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PBRN Resource CenterPractice-Based Research Networks

Sandra Burge,

Director

What is a PBRN? A group of practices devoted patient care

Affiliated with researchers and with each other

With the purpose of expanding the science base of clinical work in real-world practice.

With a sustained partnership over time, transcending a single study.

Providing a venue for studying broad populations of patients and clinicians in community-based settings.

Resource Center for PBRNs a “division” of the Institute for the

Integration of Medicine and Science. supported by a CTSA grant since 2008. our mission is to: promote academic-

clinician partnerships in order to conduct research of relevance for community clinicians.

Resource Center for PBRNs Our Staff

Sandra Burge, Director Elisabeth DeLaRosa, CE Coordinator Monica Castillo, Network Coordinator Jennifer Daniels, Network Coordinator

Active PBRNs South Texas Psychiatry Research Network South Texas Oral Health Network (STOHN) Improvement Science Research Network

(ISRN) Residency Research Network of Texas

(RRNET) South Texas Ambulatory Research

Network (STARNet)

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Cervando Martinez, DirectorThomas Oates, Co-DirectorRahma Mungia, Co-Director

Introducing… Melissa Deuter, MD

South Texas Psychiatry PBRN

Melanie Taverna, MS, RDH South Texas Oral Health Network (STOHN)

South Texas Psychiatric PBRN

Successes and Challenges of Conducting Health Research

Who is the South Texas Psychiatric PBRN

• The South Texas Psychiatric PBRN is an organization of community clinicians who collaborate together with UTHSCSA researchers to answer meaningful questions that will improve practice and patient care.

• Network is composed of 72 individual Psychiatrist in and around South Texas.

• PBRNs have been recognized as excellent tools for conducting a variety of research activities in primary care.

Successes

• Current research project (in the final steps of data collection):

• SSRIs and Alcohol Risk

• Completed research projects:

• Examining Negative Reactions: A Feasibility Study

• Examination of the Doctor-Patient Relationship

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Successes - Cont.

• Publications

• The South Texas Psychiatric Practice – Based Research Network

Published in San Antonio Medicine.com - www.samemedicine.com

• How not to be a difficult patient

Published in Thought Broadcast – www.thoughtbroadcast.com

A Psychiatrist’s Thoughts – Straight To Your Head & HCPlive.com

Challenges

• Clinician participation

• Choosing a project from many ideas

• Plan translating into streamlined procedure

How the latest project came to life…

• The purpose of this pilot project is to address a real world problem encountered by many psychiatrists, patients withholding topics of concern till the last minute of a psychiatric appointment.

• This issue was identified by fellow psychiatrists at one of our quarterly Psychiatry PBRN meetings.

• Through discourse it was decided that, with the assistance of an implemented tablet-based agenda setting tool, we would develop a method for patients to outline the agenda of each visit prior to the start of their session.

Project Overview

• This study is being conducted by the Psychiatric PBRN in collaboration with EvaluTrac LLC to develop and test Session Conversation Starter tablet-based agenda setting tool (SCS TBAST) in the clinical setting.

• The SCS TBAST will allow the patient to flag important issues or concerns prior to the start of their session.

• This project aims to integrate technology into the clinical setting by administering an agenda setting tool to assist the psychiatrist and patient in the course of their treatment plan.

Real World Significance

• AGENDA SETTING:

1. The Affordable Care Act has encouraged providers to involve patients as proactive participants in maintaining their own good health, by effectively managing their chronic disease and engaging in shared decision making with their physicians.

2. Patient activation requires the patient to be involved in the decision making process of their own treatment and insists that the patient has the knowledge, skills, and confidence needed to manage one's own health.

IIMS CE GRANT AWARD

• Title: Pilot Study to Develop & Evaluate the South Texas Psychiatric PBRN’s Session Conversation Starter Tablet-Based Agenda Setting Tool (SCS TBAST) to Enhance Psychiatric Follow-up visits.

• TECHNOLOGY USED IN CLINICAL PRACTICE:

1. The use of electronic devices to assist in clinical management of medically ill patients has gained widespread interest and use (Heron & Smyth, 2010; Forchuk, Donelle, Ethridge & Warner, 2015).

2. Electronic devices such as smartphones/tablets and wearable programmable devices have been developed to monitor a variety of patient physiological and psychological variables of clinical usefulness, but typically their use has been restricted to primary care settings

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Methods

• The project will distribute 5 tablets in two month waves to 5 PBRN member practices (N=10 Psychiatrists).

• Psychiatrists will be expected to use the device for 2 months with all consecutive follow-up patients that volunteer to participate in the project.

• Estimated Patient enrollment for each psychiatrist is 20+ patients.

Methods - Cont.

• Three surveys will be administered to evaluate the effectiveness and overall satisfaction of the patient-doctor interface:

1. Pre-Patient Questionnaire - To be filled out before using the SCS TBAST

2. Post-Patient Questionnaire - To be filled out after using the SCS TBAST

3. Psychiatrist Questionnaire - To be filled at the end of the follow-up visit

Expected Findings

• We anticipate that this project will

• Promote a simplified collaborative decision-making between psychiatrist and their patients by using the tablet to help set the agenda for clinician visits

• Create a more efficient follow-up visit resulting in a decline of patient-withheld concerns

• Improve satisfaction for both patient and psychiatrist

• Improve patient outcomes overall

Conclusion - Next Steps

• We are currently in the process of recruiting more psychiatrists for the project.

• May 2016 is our expected start date.

• We expect to use the SCS TBAST with over two hundred patients within the following year.

• The South Texas Psychiatric PBRN members participating in this project will provide exit interviews with their views and suggestions for improving technology like this in the clinical setting for future purposes.

• We hope to be able to distribute this product to other psychiatrists who may need assistance in developing physician-patient collaborative decision-making.

A knowledge explosion

(c)1995 The Cochrane Collaboration. Reprinted with permission

Dental Practice Based Research Networks

http://nationaldentalpbrn.org/https://iims.uthscsa.edu/STOHN/home

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• a group of dental practices  • joined together to investigate research questions • engage in sharing experiences and expertise. 

What is a Dental (PBRN)?

Designed to gather real world evidence for the prevention and treatment of oral diseases.

• relevant to clinical practice

• by practitioners

• In offices within typical clinic flow

Laboratory Clinical trials        Practice‐based           

research                in academic settings                            research

How is PBRN research different from other types of research?

2008‐60 dentists and hygienists>11,000 patients per year6 completed studiespublications

Who is STOHN http://iims.uthscsa.edu/stohn/home

• 7 years (2012‐2019) • $66.8 million

6000 practioners/nationwide

Clinical observational studies

Survey Research

The National Dental PBRN  

the nation’s network

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Success & ChallengesCollaboration is Key

Identify knowledge gap

Systematic search for adequate

answer

Generate and clarify study

question

Design StudyCollect data

Analyze and interpret results

Implement in practice

Practitioners

• “If we want more evidence‐based practice, we need more practice‐based evidence.” 

• Lawrence W. Green, Dr.PH

References

Quality improvement: science and action. Circulation 2009; 119: 1962‐1974.

How can primary care cross the quality chasm? Annals FamMed 2009; 7(2): 164‐169.

Moving things forward with PBRNs

• Behavioral (behavior change)• New Knowledge Acquisition/Novel Nicotine Products

• Oral Cancer Exam • Antibiotic Prophylaxis• Provider Intervention Study: Reducing Opioid Misuse

• BONJ 

• Diagnostic (knowledge and awareness)

• Pilot: HPV Detection/ Oral Cancer• Suspicious Occlusal Caries

• Therapeutic (knowledge and action)• Cracked Tooth Registry

• Management of Dentinal Hypersensitivity

• Factors for Successful Coverage Crowns

• Smoking Cessation

• Use of Dental Sealants

• Management with Anticoagulant Therapy

Successes of PBRN Studies

Quick Polls/Surveys

Quick Polls‐quick and easy contact with practitioners‐open to all membership‐knowledge and awareness‐provides baseline data for future studies‐provides immediate engagement‐fast turn around of results

Surveys‐more involved with images and case studies

QP: Xerostomia

Top priority by practioners at the annual sessions327 responses with 62 narrative comments

• 70% not satisfied with ability to manage

• “difficult disorder to treat.”

• “not a satisfactory fix”

• “Very vexing problem”

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Xerostomia

Hypothesis:

1) Xerostomia is a common and frequently unrecognized problem in South Texas 

2) Levels of awareness by both practitioners and patients represent major determinants toward recognition and management of xerostomia. 

Submitted for CE Grant Award

What is MOST importantIn a dental practice based research network?