4th Quarter 2024

Welcome to the last FCM Research Group Newsletter for 2024! We've had a productive second half to the year, complete with publications and international travels. Thank you for visiting our page and we're excited to share our work with you.

Click here for our 2024 year in review.

NAPCRG Conference - Québec City, Canada

FCMRG took planes, trains, and automobiles to safely travel to Québec City, Canada for the annual North American Primary Group (NAPCRG) Conference. We had ten abstracts accepted to the conference, which included work from all of the students formally working with FCMRG, one Carilion physician (PI), our research coordinator, and our fearless leaders themselves: Drs. Epling and Rockwell. The conference opened on Thursday with an inspirational plenary given by Iona Heath, CBE, FRCGP who illustrated a poetic metaphor between the work Bread and Roses and the essence of primary care. She eloquently spoke of how those working in primary care experience both the "bread" (what we need) and "roses" (moments that spark joy). That afternoon we supported Michelle Rockwell, PhD, RD, for her oral presentation, An Evaluation of Patient Outcomes Associated with Sludge (Administrative Burdens) in Cancer Screening. Despite her travel delays resulting in a midnight arrival one day late, subsequent 2am Uber ride the morning of her presentation, and her water heater masquerading as a battery-drained fire alarm all night, she gave a spot-on presentation resulting in wonderful audience engagement. Congrats Dr. Rockwell! Later, Emily Cox, MS, MPH, RD, FCMRG Research Coordinator, presented her work, Patient Perceptions of a Lifestyle Medicine Clinic in Southwest Virginia, in the Distinguished Trainee Session; as her abstract was selected as top ten in the trainee category. Thursday's sessions concluded and everyone retired to their hotels for the evening.

All FCMRG's NAPCRG attendees (left to right, clockwise): Nancy Wu, Matthew Vinson, Dr. Michelle Rockwell, Isaiah Yim, Grace Yim, Emily Cox, Brianna Chang, Dr. Cynthia Morrow, Dr. John Epling, Dr. Elizabeth Polk

Nancy, Brianna, Dr. Rockwell, Matthew, and Dr. Epling pose in front of Matthew's poster

Dr. Rockwell presents findings about Sludge (administrative burden) in colorectal cancer screening

Emily Cox, FCM Research Coordinator, stands with her slide for the Distinguished Trainee session

Emily, Dr. Epling, Dr. Polk, Isaiah, Matthew, and Nancy smile before a presentation session

The rest of the conference included the organized chaos of eight individual poster presentations from FCMRG, attendance to a wide variety of oral presentations, and several more keynote speakers. All of our poster presentations are highlighted below. We had Friday afternoon off to explore Québec -- despite the balmy 35°F weather with ~25-30mph winds. We wandered through German-style Christmas markets and cobblestone streets illuminated by holiday lights, listened to live music, and savored French cuisine. On Saturday evening, Dr. Epling treated FCMRG to dinner in Old City before we all parted ways.. well sort of. We met (with merriment) at 4am the following morning to begin our travels home. All in all, NAPCRG offered a comprehensive learning and networking experience with the added bonus of the opportunity to appreciate Québec.

Accepted Abstracts

Completed Research

Dr. Rockwell: An Evaluation of Patient Outcomes Associated with Sludge (Administrative Burdens) in Cancer Screening (oral presentation)

Dr. Epling: Educational intervention utilizing population health managers to reduce COPD-related healthcare utilization (poster)

Cox (Research Coordinator): Patient Perceptions of a Lifestyle Medicine Clinic in Southwest Virginia (oral presentation, poster)

Wu (M4): Implementation Evaluation of a Community Health Worker Program for Patients with Type 2 Diabetes or Hypertension (poster)

Vinson (M4): A brief theory driven patient education video to reduce potentially harmful regular over-the-counter NSAID use (poster)

Chang (M3): Interactions of Multiple Chronic Conditions and Sludge on Treatment Burden and Delayed/Skipped Colorectal Cancer Screenings (poster)

Turner (TBMH): Low-Value Opioid Prescribing Trends for Acute Low-Back Pain in Rural Virginia Between 2019-2021 (accepted abstract)

Click here to access the Annals of Family Medicine and see our published abstracts.

Research In Progress

Dr. Rockwell: A Practice-Based Intervention to De-implement Potentially Harmful Nonsteroidal Anti-Inflammatory Drugs in Primary Care (poster)

Dr. Polk (FCM Residency Faculty): Enhancing and Evaluating a Lifestyle Medicine Clinic in Southwest Virginia (poster)

Yim (M3): Evaluating the Consequences of Switching from Long-Term Opioids to Long-Term NSAIDs in Patients with Chronic Kidney Disease (poster)

New Publications

FCMRG had an impressive five papers and seven abstracts published in the second half of 2024!

One paper was a commentary by Michelle Rockwell, PhD, RD and Mark Fendrick, MD on reducing low-value care as a feasible approach to enhancing access to high-value care for older Americans. Elizabeth Polk, MD, FAAFP, one of our physician collaborators and PI for the Lifestyle Medicine project had an original article published in The American Journal of Lifestyle Medicine.

For folks interested, each photo links to the journal to read our work. Navigate to the NAPCRG section of this newsletter for links to the abstracts.

The publication, Patients' experiences with 'sludge' (administrative burden) in the cancer screening process and its relationship with screening completion, experience health system distrust, captured the attention of the Agency for Healthcare Research and Quality (AHRQ) and made the headlines of the July 2024 issue of AHRQ News Now!. Cass Sunstein, JD, former Administrator of the Office of Information and Regulatory Affairs under President Obama, American legal scholar with expertise in behavioral economics, and author of Sludge: What Stops us from Getting Things Done and What to Do about Dt, even gave the research team a shout out on X.

Ongoing Projects

CKD and medications

Dr. Rockwell is leading a number of research projects related to the utilization of potentially harmful prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with high-risk conditions, such as chronic kidney disease (CKD). She is collaborating with Carilion’s HART team, Dr. Epling, Isaiah Yim, Matthew Vinson, and several others to analyze racial variation in NSAID prescribing in CKD patients and conducting pilot work for a practice-based de-implementation trial.

Take a deep breath..

Most of our health services research projects do not involve clinical trials. One exception is Drs. Dulaney and Epling’s randomized clinical trial focused on evaluating the impact of diaphragmatic breathing on in-clinic repeat blood pressure measurements. We are about one third of the way to our target enrollment of 134 patients. Thanks to Gabby Peregrino, Emily Cox, Andy Chitwood, and the staff at the clinics for their efforts on this project.

We can't wait for 2025!

Our patient-focused ‘sludge’ research uncovered multiple consequences of administrative burden in the colorectal cancer screening pathway. Waiting - especially passive waiting for tests to be scheduled or occur – is particularly problematic for patients. Specifically, longer wait times are associated with poorer experience, health system distrust, and increased likelihood of forgone screenings. We have been planning research and writing grant proposals focused on minimizing the negative consequences of waiting. More to come in 2025 – hopefully you can stand the wait!

New Students

FCMRG attended the Research Live! fair at VTCSOM to help students find their research mentors and vice versa. Through connections made at the event, we are excited for Camille Mittendorf and Kate Watson to be joining FCMRG in Spring of 2024. Welcome Camille and Kate! We also had the privilege of working with Andy Chitwood, a Translational Biology, Medicine, & Health (TBMH) student who completed one of his research rotations with our group.

Camille Mittendorf (VTCSOM, M1)

Before joining VTCSOM, Camille lived in Utah doing nutrition clinical research at Utah State University, where she worked as a lab manager and phlebotomist. Cami is passionate about integrative health, food is medicine principles, and how we can use these tools to address chronic and autoimmune disease and complement other treatment approaches.

Kate Watkins (VTCSOM, M1)

Kate moved from California with a background in healthcare consulting as well as health services research in Stanford Medicine’s Health Leadership, Innovation, and Organizations (HELIO) labs. Kate is interested in research around quality and value in healthcare as well as that which contributes to the improvement of healthcare delivery and population health.

Andy Chitwood (TBMH)

Andy Chitwood spent eight weeks with FCMRG, working closely on two projects, Examining the Impact of Diaphragmatic Breathing in Lowering Blood Pressure Re-measurement: A Pilot Study (DDB), and an internal quality improvement project centered around medical and clinical staff's experience with sludge. Andy helped with data collection in primary care offices and began writing the manuscripts for DDB. He also took the lead in qualitative analysis on the sludge project. We are wishing Andy the best as he continues through the TBMH program.

Newsworthy Happenings

Congratulations, Dr. Epling!

We'd like to take a moment to recognize and congratulate Dr. Epling, as he has changed his Carilion Clinic-focused duties recently. Carilion has created a new position of Medical Director for Ambulatory Quality and Population Health that brings together work on the Clinic's Ambulatory Quality Committee, ACAPS and work as the physician leader of Carilion Clinic's Accountable Care Organization, Doctors Connected. Dr. Epling previously served for seven years as Medical Director of Employee Health and Wellness. His leadership in Research in the Department of Family & Community Medicine will remain unchanged.

Guest Lecturers

Drs. Epling and Rockwell were guest lecturers for Virginia Tech's Human Nutrition, Foods, and Exercise (HNFE) course on Translational Sciences (HNFE 5204).

Dr. Krist Visits VTCSOM

In October, Dr. Krist, a collaborator with FCMRG, professor and director at VCU, and family medicine physician, visited VTCSOM for the Timothy A. Johnson Medical Scholar Lecture Series.

Etc.

Lakes and Pickles and Sludge.. oh my!

Lake Day 2024

Dr. Epling and his family graciously hosted FCMRG for Lake Day 2024. Everyone enjoyed a cook-out style meal, took a ride on the boat, and spent time on the lake. Barry Rockwell even learned to paddle board! Thank you to Dr. Epling for hosting the group.

Thank you for taking the time to read our newsletter! Wishing you and your friends and family a happy and healthy holidays.

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