AAFP National Research Network Newsletter – Summer 2019

In This Issue

AAFP NRN Project Recruitment

Test a New Adult ADHD Toolkit in Your Practice

The AAFP NRN is recruiting practices to participate in a research project that aims to test the recently developed Adult ADHD Toolkit. The toolkit was created in collaboration with experts in adult attention deficit hyperactivity disorder (ADHD), including pharmacists, family medicine physicians, and a patient advocate. The toolkit provides information and resources necessary to screen, diagnose, manage, and treat ADHD in adults. Practices who participate in this project will receive $3,000 in total compensation. If you are interested in learning more about this project, please contact Cory Lutgen, project manager (clutgen@aafp.org), or Natalia Loskutova, project principal investigator (nloskutova@aafp.org).

Improve Your Agenda-setting Process

Agenda setting is an important concept in primary care. Physicians and other clinicians are limited in the amount of time they can spend on patient visits, and patients often have a number of issues to discuss. Clinicians and patients are in need of tactics to manage the time they spend together and maximize the effectiveness of the patient visit. The AAFP NRN, in collaboration with the AAFP Division of Practice Advancement, is developing a new AAFP Transformation in Practice Series (TIPS) resource designed to specifically address agenda setting. AAFP TIPS resources combine interactive learning courses with ready-to-use resources and seek to transform your practice by making practice improvement faster and easier. The AAFP TIPS: Agenda Setting module provides physicians, care teams, and patients with resources designed to help prepare for and prioritize visits. Check back in the fall for more information when the AAFP TIPS: Agenda Setting will be released. If you would like to learn more about testing this resource in your clinic, contact Cory Lutgen (clutgen@aafp.org).

Participate in an Alcohol Screening Project

The AAFP is working with the AAFP NRN to recruit members to participate in an alcohol screening and brief intervention (SBI) quality improvement project. The AAFP is helping practices implement routine alcohol SBI in collaboration with the Centers for Disease Control and Prevention (CDC). Practices will gain insight into their own workflow and receive training, education, and tools to achieve sustainable quality improvement using the AAFP’s Office Champions model. Practices that participate will receive $1,000 per year (for a total of $3,000 each). Each of the 25 family physician champions selected will receive Part IV maintenance of certification credit at the end of the project through the American Board of Family Medicine. Applications are due August 31, 2019, and participation is limited to 25 practices. Apply for the project here.

AAFP NRN News

Talking to Your Patients about Medication Costs

It’s time to talk about cost with your patients. Thirty-five percent of Americans younger than 64 years report not getting needed medical care because of out-of-pocket costs. The AAFP NRN, in collaboration with the University of Rochester, recently published two articles around this topic in the Annals of Internal Medicine and FPM. Materials are free and open access. This project is being developed into a performance improvement (PI) continuing medical education (CME) resource and an AAFP TIPS topic to be released in fall 2019.

Opioid Response Network Provides Assistance with Opioid Use Disorders

In response to the nation’s opioid crisis, the Opioid Response Network (ORN) was created by the American Academy of Addiction Psychiatry (AAAP), along with 27 other national health care organizations, including the AAFP. The ORN provides technical assistance in the prevention, treatment, and recovery from opioid use disorders. Assistance includes local training and free education for specific needs of local communities to address the opioid crisis. When you seek assistance, the ORN identifies individuals with training and experience in your community to help facilitate access to evidence-based resources. Submit a request to receive technical assistance from the ORN.

Two sessions are scheduled at FMX to discuss the program. Plan to attend either session to learn more about the ORN and how they can assist your community. Look for the session on the FMX schedule titled, Collaborative Care: State Tartgeted Response Technical Assistance for Opioids - How it Works and How it Can Help.

Apply for the AAFP NRN Advisory Group

Are you interested in serving in the AAFP NRN Advisory Group? Advisory group members advise the network in matters pertaining to the strategic plan, research agenda, and engagement of new and established members of the AAFP NRN. This group meets 3-4 times annually (once in-person and 2-3 times by conference call). Liaisons, students, and residents/fellows serve one-year terms, and other roles serve a two-year term. All positions may be renewed for one additional term, provided the incumbent is still eligible for the position.

Current open positions: patient member and patient advocate member

Upcoming open positions: student member and resident/fellow member (beginning January 1, 2020)

For more information about the advisory group, see the "Apply to Become an Advisory Group Member" section on the AAFP NRN’s website.

Update Your Information and Receive a Gift

Please help us keep our membership records current. Update your information to receive your choice of a coffee mug, water bottle, blanket, or tool keychain that displays the AAFP NRN logo. We are asking for contact information, information about your practice, demographic information and affiliations, and practice ownership. A member of your practice staff may fill out the survey on your behalf.

When major milestones are reached, it is often important to reflect on where you have been. Throughout this year, we have been highlighting key moments and people in the history of the AAFP NRN that have shaped who we are today. In 20 years, the AAFP NRN has been led by four directors. In this issue, we invited each of the former directors and current director to offer their perspectives of the first 20 years of the AAFP NRN.

John Hickner, MD, FAAFP, former director of the AAFP NRN (2000-2003)

Hickner was serving as the chairman of the board of the Ambulatory Sentinel Practice Network (ASPN) and was an active AAFP member. Along with John Orzano, MD, the two proposed moving the research capacity of ASPN to the AAFP in 1999.

"Through a request at an AAFP board meeting in 1999, we provided an outline to establish the [AAFP] NRN. At the formation of the network, close to 300 members of ASPN joined the [AAFP] NRN. The advantages of participation well documented, including intellectual stimulation, comradery, and contributing to new knowledge. The future of practice-based research networks (PBRNs) was bright. There was interest nationally in creating a learning heath system to increase quality and efficiency, and PBRNs were an integral part of this transformation."

Wilson Pace, MD, FAAFP, former director of the AAFP NRN (2003-2015)

"The network had potential, but it needed more than just a director. It had too many missing pieces, and so we sought to connect it to the regional research network of the Department of Family Medicine at the University of Colorado. That started the process of converting the [AAFP] NRN from a national network outside of an academic center without the necessary resources into becoming a national network where we were able to get into much more aggressive types of research. The affiliation with the AAFP gave us credence with many groups and other family medicine-oriented networks. When I started, we had 400-500 physician members, and we were spread sparsely around the country. When I left, we had about 3,000 members. You need size as a national network."

Pace also commented on some of the challenges the AAFP NRN faced:

"There were several board presidents who understood and supported the [AAFP] NRN, but there were also concerns from AAFP leadership about continuing support of the [AAFP] NRN. There was always a concern about whether this was the right thing to do for a professional society. At the board level, there was a strong recognition that it was good for the AAFP to have a research network that was recognized as one of the premier family medicine practice-based research networks, which takes time. We had to earn those stripes."

"It's critical that we continue to do research. Clearly, we need to be involved in research and we need our patients involved in research. The construct of research, advancing knowledge from different models in a learning health system starts to be an interesting milieu for practice-based research. We always need to look at what we do, how we do it, how our patients respond, and most importantly, make sure we’re doing the right things for the patients at the primary care level."

Jennifer K. Carroll, MD, MPH, current director of the AAFP NRN (2015-present)

"During the past 20 years, we have witnessed amazing growth at the [AAFP] NRN in many ways. Our portfolio of studies reflects a diversity of questions, topics, and methods across the spectrum of family medicine. We are fortunate to have both long-standing, loyal, engaged members, as well as many new members becoming a part of our [AAFP] NRN community. We are also fortunate to have strong relationships with many other practice-based research networks and family medicine research partners across the U.S. Though the future holds many uncertainties and challenges for advancing family medicine research, we are excited about continuing to both lead and support research that addresses the questions of the highest relevance to our specialty."

Joseph LeMaster, MD, MPH, FAAFP, was introduced to the AAFP NRN in 2011 by Kim Kimminau, PhD, who was the research director of the AAFP NRN at the time. The two served as family medicine faculty members together at the University of Kansas.

While his introduction to the AAFP NRN may have began in 2011, LeMaster’s path in research began earlier and a continent away. After earning his medical degree from the University of Kansas in 1985, LeMaster completed his residency at John Peter Smith Hospital (JPS International Health Clinic) and spent two years in emergency medicine. Then, LeMaster and his family moved to Nepal, where they lived and he delivered international medical service for the next ten years.

During his time in Nepal, LeMaster discovered his passion for research:

"After completing a couple of years as a rural program manager in eastern Nepal, I provided epidemiological consultancy to colleagues, including several projects on mountain sickness. One of those consultancies developed into a full-time position as a staff epidemiologist and ‘leprosy physician,’ at Anandaban Leprosy Hospital near Kathmandu, Nepal. I did this for a bit more than a year, and we completed a number of publications on a variety of topics, including risk factors for various immunological reactions in Hansen’s Disease (still called leprosy internationally), as well as new potential skin tests for Hansen’s Disease."

Unfortunately, in 2000, a civil war broke out in Nepal. LeMaster, his wife, and two children were forced to return to the U.S. For LeMaster, this brief exposure to research set the stage for future interests. "When we returned from Nepal, I already had the ‘research bug,’" LeMaster said.

Before he could take the next step, LeMaster knew he needed additional training, so he applied to a training program for primary care researchers in the Department of Family Medicine at the University of Washington (UW), which included the opportunity to complete a Master of Public Health (MPH) degree: "That academic environment, the researchers and colleagues I met [at UW], really launched me into a research career in family medicine." The environment, along with Laura-Mae Baldwin, MD, and Gayle Reiber, PhD, were instrumental to inspire LeMaster to "think through the practical problems of designing a research study" and introduced him to his "first large-funded study."

After completing his MPH and primary care research training program, LeMaster moved on to the University of Missouri-Columbia and later the University of Kansas, where he served as family medicine faculty. While at MU and during his early years at KU, LeMaster honed his craft in writing grant proposals and manuscripts. He credits David Mehr, MD, who "spent countless hours providing feedback on my proposals and manuscripts and challenging me to 'stay focused.'"

LeMaster also recognized Ann Macaulay, MD, for "opening doors into the world of participatory health research and leadership," and Anne Walling, MB ChB, for being "instrumental in helping me discover family medicine as an academic specialty" and for "modeling how to help junior colleagues make a start in their own academic careers."

Today, LeMaster serves as a tenured professor at KU, while dedicating time to practicing inpatient and outpatient medicine with refugees. "My patient panel is mostly Bhutanese-Americans who speak Nepali—my second language." In between, LeMaster teaches medical students and residents, and is a member of the AAFP NRN leadership team. He also serves as an AAFP NRN principal investigator, where he writes and leads AAFP NRN research projects. Currently, LeMaster is leading a PCORI Eugene Washington Engagement Award entitled, Building PCOR Capacity with Newcomer Patients in Practice-based Research Networks. It is focused on developing research capacity among AAFP NRN practices that serve patients with limited English proficiency, his current research focus since returning to Kansas City.

A theme in LeMaster’s story is other people. LeMaster credits his many friends and acquaintances throughout his life as the reason why he is where he is today:

"I can’t say enough about how important finding good mentors has been for me. Now, I’m committed to help incoming medical students, residents, and faculty get excited about providing and improving health care for marginalized patient populations, especially immigrants and refugees. It’s also an aim to mentor young Bhutanese students who are interested in pursuing a career in medicine, in hope that one or more will assume care of my patient panel by the time I retire."

Cheesesteaks, the Liberty Bell, and connecting with your friends at the AAFP NRN—these are a few of the many things you can look forward to when you register to attend the AAFP Family Medicine Experience (FMX) in Philadelphia held September 24-28, 2019. FMX is the AAFP’s largest annual meeting where you can gather with your peers and remember why you fell in love with family medicine.

Find the AAFP NRN in the exhibit hall, and plan to attend our sponsored continuing medical education (CME) opportunities and four expanded learning sessions.  View the entire schedule of FMX sessions here and the expanded learning sessions here.

2019 FMX CME opportunities:

• Practice-based Research Networks: The Laboratories of Family Medicine (one CME credit)
• State Targeted Response Technical Assistance for Opioids - How it Works and How It Can Help You (one CME credit)
• Collaborative Care: Integrating Behavioral Health into Primary Care (one CME credit)
• Dementia and Alzheimer’s Disease (one CME credit for both the course and practice-based learning sessions)
• Medication Assisted Treatment (MAT) Waiver Training, Parts I and II (no CME credit; $50 fee for part I; free for part II)

2019 FMX expanded learning sessions:

• Using a Team-based Approach to Address Patients’ Cost of Medications
• Adult ADHD: Practical Tools and Resources
• Expanding Research to Practice: Evidence-Based Tools from the AAFP for Practice Improvement

You can also find us at a Chat & Chew session.

Projects, Publications, and Proposals 

In collaboration with the University of Rochester, the AAFP NRN recently published articles in the Annals of Family Medicine and FPM about medical costs. A supplement in the Annals of Internal Medicine highlights the work of grantees of the project. Materials are free and open access. The work around this project is being developed into a performance improvement (PI) CME resource and will be released in fall 2019.

Wilson Pace, MD, FAAFP, former director of the AAFP NRN, was one of six authors for the fifth most read article in the Annals of Family Medicine in 2018. The article, Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial, assesses patient and practice outcomes after introducing the Asthma Activities, Persistent, triGGers, Asthma medications, Response to therapy (APGAR) tools in primary care practices.

Carroll JK, Farah S, Fortuna RJ, Lanigan AM, et al. Addressing medication costs during primary care visits: a before-after study of team-based training. Ann Intern Med. 2019;170(9_Supplement):S46-S53.

Fiscella K, Venci J, Sanders M, Lanigan AM, Fortuna RJ. A practical approach to reducing patients’ prescription costs. FPM. 2019;26(3):5-9.

Jennifer K. Carroll, MD, MPH, director of the AAFP NRN, along with Bonnie Jortbert, PhD, and others, submitted an R18 grant proposal to the NIH, titled Integrating Virtual Visits into Medical Nutrition Therapy to Improve Obesity Outcomes in Primary Care. "We would like to thank all individuals and practices that took the time to complete online surveys that assessed members’ interest and capacity for this project," Carroll said. "We would also like to extend our gratitude to the individuals and practices that submitted letters of support."

Natalia Loskutova, MD, PhD, submitted an R01 grant to the NIH, titled TOPiC AWV: Towards Optimizing Primary Care Annual Wellness Visits.