I first worked with Dr. Huffstetler on a research project on Primary HPV testing through the VCU Summer Research Scholarship Program. I learned from my experience working with her the many ways family medicine physicians can make a difference in primary care research. I became very interested in the evolving guidelines around HPV testing and the new method of self-collected testing as a way to potentially eliminate health disparities in HPV screening rates. I decided to research this interest further through a systemic review research project. This research project combines several of my interests within family medicine: preventative health care, maternal health, and decreasing health disparities.
Introduction: The US Preventive Services Task Force (USPSTF) recommends cervical cancer screening through high-risk HPV (hrHPV) testing alone, or in combination with cytology, for women 30-65 years old. Primary hrHPV testing can be conducted using a clinician-collected or patient-collected (“self-sampling”) cervico-vaginal swab. Prior systematic reviews demonstrated the acceptability of self-sampling, but less is known regarding the concordance between patient and clinician sampling. This study aims to conduct a systematic review of the concordance and kappa between clinician-collected and patient-collected samples in hrHPV testing. Methods: PubMed, Embase and Cochrane were queried for relevant studies assessing concordance. English-language studies of hrHPV screening for cervical cancer in patients of average risk were included. Studies must have reported detection rate, concordance, and kappa. Results: A total of 1994 eligible studies were identified. Of those, 33 articles were included. Participant ages ranged from 15 to >60 years old. There were studies included from 17 different countries. The rate of HPV detection varied from 4.7% to 63% in patient-collected samples and 3.7% to 62% in physician-collected sampling. The average concordance was 89.29% (range 76.4%-96.2%). The average kappa was 0.65 (range 0.37-0.77). Discussion: Self-sampling primary hrHPV is an accurate, reliable test for identifying HPV positivity. Self-sampling is low cost, less invasive for patients, and offers the possibility of home testing which could reduce barriers for individuals and improving equitable testing. The results of this systematic review will provide insight into the accuracy of self-testing, as well as inform HPV screening guidelines on incorporating self-testing in the future.
Interested in learning more about the field of addiction medicine and how it intersects with family medicine, I completed a summer research project with principal investigator, Jacqueline Britz, on her existing project examining opioid mortality in Virginia. I was particularly interested in the qualitative aspects of the project and how it prioritizes community engagement throughout the research process. My time with the team and the department gave me valuable insight not only into addiction medicine, like I’d hoped, but also the unique role that family medicine providers play in combating the opioid epidemic.
The opioid epidemic continues unabated nationally and in Virginia, with over 2,000 opioid overdose deaths statewide in 2021. In fact, fatal drug overdose is the leading cause of unnatural death in Virginia, with opioids comprising approximately 80% of fatal overdoses. While most existing research focuses on individual risk factors and areas with poor opioid-related outcomes, the Bright Spot project uses a strengths-based approach that identifies communities where opioid mortality is actually less than expected. Over the past year, the VCU Department of Family Medicine and Population Health, funded by a Department of Medical Assistance Services (DMAS) Support Act Grant, identified 50 Bright Spot communities across Virginia where opioid mortality was substantially less than would be expected based on community-level risk factors. The next aim is do qualitative interviews with key stakeholders in select Bright Spot communities to inform what is going right in these communities and what interventions might be useful to implement elsewhere. This specific project’s aim was to begin planning these qualitative interviews. As part of initial planning, researchers held informal conversations with a multidisciplinary set of experts in the field. These conversations illuminated some basic themes that will guide the formal interviews scheduled for later this year. Takeaways included the importance of 1) community buy-in, and not just availability, of MAT (Medication-Assisted Treatment), 2) prioritizing integrative care models, and 3) peer-led programming. This project will play an important role in informing qualitative interviews to identify community-level interventions that combat opioid-related mortality in Virginia.
Preventive health is an integral part of Family Medicine training and primary care clinics. The National Colorectal Cancer Roundtable and the American Cancer Society (ACS) have set a goal of 80% CRC screening completion in every community. Primary care settings are a key player in Colorectal Cancer (CRC) screening, especially academic safety net health systems where underscreened populations are highly represented. The COVID-19 pandemic reduced the screening rates of various cancers, including CRC. Therefore, it is important, now more than ever, to learn about how to incorporate evidence-based interventions in clinical practice to help improve CRC screening rates and reach the national goal. Additionally, quality improvement and preventative health are two of my major passions in Family Medicine, and pursuing this quality improvement project was a great opportunity to develop my skills in practice transformation and help improve CRC screening rates at my clinic.
Colorectal Cancer (CRC) is the third leading cause of cancer death in the United States. Though CRC is often preventable through screening, CRC screening rates remain below national goals with disparities along lines of race, socioeconomic status, and rurality. Family Medicine providers are well positioned to increase CRC screening rates, especially at academic safety net health systems where underscreened populations are highly represented. Stool-based tests are being utilized more to improve screening rates given their low cost, noninvasive nature, and efficacy. The purpose of this study is to increase CRC screening rates at the University of Virginia Family Medicine (UVA FM) clinic through the implementation of evidence-based initiatives aimed to increase stool-based testing. The first intervention, implemented in February 2022, consisted of process mapping, provider education about CRC screening modalities, and the use of CRC screening “Conversation cards”. This intervention has increased the CRC screening rate from 58% to 64% among patients aged 50-75 years who were seen in the clinic. Additionally, the average number of stool-based tests ordered per month has increased from 24 tests to 31 tests. The current average monthly return rate for fecal immunochemical test (FIT) is 46.5% compared to 65% for Cologuard. Therefore, the next intervention will focus on patient outreach for patients who have a FIT ordered but not completed.
This research project was done when we were leaders of the Refugee and Immigrant Medical Association at our medical school. We aspired to pursue this project because Roanoke is a federally recognized region for the refugee populations and we wanted to discern how we could further improve the health and livelihood of the immigrant and refugee communities locally. More specifically, we wanted more information on COVID-19 vaccine accessibility and attitudes because racial minorities are disproportionately affected by COVID-19.
Background -Racial minorities have been disproportionately affected by COVID-19. After the COVID-19 vaccine release, the devastating effects of COVID-19 have decreased exponentially. Recent studies have demonstrated that strong vaccination outreach programs have significantly assisted in narrowing the vaccination gap between minorities and nonminority groups. While general trends in COVID-19 vaccination among minorities have been documented, this study explores the trends locally. Methods A 14-question anonymous survey was administered to 69 individuals attending community events. Information regarding vaccination rates and knowledge as well as de-identified demographics were obtained. Results – Of the participants, 73.9% identified as members of racial minority groups; 70.8% identified as Latinx, and 7.24% identified as Black. Among the minorities, 11.8% reported not knowing where to get the COVID-19 vaccine, however, all respondents in this group reported that they would get the vaccine if it was available to them. Nevertheless, 13.7% of the respondents have concerns about possible side effects of the vaccines. Conclusion/Discussion – Our data illustrates that the main minority groups, Latinx and Black communities, were less hesitant to immunization. This demonstrates successful minority vaccination outreach, however, there still exists a gap in knowledge and vaccine accessibility in our community. Furthermore, there may be some hesitations to receiving vaccines due to concerns over side effects. We hope this data will enable the formation of language-specific vaccine educational programs and robust partnerships with underserved communities to assist in providing COVID-19 vaccine access, strengthen minority health outcomes and further protect our local communities as it continues to combat COVID-19.
I used to volunteer as a summer camp counselor for foster youth, and I became deeply invested in the dynamics of foster care and addressing unmet needs that I could fulfill as their counselor. Through this experience, I also learned about the constant instability these children faced and many of my campers confided in me about their desire for consistency and autonomy in a life riddled with unpredictability. As I entered medical school and found a calling in pediatrics, I wondered how the healthcare system could serve as a source of security for these children – a place that listened to their needs, addressed them appropriately, empowered them to understand and have control over their bodies, and always remained available whenever they needed. I connected with Dr. Foster and the Foster Care Clinic with the hopes of understanding these children’s unique needs, the current deficits in healthcare delivery, and how to transform the clinic into a steady, comforting source for children unfairly surrounded by chaos.
Introduction: Virginia has over 5000 foster care children who deserve comprehensive, effective healthcare. To improve health outcomes, we intend for ≥75% of newly admitted children to undergo a thorough evaluation by the Foster Care Clinic within 72 hours, improving their medical literacy and providing connections to necessary resources. Methods: A 72-hour pipeline from foster care entrance to VCU Foster Care Clinic visit will be created through legislative advocacy. Visits will include developmental, mental health, educational, and dental evaluations, supplemented by social support programs. Efficacy will be evaluated by comparing numbers of children entering foster care with clinic patients; average time between system entrance and clinic visit; number of interventions/referrals generated; and a survey of foster youth and guardians’ knowledge of medical needs and resources before and after visiting. Results: We recruited medical students through the Richmond Child Safety Collaborative. A scheduling error was identified and corrected, increasing efficiency of Henrico County admits into the clinic. An advocacy proposal was created for the Child Protective Services Director to advance legislative reform. A survey has been developed to evaluate patients and guardians’ understanding of their medical conditions and available resources. Finally, a partnership has started with Hilliard House to address housing and resource insecurity. Conclusion: We can create a more efficient system that responds to foster youth’s distinctive health needs. Family physicians and primary care providers are uniquely positioned to fill this gap by providing longitudinal care that addresses the needs identified by the Foster Care Clinic.
During night call, a patient kept spiking fevers despite broad spectrum antibiotics and previous drawn blood cultures. I became interested in reviewing available data on ordering repeat blood cultures and comparing it to the practice on our inpatient service.
Common practice of “culture if spikes” leads to frequent ordering of blood cultures despite low diagnostic yield and complications, including patient discomfort, increased antibiotic use and longer hospital stays due to contaminants. In review of literature, there is no evidence for repeat blood cultures in uncomplicated GNR bacteremia unless patient has new episode of sepsis, persistent fever or leukocytosis 72 hours after start of antibiotics. Complicated bacteremia includes patients with febrile neutropenia, MDR organism, ESRD on HD, endovascular infection, known source or unresolved focus of infection. I reviewed the guidelines and provided a guide for our inpatient service in ordering repeat blood cultures in all patients with GNR bacteremia. I analyzed the rate of ordering repeat blood cultures before and after my intervention. Prior to intervention, cultures were repeated 14 out of 16 times. After the intervention, cultures were repeated 3 out of 6 times for appropriate indications (ESBL, febrile neutropenia and new episode of sepsis). In conclusion, this study was 100% effective in eliminating inappropriate recultureing and demonstrated improvement in patient care.