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.

Class of 2010 Abstract / OBJECTIVES: Describe the characteristics and research interests of Community Health Centers (CHC) pharmacists and pharmacies in a pharmacy based practice based research network (PBRN). METHODS: Pharmacy directors of eight Arizona CHC pharmacies were initially contacted by telephone and asked to participate in a survey. The survey was then sent to these directors via email and a second telephone conversation was set up to re-­‐administer the survey and gather the answers to the questionnaire. The questionnaire consisted of demographic, clinical and practice related questions targeted at identifying areas of interest for research in developing a community pharmacy practice based research network (PBRN). RESULTS: The data regarding the demographics and characteristics of the Arizona CHC pharmacies, pharmacists, and patients showed that only two pharmacies served more than 300 patients per day and dispensed more than 400 prescriptions per day. The data found that an average of 46% of the patients that went to these pharmacies did not consider English as their primary language and that an average of 49% of the patients were Hispanic/Latino. The data collected regarding the clinical interests of these pharmacies showed that asthma had the highest level of clinical interest among the eight CHC pharmacies (average rank = 3.1). For the public health interests of the CHC pharmacies, patient adherence/compliance was ranked the most important (average rank = 3.1). In regards to internal practice site interests job satisfaction was the most highly ranked interests among these CHC pharmacies (average rank = 3.1). CONCLUSIONS: The data suggests asthma, job satisfaction and patient compliance/adherence are the top areas of interest in the clinical, internal worksite, and public health sectors. The data collected from this study will help to establish a pharmacy based PBRN in Arizona and provide a starting point in terms of research topics that will be explored. The establishment of an Arizona pharmacy based PBRN is very important since it will provide cohesiveness between research and community based practice of Community Health Centers in Arizona and is a step in the right direction in terms of growth of these centers.

Background: Chronic conditions comprise a significant amount of healthcare utilization. For example, people with chronic diseases account for 51% of family physician encounters. Therefore, diagnostic algorithms based on comprehensive clinical records could be a rich resource for clinicians, researchers and policy-makers. However, limitations such as misclassification warrant the need for examining the accuracy of these algorithms. Purpose: To investigate and enhance the accuracy of the diagnostic algorithms for five chronic diseases in the Canadian Primary Care Sentinel Surveillance Network. Methods: DESIGN: A validation study using primary chart abstraction. SETTING: A stratified random sample of 350 patient charts from Kingston practice-based research network. OUTCOME MEASURES: Sensitivity and specificity for the diagnostic algorithms. ANALYSIS: A multiple logistic regression model along with the receiver operating characteristic curve was employed to identify the algorithm that maximized accuracy measures. Results: The sensitivities for diagnostic algorithms were 100% (diabetes), 83% (hypertension), 45% (Osteoarthritis), 41% (COPD), and 39% (Depression). The lowest specificity was 97% for depression. A data-driven logistic model and receiver-operating characteristic curve improved sensitivity for identifying hypertension patients from 83% to 88% and for osteoarthritis patients from 45% to 81% with areas under the curve of 92.8% and 89.8% for hypertension and osteoarthritis, respectively. Conclusion: The diagnostic algorithms for diabetes and hypertension demonstrate adequate accuracy, thus allowing their use for research and policy-making purposes. A multivariate logistic model for predicting osteoarthritis diagnosis enhanced sensitivity while maintaining high specificity. This approach can be used towards further refining the diagnostic algorithms for other chronic conditions. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-07-23 17:58:11.302

Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research

In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.

The objectives of this study were to: 1) create a measure of PBRN clinician member individual performance; 2) produce a rich description of PBRN directors' leadership behaviors and styles; and, 3) identify significant relationships between PBRN director leadership-PBRN clinician member performance. A sequential, exploratory mixed methods design was used to interview and survey PBRN directors and non-director participants. In Phase I, a semi-structured interview guide was used to identify PBRN director leadership behaviors, PBRN non-director performance behaviors and expectations, and decision making activities. A clinician member performance measure was created using a validated behavioral item extraction method. A thematic analysis was conducted on all other data. In Phase II, two quantitative surveys were administered to PBRN directors assessing demographics, membership activity, PBRN productivity, and clinician member performance. One survey was administered to PBRN clinician members assessing their demographics, activity level, and their perceptions of PBRN leadership behaviors. Clinician member performance within PBRNs is a multidimensional construct distinct from participation that is comprised of ownership and engagement aspects, although there is some evidence of a further division into leadership, awareness, follow-through, and communication factors. Collaborative leadership was reported as being distributed to all roles in the PBRN, but is primarily inculcated by a collaborative PBRN director. Time and funding were reported as important resources necessary for the completion of PBRN activities, and are increasingly becoming more limited in their availability. PBRNs engage in a variety of projects and other activities carried out and monitored through ongoing collaborative communication and consensus-based decision making efforts. Top-down decision making patterns by PBRNs have negative relationships with measures of productivity. Directive and participative leadership behaviors do not appear to have direct relationship with clinician member performance, but years of involvement in current PBRN does have a positive association. However, further investigation is necessary to replicate these findings in larger samples. Aiding busy clinicians with engagement through use of central staff may be beneficial. PBRN directors should focus on strengthening collaborative culture of their PBRN and minimizing barriers to effective communication and decision making.

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.

No description available.

La méthodologie de l’évaluation en psychothérapie s’est longtemps limitée aux résultats issus d’essais cliniques comparatifs de groupes. L’objectif, engagé dans les années 2000, de comprendre ce qui cause son efficacité a engagé un renouvellement méthodologique. Son application concrète est peu documentée. La première partie présente, à partir d’une revue de la littérature centrée sur l’introduction de la recherche sur le processus associée aux résultats, comment le paradigme interactionnel multifactoriel de la psychothérapie a stimulé le développement de méthodes adaptées à la complexité et à l’observation en conditions naturelles. La seconde partie introduit autour de cinq axes principaux les questions méthodologiques générales et spécifiques de cette nouvelle orientation : 1. une épistémologie interactionnelle et transactionnelle ; 2. Un recentrage sur les études mixtes intensives de cas ; 3. Une investigation clinique et théorique multifocale des processus et mécanismes de changement ; 4. une forte relation clinicien-chercheur ; 5. une approche statistique innovante. La troisième partie expose l’expérience et les questions soulevées par la mise en œuvre de ce programme dans le cadre d’un réseau de recherche clinique centré sur les pratiques, du recueil des données jusqu’à l’analyse des processus et mécanismes de changement, et les résultats qui en sont issus. La quatrième partie présente une revue détaillée de la littérature. Ce travail devrait favoriser les collaborations avec les disciplines connexes et l’efficience des traitements par une meilleure connaissance des conditions et des mécanismes de changement associée au développement d’une base de données issue d’études de cas. / The methodology of assessment in psychotherapy has long been limited to results from comparative group clinical trials. The objective, expressed in the 2000s, to understand what is causing its effectiveness has involved a methodological renewal. Its concrete application is poorly documented. The first part presents, from a review of the literature focusing on the introduction of research on the process associated with outcomes, how the multifactorial interactional paradigm of psychotherapy has stimulated the development of methods adapted to the complexity and observation in natural conditions. The second part introduces the general and specific methodological questions of this new orientation around five main axes: 1. an interactional and transactional epistemology; 2. A refocusing on intensive mixed case studies; 3. A multifocal clinical and theoretical investigation of the processes and mechanisms of change; 4. a strong clinical-researcher relationship; 5. an innovative statistical approach. The third part presents the experience and issues raised by the implementation of this program as part of a practice-oriented clinical research network, from data collection to analysis of processes and mechanisms of change, and results. The fourth part presents a detailed review of the literature. This work should foster collaborations with related disciplines and treatment efficiency through a better understanding of the conditions and mechanisms of change associated with the development of a case study database.