural Tennessee, has developed and implemented a prenatal care outreach program for the local Hispanic population. Through this program Hispanic pregnant women receive educational and clinical services ranging from prenatal education materials and at-home visits to translation services and Lamaze training. The purpose of the current study was to determine the impact of RMS’ prenatal outreach program on the birth outcomes of regional Hispanic mothers. METHODS: A retrospective medical file review using RMS electronic medical records as well as prenatal outreach program documents, including all patients that gave birth during 2013, was conducted. Independent variables included the mother’s age and ethnicity, identification as migrant/seasonal worker, weeks of gestation at first prenatal visit, number of prenatal visits, and number of prenatal outreach visits/contacts. Dependent variables included infant’s gestational age at birth (weeks), infant’s birth weight (oz.), and APGAR scores. RESULTS: In total, 213 women received care for pregnancies with expected due dates in 2013. Of those, birth outcomes data were available for 180. There was no significant difference in the incidence of low birth weight for infants of non-Hispanic and all Hispanic mothers (9.8% v. 4.3%; p=.14) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (5.1% v. 3.4%; p=.66). Likewise, there was no significant difference in the incidence of pre-term birth (<37 weeks) between non-Hispanic and Hispanic mothers (12.9% v. 8.5%; p=.35) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (6.7% v. 10.3%; p=.47). While the number of prenatal visits for Hispanic mothers was significantly correlated with birth weight (r=.35; p<.001) and gestational age at birth (r=.40; p<.001), the number of prenatal outreach visits was not significantly correlated with birth weight (r=.16; p=.08) or (r=.15; p=.10). CONCLUSIONS: The RMS prenatal outreach program has closed the prenatal care disparity gap between their Hispanic and non-Hispanic patients. However, there was no therapeutic advantage to an increased number of outreach visits, indicating RMS could standardize the program with a low frequency of visits.

Sexual health affects many aspects of patient health; however, it is often not addressed with patients, and research shows that sexual health is not emphasized in medical education. Primary care providers ought to be on the front lines of the integration of sexual health into patient centered care. In rural areas, this responsibility often falls to family medicine physicians as patients do not have access to Ob/Gyns (obstetrician and gynecologist). The objective of this study was to assess the types and prevalence of sexual health concerns among patients in rural Appalachia and also to assess the comfort level of family medicine physicians in addressing and managing sexual health concerns. Sexual health was defined to include sexual wellness, infections, contraception, and sexual dysfunction. Participants included East Tennessee State University (ETSU) family medicine attending physicians (faculty physicians) and resident physicians at three designated ETSU residency clinic sites. We designed and distributed an eighteen-question survey to residents and faculty physicians in order to evaluate how the recently emerging sexual health emphasis has translated to the practice of family medicine in East Tennessee. Of note in the data analysis, the majority of providers reported they feel at least moderately comfortable discussing sexual health with patients. However, when asked how frequency they address sexual health with patients, most providers reported that they do not frequently ask patients about sexual health concerns. Even though the American College of Obstetrics and Gynecology (ACOG) recommends long-acting reversible contraceptives (LARCs) as first-line contraceptives, less than half of providers recommend LARCs to patients. Additional exploration is needed to address why most family medicine physicians do not ask patients about sexual health as well as to determine if any regional barriers exist. This data also suggests that family medicine providers often do not have the means to recommend first-line contraception, likely due to lack of access and/or lack of knowledge regarding current recommendations. This study suggests that more emphasis should be placed on addressing sexual health and there is a need for additional training perhaps through educational workshops, or the distribution of educational brochures, or training in LARC placement.

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