Digital Commons Network^™

Home-Based Primary Care In Patients With Dementia: Impact On Cost, Medication Use, And Patient Satisfaction, Megan O'Leary

Theses and Graduate Projects

Background: Individuals living with dementia deserve affordable, accessible, and effective healthcare. These patients often face barriers that make it difficult to consistently access traditional in office primary care. Home-based primary care (HBPC) holds the opportunity to bridge the gap between individuals with dementia and preventative healthcare resources.

Purpose: Dementia rates are increasing as the population ages, and additional research is needed to determine the optimal treatment model for individuals with dementia. This literature review evaluates if patients with dementia receive improved care with HBPC vs in office primary care through examining cost, medication use and compliance, and patient satisfaction.

Methods: …

Registered Nurse-Led Annual Wellness Visits In Rural Health Clinics: A Program Evaluation Of A New Role, Tina Switzer

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare Annual Wellness Visit (AWV) has been a free yearly, comprehensive preventive care opportunity for most Medicare beneficiaries since 2011. Because of the time intensive nature of these visits, the overall national completion rate for them has been low as providers often perceive time and resource constraints. Registered Nurses (RNs) have the skill set to complete these visits with minimal provider involvement. Rural residents often face health care access barriers and outcome disparities, and Rural Health Clinics (RHCs) are a …

Social Determinants Of Access To Primary Care In Canada, Feben W. Alemu

Electronic Thesis and Dissertation Repository

Despite the promise of universal care, many Canadians report having unmet healthcare needs. We conducted two studies: (1) a systematic review of studies on social determinants of health (SDH) and unmet need; and (2) a secondary analysis using the Canadian Longitudinal Study on Aging (CLSA) to investigate the association of SDH and (2a) self-reported unmet need and (2b) having a family physician. The review (n=40) found a positive association between unmet need and lower income, mental health and chronic conditions, and negative association with older age, better perceived health and having a family physician. The CLSA analysis found the odds …

Evaluating Literacy Sensitive Client Education Materials For The Smmart Clinic, Mckenzie Brink, Kelsey L. Colvin, Kelsey Holmer, Rachel G. Kullas, Paige M. Loy, Alexander W. Manos, Gretta N. Obeid, Kelly O'Connor, Allison Park

Graduate Projects & Research

This master’s project was completed in collaboration with the St. Mary’s Medical and Rehabilitative Therapies (SMMART) Clinic, located on the campus of St. Catherine University in St. Paul, Minnesota. Through the completion of literature reviews, a needs assessment, and project activities, nine graduate occupational therapy students analyzed the needs of this clinic and aimed to improve client care. The SMMART clinic serves primarily Spanish-speaking clients who are low-income, uninsured, or underinsured. This population often faces obstacles in accessing primary health care and rehabilitation, including language and literacy-related barriers. Occupational therapy can play an important role in addressing these barriers and …

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Telehealth And Hospital Readmissions For Heart Failure Patients: A Literature Review, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Currently heart failure affects over six million people and is expected to increase to over eight million people by 20230. The US Census Bureau estimates over 60 million people live in a rural setting. This literature review seeks to determine the state of the science regarding the utilization of Telehealth to reduce heart failure readmissions in rural areas.

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Implementing A Depression Screening Process Within A Primary Care Setting Initiative To Improve Quality Patient-Centered Healthcare, Mark Beech

Doctoral Projects

Depression is more widespread than many people understand. Depression is a common mental disorder involving millions of people from all backgrounds, races, and socioeconomic levels (World Health Organization [WHO], 2020). Depression not only affects one’s mental well-being but can be often linked to one’s physical well-being. Additionally, depression is often misdiagnosed and can many times go undetected. The stigma of depression or any mental health disorder still has many patients feeling shameful and the need to be secretive which can prevent proper treatment. The implementation of a depression screening process by utilizing a tool for early depression detection is essential …

Sex Differences In The Clinical Presentation Of Early Psychosis In A Primary Care Setting, Brooke Carter

Electronic Thesis and Dissertation Repository

Psychotic disorders can be variable in clinical presentation, and there may be differences by sex. The objective of this thesis was to explore sex differences in the clinical presentation of early psychosis in the context of primary care. Our systematic review and meta-analysis found that men experienced more negative symptoms and had a higher prevalence of substance use issues, whereas women experienced more depressive symptoms and had higher functioning. Our electronic medical record analysis from primary care found that positive symptoms and substance use were less prevalent in the medical records of women. We also found that visits by women …

The Efficacy Of Tailored Text Messages To Improve Medication Adherence And Lifestyle Changes For Patients With Type 2 Diabetes Mellitus, Vanessa B. Silverio

Evidence-Based Practice Project Reports

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by increased amounts of glucose in the blood, and is the seventh leading cause of death in the United States (United Health Foundation [UHF]), 2021). T2DM can be effectively treated with medication and behavioral lifestyle modifications. Even small improvements in glycemic control can reduce the risk for debilitating complications such as heart disease, stroke, kidney disease, sepsis, and retinopathy (Wang et al., 2021, Haider et al., 2019). The purpose of this evidence-based practice (EBP) project was to identify the most effective intervention for improving medication adherence, lifestyle changes, and hemoglobin …

Utilizing A Personal Health Coach In The Management Of T2dm, Emily Killebrew, Matthew Huelsman, Verah Bonareri, Terri Furfaro

Doctor of Nursing Practice Projects

Management of type 2 diabetes mellitus (T2DM) can reduce hemoglobin a1c values and ultimately reduce the risk of morbidity and mortality. Many adults live with uncontrolled T2DM due to a lack of knowledge of disease management. The purpose of this project was to evaluate the implementation of a personal health coach for the management of T2DM in adult patients. An extensive literature review was conducted, and the use of the Diabetes Management Self-Efficacy Scale (DMSES) was chosen to evaluate participants’ self-efficacy regarding their T2DM. Adult patients aged 21-75 with a diagnosis of T2DM and a hemoglobin a1c >7 in a …

Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney

Doctor of Nursing Practice Projects

Depression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who …

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Hepatitis C Screening, Confirmation, And Referral Improvement Project, Maria E. Mcmahon

Doctor of Nursing Practice Scholarly Projects

Hepatitis C is an illness caused by the blood-borne Hepatitis C virus (HCV), and usually becomes a chronic condition. Left untreated, HCV can lead to severe liver disease and liver failure. Newer treatments are effective and well tolerated, but most people with chronic HCV are not accessing treatment due to several factors that will be discussed. The primary objectives of this quality improvement project were to improve the treatment cascade, provide education to providers and patients, and facilitate screening, virus confirmation, and referral to treatment, in a Federally Qualified Health Center.

Community Health Worker Intervention To Improve Hba1c In Adult Diabetic Patients, Megan Wojtko

Doctor of Nursing Practice Projects

Type 2 Diabetes Mellitus (T2DM) is a disease that disproportionally impacts patients with multiple socioeconomic barriers that are often difficult to address during a primary care visit. Several provider and practice-level barriers also exist including time limitations within the visit and lack of trained staff to help with patient education and case management. Uncontrolled T2DM leads to poor health outcomes and increased healthcare costs. Community Health Workers (CHW) are trained lay persons that can successfully address the patient’s unmet needs and assist with the provider’s recommendations. The purpose of this project was to explore if a CHW led intervention focused …

A Comprehensive Literature Review Of Recruitment And Retention Strategies For Primary Care Providers In Rural Communities, Christian Folken

Capstone Experience

Workforce trends within the United States indicate a growing crisis in the availability and distribution of primary care providers. Rural communities have been disproportionately affected by the lack of primary care providers. The gap in available primary care services in rural areas severely affects the population health outcomes of these communities. There is a critical need for rural healthcare systems to effectively understand and implement recruitment and retention strategies of primary care providers to meet the needs of their patients and community. The goal of this paper is to provide a centralized resource of evidence-based strategies regarding the recruitment and …

An Evaluation Of Covid-19 Vaccination Rates Of The Patients At The Kentucky Racing Health Services Center., Aditya Mehta

College of Arts & Sciences Senior Honors Theses

COVID-19 vaccines have been widely available to the U.S. public since early 2021. However, vaccination rates still vary considerably across geographical areas and different populations. The objective of this study was to research overall vaccination rates against COVID-19 for Latinx patients at the Kentucky Racing Health Services Center (KRHSC). Vaccination and booster data was collected from June to December 2021 for all unique patients visiting the center. It was initially hypothesized that these rates of vaccination and booster doses for the KRHSC patients would be lower than the data reported by Kentucky and Jefferson County. After a retrospective review, the …

Evaluation Of Early Primary Care Implementation Of Point Of Care Ultrasound In Outcomes Of Patients With Dyspnea As Compared To Standard Diagnostic Exams, Mcglinchey Chase

Physician Assistant Scholarly Project Papers

The purpose of this systematic literature review is to evaluate the applicability of point of care ultrasound (POCUS) in rural primary care. More specifically, the review seeks to evaluate the use of POCUS regarding outcomes in patients with dyspnea. Six of the most common and potentially life-threatening causes of dyspnea were chosen to review. They are asthma, heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, pneumothorax, and pulmonary embolism. In this review, a literature search was performed using the following electronic databases: PubMed, Cochran Review, and Google Scholar. Only articles since 2011 were selected for review with the majority being …

A Multimodal Intervention For Weight Loss In Primary Care, Amber Smith

Evidence-Based Practice Project Reports

Obesity is a worsening pandemic that requires immediate action. It is recommended that primary care providers screen patients for obesity and provide multimodal behavioral interventions to their patients to treat and prevent obesity (USPSTF, 2018). The purpose of this evidenced-base practice (EBP) project is to implement a multimodal intervention for weight loss in adults within primary care. Five search engines were utilized, and 16 articles were ultimately selected as evidence. The evidence supported self-monitoring and close follow-up while in active weight loss. The Iowa Model for EBP to promote quality care was used as the framework to guide the project …

Improving Vaccination Rates In Pediatric Primary Care, Lauren E. Osbeck

Doctoral Dissertations

Objectives: In a small, rural pediatric primary care clinic, the effectiveness of electronic patient portal reminders were evaluated at improving vaccination rates for school required immunizations.

Methods: A quality improvement project was initiated utilizing The Social Ecological Model. All pediatric patients were sent reminders who were under-immunized. This QI project evaluated the effectiveness of vaccine reminders on the improvement of immunization rates in the clinic

Results: Total number of fully-vaccinated patients within the practice improved (2%) and patients under-immunized decreased by 1%. 87 immunizations were given to patients were given to patients who were under-immunized and an average of 10% …

Development Of A Point-Of-Care Ultrasonography Workflow Within A Rural Clinic, Lauren Myers

Culminating Experience Projects

Abstract

Background and Objectives: Healthcare has revolutionized with advancements in ultrasound technology. Among these advancements and the increasing availability of imaging modalities is point-of-care ultrasonography (POCUS) technology.

Problem: While POCUS has gained considerable ground in primary care, infrastructure to support its utility is deficient. The purpose of this project was to design, pilot, and evaluate a POCUS workflow to facilitate technology utilization and increase access to care.

Methods: Program development and evaluation involves the design, implementation, and evaluation of an evidence-based workflow for POCUS technology. The project was intended to address the needs of individuals in a rural setting. Participants …

Evaluating & Improving Adolescent Mental Health Accessibility In Vt, Kaitlyn A. Surwilo

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Rates of anxiety among adolescents are increasing. Providers at a rural Vermont clinic identified the need for an evidence-based process to use when adolescents screen positive for anxiety. Reports from providers regarding the challenges of referring to mental health providers called the accessibility of care into question.

Purpose: The purposes of this quality improvement project are to create an evidence-based toolkit for adolescent anxiety and assess the accessibility of mental health care in Vermont.

Methods: A literature review identified mindfulness and exercise as effective tools for managing anxiety. An anxiety toolkit was designed for adolescents aged 11-18 …

Knowledge Of Guidelines On Pediatric Patients In Foster Care, Katharine A. Stones

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: The American Academy of Pediatrics (AAP) identifies children living in foster care (CFC) as a special health care needs population due to a high prevalence of health conditions. To address these disparities, the AAP released guidelines regarding the timeliness of medical assessments for CFC. Lack of recognition of the guidelines further widens health disparities experienced by this population. This project’s purpose was to 1.) Improve pediatric providers’ and nurses’ knowledge of AAP guidelines by at least 50% and 2.) Initiate acknowledgment by participants that CFC represent a special health care needs population.

Methods: Following conduction of qualitative interviews and …

Staff Education Program On Postpartum Depression Screening, Pamela Barstow

Walden Dissertations and Doctoral Studies

AbstractPostpartum depression (PPD) in the US is a serious health concern that negatively impacts an average of 11.5% of women, with 13.36% of women in Virginia in 2018 reporting PPD symptoms. Mothers experiencing PPD may have trouble bonding with their infants, which may negatively impact childhood growth and development. However, fewer than one-half of pediatricians screen mothers of infants for PPD. Literature supports staff education on PPD to promote the wellbeing of postpartum mothers and their infants. Using the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this Doctor of Nursing Practice project was to …

Increasing Rates Of Urine Albumin Creatinine Ratio Ordering By Providers In Diabetics In Adult Primary Care: A Quality Improvement Initiative, James Ehrlich

DNP Scholarly Projects

Background: The rising incidence of diabetes within the United States and worldwide has led to increased diabetes related morbidity and mortality. As the leading cause of end stage renal disease (ESRD), more attention needs to be placed on increasing rates of diabetic nephropathy screening. The vast majority of diabetics are treated in primary care, positioning primary care as a center focus for diabetes related screening and treatment.

Local problem: Low rates of diabetic nephropathy screening were noted at an academic medical center affiliated primary care clinic. A quality improvement initiative was elicited to increase the number of urine microalbumin creatine …

Estimating Weighted Panel Sizes For Primary Care Providers: An Assessment Of Clustering And Novel Methods Of Panel Size Estimation On Electronic Medical Records, Martin A. Lavallee

Theses and Dissertations

Primary Care is on the frontlines of healthcare, thus they see the most diverse set of patients. In order to achieve high functioning primary care, a practice must establish empanelment, the pairing of patients to providers. Enumeration of empanelment, or estimating panel sizes, helps ensure that the demands of the patients demand the supply of providers and optimize the balance of primary care resources to improve quality of care. Further we can adjust panel sizes by using patient-level data on healthcare utilization and complexity extracted from the electronic medial record to determine the amount of care or burden of work …

Effects Of Gender, Physical Activity, Weight Status, And Mental Health Symptomatology On Primary Care Utilization, John W. Carew, Jaime Cotton, Hannah Shoshan, Alex Gevirtz, Thomas Delaney, Donna O'Malley

Master of Public Health Culminating Projects

Objectives. To determine the association between weight status, gender, physical activity, and mental health symptomatology on utilizing primary care in the last year.

Methods. We used data from the 2019 Vermont Behavioral Risk Factor Surveillance System. We used multivariate logistic regression and X² tests of association to assess factors associated with primary care utilization.

Results. Gender and obese or overweight status are significantly associated with one’s likelihood of utilizing healthcare in the past year. For those with 1-13 bad mental health days, the odds of having utilized healthcare in the past year are 1.65 times greater among women than …

Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury

All ETDs from UAB

Background: Significant issues of inconsistent patient services in the U.S. health system impact health outcomes and create high cost. Limitations of immobility, inefficiency, and accessibility sacrifice patient treatment, delay recovery, and escalate health risks from the lack of primary care physicians. The primary purpose of this study was to examine meVisit, a connective mobile technology, as a feasible primary care solution to address escalating health costs by reducing emergency room (ER) visits and inpatient admissions (IA). Methods: The feasibility study applied descriptive and inferential statistics to secondary data (n=4,024) and compared the two independent patient groups from the same large …

Evaluating The Feasibility Of A Collaborative Care Clinical Pathway For The Treatment Of Adolescent Depression And Anxiety In Rural Pediatric Primary Care, Kayla R. Watson

Graduate Theses, Dissertations, and Problem Reports

Evaluating the Feasibility of a Collaborative Care Clinical Pathway for the Treatment of Adolescent Depression and Anxiety in Rural Pediatric Primary Care

Kayla Watson

Background: Due to a national shortage of Child and Adolescent Psychiatrists (CAP), Primary Care Providers (PCP) are often required to manage patients with mental health disorders despite a lack of focused training and lower self-efficacy or confidence in the management of these disorders. Referral to CAPs for management following the diagnosis of adolescent depression and anxiety is a common practice. The integration of mental health services within the primary care setting can overcome many of these …

Assessment Of Conduct Disorder In Primary Care: Integrative Review, Chantel M. Kilford

DNP Qualifying Manuscripts

Conduct disorder and behavioral problems in children are the 6^th most prominent childhood health disorder within the United States of America. Early recognition and interventions have shown to improve outcomes and reduce lifelong adult sequela. Evidence suggests that primary care providers are not confident or knowledgeable about identification and assessment of the disorder. The manuscript examines the prevalence, co-morbidities, trajectories, mortality risk and outcomes of conduct disorder. Health disparities and diagnostic stigma are also addressed. Additionally, the manuscript provides primary care providers with evidence-based research and recommendations for prompt identification and screening. Conduct disorder has devasting individual, social, and …