What type of research do you do?
My work focuses mainly on reducing – and ideally eliminating – smoking-related disparities: trying to improve access and utilization of smoking cessation assistance in healthcare settings, and primarily within the safety net. So I work very closely with OCHIN.
In the last couple years I also have become more interested in the treatment of other substance use, primarily opioid use disorder, because it is one of the other few substance use disorders that is treated in primary care. So similarly – figuring out how we can improve access and utilization of treatment.
What projects are you working on?
I was recently awarded two grants:
I received funding from NCI for the CONNECT grant, which assesses the impact of implementing a Tobacco Quitline eReferral using academic detailing (which is kind of a fancy word for training) on Quitline reach and effectiveness. We’ll be going into community health centers (CHCs) and doing provider and staff education and training around use of this system.
We’ll also share best practices around helping people to quit. We will compare this approach to the standard implementation, where it’s often simply an email with information about a new tool CHCs can use.
The other one is funded by NIDA and is looking at use of telehealth for opioid use disorder treatment, since many of our patients switched over to telehealth during the pandemic. We'll be using mixed methods (quantitative and qualitative data) from two of our Family Medicine clinics to understand the impact of telemedicine on access and engagement in opioid use disorder treatment.
I also lead a project at the VA that is examining policies requiring smoking cessation prior to elective surgery and the impact it has on rural Veterans. I am involved with the Western States node of the NIDA Clinical Trials Network. I also am a co-investigator on multiple projects led by colleagues in Family Medicine.
What got you into this field? What's your background?
I have my Ph.D. in clinical psychology. Like most people, my passion is based on personal experiences. I grew up in a small town in southern Oregon where smoking and substance use are pretty common. I saw family and friends struggle with addiction throughout my life.
I actually knew I wanted to be a clinical psychologist in 8th grade. I originally envisioned doing clinical work, so I went to grad school to become a psychologist. During my training, I got introduced to research and I was sold on it.
I love doing clinical work, but the impact is typically on one person at a time. I really wanted to be able to have a broader impact.
I worked on randomized smoking cessation trials before I came to OHSU, which were great, but they often had to exclude people with other conditions, such as depression or anxiety. Most people who smoke often have quite a few comorbidities. With these projects I’m working on now, they include patients seen in real-world settings.
When I joined Family Medicine in 2011, that’s when I first started working with OCHIN, and it was a great opportunity to get into the community health centers and really work with patients and providers and do more pragmatic trials.
What drew you to OHSU Family Medicine? What’s kept you here the past 10 years?
Having these collaborations with clinicians and with educators, I would say that's probably the best way to go about research. Because you know, as a researcher you're not in the clinics, so it's great to be able to see ideas from clinicians come into fruition. Being able to collaborate with people outside of research to really know what needs to be done – it’s really cool.
Up until now, I've been focused on secondary data analysis – understanding where the disparities are before trying to implement some sort of intervention. But I'm really excited about the CONNECT grant with OCHIN, because it is an intervention study – this is what I want to do.
I do think that Family Medicine is very unique, not only with our research endeavors, but being able to potentially apply our research findings to our own clinics. The best part of Family Medicine is working with such smart and amazing colleagues across the entire department.
I saw Nat’s interview where she said it's like family. It often does feel like family. There's not a lot of researchers in family medicine – although we keep growing – and so we tend to really work together.
What do you hope to see happen in this field in the next 5-10 years?
For me, it really is decreasing the barriers. Not just for smoking cessation, but substance use in general. Reducing the stigma. Insurance is a barrier. Policy impacts on treatment.
For example, in the VA project I mentioned earlier, we are interviewing rural patients and providers and surgeons to find out what their experiences have been around needing to quitting smoking prior to elective surgery. Rural patients already have barriers, and add in the higher rates of smoking. Is this policy increasing quit rates? Is it increasing disparities? And what is being provided in terms of cessation support to make sure that they're as successful as they can be?
If we see that something needs to be done, the plan is in the next year to develop a telehealth intervention. An intervention to get patients the help that they need, and remove some barriers to accessing treatment for patients in rural areas.
Overall, I hope we can reduce barriers to substance use disorder treatment, including making treatment accessible and truly integrated into all primary care settings – helping to reduce stigma.