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Background: Having diabetes may increase the odds of late-stage breast cancer. In Kentucky, the rates of late-stage disease are higher in rural than in urban areas, particularly in rural Appalachia. The objectives of the study were to examine the relationship between diabetes and cancer screening and to determine whether Appalachia residence modifies this association.Methods: One thousand thirty Kentucky adults responded to a 2008 telephone survey that measured whether they had diabetes; lived in Appalachia; had guideline-concordant screening for breast (mammogram, clinical breast examination), cervical (Papanicolaou), and colorectal (fecal occult blood test or sigmoidoscopy/colonoscopy) cancer; and whether they reported receiving mammograms regularly every 1 to 2 years.Results: Of the subjects, 16% had diabetes, 21% were Appalachian, and 32% were men. In multivariate analysis, women with diabetes had about half the odds of "regular" mammography screening (

Context Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose To examine primary care physicians’ identification of hereditary cancers. Methods A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United States, stratified by rural/non-rural and Appalachian/non-Appalachian practice location (N=176). Identification of hereditary breast-ovarian cancer (BRCA1/2), hereditary non-polyposis colon cancer (HNPCC), and other hereditary cancers was assessed. Findings Less than half of physicians (45%) reported having patients with cancer genetic testing. Most (70%) correctly identified the BRCA1/2-relevant scenario; 49% correctly identified the HNPCC-relevant scenario. Factor analysis of psychosocial variables revealed 2 factors: Confidence (knowledge, comfort, confidence) and Importance (responsible, important, effective, need) of identifying hereditary cancer. Greater confidence was associated with use of 3 generation pedigree in taking family history. Greater knowledge and access to genetic services were associated with use of genetic testing. More recent graduation year, greater knowledge, and greater confidence were associated with identifying the BRCA1/2-relevant scenario. Greater knowledge and confidence were associated with identifying the HNPCC-relevant scenario. Conclusions Although rural Appalachian physicians do not differ in ability to identify high risk individuals, access barriers may exist for genetic testing. Interventions are needed to boost physician confidence in identifying hereditary cancer and to improve availability and awareness of availability of genetic services.

Objectives To examine the current levels of information technology (IT) use in a primary care practicebased research network (PBRN) in order to inform future development of its infrastructure. Participants Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN), as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. Methods A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Results Response rates for the surveys were 46% (n=68) for the office managers and 51% (n=116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. Conclusion While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low. The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

The Cardiovascular Risk Education and Social Support (CaRESS) study is a randomized controlled trial that evaluates a social support intervention toward reducing cardiovascular risk in type 2 diabetic patients. It involves multiple community-based practice sites from the Kentucky Ambulatory Network (KAN), which is a regional primary care practice-based research network (PBRN). CaRESS also implements multiple modes of data collection. The purpose of this methods article is to share lessons learned that might be useful to others developing or implementing complex studies that consent patients in PBRNs. Key points include building long-term relationships with the clinicians, adaptability when integrating into practice sites, adequate funding to support consistent data management and statistical support during all phases of the study, and creativity and perseverance for recruiting patients and practices while maintaining the integrity of the protocol.