Primary Care Research Institute

Larry Gabel, PhD, Director

In September 2000, faculty from the Department of Family Medicine, the Division of General Internal Medicine, the Division of Ambulatory Pediatrics and other academic disciplines at Ohio State established the Ohio State Primary Care Research Institute (PCRI). Funded initially by the Health Resources and Services Administration of the U.S. Department of Health and Human Services, the PCRI completed its second three-year period of infrastructure funding during 2006. Continuing on a self-sustaining basis, the PCRI fosters, facilitates and reports collaborative interdisciplinary research to optimize health. It aims to be recognized as a center of excellence for the quality, quantity and impact of its research on the professional literature, the development of public policy and health outcomes.

Ongoing Research Programs

The PCRI’s collective laboratory is the 24-site Ohio State Primary Care Practice-Based Research Network (OSUPC-PBRN), which covers all of Franklin County and serves some 107,000 patients annually. The OSUPC-PBRN consists of 10 clinical practice sites of the Ohio State Primary Care Network, nine Close-to-Home Health Centers of Children’s Hospital and five practices of the Columbus Neighborhood Health Center, Inc. With 107 primary care physicians, these 24 practices serve a diverse patient population and provide care through nearly 308,000 patient visits a year.

Research Accomplishments of 2006

Douglas Post, PhD, is principal investigator for a clinical trial on Efficacy of Web-Based Training in Skin Cancer. Melanoma is a major health problem that affects more than 50,000 Americans each year and continues to increase in incidence, unlike most cancers. Although it is almost always visible on the skin and almost always curable when caught at an early stage, many still die from this disease. Primary care physicians commonly fail to look at key areas of the skin during examinations and hence miss opportunities to save lives. There is evidence that teaching basic skills related to skin cancer may improve physician examination and counseling. This project is testing efficacy of the Skin Continuing Education Course (compared to a course on weight control) via a randomized trial in a sample of primary care physicians. Methods include first developing a Basic Skin Cancer Triage (BSCT) curriculum for the Webbased skin course and then developing a comparable Web-based course on obesity/overweight assessment and counseling as a comparison intervention. Physicians will be randomly allocated to one of the two courses. The primary endpoint will be physician performance of skin examination during routine visits at 12 months after the course, and physician counseling around skin cancer issues. This will be assessed by patient exit interviews and physician self-assessment. Efficacy of the course for improving physician skin cancer triage skills and changing physician attitudes and knowledge regarding skin cancer issues will be assessed.
Kelly Kelleher, MD, MPH, is principal investigator for a Trial of Automated Risk Appraisal in Adolescents (TARAA). A partnership among Columbus Children’s Hospital, the Close to Home Primary Care Centers and www.flipsidemedia.com, this project aims to improve services for problem drug use/abuse and other risk-taking behavior for youth in primary care settings through research on early identification and monitoring. The study compares an intervention that combines computerized risk assessment and telephone support to usual care plus mailed screening results. Investigators want to: compare the frequency of problem drug use and abuse identified in the intervention group with use and abuse among youths in the usual-care group; examine the frequency of counseling, referral, psychotropic medication or other interventions for youth who screen positive for problem drug use and abuse on risk assessment; and evaluate the effect of the telephone support program on return to primary care, likelihood of completing referrals, number of primary care visits, and satisfaction with services after four months.
Mira Katz, PhD, is principal investigator for Patient Activation to Increase Colon Cancer Screening, a randomized, controlled clinical trial that focuses on improving colorectal cancer screening rates by “patient activation.” The study will test the effectiveness of patient communication skills training coupled with colorectal cancer screening information and barriers to counseling to improve screening rates. Part of a partnership with the Columbus Neighborhood Health Center, Inc., this research has far-reaching potential because, if shown to be effective, this colorectal cancer-screening program can be shared to improve screening among medically underserved populations.
Judy Groner, MD, is principal investigator for a clinical trial titled Can Changing How Mom Eats Prevent Obesity in Toddlers? This project aims to reduce the rising rate of obesity in very young children by helping mothers adopt focused eating patterns. Lowincome urban infants and mothers starting well-child care in Children’s Hospital Primary Care Network constitute the study population. The project contains a controlled study of two interventions: an addition to the nutritional anticipatory guidance offered during well-child visits, which focuses on structuring maternal- eating behavior; and an augmentation of the advice given in physician practices by providing access to a six-week transition to parenting group, which focuses on the eating advice given in the clinics. Participating mothers are randomized to either receive an invitation to join a group or not. Anticipated outcomes of the project include: achieving a 10-percent reduction in the percentage of overweight toddlers in the intervention/support group; improving infant and toddler eating patterns in relation to accepted standards; increasing mothers’ readiness and recognition of a need to change family eating habits; and increasing the structure of maternal eating patterns. If effective, this low-cost intervention would fit well into current pediatric practices.
Doug Post, PhD, is principal investigator for a $240,000 project funded by the National Cancer Institute and titled Patient-Centered Communication During Chemotherapy. Studies have indicated that communication problems between cancer patients and clinicians are a major barrier to managing patients’ pain, depression and fatigue. This project addresses this problem by developing and evaluating a personal digital assistant (PDA)-based patient communication intervention for breast cancer patients undergoing chemotherapy. Patients are asked to complete fatigue, depression and pain inventories on a PDA at the beginning of chemotherapy and once a week through completion of treatment. On the day before each treatment, a summary of fatigue, depression and pain scores is integrated with a tailored patient communication skills training program and displayed on the PDA. Patients are taught through role modeling how to effectively communicate their symptoms and are encouraged to bring the PDA with their symptom summaries to each chemotherapy treatment so they can share the information with their clinician. Effects of the intervention are assessed over the course of treatment. Focus groups are then used with study participants to assess their responses to the intervention and their perceptions of the system’s value.
Electra Paskett, PhD, MSPH, is principal investigator for a $1.4 million Ohio Patient Navigator Research Project funded by the American Cancer Society. This project, which aims to alleviate disparities in timely diagnosis and treatment of breast, cervical and colorectal cancer, represents a partnership among the Ohio State University Comprehensive Cancer Center, the Ohio State Primary Care Practice-Based Research Network, and community partners (e.g., the Ohio American Cancer Society Division and the Ohio Commission on Minority Health). Specific aims include: assessing baseline rates and barriers, as well as strategies to overcome barriers to receiving timely diagnostic and treatment services; developing the Ohio Patient Navigator Research Program through a consortium of institutions in Ohio; implementing and evaluating the patient navigator program in 12 clinics/health centers using a group-randomized, controlled design to assess the efficacy of this intervention in reducing time to delivery of cancer care and noncancer resolution, or reducing time to cancer diagnosis and treatment after an abnormal finding from a detection procedure for breast, cervical or colorectal cancer; assessing barriers to implementing the intervention program; conducting a cost-effectiveness evaluation of the program; and assessing the impact of the program on community-level indicators. Study results are expected to reduce the burden of cancer in underserved populations.

Research Accomplishments of 2005

The research of Douglas Post, PhD, associate professor in the Department of Family Medicine, illustrates the value of the PCRI and the OSUPC-PBRN to investigators. Post’s expertise is in healthcare communication related to cancer control and prevention. Building on the resources of the OSUPC-PBRN, he is principal investigator for an NCI-funded study to develop and assess the effects of a PDA-based patient communication tool for breast cancer patients undergoing chemotherapy.
Post also is collaborating with PCRI researcher Mira Katz, PhD, on her NCI-funded project regarding patient communication training and colorectal cancer screening.
Post is co-principal investigator for the Patient Navigator Research Program, an NIH-consortium study funded by the American Cancer Society to PCRI researcher Electra Paskett, PhD, MsPH. Post is also co-investigator on Paskett’s NCI-funded Center for Population Health and Health Disparities project.
Post is working with Martin Weinstock, MD, PhD, from Brown University as one of four site principal investigators on a study investigating the effects of an education program on skin cancer detection and counseling skills for primary care physicians.
An NIH-funded study, “Can Changing How Mom Eats Prevent Obesity in Toddlers?,” involves a multidisciplinary group including: principal investigator Judy Groner, MD, professor of Ambulatory Pediatrics at Columbus Children’s Hospital; and co-investigators Lisa Murray-Johnson, PhD, assistant professor in the Department of Communications; Patricia Schwirian, PhD, RN, professor emeritus in the College of Nursing and the Department of Family Medicine; and Theresa Skybo, RN, PhD, assistant professor in the College of Nursing. Consultants include Manish Maskay, PhD, Columbus Public Health Department; Kelly Kelleher, MD, and William Gardner, PhD, Children’s Hospital Clinical Research Center; and Gina French, MD, University of Hawaii Medical School. This project encourages mothers of low SES urban newborns to start well-child care in the OSUPC-PBRN in hopes of: 1) achieving a 10-percent reduction in overweight toddlers in the intervention group compared to the control group; 2) improving infant and toddler eating patterns; 3) increasing the mothers’ recognition of a need to change family eating patterns; and 4) increasing the structure of maternal eating patterns. The intervention is low-cost and fits into current pediatric well-child practice.

OSU Primary Care Research Institute
(614) 293-8007