Welcome to the patient lab

Jill Cochran, Ph.D., APRN, C-FNP is making a difference in the health and lives of West Virginia residents through medical practice and research. Her research lab is not the typical basic science research lab with test tubes and microscopes. Instead, it has medical equipment and real patients - the clinic exam room.

"Welcome to the patient lab," Cochran said. "You can't separate medical practice and research. In the clinic 'every day practice' is a type of research and we use that research to change how we treat patients. It is easy for medical professionals to feel as though they are not contributing to research due to the demands of a full practice," she continued. "However, if a health practitioner is seeing patients, then they are collecting and evaluating data.

As we notice patterns of success (e.g.; improved patient health) in our practice, we need to collect, evaluate and report these data."

WVSOM provides Cochran the ideal setting for a health care professional. As a WVSOM faculty member, she is encouraged and supported to conduct clinically based research through the West Virginia Clinical and Translational Science Institute (WVCTSI) and she practices primary care at the WVSOM Robert C. Byrd Clinic (RCBC). Each day she challenges students to not only care for individual patients, but to look for progress in trends and victories and then discuss the findings.

Cochran has been led to specific research projects through observations in her own practice. "We need to take the problems we face in practice and translate the questions into research. Currently, our latest clinical research has to do with reconciliation of medications taken by our patients," Cochran said.

Cochran was intrigued when she attempted to obtain a comprehensive list of all medications and supplements from her patients to understand the possible interactions of the medicines. After experiencing first-hand with her mother how difficult it was to compile a complete and accurate list of all her medications, she wondered if there was a way to improve a patient’s health through “med reconciliation,” — the reconciliation of all medications used by one patient and what effect their interaction has on that patient — and a research project was born.

Cochran's plan was to understand and improve patient reporting of all medications to include over the counter, prescription medications and home herbal supplements. The research project began by asking patients how they report medications and what would help them remember to report all medications and supplements.

As a part of her research, Cochran began to consider the serious ramifications of physicians making decisions on incomplete or false information. She determined that different methods of gathering medication lists could be tested and data collected on what seemed to work in the Robert C. Byrd Clinic. Then, with the support of a WVCSTI HOPE (Health Outcomes and Policy Evaluation) grant she began collecting data on clinical tools with patients. One tool, titled Med Manage, has had great success. Clinicians use a drawing of a human body to "walk through" each area, symptom or malady to ask what medication the patient is taking.

"We are working to make an impact in primary care. We can help patients and families have a more thorough knowledge of all of their medications," Cochran said. "Thus far, our team has seen a significant increase in the number of reported medications from patients when the Med Manage tool has been used."

Cochran's next round of this clinical project, which will involve two WVSOM students, will focus on geriatric patients. This target audience tends to take certain types of over-the-counter medications and may be the most vulnerable to issues involving unreconciled meds.

She is also focused on finding the appropriate platform to share findings in clinical research. "We are building this foundation of knowledge that could significantly improve medication reconciliation. Could this reduce the number of readmission rates in elderly patients? How will we share it with colleagues throughout the state and beyond? And, how will we learn of the success that others have had in their clinical practices?" she asked rhetorically.

"Clinical translational research is driven from the bedside of patients. What works, what doesn't, where are there consistent records of success and how do we share that information?" she continued. "At WVSOM, we're preparing students to not only take excellent care of their patients, but to understand and evaluate their care models using Quality Improvement and Quality Assurance. We can all learn from each other."

Date Added: 
Thursday, December 6, 2018