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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.

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,

The 2021 “Community Health Needs Assessment” of Hawkins County, Tennessee conducted by regional hospital system, Ballad Health, identified mental health and substance abuse among the top 3 health priorities for the county. With input from community stakeholders, 5 ETSU medical students organized a 3-part intervention targeting 6th grade students (n=43) testing the hypothesis that individuals with competent coping skills and mental health awareness are less likely to turn to substances to manage life stressors. Lesson plans were crafted using Kolb’s experiential learning model and pre/post surveys collected at each session assessing participant awareness, self-efficacy, perceived stress, and feedback. Results indicated statistically significant improvements in student awareness of positive and negative coping skills and self-efficacy, along with favorable responses from students regarding lesson style. Continuation of the study with longitudinal assessments is needed to prove the hypothesis and indicate effectiveness of the intervention as a tool for reducing substance use in the region.

Despite the known dangers of pregnancy smoking, rates remain high, especially in the rural, Southern United States. Interventions are effective, but few have been developed and tested in regions with high rates of pregnancy smoking, a culture that normalizes smoking, and a hard-to-reach prenatal population. The goals were to describe a smoking cessation intervention, the Tennessee Intervention for Pregnant Smokers program, and examine the impact on quit rates compared to usual care. Additionally we sought to examine reduction in smoking levels and number of quit attempts related to the intervention and finally to examine the impact of the intervention on birth outcomes. Intervention and historical control group participants, all smokers at entry to prenatal care, were recruited from five medical practices providing prenatal care in rural, South-Central Appalachia. The intervention, an expanded 5A’s (Ask, Advise, Assess, Assist, Arrange) model, was delivered by trained health educators. Over 28% of intervention group women quit smoking, compared to 9.8% in the control group. Two thirds of intervention group women significantly reduced smoking by delivery, with 40%+ attempting to quit at least once. Compared to controls, intervention group women saw significantly better birth outcomes, including newborns weighing 270g more and 50% less likely to have a neonatal intensive care unit admission. Among intervention group participants, those who quit smoking had significantly better birth outcomes than those who did not quit smoking. Findings point to the potential for appropriately tailored pregnancy smoking interventions to produce substantial improvements in birth outcomes within populations with health disparities.

Due to an increase in the need for allied health professionals, there is a growing interest to assess the allied health workforce and its employment needs. This is especially true in medically underserved rural areas where there is a critical shortage of allied health professionals. A survey was sent to allied health administrators across a variety of allied health disciplines working in Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences of perceptions of strategy effectiveness among allied health disciplines, and key strategies for rural allied health recruitment. Little is known about organizational policies impacting recruitment and retention practices of allied health professionals in Tennessee hospitals. Understanding of this problem is vital to the prevention of a critical shortage of allied health professionals. Therefore, this study sought to compare rural and urban hospital in Tennessee with respect to recruitment and retention needs.

There has been little discussion in the literature regarding the financial value of the services provided to the participants in health fairs. This article examines the financial value of preventive services provided through a community health fair in an economically depressed area of southwest Virginia. Current Procedural Terminology codes were assigned to the services provided in order to estimate costs participants might incur for such services. An average 50-year-old man would have paid up to $320 to obtain commonly recommended preventive services available free at the fair. An average 50-year-old woman would have paid up to $495. Overall, over $58,000 in services were provided through the health fair. This community health fair provided preventive services that many participants otherwise might have found to be cost-prohibitive.

This talk will: 1. Define existing breastfeeding best practices 2. Review breastfeeding initiatives and metrics 3. Discuss geographical considerations and cultural competency 4. Examine case studies of at-risk breastfeeding families

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