Internal Medicine Commons^™

Improving Cancer Screening Rates In Primary Care Via Practice Facilitation And Academic Detailing: A Multi-Pbrn Quality Improvement Project, Christopher P. Morley, Laura A. Schad, Laurene M. Tumiel-Berhalter, Laura A. Brady, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger

Journal of Patient-Centered Research and Reviews

Purpose: In the United States, cancer screening rates are often below national targets. This project implemented practice facilitation and academic detailing aimed at increasing breast, cervical, and colorectal cancer screening rates in safety-net primary care practices.

Methods: Three practice-based research networks across western and central New York State partnered to provide quality improvement strategies on breast, cervical, and colorectal cancer screening. Pre/postintervention screening rates for all participating practices were collected annually, as were means across all practices over 7 years. Simple ordinary least squares linear regression was used to calculate the trend for each cancer type and test for statistical …

Patient And Clinician Characteristics That Predict Breast Cancer Screening Behavior In 40–49-Year-Old Women, Sarina Schrager, Claudia Evaristo, Terry Little, Lori Dubenske, Elizabeth S. Burnside

Journal of Patient-Centered Research and Reviews

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women’s breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe

HCA Healthcare Journal of Medicine

Background

Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.

Methods

This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …

Determining The Perception And Willingness Of Primary Care Providers To Prescribe Advanced Diabetes Technologies, Alexander O’Donovan, Sean M. Oser, Jessica Parascando, Arthur Berg, Donald E. Nease Jr., Tamara K. Oser

Journal of Patient-Centered Research and Reviews

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically …

Anal Cancer Screening At Truman Health Services, Peter D. Tran, Harshdeep Babbar

Quality Improvement/Patient Safety Symposium

Anal Papanicoloau Screening at Truman Clinic

Anal cancer is a squamous cell cancer associated with human papillomavirus (HPV), the same virus that is associated with cervical cancer. Although vaccination against HPV has been shown to be effective in reducing overall rates of infection, the number of new anal cancer cases has been rising for many years. In HIV-infected men and women, the incidence is even higher of anal cancer than in the general population. Current rates in an HIV-infected MSM population have been estimated to be as high as 70-144 per 100,000, with some studies of HIV-infected individuals showing that …

A Tailored Multicomponent Intervention In Primary Care For Survivors Of Adverse Childhood Experiences (Aces), Rebecca L. Peterson

Evidence-Based Practice Project Reports

Adverse childhood experiences (ACEs) include 10 traumatic events of abuse, neglect, and household dysfunction that occur before 18 years of age. Adverse childhood experiences affect greater than 60% of the population, and approximately one in six individuals affirm that they have experienced four or more types of ACEs. They are associated with negative, long-term health outcomes in adults, including 9 out of the 10 leading causes of death in the United States (Centers for Disease Control and Prevention, n.d.; Felitti et al., 1998). The purpose of this evidence-based practice project was to implement a tailored, multicomponent intervention to mitigate the …

Keeping Primary Care Providers Informed About Detecting Skin Cancer In Young Adults, Riley J. Spears

Evidence-Based Practice Project Reports

Skin cancer is a common, life-threatening disease that affects anyone, regardless of age or skin color (American Cancer Society [ACS], 2020). The incidence of melanoma is on the rise for young adults, with an estimated 2,400 new cases for individuals aged 15 to 29 (ACS, 2020). Although skin cancer is highly preventable, clinical guidelines are inconsistent regarding skin cancer screening. The purpose of this evidence-based practice (EBP) project was to determine if the implementation of the INternet curriculum FOR Melanoma Early Detection (INFORMED) program would improve primary care providers’ (PCPs’) confidence about skin cancer and the number of completed and …

Efficacy Of Diabetes Self-Management Education Administered Via Telehealth For Adults With Uncontrolled Diabetes, Tanner Free

Evidence-Based Practice Project Reports

Patient’s with a diagnosis of diabetes require significant lifestyle modification and education. The need for patient education has led to the development of diabetes self-management education (DSME) classes. Unfortunately, utilization of DSME classes is only 5% among Medicare beneficiaries and 6.8% among privately insured patients (Centers for Disease Control [CDC], 2018). The purpose of this evidence-based practice (EBP) project was to implement DSME via telehealth and assist with goal formation to help patients with uncontrolled diabetes achieve glycemic control by increasing access to crucial education. The intervention consisted of bi-weekly calls for a period of 3 months. Participant data were …

The Use Of Automated Text Messaging As An Intervention For Smoking Cessation, Oluwasayo Sinkaiye

Evidence-Based Practice Project Reports

Tobacco smoking is a widespread problem that affects the adult population in the United States (U.S.). In 2018, about 14 of every 100 adults in the USA aged 18 years or older were cigarette smokers (Centers for Disease Control and Prevention [CDC], 2020). Tobacco smoking is associated with chronic disease conditions that have serious health implications including cancer, heart disease, diabetes, and chronic obstructive pulmonary disease (COPD) (CDC, 2020). The purpose of this evidence-based practice project (EBP) was to determine the effectiveness of an automated text messaging application (SmokefreeTXT) for smoking cessation in a primary care setting for adult cigarette …

Heart-Healthy Integrative Nutritional Counseling Group Education Sessions Among Chinese Americans With Cardiovascular Risk Factors Or Disease: A Primary Care Quality Improvement Pilot, Jasmin Woo, Evelyn Y. Ho, Jane Jih

Journal of Patient-Centered Research and Reviews

Purpose: Current biomedical cardiovascular disease nutrition counseling does not incorporate Chinese medicine principles.

Methods: A heart-healthy integrative nutritional counseling (H2INC) curriculum consistent with Chinese medicine principles and biomedical nutrition guidelines was taught to Chinese Americans in group education sessions. Chinese-speaking patients with cardiovascular disease or risk factors from an urban general medicine practice were recruited to attend a 90-minute group session. Participants completed pre-post surveys to assess the impact of H2INC on their perceived heart-healthy nutrition knowledge and empowerment, as well as the cultural relevance of H2INC.

Results: A total of 47 participants (mean age: 74 years; 63.8% female) attended …

A Smartphone Intervention To Reduce Hospital Readmission Rates In Adult Patients Who Have Heart Failure, Jami L. Crisman

Evidence-Based Practice Project Reports

Heart failure (HF) is the leading cause of 30-day hospital readmission, with up to 23.5% of Medicare beneficiaries requiring subsequent admission within 30 days post hospital discharge (CMS, 2020a). Mobile-health applications (MHA), such as smartphone applications, have emerged as cost-effective methods to safely manage chronic disease in the outpatient setting (Inglis et al., 2015). The purpose of this evidence-based practice (EBP) project was to evaluate the impact of a MHA on HF-related 30-day readmission rates. The Iowa Model Revised guided the implementation of the project in a rural, for-profit hospital in Northwest Indiana. An extensive literature search was conducted, and …

Hypertension Management: Improving Medication Adherence Through The Use Of Daily Text Messages, Gaelle Bulabula

Evidence-Based Practice Project Reports

Hypertension (HTN) is the leading cause of hospitalization and is responsible for approximately 50% of cardiovascular and cerebrovascular events (Al-Noumani, et al., 2018). Uncontrolled HTN can lead to comorbidities including ischemic heart disease, renal disease, or life-threatening arrythmias (World Health Organization [WHO], 2019). The leading cause of HTN is medication non-compliance (Varleta, et al., 2017). The purpose of this evidence-based practice project was to determine the effectiveness of daily text messages on antihypertensive medication adherence. A comprehensive review of literature generated ten high-level evidence studies demonstrating that daily text messages near each medication dosing time is best practice for improving …

A Watched Pot Never Boils: Attentive Care Needs No Timer, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on the premise that length of patient consultation time is less important than what patients perceive happened during that time. Regardless of the time allotted to a clinical visit, health care providers should make efforts to address the emotional and psychosocial needs of their patients. As always, taking a little time to express empathy can make a big difference in patient satisfaction.

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Dry Eye: Patient Education, Mark Oet

Family Medicine Clerkship Student Projects

Recent literature has shown increased incidence of dry eye and eye strain symptomatology during the COVID-19 pandemic, coinciding with an increase in screen time for almost all populations. This project aims to address this observation at a community level by creating a patient-friendly education pamphlet for Newtown Primary Care about dry eye and digital ocular strain based on American Academy of Ophthalmology guidelines.

The Preventative Healthcare Shortage: A Look At The Vt And Ct Community Perspectives And Medical Student Interest, Michael J. Lawler

Family Medicine Clerkship Student Projects

We adapted and modified a previously generated survey to better understand the motivations and barriers of medical students to enter primary care. The survey was dispersed to all medical students at LCOM as well as third and fourth year medical students at Ross University and American University of the Caribbean (AUC). We analyzed preliminary data from 100 respondents. Notable barriers identified included cost of medical school, stigma associated with primary care, and inadequate time spent with patients. Recommendations for possible intervention were discussed.