Updates from WREN

It is now almost four years since the rebirth of WREN (Wisconsin Research and Education Network). I have just completed the final grant reports for our first two federally funded grants and David Hahn's (Madison - Dean Clinic) Acute Bronchitis study and ramping up for his randomized clinical trial of Azithromycin for adult-onset asthma. WREN has also worked with Leon Redant (Mauston - Mile Bluff Clinic) studying the use of BMI as a vital sign and has lent support for external studies as well.

We hope to continue providing WREN's clinician researchers with something extra while improving health outcomes for the people of Wisconsin through education, and through promoting and conducting primary care research in partnership with primary care clinicians and the communities they serve.

Wisconsin Primary Care Research Forum

Many thanks to the WAFP (Wisconsin Academy of Family Physicians), the MCW (Medical College of Wisconsin) Department of Family and Community Medicine and the University of Wisconsin Department of Family Medicine for co-sponsoring the first Wisconsin Primary Care Research Forum. This one-day meeting will be held on Friday June 2nd at the Crowne Plaza Hotel and Conference Center in Madison. This event will provide a common forum for the presentation of Wisconsin-based primary care research and facilitate interaction of Wisconsin primary care researchers at all levels. Attendees will include:

• Medical students
• Family practice residents
• Fellows
• Academic physicians
• Community physicians

Continuing medical education credit will be offered for attendees. The registration fee will be free! Please plan to join us for a day of Wisconsin bred primary care research. Details, registration form and call for papers will be coming shortly.

Family Medicine International Adoption Clinical Practice Survey

WREN is participating in a resident research project assessing the attitudes and approaches of family physicians in dealing with international adoption. International adoption is common in the United States resulting in the arrival of 22,884 children in 2004. The parents who adopt children internationally are often left with questions about the health of the children, and without solid information on whom to look for answers. Pediatricians with sub-specialty training in infectious diseases are often sought to provide care for internationally adopted children, but it is our belief that family physicians should be able to play this role as well.

Given that WREN clinicians have a track record of a high rate of response to questionnaires, we are employing a dual-stage distribution to WREN and to WAFP. WREN results, especially if the response rate is high, serve to validate the WAFP sample.

For this study Kristen Lerberg, MD (second-year resident at the Madison Family Medicine program) is collaborating with Jon Temte, MD,PhD, Beth Potter, MD (Family Medicine faculty at Madison), Jim Conway, MD (pediatric infectious disease specialist at University of Wisconsin) and Katie Miller, MD (family physician and adolescent medicine fellow at UCSF). Look for a brief report on the findings in the near future and respond to the survey if you have not done so as of yet.

Complexity in Family Medicine

You may remember a discussion on the proposed "complexity study" from the 2005 Annual WREN Convocation of Clinicians. An application was submitted to AHRQ (Agency for Health Care Research and Quality) to examine the interplay between problem density in primary care encounters, clinician mental workload, medical error and quality of care. We have received an excellent priority score from AHRQ (143) and this initiative will likely be funded. If it is, we will be recruiting 30 hearty souls for this study, along with 30 hearty medical assistants. This study is designed to take minimal time out of a busy clinic day. Your participation would be most appreciated!

A pilot study conducted by medical students last summer has helped illustrate the concept of problem density. The students collected data on 180 encounters in family practice teaching clinics. This data helped to define the number of discrete clinical problems or issues discussed, evaluated and/or managed during a single, face-to-face clinical encounter divided by the time spent for this encounter and normalized to a one-hour period. A minimal estimate for WREN physicians is 12 problems per hour. A manuscript is in preparation for this study.

Health Literacy in Primary Care

WREN was funded by the AAFP Foundation (American Academy of Family Physicians) to conduct a survey on the attitudes and approaches of family physicians with respect to healthcare literacy. Clinicians from WREN, the University Of Wisconsin Department Of Family Medicine, the WAFP, and the AAFP not practicing in Wisconsin responded to a 12-question survey sent by e-mail with a hyperlink for online data collection.

Of the 462 responses, WREN had the highest response rate at 60%. All groups significantly underestimated the prevalence of low literacy to a similar degree and had similar estimates of the impact of low literacy on health outcomes. Significant differences were found between Wisconsin Clinicians and non-Wisconsin Clinicians in the rates of screening for low literacy (7.1% vs. 17.5%). Overall we found that clinicians recognize the importance of low literacy in the health of their patients, but underestimate its prevalence, and few employ screening. WREN accurately represents Wisconsin but is different from the national sample.

Mike Grasmick, PhD (WREN Research Specialist) will be presenting these results at the annual AHRQ practice-based research network meeting in May.