Medicine and Health Sciences Commons^™

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Efforts To Reduce Concomitant Opioid And Benzodiazepine Prescribing At The Lexington Veterans Affairs Medical Center, Kaitlyn A. Staton

MPA/MPP/MPFM Capstone Projects

The United States is in the throes of an opioid epidemic. Any person who uses an opioid medication may experience an intentional or unintentional overdose. An overdose is more likely to occur when an individual ingests an opioid in combination with certain classes of medications, such as benzodiazepines or nonbenzodiazepines (Z-drugs). These medications are more likely to cause sedation and respiratory depression when taken together. Veterans, due to their unique mental and physical health challenges, are more likely to experience an overdose when they receive a combination of opioid therapy with benzodiazepine or Z-drug therapy as opposed to a single …

Comparative Storage And Utilization Analysis Of Insulin Across Inpatient Hospital Settings, Tristan A. Moorman

MPA/MPP/MPFM Capstone Projects

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Psychotropic Medication Utilization In Care Home Residents Age 65 Or Older Compared With The Equivalent General Population In Scotland, Tyler P. Stewart

MPA/MPP/MPFM Capstone Projects

Purpose: In Scotland, care homes provide assisted living and medical services. Psychotropic medications (antipsychotics, anxiolytics, and hypnotics) may be over utilized in these facilities. This study compared psychotropic medication utilization in elderly care home residents to the equivalent population of non-care home residents. It is hypothesized that patients in care homes utilize psychotropic medications more than non-care home residents.

Methods: Demographic and prescription information for all patients aged 65 years and older on January 1, 2011 who received at least one prescription for a psychotropic medication during 2011 was retrieved from the national Prescribing Information System (PIS). Patients were grouped …

Kentucky Pharmacist Opinions Of The Potential Reclassification Of Pseudophedrine As A Legend Drug, Kathleen E. Monson

MPA/MPP/MPFM Capstone Projects

Methamphetamine is a drug of abuse, which is often produced in clandestine laboratories. Recent efforts to curb methamphetamine abuse are aimed at controlling access to precursors, including pseudoephedrine (PSE), used in illicit methamphetamine production. Currently, access to PSE is controlled in Kentucky by placement behind pharmacy counters, retail quantity limitations and electronic tracking. Recent legislation proposed in Kentucky to change PSE from non-prescription to a legend medication was unsuccessful and highly controversial. The objective of this project is to collect and analyze pharmacists’ opinions on the effectiveness of current precursor controls, proposed legislation to make PSE a legend drug and …

Influence Of Prescription Drug Monitoring Programs On Acetaminophen-Related Liver Toxicity, Aaron Barcelo

MPA/MPP/MPFM Capstone Projects

No executive summary.

Influence Of Medical Marijuana Programs On Controlled Substance Utilization, James A. Farley Ii

MPA/MPP/MPFM Capstone Projects

Currently there are no studies examining the impact of medical cannabis programs on controlled substance prescribing. The intent of this study is to conduct a preliminary investigation into whether cannabis substitution for prescription drugs results in lower rates of controlled substance use. The hypothesis is that controlled substance use (in this project, defined by controlled substance supply) will decline in states after the introduction of medical cannabis programs.

State and year–specific per capita retail distributions of the seven most commonly prescribed opioid drugs (fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone) were obtained from the Automation of Reports and Consolidated …

Should Pseudoephedrine (Pse) Be Moved From Behind The Counter To Prescription-Only? An Analysis Of Pse As An Otc Medication And A Precursor For Methamphetamine Production, Jerry Dillon

MPA/MPP/MPFM Capstone Projects

Kentucky State Senator Tom Jensen recently sponsored Senate Bill 45, which would change pseudoephedrine (PSE) from an over-the-counter to a schedule V prescription-only drug. The bill failed, but the debate continues as to whether Kentucky should make PSE, a precursor required to manufacture illicit methamphetamine, a controlled drug that is available by prescription only.

Methamphetamine abuse has been increasing in Kentucky as well as in the rest of the country, despite efforts to control the sale of PSE through federal and state legislation. The Combat Methamphetamine Epidemic Act (CMEA) of 2006 and Kentucky’s initiative to electronically monitor the sales of …

Dental Service Utilization In An Academic Setting: An Analysis For Improved Oral Health, Paula R. Sandford

MPA/MPP/MPFM Capstone Projects

The National Oral Health Surveillance System (NOHSS) is the result of a collaborative effort between the Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors which is designed to monitor aspects of oral health and disease on both a national and state level. The NOHSS ranks Kentucky at or near the bottom in most oral health indicators. The primary message of the Surgeon General’s May 2000 report on Oral Health in America was to emphasize the link between oral health and overall health including the effect on day‐to‐day activities such as work and school …

The Relationship Between Obesity And Skin And Soft Tissue Infections, Juliana Swiney

MPA/MPP/MPFM Capstone Projects

The Problem:

It is well known that our country is experiencing an obesity epidemic: 33.9% of all adults are obese (BMI>30) and 67% of adults are either overweight or obese (BMI>25). Obesity is a risk factor for several serious disease states such as, diabetes, stroke, hypertension, heart disease and some types of cancer. It also has a less well defined relationship with skin and soft tissue infections.

Although it is known that excessive weight increases the opportunity for harmful skin conditions, this relationship has not been as well studied. Some of the mechanisms that predispose obese people to …

The Implementation Of The Kentucky Transitions: A Money Follows The Person Demonstration Grant Program, Amie Goodin

MPA/MPP/MPFM Capstone Projects

Kentucky Transitions is a Kentucky Medicaid program that is funded primarily by a grant from the Centers for Medicare and Medicaid Services. The purpose of this program is to transition individuals residing in long-term care facilities back into the community, where they will continue to receive health, social, and other benefits but do so in an approved residential setting. Individuals living in the community may experience higher quality of life and the increased ability to choose how and when they receive services, while Medicaid reaps the projected financial benefit of providing less-expensive community alternatives for care.

Though Kentucky Transitions operates …

Evaluating The Healthy States Initiative Policy Forums, Jessica Harmon

MPA/MPP/MPFM Capstone Projects

Since 2005, The Council of State Governments (CSG) has participated in a cooperative agreement funded by the Centers for Disease Control and Prevention (CDC) called the Healthy States Initiative. The initiative promotes public health by providing information resources to state legislators through publications and public health forums. CSG is interested in information about the impact of the public health forums on state legislators. More specifically, they would like to know if the forums have encouraged the participants to produce public health legislation, to support funding for public health projects, and to work closely with colleagues and various groups to improve …

The Influence Of Veterinary Schools On The Veterinary Labor Market, Kyle Bosh

MPA/MPP/MPFM Capstone Projects

Problem Statement:

Does the presence of a veterinary school in a state influence the supply of veterinarians practicing in that state? Citizens and animals in states without a veterinary school are at a disadvantage if the presence of a veterinary school significantly improves public health and access to medical services in those states that have a veterinary school.

Research Strategy:

The unit of analysis in this study is 50 states and the District of Columbia. The study is designed as a cross-sectional analysis of 2006 pet, 2002 livestock, 2006 human, labor, and economic data. The study uses simultaneous equations to …

Mental Illness And Barriers To Health Care Access, Charlene Powell

MPA/MPP/MPFM Capstone Projects

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

• Does mental illness predict greater difficulties with access to health care?

Methodology

The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate …