Class of 2010 Abstract / OBJECTIVES: To identify and describe practical incentives and barriers for community health center pharmacists in adopting a practice based research network (PBRN) that facilitates sustainable collaboration. METHODS: Directors of pharmacy at Community health centers listed as members of Arizona Association of Community Health Centers (AACHC), with on-site pharmacies, were contacted via telephone. During initial contact an IRB approved script was used to recruit the pharmacy director’s participation, at which time the subject’s disclaimer form was read and an appointment for a future phone interview was scheduled. Phone Interviews were conducted using a standardized questionnaire, and all results were manually recorded on a standardized data collection form. Data collected included, site specific information including the: educational background of the pharmacy director, and his or her perceived inducements and barriers to participating in a pharmacy based PBRN with the University of Arizona. RESULTS: Phone interviews were completed by 8 directors of pharmacy, 4 women (50%) and 4 men (50%). A total of 5 participants (62.5%) had a BS degree, 2 (25%) had PharmD degrees and 1 (12.5%) had both as BS and a PharmD degree. The mean length of time in current position was 5.56 yrs (SD= 4 yrs.). 75% of the participants indicated that they considered working with the University of Arizona (UofA) as an inducement, the same number of participants felt that their staff and practice as a whole would also consider it an inducement. Overall participants indicated that both their personal (75%) and staff‘s (87.5%) motivation to improve the pharmacy profession was considered an inducement, as well as their opportunity for professional growth (75%). All of the participants (100%) indicated they did not have adequate staffing to support research at this time and therefore felt it was a barrier to participation. When asked about resources as a whole, including staff, time and technology 87.5% of the participants felt this was a barrier. Other common barriers were; anticipated time requirements (75%), current schedule/time allowances (75%), staff’s outside commitments (75%). Out of the 8 participants only 2 (25%) are currently participating in PBRNS at this time, 3(37.5%) have research ideas that they are interested in working on, and 3(37.5%) indicated that they were not currently participating nor did they have any current interests. The major themes identified as inducements to participation were patient benefit, time/staffing involvement, and professional growth. CONCLUSIONS: The most common barriers to participating in a PBRN were: working with the UofA, motivation to improve the profession of pharmacy and the opportunity for professional growth. The most common inducements were staffing, current resources, anticipated time requirements, current schedules and outside commitments.

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.

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.

Class of 2013 Abstract / Specific Aims: To evaluate and describe the Agency for Healthcare Research and Quality (AHRQ) affiliated practice-based research network (PBRN) websites to determine the best qualities regarding format, content, and accessibility using a developed PBRN website information extraction form. Methods: A PBRN information extraction form was developed to assess the format, content, and accessibility of each AHRQ-affiliated PBRN website. Each student investigator completed an electronic copy of the extraction form for each PBRN website to confirm consistency of findings. A phone interview was then conducted with the webmasters of the PBRNs with the highest scores to determine the influences and challenges those webmasters faced during the development of their PBRN websites. Main Results: The information extraction form was completed for each of the 104 active PBRN websites in the U.S. The most common elements seen on the PBRN websites were site map, email address, mission statement, phone number, and search toolbar. The inter-rater agreement between the two student investigators for the data collected was 84 percent. Regarding the webmaster interviews, the majority of the webmasters believed that the single most important factor in creating a successful PBRN website was identifying the audience of the PBRN and making the material appropriate for that audience. Conclusion: The developed information extraction form was used to successfully evaluate and describe the AHRQ-affiliated PBRN websites. Audience identification is important in order to provide appropriate content, as well as in the development of an effective PBRN website.

Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.