2005, has developed formal institutional mechanisms to facilitate community-university partnershi... more 2005, has developed formal institutional mechanisms to facilitate community-university partnerships that serve the needs of communities and the university. The College developed these partnerships as part of its founding; therefore, the University of Georgia model may serve as an important model for other new public health programs. One important lesson is the need to develop financial and organizational mechanisms that ensure stability over time. Equally important is attention to how community needs can be addressed by faculty and students in academically appropriate ways. The integration of these 2 lessons ensures that the academic mission is fulfilled at the same time that community needs are addressed. Together, these lessons suggest that multiple formal strategies are warranted in the development of academically appropriate and sustainable university-community partnerships.
Introduction: Rural residents are at elevated risk for lung cancer and related mortality, yet lim... more Introduction: Rural residents are at elevated risk for lung cancer and related mortality, yet limited research has explored their perspectives on cancer risk or prevention options, including tobacco treatment and lung cancer screening with low-dose computed tomography (LDCT). This qualitative study examined attitudes and beliefs among rural adults who reported either current or former tobacco use, as well as disengagement from the health care system. Methods: We conducted 6 focus groups with rural Maine residents at risk for lung cancer based on age and smoking history (n = 50). Semistructured interviews explored participants’ knowledge, perceptions, and attitudes regarding lung cancer risk, LDCT screening, and patient provider relationships. Inductive qualitative analysis of interview transcripts was conducted to identify key themes. Results: Participants were cognizant of their elevated lung cancer risk, yet few were aware of LDCT screening. When informed about LDCT, most participants indicated a willingness to undergo screening, although a substantial minority indicated reluctance related to fear and fatalism. Participants generally expressed the belief that relationships with a primary care provider could support their health and identified several provider factors that influence these relationships, including attention and time for patient concerns; respect and non-judgmental, nonstigmatizing attitudes; treating patients as individuals; and provider empathy and emotional support. Conclusions: Rural residents at risk for lung cancer report limited knowledge and substantial ambivalence regarding LDCT screening, but identify provider behaviors that may promote patient-provider relationships and greater engagement with their health. More research is needed to confirm these findings and understand how to help rural residents and healthcare providers work together to reduce lung cancer risk.
Faculty members in family practice residencies are increasingly being asked to help residents dev... more Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology. This project, which was carried out in 1999–2001, utilized a multifaceted approach that included improving the residency's technology infrastructure, conducting two instructional workshops, and offering EBM mentoring for preceptors. Faculty members also designed and carried out independent informatics projects. Pre- and post-project assessments of faculty members demonstrated a significant improvement in computer and EBM skills, and informal feedback from residents indicates that these skills have been successfully applied to the faculty members' teaching of residents and their practice of family medicine. This project had a positive impact on the faculty members in the residency program, increasing both their ability to employ information technology in individual and group teaching sessions and their use of EBM in clinical practice. Also, the culture within the residency program has been changed to one of utilizing computers and the Internet as principal resources for up-to-date information.
The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) ... more The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine. Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention. Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified initial challenges in incorporating the tool into the primary care visit (31%). Patients expressed a favorable view of the service, sharing an openness to being screened more regularly (75%) and a desire to have screenings performed at Western Maine Primary Care going forward (81%). Discussion: Patients were generally favorable about their experience with the new DR screening technology. Providers indicated challenges due to the limited availability of trained medical assistant photographers during the initial implementation of DR screening, as well as timing issues in coordinating screening with regular office appointments. Conclusions: This study supports further investigation of this technology in primary care, particularly in areas with challenges to care access. The potential benefits of this innovative tool in caring for people with diabetes includes improving access to retinopathy screenings and supporting wider detection of visionthreatening retinopathy.
... Neil Korsen, MD Maine Medical Center Family Practice Residency Program Portland, Maine Edward... more ... Neil Korsen, MD Maine Medical Center Family Practice Residency Program Portland, Maine Edward Nowicki, MD Dartmouth Medical School Hanover, New Hampshire Ann Thering, MLS Family Practice Inquiries Network ... 1. Pedersen TR, Wilhelmsen L, Faergeman O , et al. ...
The world of primary care was galvanized in 2007 by the publication of the Joint Principles of Th... more The world of primary care was galvanized in 2007 by the publication of the Joint Principles of The Patient-Centered Medical Home (PCMH) that spells out the fundamental features of a primary health care setting in which a team of clinicians offers accessible first-contact primary care. 1 This care should be personal, coordinated, continuous, and comprehensive-it should address most or all of a person's health care needs. Comprehensiveness confers value to the PCMH, and is an especially important principle. 2 By some means, "all of a person's health care needs" must be addressed in the PCMH. This cannot be achieved without including the behavioral aspects of health. Yet comprehensiveness often is not achieved in PCMH efforts because behavioral issues are not addressed. This shortfall requires redress.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioec... more Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioeconomic deprivation and geographic barriers to care may both influence lung cancer prevalence and outcomes. We sought to describe how socioeconomic deprivation and rurality are related to lung cancer prevalence and mortality. Methods: We conducted a population-based cross-sectional analysis of: 1) prevalent lung cancers identified in a statewide all-payer claims dataset between 2012 and 2016; 2) lung cancer deaths in Maine from 2012-2016, ascertained by the state death registry; 3) rurality; and 4) area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (in quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk F...
Many problems have been identified in the usual care of patients with depression, including lack ... more Many problems have been identified in the usual care of patients with depression, including lack of identification, overreliance on medications, and inadequate treatment and follow-up. Most of these problems can be attributed to an absence of depression care systems in primary care practice. We collected information from a group of practices to assess the need for and acceptability of such systems. We conducted 4 focus groups with primary care physicians and their staffs to identify attitudes and perceived behaviors for depression problems and to determine the participants' level of acceptance of alternative systematic approaches. We also surveyed clinicians and a sample of patients who recently visited their practices. Systematic screening was viewed unfavorably, and many barriers were identified with collaborative care with mental health clinicians. Participants did support involvement of other office staff and more systematic follow-up for patients with depression. The patien...
Context: The PHQ-9 is a validated, short self-report questionnaire designed to be used in primary... more Context: The PHQ-9 is a validated, short self-report questionnaire designed to be used in primary care for diagnosis and management of depression. We wished to assess its use for monitoring symptoms in patients being treated for depression. Objective: to measure the use of the PHQ-9 in 12 months following an elevated score in adult patients in primary care practices. Study design: retrospective cohort study with descriptive analysis of use of PHQ-9 for follow up; stratified by age category, gender, severity and chronicity of symptoms, and whether referred to integrated behavioral health. Setting or Dataset: EMR data including dates and results of PHQ-9, patient demographics, and referral data. Population Studied: Adults aged 18 and older with a PHQ-9 score of 10 or higher during calendar year 2018. No one was excluded. Outcome measure: Primary outcome measure was the number of PHQ-9's done in 12 months following the initial elevated score (index score). Secondary outcome measures are a set of quality measures for depression care related to monitoring with PHQ-9 at 6 and 12 months following index score. Results: among all patients, mean number of PHQ-9 following index score was 2.1. This was increased for those with chronic symptoms (defined as having an elevated score at least once in calendar year 2017. It was increased slightly as severity of index symptoms increased. It was increased substantially for those referred to integrated behavioral health clinicians in the practices. Conclusions: the PHQ-9 is underutilized as an instrument for monitoring patients who are being treated for depression in primary care. Measurement based care has a strong evidence base and interventions to improve utilization of the PHQ-9 for monitoring are likely to improve depression outcomes in primary care.
Comments on CTAF Draft Report received by March 20, 2015 • Macaran A. Baird, MD, MS, Professor an... more Comments on CTAF Draft Report received by March 20, 2015 • Macaran A. Baird, MD, MS, Professor and Head, UMN Department of Family Medicine and Community Health, Minneapolis, MN • Roger Kathol, MD, CPE, President, Cartesian Solutions, Inc., Burnsville, MN • Jürgen Unützer, MD, MPH, MA, Professor and Chair, Psychiatry and Behavioral Sciences, University of Washington; Director, AIMS Center, Seattle, WA • Saul Levin, MD, MPA, CEO and Medical Director, American Psychiatric Association, Arlington, VA • Rachel Wick, Program Officer – Health Care and Coverage, Blue Shield of CA Foundation, San Francisco, CA • Florence C. Fee, JD, MA, Executive Director, No Health without Mental Health (NHMH), San Francisco, CA – Arlington, VA
Background: Growing evidence suggests that stigmatization is an important barrier to the receipt ... more Background: Growing evidence suggests that stigmatization is an important barrier to the receipt and delivery of optimal heath care services. While the consequences of stigmatizing attitudes have been well-studied for some conditions (e.g., HIV, mental health disorders), less is understood about smoking stigma and, in particular, the effects of physicians’ stigmatizing attitudes towards people who smoke. Addressing this knowledge gap is an important need for efforts to prevent lung cancer and other smoking-related illnesses
Although shared decision making is recommended for cancer screening, it is not routinely complete... more Although shared decision making is recommended for cancer screening, it is not routinely completed in practice because of time constraints. We evaluated a process for improving decision making about colorectal cancer (CRC) screening using mailed decision aids (DAs) with follow-up telephone support in primary care practices. Methods: In three primary care practices, we identified patients aged 50-75 years who were not up to date with CRC screening. DAs were distributed via mail with telephone follow-up to eligible patients. Charts were reviewed six months later for CRC screening completion. Results: Among 1,064 eligible patients who received the mailed DA, 513 (48.2%) were reached by phone. During the six months after the intervention, 148/1064 (13.9%) patients were screened for CRC (4.8% underwent a fecal immunochemical test; 9.1% underwent colonoscopy). Younger patients (aged 50-54 years) had higher rates of any screening (32.4%) compared with all other age groups (range 12.8-19.6%). Medicaid patients had the lowest rates (4.0%) and insured patients had the highest rates (45.3%) of screening. Overall, 113/513 (22.0%) of patients who were reached by phone and 35/551 (6.4%) of patients who were not reached by phone completed screening within six months. Conclusion: A standard process for identifying patients unscreened for CRC and DA distribution via mail with telephone decision support modestly increased CRC screening. This finding is consistent with the goal of providing preference-sensitive care and informed decision making. Improving care processes to include decision support outside of office visits is possible in primary care practices.
Rural communities need access to effective interventions that can prevent functional decline amon... more Rural communities need access to effective interventions that can prevent functional decline among a growing population of older adults. We describe the conceptual framework and rationale for a multicomponent intervention (“Mind, Mood, Mobility”) delivered by Area Agency on Aging staff for rural older adults at risk for functional decline due to early impairments in cognition, mood, or mobility. Our proposed model utilizes primary care to identify at-risk older adults, combines evidence-based interventions that address multiple risk factors simultaneously, and leverages a community-based aging services workforce for intervention delivery.
2005, has developed formal institutional mechanisms to facilitate community-university partnershi... more 2005, has developed formal institutional mechanisms to facilitate community-university partnerships that serve the needs of communities and the university. The College developed these partnerships as part of its founding; therefore, the University of Georgia model may serve as an important model for other new public health programs. One important lesson is the need to develop financial and organizational mechanisms that ensure stability over time. Equally important is attention to how community needs can be addressed by faculty and students in academically appropriate ways. The integration of these 2 lessons ensures that the academic mission is fulfilled at the same time that community needs are addressed. Together, these lessons suggest that multiple formal strategies are warranted in the development of academically appropriate and sustainable university-community partnerships.
Introduction: Rural residents are at elevated risk for lung cancer and related mortality, yet lim... more Introduction: Rural residents are at elevated risk for lung cancer and related mortality, yet limited research has explored their perspectives on cancer risk or prevention options, including tobacco treatment and lung cancer screening with low-dose computed tomography (LDCT). This qualitative study examined attitudes and beliefs among rural adults who reported either current or former tobacco use, as well as disengagement from the health care system. Methods: We conducted 6 focus groups with rural Maine residents at risk for lung cancer based on age and smoking history (n = 50). Semistructured interviews explored participants’ knowledge, perceptions, and attitudes regarding lung cancer risk, LDCT screening, and patient provider relationships. Inductive qualitative analysis of interview transcripts was conducted to identify key themes. Results: Participants were cognizant of their elevated lung cancer risk, yet few were aware of LDCT screening. When informed about LDCT, most participants indicated a willingness to undergo screening, although a substantial minority indicated reluctance related to fear and fatalism. Participants generally expressed the belief that relationships with a primary care provider could support their health and identified several provider factors that influence these relationships, including attention and time for patient concerns; respect and non-judgmental, nonstigmatizing attitudes; treating patients as individuals; and provider empathy and emotional support. Conclusions: Rural residents at risk for lung cancer report limited knowledge and substantial ambivalence regarding LDCT screening, but identify provider behaviors that may promote patient-provider relationships and greater engagement with their health. More research is needed to confirm these findings and understand how to help rural residents and healthcare providers work together to reduce lung cancer risk.
Faculty members in family practice residencies are increasingly being asked to help residents dev... more Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology. This project, which was carried out in 1999–2001, utilized a multifaceted approach that included improving the residency's technology infrastructure, conducting two instructional workshops, and offering EBM mentoring for preceptors. Faculty members also designed and carried out independent informatics projects. Pre- and post-project assessments of faculty members demonstrated a significant improvement in computer and EBM skills, and informal feedback from residents indicates that these skills have been successfully applied to the faculty members' teaching of residents and their practice of family medicine. This project had a positive impact on the faculty members in the residency program, increasing both their ability to employ information technology in individual and group teaching sessions and their use of EBM in clinical practice. Also, the culture within the residency program has been changed to one of utilizing computers and the Internet as principal resources for up-to-date information.
The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) ... more The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine. Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention. Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified initial challenges in incorporating the tool into the primary care visit (31%). Patients expressed a favorable view of the service, sharing an openness to being screened more regularly (75%) and a desire to have screenings performed at Western Maine Primary Care going forward (81%). Discussion: Patients were generally favorable about their experience with the new DR screening technology. Providers indicated challenges due to the limited availability of trained medical assistant photographers during the initial implementation of DR screening, as well as timing issues in coordinating screening with regular office appointments. Conclusions: This study supports further investigation of this technology in primary care, particularly in areas with challenges to care access. The potential benefits of this innovative tool in caring for people with diabetes includes improving access to retinopathy screenings and supporting wider detection of visionthreatening retinopathy.
... Neil Korsen, MD Maine Medical Center Family Practice Residency Program Portland, Maine Edward... more ... Neil Korsen, MD Maine Medical Center Family Practice Residency Program Portland, Maine Edward Nowicki, MD Dartmouth Medical School Hanover, New Hampshire Ann Thering, MLS Family Practice Inquiries Network ... 1. Pedersen TR, Wilhelmsen L, Faergeman O , et al. ...
The world of primary care was galvanized in 2007 by the publication of the Joint Principles of Th... more The world of primary care was galvanized in 2007 by the publication of the Joint Principles of The Patient-Centered Medical Home (PCMH) that spells out the fundamental features of a primary health care setting in which a team of clinicians offers accessible first-contact primary care. 1 This care should be personal, coordinated, continuous, and comprehensive-it should address most or all of a person's health care needs. Comprehensiveness confers value to the PCMH, and is an especially important principle. 2 By some means, "all of a person's health care needs" must be addressed in the PCMH. This cannot be achieved without including the behavioral aspects of health. Yet comprehensiveness often is not achieved in PCMH efforts because behavioral issues are not addressed. This shortfall requires redress.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioec... more Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioeconomic deprivation and geographic barriers to care may both influence lung cancer prevalence and outcomes. We sought to describe how socioeconomic deprivation and rurality are related to lung cancer prevalence and mortality. Methods: We conducted a population-based cross-sectional analysis of: 1) prevalent lung cancers identified in a statewide all-payer claims dataset between 2012 and 2016; 2) lung cancer deaths in Maine from 2012-2016, ascertained by the state death registry; 3) rurality; and 4) area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (in quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk F...
Many problems have been identified in the usual care of patients with depression, including lack ... more Many problems have been identified in the usual care of patients with depression, including lack of identification, overreliance on medications, and inadequate treatment and follow-up. Most of these problems can be attributed to an absence of depression care systems in primary care practice. We collected information from a group of practices to assess the need for and acceptability of such systems. We conducted 4 focus groups with primary care physicians and their staffs to identify attitudes and perceived behaviors for depression problems and to determine the participants' level of acceptance of alternative systematic approaches. We also surveyed clinicians and a sample of patients who recently visited their practices. Systematic screening was viewed unfavorably, and many barriers were identified with collaborative care with mental health clinicians. Participants did support involvement of other office staff and more systematic follow-up for patients with depression. The patien...
Context: The PHQ-9 is a validated, short self-report questionnaire designed to be used in primary... more Context: The PHQ-9 is a validated, short self-report questionnaire designed to be used in primary care for diagnosis and management of depression. We wished to assess its use for monitoring symptoms in patients being treated for depression. Objective: to measure the use of the PHQ-9 in 12 months following an elevated score in adult patients in primary care practices. Study design: retrospective cohort study with descriptive analysis of use of PHQ-9 for follow up; stratified by age category, gender, severity and chronicity of symptoms, and whether referred to integrated behavioral health. Setting or Dataset: EMR data including dates and results of PHQ-9, patient demographics, and referral data. Population Studied: Adults aged 18 and older with a PHQ-9 score of 10 or higher during calendar year 2018. No one was excluded. Outcome measure: Primary outcome measure was the number of PHQ-9's done in 12 months following the initial elevated score (index score). Secondary outcome measures are a set of quality measures for depression care related to monitoring with PHQ-9 at 6 and 12 months following index score. Results: among all patients, mean number of PHQ-9 following index score was 2.1. This was increased for those with chronic symptoms (defined as having an elevated score at least once in calendar year 2017. It was increased slightly as severity of index symptoms increased. It was increased substantially for those referred to integrated behavioral health clinicians in the practices. Conclusions: the PHQ-9 is underutilized as an instrument for monitoring patients who are being treated for depression in primary care. Measurement based care has a strong evidence base and interventions to improve utilization of the PHQ-9 for monitoring are likely to improve depression outcomes in primary care.
Comments on CTAF Draft Report received by March 20, 2015 • Macaran A. Baird, MD, MS, Professor an... more Comments on CTAF Draft Report received by March 20, 2015 • Macaran A. Baird, MD, MS, Professor and Head, UMN Department of Family Medicine and Community Health, Minneapolis, MN • Roger Kathol, MD, CPE, President, Cartesian Solutions, Inc., Burnsville, MN • Jürgen Unützer, MD, MPH, MA, Professor and Chair, Psychiatry and Behavioral Sciences, University of Washington; Director, AIMS Center, Seattle, WA • Saul Levin, MD, MPA, CEO and Medical Director, American Psychiatric Association, Arlington, VA • Rachel Wick, Program Officer – Health Care and Coverage, Blue Shield of CA Foundation, San Francisco, CA • Florence C. Fee, JD, MA, Executive Director, No Health without Mental Health (NHMH), San Francisco, CA – Arlington, VA
Background: Growing evidence suggests that stigmatization is an important barrier to the receipt ... more Background: Growing evidence suggests that stigmatization is an important barrier to the receipt and delivery of optimal heath care services. While the consequences of stigmatizing attitudes have been well-studied for some conditions (e.g., HIV, mental health disorders), less is understood about smoking stigma and, in particular, the effects of physicians’ stigmatizing attitudes towards people who smoke. Addressing this knowledge gap is an important need for efforts to prevent lung cancer and other smoking-related illnesses
Although shared decision making is recommended for cancer screening, it is not routinely complete... more Although shared decision making is recommended for cancer screening, it is not routinely completed in practice because of time constraints. We evaluated a process for improving decision making about colorectal cancer (CRC) screening using mailed decision aids (DAs) with follow-up telephone support in primary care practices. Methods: In three primary care practices, we identified patients aged 50-75 years who were not up to date with CRC screening. DAs were distributed via mail with telephone follow-up to eligible patients. Charts were reviewed six months later for CRC screening completion. Results: Among 1,064 eligible patients who received the mailed DA, 513 (48.2%) were reached by phone. During the six months after the intervention, 148/1064 (13.9%) patients were screened for CRC (4.8% underwent a fecal immunochemical test; 9.1% underwent colonoscopy). Younger patients (aged 50-54 years) had higher rates of any screening (32.4%) compared with all other age groups (range 12.8-19.6%). Medicaid patients had the lowest rates (4.0%) and insured patients had the highest rates (45.3%) of screening. Overall, 113/513 (22.0%) of patients who were reached by phone and 35/551 (6.4%) of patients who were not reached by phone completed screening within six months. Conclusion: A standard process for identifying patients unscreened for CRC and DA distribution via mail with telephone decision support modestly increased CRC screening. This finding is consistent with the goal of providing preference-sensitive care and informed decision making. Improving care processes to include decision support outside of office visits is possible in primary care practices.
Rural communities need access to effective interventions that can prevent functional decline amon... more Rural communities need access to effective interventions that can prevent functional decline among a growing population of older adults. We describe the conceptual framework and rationale for a multicomponent intervention (“Mind, Mood, Mobility”) delivered by Area Agency on Aging staff for rural older adults at risk for functional decline due to early impairments in cognition, mood, or mobility. Our proposed model utilizes primary care to identify at-risk older adults, combines evidence-based interventions that address multiple risk factors simultaneously, and leverages a community-based aging services workforce for intervention delivery.
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Papers by Neil Korsen