Heidi Munger Clary, MD, MPH, is making significant impact in the world of neurological medicine as the chair of the Psychosocial Comorbidities committee within the American Epilepsy Society (AES) and chair of the American Academy of Neurology Epilepsy Quality Measure Workgroup. Through the AES, she was able to provide some input into the new development of the National Institute of Neurological Disorders and Stroke (NINDS) epilepsy research benchmarks. What experiences laid the groundwork for this impact? A CTSI Pilot Award, time as a NeuroNEXT fellow, and a 2019 KL2 Scholars Award.
|Dr. Munger Clary’s KL2 Focus Study
“Anxiety and Depression in Epilepsy: Assessing Outcomes via the Electronic Health Record”
|Anxiety and depression are highly prevalent and major contributors to poor quality of life and other poor outcomes in epilepsy. Despite this importance, anxiety and depression are under-recognized and undertreated in epilepsy. The purpose of this project is to implement and assess a learning health system, electronic medical record (EMR)-based screening and outcome assessment for anxiety and depression in the epilepsy clinic. This will advance our ability to conduct pragmatic, EMR-based research to develop and assess epilepsy clinic-based interventions for anxiety and depression in epilepsy.
KL2 Mentored Career Development Award: 2019
“It’s been incredible,” Munger Clary says, saying the KL2 program specifically has allowed her to develop and test innovative, electronic medical record embedded clinical and research screening tools without the need for extra staffing. The KL2 program provides two years of research support which has allowed Munger Clary to focus on the science behind her research screening: “This is a method that will really reduce the burden of research staffing needed to do these kinds of studies and it’s important.”
This is Munger Clary’s passion: helping Neurologists in clinical practice settings address anxiety and depression in epilepsy to improve outcomes. “Despite the importance and prevalence of these symptoms and good evidence-based treatments in general populations, most patients do not receive treatments due to various barriers.” For Munger Clary, the disorders within the study of Neurology affect the whole person—from socioeconomics to emotional and behavioral health. “My goal is to develop practical ways and tools that we, as Neurologists, can use to tackle those symptoms directly in epilepsy clinics.”
NeuroNEXT fellowship: July 2018-June 2019
In 2018, Munger Clary was awarded the NeuroNEXT fellowship from Wake Forest School of Medicine’s Department of Neurology, which provides 1 year of support career development in the context of an NIH-funded clinical trials network. As she says, this award “allowed me to start training in bioinformatics, implementation science and grant preparation. This fellowship was a bridge between the CTSI pilot and KL2 program.”
CTSI Pilot Award: April 2018-March 2019
Munger Clary says her CTSI-Pilot funded study provided the structure and capability to run a feasibility pragmatic trial. “The trial looked at neurologist treatment of anxiety and depression vs. psychiatry referral, which led to some unexpected results that have fueled future work.” Munger Clary reports that this trial completed almost 1,000 anxiety and depression screenings in the epilepsy clinic during routine visits. “One of our findings was that patients who had anxiety and depression symptoms were interested in participating in research, but those who were sicker were more interested and less likely to be eligible for the study. We also found that symptomatic patients strongly preferred neurologists manage their anxiety or depression rather than being referred to a psychiatrist” Such findings would not have been possible without funding through CTSI’s Pilot award.
A Framework for Success
Munger Clary emphasizes the importance of the services she accesses through the Wake Forest CTSI. “The CTSI is amazing. I am someone who started out as a pure clinician, with some research training background doing small amounts of homegrown research. The CTSI has really made the difference in me being able to access some resources and move on to do things that will hopefully lead to various external funding opportunities.”
Dr. Munger Clary continues to serve as a perfect example for the potential of clinicians actively engaged in research within an academic learning health system. “I feel there is so much that we can do as Neurologists and Epileptologists to improve the lives of patients by taking a comprehensive, patient-centered approach and thinking about the whole patient.” And this is exactly what Dr. Munger Clary is doing: approaching the whole of the patient to improve health outcomes. “I’m really drawn to work on problems that have a big impact on patients’ day to day lives and quality of life but are currently areas of challenge and neglect within the medical field.”
|The CTSI KL2 Mentored Career Development Award provides two years of support for early-career faculty from Wake Forest School of Medicine involved in translational research to expand their skills and competencies under the guidance of an experienced, multi-disciplinary mentoring team, within the context of a learning healthcare system and rapidly evolving academic research environment.