Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods.

As a nurse scientist and health services researcher, with a joint appointment between the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA), I have acquired expertise in the areas of diabetes distress, qualitative research methods, and virtual care (e.g., telehealth, digital health) as a method of care delivery. My research focuses on the current and potential ability of virtual care interventions to reduce distress, improve self-management, increase access to evidence-based care delivery, and improve patient and population health outcomes. My collaborative and interdisciplinary research focuses on how patient-, provider-, and system-level factors influence virtual care use and outcomes. As evidence of its growing significance and impact at DUSON and the VHA, my work has been well funded, published in high-impact journals, presented at select conferences, and used to guide health system decision-making. I am a sought-after teacher and mentor because I connect my research interests to teaching students and mentees rigorous and systematic research approaches. I am frequently asked by local and national colleagues to provide guidance on distress, qualitative research methods, and virtual care approaches used in grants, projects, and manuscripts.  

My research contributions have focused on alleviating psychosocial distress, developing and implementing multi-level virtual care interventions, and enhancing qualitative methods. As a staff nurse, I witnessed the psychosocial distress of patients who experience challenges in obtaining care which led to my interest in diabetes distress. I aspire and work to improve health outcomes for individuals with chronic illness by developing equitable and sustainable multi-level virtual care interventions and assessing their implementation and adaptation. Virtual care describes any remote interaction between a patient and/or members of their care team. To achieve these goals, I use qualitative methods and implementation science approaches to enhance alignment between patient, modality, disease state, and social and environmental context; my collective assessments address for whom and what purposes, in what situations and contexts, when in a disease course or clinical activity, and in what specific ways such interventions are effective. My focus on the uptake and adoption of virtual care to address psychosocial distress considers interactions with patients, between patients and clinicians, and within health care systems and the larger population.

Jennifer Gierisch, PhD,  is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  where she serves as the leader of the Partnered Research Methods Core (PRESTO)  and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's  Community Engaged Research Initiative (CeRi) for five years

Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and  community engaged research approaches.

Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development,  qualitative research

Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.

I am a research scientist and Licensed Clinical Psychologist with a background in health services research, clinical psychology, and experimental psychology. My research interests include 1) the evaluation of current integrated behavioral health settings in health care systems to optimize future implementation efforts, 2) the development of novel integrated behavioral health strategies tailored to specific populations and healthcare system needs, 3) broad processes of behavior change and self-regulation, and 4) psychometric measurement of patient reported outcomes and research methods/statistics.

These interests have taken the form of specific research endeavors involving: a) large nonrandomized investigations of electronic health records data, b) development and evaluation of telehealth interventions to improve self-management of mental and physical health behaviors, and c) evaluation of patient-reported outcomes through telehealth modalities and in primary care, specialty care, and higher level of care settings.

To date, the content domains of most of my research have involved substance use (specifically alcohol, opioids, and tobacco), health behaviors (specifically medication adherence), mental health (specifically anxiety, depression, PTSD, and eating disorders), and health services utilization.

I have diverse research interests and collaborations.  Clinical research interests include epilepsy quality-of-life interventions and therapeutics and acute care neurological issues like post-cardiac arrest management and quality-of-care issues.  I work with the Duke hyperbaric chamber team on clinical neurophysiological monitoring of ketone-related research.  

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Connor Drake is a health services researcher and implementation scientist. His research interests are at the intersection of primary care, population health management, social determinants of health, chronic illness care redesign, and health equity. He has experience with policy analysis, electronic health record data, mixed and multi methods, community engaged research, and implementation and dissemination methods. 

Dr. Drake's current research projects include leveraging telemedicine and other clinical informatics to improve chronic illness care and population health management; developing and implementing behavioral interventions and 'whole-person' care models for patients with cardiovascular disease and metabolic disorders; and studying  social care interventions to respond to social risk factors including food insecurity, housing instability, and social isolation to improve health outcomes and equity.

John Williams, MD, MHS, is a Professor of Medicine at Duke University Medical Center and a past recipient of VA Health Services Career Development and a Robert Wood Johnson Foundation Generalist Faculty Scholar Awards. He received his bachelor and MD degrees from the University of North Carolina. Dr. Williams completed residency training at the University of Iowa and a research fellowship at Duke University. He is a primary care internist who is trained in epidemiology, biostatistics, and literature synthesis. Dr. Williams’ topical interests include depression, mental health services, dementia and implementation of best practices. He is a medical editor for the Patient Centered Outcomes Research Institute and the Evidence-base Practice Program. Dr. Williams is Senior Science Advisor to the Durham VA Evidence Synthesis Program and has led numerous systematic reviews, many focusing on mental health services. Dr. Williams is board certified in Internal Medicine and active in clinical practice and resident physician education at the Durham VAMC.