Anais Tuepker

Oregon Health and Science University | OHSU · Department of Family Medicine

Objectives: Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) Emergency Departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans' lack of VHA care utilization following a positive suicide risk...

Unlabelled: To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication. Design: We conducted a qualitative study between September 2020 and February 2021...

Background Despite demonstrated efficacy, medication treatment for opioid use disorder (MOUD) remain inaccessible to many patients, with barriers identified at the individual, clinic and system level. A wide array of implementation strategies have guided efforts to expand access to MOUD, with most centered around externally-facilitated approaches t...

Importance There is increasing recognition of the long-term health effects of SARS-CoV-2 infection (sometimes called long COVID ). However, little is yet known about the clinical diagnosis and management of long COVID within health systems. Objective To describe dominant themes pertaining to the clinical diagnosis and management of long COVID in t...

Background: Community participation in health programme planning has gained traction in public health in recent decades. When an idea enters the mainstream, it becomes vulnerable to overuse and dilution, and public health professionals claiming "community participation" may intentionally or unintentionally prevent more meaningful participatory act...

Background: Health care systems have increasingly focused on patient engagement in efforts to improve patient-centered care. Appointment attendance is an integral component of patient engagement, and missed appointments are an ongoing problem for health care systems. Virtually no studies have examined how the sense of belonging is related to patie...

Women experiencing intimate partner violence (IPV) often face stigma, uncertainty, and complex emotions when deciding to disclose IPV to primary care providers. As the Patient Centered Medical Home (PCMH) model’s general assumptions and value have been more widely accepted, interest has grown in understanding how well it serves different population...

Aims We sought to identify person- and program-level factors distinguishing permanent supportive housing (PSH) residents with higher versus lower social integration; and higher versus lower instrumental functioning. Methods Among 60 PSH residents at Los Angeles' VA, surveys and medical records captured person-level factors. Using a median split, w...

Background A growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical...

Objective To incorporate user-centered design processes into the refinement of nudges designed to reduce no-shows among healthcare appointments for military veterans in the Veterans Health Administration (VA). Methods We developed candidate nudges as brief messages based on four broad concepts in behavioral science. We then conducted iterative wav...

Background: Collaboration between researchers, implementers and policymakers improves uptake of health systems research. In 2018, researchers and VHA Innovators Network (iNET) leadership used an embedded research model to conduct an evaluation of iNET. We describe our evaluation design, early results, and lessons learned. Methods: This mixed-met...

Background: Intimate partner violence (IPV) is increasingly recognized as a social factor impacting health, and health care providers are encouraged to routinely screen and refer patients for needs related to IPV. Health care settings are often challenged, however, in their ability to connect patients with community-based IPV services. Some organiz...

Purpose Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of...

Background: No-shows are a persistent and costly problem in all healthcare systems. Because forgetting is a common cause of no-shows, appointment reminders are widely used. However, qualitative research examining appointment reminders and how to improve them is lacking. Objective: To understand how patients experience appointment reminders as pa...

Background Evidence is growing that interprofessional team-based models benefit providers, trainees, and patients, but less is understood about the experiences of staff who work beside trainees learning these models.Objective To understand the experiences of staff in five VA training clinics participating in an interprofessional team-based learning...

Background National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age.Objective To examine the perspectives of middle-aged women w...

Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question...

Background/purpose To evaluate teamness perceptions of employees and trainees and associations between teamness and employee perceptions of burnout, satisfaction, and decision-making in the context of a clinical setting with interprofessional trainees. Methods Seven Veterans Health Administration (VA)-funded Centers of Excellence in Primary Care E...

Importance Studies have shown that interprofessional education (IPE) improves learner proficiencies, but few have measured the association of IPE with patient outcomes, such as clinical quality. Objective To estimate the association of a multisite IPE initiative with quality of care. Design, Setting, and Participants This study used difference-in...

Interprofessional clinical education programs have the potential to impact participants’ professional expectations and practices related to team-based care. In this qualitative study, research team members interviewed 38 graduates and 19 faculty members from such an interprofessional training program, the Department of Veterans Affairs (VA) Centers...

Background: Research on intimate partner violence (IPV) faces unique challenges to recruitment and retention. Little is known about successful strategies for recruiting and retaining in research women who have experienced IPV, and their experiences of research participation. Purpose: This article presents findings on recruitment, retention, and...

Concerns persist that care provided by resident physicians is of lower quality than that provided by more experienced attending physicians.¹ In this study, we compared quality of outpatient care between internal medicine residents and attending physicians in US Department of Veterans Affairs (VA) primary care clinics.

Background: The OpenNotes initiative provides patients online access to their clinical notes. Mental health clinicians in the Veterans Health Administration report a need for guidance on how to provide care, write notes, and discuss them in the context of OpenNotes. Aim: To provide mental health clinicians recommendations identified by patients...

Supplemental Material, VET_EXP_APPENDIX_A - Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Background Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress...

Phase 3 interview guide. (DOCX)

Objective: This study describes responses to OpenNotes, clinical notes available online, among patients receiving mental health care and explores whether responses vary by patient demographic or clinical characteristics. Methods: Survey data from 178 veterans receiving mental health treatment at a large Veterans Affairs medical center included p...

Objective: Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians. Methods: Seven focus groups and one semi-structured...

Background The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date. Objective We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which charact...

The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at...

Camaraderie and shared narratives, coupled with clinical guidance, may help motivate veterans to better manage their diabetes.

Objective Understand patients’ experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management. Methods We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using them...

The Veterans Health Administration (VA) Patient Aligned Care Teams (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees. We sought to identify key themes in the experience of primary care p...

Quality improvement is a central goal of the patient-centered medical home (PCMH) model, and requires the use of relevant performance measures that can effectively guide comprehensive care improvements. Existing literature suggests performance measurement can lead to improvements in care quality, but may also promote practices that are detrimental...

BACKGROUND: The Veterans Health Administration (VA) Patient Aligned Care Teams (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees. OBJECTIVE: We sought to identify key themes in the exper...

Background: As in other communities in the United States, information is lacking about the health needs of Africans refugees and immigrants living in Portland, Oregon. In 2008, the African Partnership for Health coalition (APH) was formed to carry out research, advocacy and education to improve the health and well-being of Africans in Oregon. This...

Background: Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their e...

• To obtain information from African refugees and immigrants about their health needs and barriers to health care. • Lay the foundation for future work of the African Partnership for Health, a coalition of African community members, service providers, and researchers. • Since the 1990s, many African refugees arrived in the United States from war-to...

Purpose Aware that “those who aren't counted don't count” in health program planning, a community coalition, called African Partnership for Health, attempts a current estimate of the African community living in Portland, Oregon, USA. This paper seeks to describe the findings. Design/methodology/approach The paper's definition of the “African commu...

In 2009, President Obama and Secretary Shinseki committed to ending homelessness among Veterans. In support of that effort, the Federal Strategic Plan to Prevent and End Homelessness 2010 developed by the United States Interagency Council on Homelessness (USICH) established as one of its goals to prevent and end homelessness among Veterans in five...

Purpose: In developing interactive tools to promote shared decision making, a fundamental design goal is to ensure that the tool presents decision-critical evidence in ways that are easy to understand. Patients who have recently made cancer treatment decisions can be useful informants for testing presentation approaches. Method: We previously had...

Purpose: Determine the best method to help patients understand their preferences and apply information about risks and benefits to a high-stakes decision about prostate cancer treatment. Methods: We created a computer-based interactive decision aid (DA) to help men participate in decisions about treatment choice for localized prostate cancer, whi...

This paper argues on ethical and practical grounds for more widespread use of an integrated approach to refugee healthcare, and proposes a basic model of assessment for integrated systems. A defining element of an integrated approach is an equal ability by refugee and host nationals to access the same healthcare resources from the same providers. T...

Based on a range of field interviews conducted in South Africa in 1999-2000, this article argues that South Africa's currently evolving asylum regime, though legally encompassing both UN and Organization of African Unity (OAU) definitions of a refugee, in practice privileges a particular reading of the OAU definition whereby the properly recognizab...

Thesis (B.A.)--Harvard University, 1996. Includes bibliographical references (leaves 101-108).