2020 NAPCRG Recap

Conference Spotlights New Research to Benefit Primary Care 

Febuary 4, 2021, 3:24 pm News Staff — The talents of family medicine researchers from across the United States and elsewhere were on full display at the 48th annual meeting of the North American Primary Care Research Group, held virtually late last year.

The COVID-19 pandemic was one of the most widely covered topics at the annual meeting. Of the 701 sessions presented, 162 discussed some aspect of COVID-19 and primary care.

Other topics that were the focus of extensive research included telehealth/telemedicine (88 sessions), social determinants of health (48 sessions), opioids (37 sessions) and hypertension (24 sessions).

The research of three organizations affiliated with the AAFP — the Robert Graham Center, the AAFP National Research Network and HealthLandscape — was featured at the meeting.

Among the AAFP NRN’s 12 presentations, those of particular interest to family physicians included the following.

Barriers and Facilitators to Continuous Glucose Monitoring for Diabetes in Primary Care: This presentation was based on collaborations between the AAFP NRN and the University of Colorado Department of Family Medicine. In this study, researchers surveyed AAFP members to identify primary care clinicians’ experience with continuous glucose monitoring, as well as barriers and facilitators to CGM use in primary care. They found that 38% of respondents have prescribed CGM and that practicing further away from an endocrinologist was associated with higher likelihood of having prescribed CGM. In addition, 72% of respondents reported being likely to prescribe CGM if they had access to either a workshop/education session or a consultation on insurance coverage issues. T project helps inform the need for development of education for primary care physicians that focuses on use of CGM and addresses insurance coverage issues related to CGM prescribing.

Cluster-Randomized Trial of Intervention to Improve Care of Chronic Pain: This study was based on collaborations between the AAFP NRN and the University of Missouri Department of Family and Community Medicine. It tested whether a photo-elicitation intervention designed to improve patient and clinical communication and create a shared understanding of living with chronic pain would improve a three-item pain measure, as well as ratings of self-efficacy and patient-centeredness of the physician-patient interaction. While the study did not demonstrate any statistically substantial effects, the intervention showed promise by helping refocus the pain conversation, creating a clearer understanding of the functional impact of chronic pain, creating a more collaborative visit and strengthening the patient-physician relationship.

Socioeconomic Impact of COVID-19 and Willingness to Be Vaccinated in African American/Black & Hispanic/Latinx Asthmatic Adults: This research was based on collaborations between the AAFP NRN, Brigham and Women’s Hospital, the DARTNet Institute and Harvard Medical School. It examined the socioeconomic impact of the COVID-19 pandemic on African American and Hispanic/Latinx patients in a large asthma trial and their willingness to receive a COVID-19 vaccine in the future. About two-thirds of participants reported hesitancy or unwillingness to receive a free COVID-19 vaccine. The authors stated that future studies are needed to explore associations between socioeconomic stressors and asthma outcomes over time, and to understand COVID-19 vaccine receptivity in this population.

Of the RGC’s nine presentations, those of particular interest to FPs included the following.

Beyond Flexible: The Family Medicine Workforce and Clinical Redeployment During COVID-19: his research focused on the volume of evaluation and management services across six sites of care for a cohort of 78,416 family medicine physicians in Medicare practicing in both urban and rural areas. The research found that family physicians had wider scopes of practice and higher representation in rural (i.e., higher need) areas than other specialties.

Capacity of Primary Care to Deliver Telehealth in the United States: In this session, researchers used data from the 2016 National Ambulatory Medical Care Survey to explore and quantify the telehealth capacity of primary care. Of 850 million total encounters, 394 million encounters occurred in primary care. Nearly half of primary care physicians provided telephone or e-consults to patients. Thirty-five percent of all patient-physician interactions, and 42% of encounters in primary care, were defined as being amenable to telehealth, meaning that the physical presence of the physician was not required to provide a service.

HealthLandscape also delivered three presentations at the meeting.

Comparing Clinical Quality Outcomes for Appalachia and Non-Appalachia Health Centers: This research explored clinical quality measures for health centers within and outside the Appalachian region. The investigators found that health centers in Appalachia perform better than non-Appalachia health centers for most quality measures, including diabetes control and geographic variation of clinical quality within the Appalachian region. Given the disparities in health outcomes for Appalachia compared to non-Appalachia, increasing access to care for health centers could help improve health outcomes in the region.  

Identifying Priority Areas for Improving Access to Maternity Care: This research identified priority rural maternity care deserts based on geographic distance to care, social deprivation and race/ethnicity. The results indicated that specific rural maternity care deserts in the United States face higher barriers to maternity care or are at risk for worse maternal care outcomes. The research makes that case that maternity care interventions should be targeted based on diverse criteria that incorporates geographic access, social deprivation and race/ethnicity.

Place Matters: Improving Population Health in the Era of COVID-19: This session described the importance of geography to population health; gave a practical understanding of the tools, methods and data available to conduct population health research and practice; and considered ways in which care providers can use these resources to inform their practice, with a particular emphasis on COVID-19.

Westfall summarized how the research presented at NAPCRG affects the way FPs and other primary care clinicians practice.

“NAPCRG is the home to primary care research. That’s the research that is most relevant to family doctors, conducted in family practices, and feasible for family practice,“ said Westfall, adding, “The research results are immediately relevant because they came from primary care practice, and were mostly conducted in primary care practice.”

Christina Hester, Ph.D., M.P.H., the NRN’s research director thanked the AAFP members and members of the AAFP NRN who participated in projects, including those who invited researcher into their practices.

“The contributions of the practicing clinicians to these research endeavors ensure that the findings will be relevant for real-world clinical care,” Hester said.

New Opportunities Ahead

Julie Sutter, M.P.A., M.S., C.A.E., NAPCRG’s executive director, told AAFP News that the transformation to a virtual setting created opportunities that could prove beneficial at future meetings.

“Even though the recent conference featured rich research and interactive sessions, we were not able to offer some programs that had traditionally been included in the meeting in the past,” said Sutter. “As a result, we plan to host other programs next year to connect primary care researchers with year-round programming beyond the annual meeting.”

In addition, Westfall encouraged clinicians to participate in the research process and present their findings.

“NAPCRG is a great place to exercise your natural curiosity. You can learn, you can meet people, you can start asking questions that matter to you and your patients, and you can find partners to work with you along the way,” he said.

The next NAPCRG annual meeting is scheduled for Nov. 19-23 at the Quebec City Convention Center in Quebec, Canada — an event Sutter is already looking forward to.

“This has been a year of looking for silver linings, and I am excited about how this community pulled together to connect and engage despite the difficult circumstances,” Sutter said. “This experience has set the stage for a lineup of new or enhanced programs next year to supplement the annual meeting.”