Reports of Persistent Change in the Clinical Encounter Following Research Participation: A Report From the Primary Care Multiethnic Network (PRIME Net)

Robert Rhyne; Andrew L. Sussman; Doug Fernald; Nancy Weller; Elvan Daniels; Robert L. Williams; On Behalf of PRIME Net Clinicians

doi:10.3122/jabfm.2011.05.100295

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Table 1.

Demographics of Clinician Survey Samples

Survey Items	Short-Term (3 to 6 Months) Follow-Up Survey (PRIME Net) N = 73	Long-Term (3 to 4 Years) Follow-Up Survey (RIOS Net) N = 72
Clinician background^*
Family Medicine	43	40
Pediatrics	3	18
Internal Medicine	16	6
Nurse practitioner/physician assistant	9	7
Network affiliation^*
RIOS Net	19	72
SPUR-Net	27	—
SERCN	15	—
CaReNet	11	—
Years since graduation, n (%)
<5	—	3 (4)
5 to 10	—	19 (27)
10 to 20	—	24 (34)
>20	—	25 (35)
Years since residency, n (%)
<5	10 (14)	—
5 to 10	15 (21)	—
11 to 20	12 (16)	—
>20	17 (23)	—
Residents, midlevel providers	19 (26)	—

↵* Totals vary due to missing responses.
PRIME net, Primary Care Multiethnic Network; RIOS Net, Research Involving Outpatient Settings Network, New Mexico; SPUR net, Southern Primary care Urban Research Network, Houston, Texas; SERCN, Southeast Regional Clinicians Network, 11 Southeastern states; CaReNet, Colorado Area Research Network, Colorado.

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Table 2.

Clinician Reports of Change in the Encounter

Survey Items^*	Short-Term Follow-Up Survey (3 to 6 Months) N = 73 n (%)	Long-Term Follow-Up Survey (3 to 4 Years) N = 72 n (%)	P Value^† of Test for Difference Between Short-Term and Long-Term Survey Results
Were you aware of the association of Acanthosis Nigricans (AN) with hyperinsulemia and/or diabetes before training for this project?
Yes	60 (82%)	57 (79%)	0.81
No	10 (14%)	10 (14%)
Not sure	3 (4%)	5 (7%)
As a result of my participation in this project, I more commonly check the back of a patient neck for AN.
Yes	63 (86%)	57 (79%)	0.32
No	7 (10%)	13 (18%)
Not sure	3 (4%)	2 (3%)
As a result of my participation in this project, I am diagnosing AN more often.
Yes	50 (68%)	47 (65%)	0.90
No	17 (23%)	18 (25%)
Not sure	6 (8%)	7 (10%)
As a result of my participation in this project, I more commonly inquire about diabetes risk factors among my patients.
Yes	44 (60%)	38 (54%)	0.33
No	27 (37%)	27 (38%)
Not sure	2 (3%)	6 (8%)
As a result of my participation in this project, I spend more time counseling patients who have diabetes risk factors about diet, exercise, or weight control.
Yes	50 (68%)	39 (54%)	0.13
No	20 (27%)	25 (35%)
Not sure	3 (4%)	8 (11%)
As a result of my participation in this project, I have discussed AN with my colleagues.
Yes	44 (60%)	51 (74%)	0.08
No	26 (36%)	18 (26%)
Not sure	3 (4%)	0 (0%)
I find the identification of AN provides a good opportunity to address diabetic risk factors with my patients.
Yes	67 (92%)	67 (96%)	0.44
No	4 (5%)	1 (1%)
Not sure	2 (3%)	2 (3%)
I find the identification of AN leads a patient to be more receptive to diabetic risk factor counseling.
Yes	49 (67%)	49 (69%)	0.09
No	5 (7%)	0 (0%)
Not sure	19 (26%)	22 (31%)

↵* Totals may vary due to missing responses on surveys or categorization as other.
↵† Fisher exact test.

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Table 3.

Possible Reasons for Behavior Change Following Participation in Practice-based Research Network (PBRN) Study: Supporting Clinician Comments in Qualitative Data

Reasons	Explanatory Comments by Clinicians
Increase in clinician knowledge about AN	“The AN training module was useful, and the prompting to check for AN has provided a good opening for talking to patients at risk for diabetes.”
	“(Participation in the project) increased my knowledge and gave me some specific tools to identify prediabetes and to use to begin talking to/counseling patients.”
AN as a feasible tool to assist counseling	“I think it's such an easy thing to do that I probably look for AN in almost everybody. You know, just when you're listening to their lungs, you just flip up their hair and look quickly.”
	“I think it's enhanced my clinical skills. And it's also a really good segue into counseling people on their risk for diabetes and to help them modify their lifestyle and their risk factors.”
Change in patient receptivity/motivation for counseling	“When people found that they had a skin change that you could identify as a risk.. they were very keen to that. It was like you had a flag that was being held up and people would say, ‘Oh, wow'.”
Context of the clinical encounter	“I now look for it more regularly, particularly in people who have other risk factors for diabetes. And then I use that in the context of my counseling, ‘Look, you already have some signs of insulin resistance.' So, it actually enhances my ability, I think, to motivate them to change their behavior.”