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Practice Based Research Networks (PBRNs)

Practice Based Research Networks (PBRNs). PBRNs are networks of health care professionals dedicated to do systematic inquiries to better understand health care phenomena in the clinical setting. PBRNs.

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Practice Based Research Networks (PBRNs)

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  1. Practice Based Research Networks (PBRNs) PBRNs are networks of health care professionals dedicated to do systematic inquiries to better understand health care phenomena in the clinical setting

  2. PBRNs • There are over 100 regional and national Primary Care networks in addition to those developed in Pediatrics, Nursing, Dental and Mental Health care. Within the VA system, we are aware of a Dental PBRN, a recently formed Women's Health PBRN and a Primary Care PBRN in South Texas.

  3. PBRN-VA MENTAL HEALTH • The Practice-Based Research Network at the VA (PBRN-VA) Mental Health is a network of clinicians in the South Texas Veterans Health Care System (STVHCS) dedicated to improving mental health care through multidisciplinary practice- based research.

  4. VA Mental Health PBRN Members Dr. Craig Dike (FTOPC) Drs. Stephen Stern, Albana Dassori, Matthew Jeffries, Hector Garcia, Phillip Lai, Dianne Dunn, Jeffrey Cordes, Uma Kasinalth (FTOPC) Dr. Homero Sanchez (Laredo) Dr. Jennifer Wood (Corpus, McAllen, Harlingen)

  5. PBRN-VA MENTAL HEALTH Specific goals for the PBRN-VA are: • 1) to develop ideas for research projects that are relevant to the clinicians and veterans; • 2) provide rapid feedback to clinicians about questions, methods and results; • 3) serve as "a community of learning" to draw upon the experience and expertise of mental health providers to improve the care of the veterans.

  6. PBRN- MENTAL HEALTH VA • How did we start? The PBRN-VA stems from a collaboration of STVHCS mental health providers with an existing psychiatric PBRN at the affiliated University of Texas Health Science Center at San Antonio (UTHSCSA).

  7. PBRN- VA MENTAL HEALTH • An introductory flyer about the PBRN-VA initiative was sent to all local clinicians at the Mental Health Outpatient Services (MHOS) and the PTSD Clinical Team. This flyer described the PBRN concept, types of questions that could be addressed, benefits of participation and clinical applications. • Initiative information disseminated among clinicians in formal meetings as well as informal encounters.

  8. PBRN-VA MENTAL HEALTH • Over initial sessions: • Discussed principles of the initiative. • Introduce examples of other PBRNs. • Brainstorm about potential members. • Strategize meetings. • Develop mission statement.

  9. ORGANIZATIONAL CHART

  10. PBRN-VA MENTAL HEALTH • As network consolidated: • Discussed areas of common interests. • Identified potential pilot studies. • Voted on ranking of studies. • Selected the pilot study with most votes as initial testing grounds for the network.

  11. PBRN-VA MENTAL HEALTH • Steering committee selected addressing the issue of No-Shows first, focusing on both the providers' and the patients' perspectives. These pilot projects were designed in part to assess feasibility and willingness to participate in surveys among clinic staff and patients.

  12. PBRN-VA MENTAL HEALTH • For the providers' perspective a small card containing questions about primary diagnosis, extent of concern for No-Show for future appointments and primary reasons for that belief were distributed. • For the patients' perspective, a brief survey on potential barriers for attending future appointments and beliefs about attendance to therapy was designed.

  13. 1st Study Instrument

  14. The VA PBRN’s FIRST Study • 19 Mental Health Workers from the MHOS and PCT clinics collected 267 study cards during their 2 week collection periods (March, 2010).

  15. 1st Card Study RESULTS • The top diagnoses were PTSD, Depression, Schizophrenia and Bipolar Disorder with PTSD and Depression eliciting the most concern. • Levels of Concern • 8% Very concerned • 15% Somewhat Concerned • 8 % Neutral • 23% Somewhat Unconcerned • 44% Not Concerned at all • Top reasons for concern were that patient’s poor insight into their illness and their history of No-shows. • Top reasons they were unconcerned were the patient’s good therapeutic alliance and that they were strongly motivated to stay in treatment.

  16. Patient Survey-2nd Study

  17. VA Mental Health Clinics that participated in Patient Survey Study

  18. Barriers to access to Mental Health Care StudyBasic demographic Results Age (n=598) Mean (SD) 52 (14) Gender (n=592) Male 88% Female 12% Ethnicity (n=569) non-Hispanic 37% White Hispanic White 53% African American 5% Other 5%

  19. Basic demographics • Latest period of service reported, n (%) • N=575 World War II 7 (1%) Korean 7 (1%) Korean/Vietnam Wars 17 (3%) Vietnam 287 (50%) Post-Vietnam War 52 (9%) Persian Gulf War 92 (16%) OEF 56 (10%) OIF 57 (10%)

  20. Questionnaire Response Summary • I do not have reliable transportation • N=572 • Strongly Disagree or Disagree 74% • I do not receive a reminder • N=581 • Strongly Disagree or Disagree 63%

  21. Questionnaire Response Summary • Appointment time conflicts with my work. • N=555 • Strongly Disagree or Disagree 70% • I do not have childcare for appointments • N=546 • Strongly Disagree or Disagree 75% • There are no appointments after hours. • N=552 • Strongly Disagree or Disagree 47%

  22. Questionnaire Response Summary • There are no appointments on weekends • N=557 • Strongly Disagree or Disagree 43% •  I can not afford to come. • N=550  • Strongly Disagree or Disagree 73%

  23. Questionnaire Response Summary • I do not like to talk in groups • N= 572 •  Agree or Strongly Agree 49%

  24. Top Research Priorities: 1. Predictors of Treatment compliance (7 votes) Predictors of Treatment, Therapy and Medicine compliance, participation and dropout rate. 2. Patient factors that predict treatment outcome. (5 votes) Matching patients to certain therapies. What factors predict outcomes/response (i.e. success or dropout?) 3. Dropouts at transition periods. (4 votes) Where are most patients dropping out? At which transition points?

  25. Top Research Priorities: 4. Prescriber patterns for different illnesses. (3 votes) Medicine prescription comparison between PTSD and MHOS clinic (i.e. Prazosin) 5. Metabolic Syndrome-factors influencing monitoring. (3 votes) Metabolic Syndrome: exploring weight trajectory, monitoring at physician level and system level as well as with patients with PTSD at various levels of severity.

  26. What are the next steps? • Increase membership. • Complete short membership profile. • Complete the human subjects protection training to be a part of the next project. • Refine research questions. • Look for sources of funding. • Grant writing using pilot data.

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