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  • ISSN: 2379-0547
    Volume 4, Issue 1
    Mini Review
    Daniel M. Avery*, P. Drake Lavender, Susan M. Guin, Lea Yerby, and Heather M. Taylor
    This paper describes the background of longitudinal integrated clerkships and the results of a recruitment program for primary preceptors for a newly developed longitudinal clerkship in Tuscaloosa, Alabama. A longitudinal integrated clerkship [LIC] is an innovative primary care-based community experience during the third year of medical school for a select group of self-directed students under the supervision of a primary preceptor Recruitment and retention of preceptors is critical to perpetuating a longitudinal, integrated clerkship. Eighty-five physicians were contacted about their interest in being a primary LIC preceptor at the College of Community Health Sciences and 80 agreed to be a primary preceptor the first year. Responses were all positive. Only three physicians said that they had not heard about longitudinal integrated clerkships [LIC]. There are a number of important reasons why family physicians want to be primary preceptors including the importance of primary care and family medicine, developing the next generation of physicians, maintaining interest in teaching, attracting future physicians to their community and giving back to the institution that trained them.
    Ravinder Valadri, Maureen Litchman, Deborah Spring, Namrata Singhania, Julie A. Nardella, Richard English, Linda Thomas-Hemak, and Samir B. Pancholy*
    Background: Adherence to evidence-based American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for management of chronic heart failure (HF) has shown to be associated with improved outcomes. We sought to assess the limitations in the adherence to the guideline in our primary care clinic.
    Methods: Electronic medical records (EMR) of chronic HF patients with at least 3scheduled consecutive visits to primary care physician (PCP) office within past 2 years at a family medicine residency program were reviewed in a retrospective observational study. Data from the most recent clinic visit was analyzed to assess limitations associated with adherence to the2013 ACCF/AHA guideline directed medical and device therapy.
    Results: Analysis included 155 patients. There were 73(47.1%) patients with heart failure with reduced ejection fraction (HFrEF) and 82(52.9%) patients with heart failure with preserved ejection fraction (HFpEF). In HFrEF group, 51 (86.4%) patients were on HF specific beta blockers (BB), 44 (60.3%) were on angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), 7(9.6%) were on spironolactone. Maximal tolerable dose was achieved only in 8(13.6%) patients with BBs, 24(66.7%) patients with ACEIs,1(12.5%) patient with ARBs and 5(25%) patients with spironolactone. Despite clinical indication as per the guideline, implantable cardioverter defibrillator (ICD) was not used in 35(77.8%) patients and cardiac resynchronization therapy (CRT) was not used in 15(83.3%) patients. In patients with HFpEF, optimal BP (SBP<150/90 mm Hg) was achieved in 72 (87.8%) patients. Documentation of individual patient level factors such as tolerance, compliance, and insurance-related factors that potentially limit adherence to the guideline, was not readily available.
    Conclusions: There appears to be a lag in the evidence for adherence to the 2013 ACCF/AHA guideline for management of chronic HF in Primary Care. System improvement measures should be implemented to improve documentation of management decisions made. Documentation should acknowledge consideration of recommended guidelines & provider's rationale for adhering or deviating from them.
    Research Article
    J. Grier Stewart, Scott L. Arnold, and Daniel M. Avery*
    Background: The College of Community Health Sciences in Tuscaloosa, Alabama is the Tuscaloosa Regional Campus of the University Of Alabama School Of Medicine. The mission of the regional campus is to train medical students and residents to provide primary care to rural, underserved communities of Alabama. There has been no prior study which examined where medical school graduates eventually practice and what they practice.
    Materials and methods: A list of graduating medical students assigned to the Tuscaloosa Regional Medical Campus from 1974 to 2015 was obtained from the main campus published records in Birmingham, Alabama. This list contained the years of matriculation and graduation, complete date of graduation, etc. The database was expanded to include practicing specialty and place of practice, board certification, primary care and other pertinent information.
    Results: Information was obtained on all 850 medical students assigned to the Tuscaloosa Regional Campus of the University Of Alabama School Of Medicine who have matriculated during the period of 1974 to 2015. The second top matched specialty was Internal Medicine and the second top practiced specialty after residency training was Internal Medicine. One hundred fifty-seven graduates matched into internal medicine and ninety-eight practices or have practiced general internal medicine from 1974 to 2015
    Conclusion: Sixty-two percent of graduating medical students matching into internal medicine and med/peds, have practiced general internal medicine and general med/peds compared to the national average of 20%. Even over the past 15 years since fellowship training and sub specialization have increased, 50% of graduates matching into internal medicine and med/peds have practiced general internal medicine and general med/peds today. The real answer to producing more GIM physicians may be at the medical school level with regional medical school campuses who have the expertise and emphasis on primary care.
    Hyungsoo Kim*
    Although there is a long history of interest in personality traits and their impact on cognitive abilities, personality traits have been overlooked as an importantpredictor of low health literacy. We explored and quantified the relationship between personality traits and health literacy among Americans aged 50 and older.
    We conducted analyses of 2010 data from the Health and Retirement Study (HRS), a nationally representative sample of Americans aged 50 and older. We used 1,190 respondents who were randomly drawn from one half of the 2010 HRS main survey participants and participated in the health literacy module.
    Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine Revised (REALM-R) and self-reported confidence in filling out medical forms. Personality traits were measured with the five factor model of personality: neuroticism, extraversion, conscientiousness, agreeableness, and openness.
    Neuroticism increased the odds of having low health literacy. A one-point increase in the Neuroticism score led to a 72% increase in the odds of falling into low health literacy. Extraversion increased the odds of having low health literacy by 79% while Conscientiousness and Openness reduced these odds by 51% and 29%, respectively. Personality traits were significantly associated with low health literacy for Americans aged 50 and older. In particular, Neuroticism and Extraversion were identified as negative factors for health literacy. This finding indicates a need to utilize personality traits to improve communication between health care providers and patients, and to be included in models to assess and improve individuals' health literacy.
    Case Study
    Shannon Ryan Carson, Carr C, Manley S, Sutherland S, Tompkins C, and Sampalli T*
    Musculoskeletal conditions, chronic pain and other complex chronic conditions are primary causes of disability and higher costs to the health system world-wide and in Nova Scotia. Evidence has shown that exercise is considered an effective way to prevent further deterioration and facilitate better health in individuals with these debilitating conditions. However, adherence to exercise programs is shown to be low in individuals with pain related conditions due to many factors including symptoms related to the conditions, access to the programs and lack of motivation. Primary Health Care in Nova Scotia has designed free health and wellness programs offered in community settings, namely, the Community Health Teams (CHTs). In their initial engagement with the communities, implementation of exercise programs for individuals with functional limitations due to chronic conditions was identified as a priority. Consequently, the Low Intensity Exercise Program (LIEP) was developed and implemented to address this priority of the community. In the ten-week program, participants are empowered to safely self manage symptoms of over-exertion and are taught techniques to gradually progress their physical activity. The impact of the intervention was examined in an observational study. A total of 140 individuals participated in the study and showed significant improvements in physical health and over 90% indicated being satisfied with the program. Over 50% of participants also showed improvements in modifiable risk management factors. LIEP is a one-of-a-kind initiative in Canada that has taken into account adherence challenges into its design considerations and is considered a leading practice by Accreditation Canada.
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