Digital Commons Network^™

Implementation Of Sleep Problem Screening In A Pediatric Primary Care Office, Jennifer Erin O'Donnell

Dissertations

Sleep problems, a major problem for children and their parents, are the most common complaint brought to pediatric clinicians (advanced practice nurses and other healthcare providers) attention but are often ignored and underdiagnosed in the pediatric population (Faruqui, Khubchandani, Price, Bolyard, & Reddy, 2011). “Sufficient amounts of good quality sleep are necessary for healthy development in childhood” (Bordeleau, Bernier, & Carrier, 2012, p. 254). Inadequate sleep in children has been linked to numerous adverse outcomes psychologically as well as physically (Owens, Jones, & Nash, 2011). The American Academy of Pediatrics (AAP), issued recommendations in 2002 stating screening for snoring, one …

The Impact Of Financial Incentives For Cervical Cancer Screening In Ontario's Primary Care Delivery Models, Ciara Pendrith

Electronic Thesis and Dissertation Repository

Physicians practicing in capitation-based Family Health Organizations and fee-for-service-based Family Health Groups receive bonuses for delivering preventive care, including cervical cancer screening, while those practicing in the traditional fee-for-service model do not. Financial incentives were introduced to increase Ontario’s cervical screening rate to 85%. To date, the impact of incentives for cervical screening on screening rate and cost-effectiveness have not been assessed. Patient-level data obtained from the Institute for Clinical Evaluative Sciences were used to estimate primary care model screening rates and cancer treatment costs. A microsimulation model was developed from published cervical cancer natural history models and parameterized using …

Primary Care Assessment And Interventions To Improve Physical Activity Among Insufficiently Active Adults Ages 18 Through 64 Years Old, Thomas A. Sanchez

Doctoral Dissertations

A number of chronic and debilitating conditions such as cardiovascular disease, stroke, hypertension, anxiety, depression, pain, osteoporosis, and falls are known to be delayed, improved, or prevented by increasing physical activity (PA) levels. The numbers of those affected form a substantial portion of the US population. As of 2011, for example, 26 million adults in the U.S. were diagnosed with diabetes mellitus (DM) alone. Another 79 million people had elevated blood glucose measurements putting them at risk for DM. Despite knowledge of the connection with chronic disease, PA levels are not consistently and quantitatively assessed during primary care office visits. …

Investigation Of Physician Assistants' Choice Of Rural Or Underserved Practice And Framing Methods Of Recruitment And Retention, Jennifer A. Snyder

Health Sciences Program Student Theses, Dissertations and Capstones

Objective: This dissertation analyzed one state's physician assistant (PA) workforce focusing on recruitment and retention. The goal was to identify factors associated with Indiana PAs working in medically underserved, rural, and primary-care medicine. The study evaluated characteristics of PAs who chose initially to work in rural versus urban areas and who have continued to do so. From the literature and as a result of study outcomes, a framework was developed, upon which recommendations were made for effective methods of increasing and retaining the number of PAs in primary care within rural areas. Subjects: Data were obtained from applications for PA …

Follow-Up Evaluation Of Treatment For Anxiety And Depression Provided In A University-Based Primary Care Clinic, Renée M. Grinnell

Theses and Dissertations

Although integrated primary care psychology services are becoming increasingly common, the literature lacks adequate research support for the longitudinal durability of treatment effects following the conclusion of brief primary care interventions. This study served as a follow-up program evaluation of psychological services for depression and anxiety provided at the Medical College of Virginia’s Ambulatory Care Center in Richmond, Virginia. Data were collected on 47 adult primary care patients who received treatment for depression and/or anxiety between six and 18 months prior to the follow-up telephone call. Data were collected on the trajectory of depression scores throughout and following treatment, treatment …

Assessing Blood Pressure Control In Primary Care, Ashley W. Guiliani

DNP Projects

Purpose: To evaluate provider adherence to JNC 7 by assessing documentation of blood pressure control and interventions in the absence of control in order to assist providers in reaching Healthy People 2020 goal of blood pressure control.

Methods: A retrospective chart review was conducted for patients with essential hypertension. Data collected included blood pressure, use of a home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three visits. A provider survey regarding provider barriers to blood pressure control was also completed.

Results: All surveyed providers were aware and …

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …

Reforming Primary Care In The United States: Analysis Of Deficiencies And Potential Solutions Based On Existing Models, Noah Joseph

Honors Theses

Primary care medicine is an essential component of the U.S. health care system, yet there is no other part of the health care system that is in greater trouble right now. Primary care is undergoing profound change in the United States, as evidenced by an increasingly sick population along with the concurrent decrease in the supply of doctors to care for that population. The passage and the Supreme Court’s upholding of the constitutionality of the Affordable Care Act (ACA) is but another confirmation of the need to improve upon primary care in the U.S. In this paper, the major deficiencies …

Practice Characteristics Of Graduates Of East Tennessee State University Quillen College Of Medicine: Factors Related To Career Choices In Primary Care, Ivy A. Click

Electronic Theses and Dissertations

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included …

A Community Based System Of Integrated Clinical Care: Primary Care, Mental Health And Substance Use Treatment, Terri Reuvers

All Graduate Theses, Dissertations, and Other Capstone Projects

Our segregated medical and mental health care system misses opportunities for early detection of physical disease. Missed opportunities lead to increased costs. Colorado’s Medicaid health plan estimates that an integrated health program will reduce costs for patients with psychiatric disorders by 10%. The cost of doing nothing may exceed $300 billion per year in the United States (NCCBH, 2010). The purpose of this Capstone project is to critically examine existing models of Integrated Primary and Mental Health care. These models will then be evaluated to identify those most compatible with rural communities in Southern Minnesota.

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford

Theses and Dissertations

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease characterized by symptoms of urinary urgency, frequency, bladder pain, and chronic pelvic pain in the absence of known pathology. Selection of appropriate treatments depended on the severity of the patient's symptoms and patient's preference. This review found that it is important for providers and patients to set realistic goals for symptom improvement when starting a new treatment.

The purposes of this project was to 1) conduct a substantive literature review on treatment guidelines for IC/PBS, 2) analyze the literature for comparing oral pharmacological interventions and behavioral interventions for IC/PBS, and 3) …

Influences Of Health Insurance And Primary Care On Breast And Cervical Cancer Screening Among Black Women In Boston, Gail Barlow Gall

Graduate Doctoral Dissertations

Healthy People 2010 promoted breast and cervical cancer screening to reduce cancer among all women and reduce disparities in cancer deaths between Black and White women. The REACH 2010 program targeted improving screening rates among Black women and funded a demonstration project to provide outreach, screening, patient navigation and case management for Black women in Boston. The purpose of this study was to describe associations between health insurance and primary care (having a primary care provider [PCP], quality of communications and relationship with PCP) on differences in breast and cervical cancer screening reported by Black women born in the United …

Instituting An Oral Health Preventive Service Program, Including Fluoride Varnish, For Preschool Children Birth To Five Years In A Rural Health Clinic: A Clinical Scholarship Project, Carol Ann Berger

Dissertations

Abstract This project was designed to institute an oral health preventive program in a rural health clinic, in a dental provider shortage area, promoting oral health in preschool children birth to five years by: (a) instituting a program that supports the Missouri preventive service program in oral health, (b) promoting oral screenings and fluoride varnish twice yearly, (c) assessing the risk of caries, (d) referring to appropriate dental services and (e) educating parents or guardian about the importance of oral health and how to maintain oral health at home with children birth to five years. This project sought to answer …

Identifying Patients At Risk For Obstructive Sleep Apnea In Primary Health Care : Can Obesity In Combination With Other High-Risk Diagnoses Be Used For Screening Purposes?, Clelia Lima

Electronic Theses and Dissertations

Obstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia, arrhythmia, and coronary artery disease) can be used to help PCPs identify adult patients at risk for OSA. Unlike other screening tools, these diagnoses are easy to identify in a …

Impact Of An Electronic Medical Record Implementation On Drug Allergy Overrides In A Large Southeastern Hmo Setting, Renny Varghese

Public Health Theses

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June …

An Examinaton Of The Enhanced Primary Care Model For The Organization Of Team Care In Managing Type 2 Diabetes Mellitus In The Elderly Population, Carolyn Morcom Rutledge

Health Services Research Dissertations

The healthcare system is faced with overwhelming demands as a result of the growing elderly population, especially those with chronic illnesses. One disease that significantly impacts the morbidity and mortality of the elderly population, especially the minority and poor population, is type 2 diabetes. This population often lacks access to resources and quality healthcare that may be due to inadequate knowledge by the patients and their healthcare providers regarding available services. Current models of healthcare have not been effective in meeting the healthcare demands of this population. The purpose of this study was to evaluate the effectiveness of the Enhanced …

Increasing Readiness To Change Among Smokers In A Primary Care Setting, Sheila F. Collicott

Psychology Theses & Dissertations

This study compared the effectiveness of two brief interventions, direct advice and motivational interviewing, for increasing motivation to quit among male smokers in the pre-contemplation and contemplation stages of change who were primary care patients at an Eastern urban VA medical center. Contrary to expectations, participants receiving motivational interviews did not increase more in readiness to change, motivation, and actions to quit, than those receiving direct advice or a control conversation, nor did they smoke fewer cigarettes per day. As expected, contemplators reported more cutting down and quit attempts than pre-contemplators. Factors that may have limited the effectiveness of interventions …

Chronic Pain: Nurse Practitioners' Attitudes And Interventions In Primary Care, Brenda Kay Thornton Coggins

MSN Research Projects

Chronic pain is a widespread problem affecting millions of people. Research has shown that attitudes and beliefs toward pain influence actions and reactions of both the person experiencing pain and the health care provider. Research has also shown that some health care providers have negative attitudes and erroneous beliefs about pain. This descriptive study was undertaken to explore and describe attitudes of nurse practitioners in primary care settings in Mississippi toward chronic pain and their subsequent interventions for chronic pain. Travelbee's Human-to-Human Model was utilized as the theoretical framework for this study. The two research questions asked in this study …