Primary Care Commons^™

Reducing Benzodiazepine Use For The Treatment Of Insomnia And Supporting Nonpharmacological Therapies, Unchan Pyon

Family Medicine Clerkship Student Projects

Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.

Impact Of A Boot Camp Translation Intervention On Self-Management Support In Primary Care, Donald E. Nease Jr., Jeanette M. Daly, L. Miriam Dickinson, Douglas H. Fernald, David L. Hahn, Barcey T. Levy, Leann C. Michaels, Matthew J. Simpson, John M. Westfall, Lyle J. Fagnan

Journal of Patient-Centered Research and Reviews

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools.

Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager ...

Hot Spotting Medically Complex At-Risk Patients In An Urban Primary Care Residency Clinic, Glenda Sundberg, Chris Peters, Catherine De Grandville, Natalie Sorenson, Rinal Patel, Melissa Grube

Journal of Patient-Centered Research and Reviews

Background: In the United States, 5% of patients incur 50% of health care costs. Hot spotting, a collaborative care approach, may improve patient outcomes and decrease health care costs among those considered to be super-users. Aurora Health Care may benefit from this new and innovative approach to care.

Purpose: The purpose of this pilot project was to create a more formalized plan for managing the most complex patients at Aurora St. Luke’s Family Practice Center (Milwaukee, WI).

Methods: During 2017, 20 medically at-risk patients ≥ 18 years of age were identified and tracked. Each patient was asked to voluntarily participate ...

Implementing Community-Created Self-Management Support Tools In Primary Care Practices: Multimethod Analysis From The Insttepp Study, Douglas H. Fernald, Matthew J. Simpson, Donald E. Nease Jr., David L. Hahn, Amanda E. Hoffmann, Leann C. Michaels, Lyle J. Fagnan, Jeanette M. Daly, Barcey T. Levy

Journal of Patient-Centered Research and Reviews

Purpose: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools.

Methods: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case ...

Refugees In Milwaukee: Demographic And Health-Related Characteristics Post-Immediate Resettlement, Vy T. Dinh, Fabiana Kotovicz, Natalie Sorenson

Journal of Patient-Centered Research and Reviews

Background: Since 2002, more than 13,000 refugees have resettled in Wisconsin, with two-thirds of that population residing in the city of Milwaukee.

Purpose: To explore the demographic and health-related characteristics of a growing and dynamic refugee population in Milwaukee.

Methods: We conducted a retrospective chart review of 122 established refugee patients at two family medicine residency clinics.

Results: Of the initial 268 patients who underwent the initial refugee examination, 122 (mean age: 26 years; gender: 54.0% male, 45.9% female) established care with a provider at one of the two studied primary care clinics at least 8 months ...

Patient Barriers For Weight Management Among African American Women, Owen Bowie, Jennifer Kusch, George L. Morris Iii, Tracy Flood, Jessica Gill, Renee E. Walker, Ron A. Cisler, Jennifer T. Fink

Journal of Patient-Centered Research and Reviews

Purpose: The primary aim of this study was to assess the perceptions of local African American women who are overweight or obese using semi-structured focus groups to identify barriers to weight management and factors that support strategy success. The secondary aim of this study was to determine recommendations for patient-centered weight management interventions established specifically for African American women in the Milwaukee-area community.

Methods: Three semi-structured focus groups to explore barriers to weight management were performed among women patients. Participants (N = 41) were recruited via email, postal mail, and phone as available from an academic medical center in Milwaukee, Wisconsin ...

Improving The Quality Of Life Of Patients With Chronic Pain: A Pilot Study, Betty Amuzu, Jessica J.F. Kram, Niraj Nijhawan

Journal of Patient-Centered Research and Reviews

Background: Mind and body tools, such as exercise and meditation, can impact pain-reducing brain areas and lessen the pain experience for patients with chronic pain.

Purpose: To see if introduction of mind/body tools has measureable improvement on quality of life for patients with chronic pain.

Methods: As previously reported, we conducted a pilot study on adult women with stable chronic pain who were resistant to conventional therapies. Our intervention began in June 2015 and consisted of an initial 8-hour session. Following the initial session, meetings were 1.5 hours long weekly for 8 weeks, followed by biweekly meetings for ...

Integrated Treatment Of Substance Use Disorders And Trauma Experiences: The Women Of Worth Program, Melissa A. Lemke, Lisa Berger

Journal of Patient-Centered Research and Reviews

Background: Up to 60% of women who enter substance use disorder (SUD) treatment also have been diagnosed with posttraumatic stress disorder (PTSD), which is higher than the U.S. general population of women. Traditionally, SUD and mental health treatment have occurred in separate systems, and providers in each system tend to not be dually trained. Yet, current research has found that clients with PTSD in standard SUD treatment programs experience poorer outcomes compared to their counterparts without PTSD. Given the high prevalence of PTSD among women in SUD treatment, treating both disorders at the same time and by the same ...

Characteristics Of Patients In The Specialty Access For Uninsured Program, Sally Smaida, Widalys Calderon Torres, Jessica J.F. Kram, Michelle Tong, Stephen J. Ohly, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: The Specialty Access for Uninsured Program (SAUP) is a Milwaukee County health system collaborative in which safety-net primary care clinics are paired with hospital/health systems. The clinics provide primary care services, while the hospitals provide a network of specialists. All specialty services are “covered” under SAUP at no cost.

Purpose: To examine the clinical, geodemographic, and referral pattern features of our SAUP patients and their journey to specialized care.

Methods: We prospectively identified and retrospectively reviewed patients ≥ 18 years of age residing in Milwaukee County that were enrolled in SAUP during 2017. To be eligible for SAUP (ie ...

How To Translate Self-Management Support Tools Into Clinical Practice, Matthew J. Simpson, Jeanette M. Daly, Douglas H. Fernald, John M. Westfall, Leann C. Michaels, Barcey T. Levy, David L. Hahn, Lyle J. Fagnan, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients.

Methods: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks’ Self-management Tools Through Engaging Patients and ...

Adapting Boot Camp Translation Methods To Engage Clinician/Patient Research Teams Within Practice-Based Research Networks, Lyle J. Fagnan, Matthew J. Simpson, Jeanette M. Daly, Leann C. Michaels, David L. Hahn, Barcey T. Levy, Douglas H. Fernald, John M. Westfall, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective.

Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp ...

Patient Self-Management: Tools And Barriers, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In his issue introduction, the editor-in-chief of the Journal of Patient-Centered Research and Reviews comments on the theme of patient self-management of chronic diseases and the related articles published therein. Illnesses such as cardiovascular disease, diabetes, epilepsy, arthritis, asthma, and obesity often require patients to administer their own medication daily or adhere to strict dietary restrictions. Progress is being made on the process of implementation and evaluation of patient self-management tools in primary care practices. Barriers to self-management tool implementations in clinics, as well as their use by individual patients, must be understood and addressed.

Nortex Fall 2018 Newsletter, North Texas Primary Care Practice-Based Research Network

North Texas Primary Care Practice-Based Research Network (NorTex) Newsletter

No abstract provided.

Emerging Themes In Food Security: Environmental Justice, Extended Families And The Multiple Roles Of Grandmothers., Ethel Alderete, Lauren Sonderegger, Eliseo J Pérez-Stable

Journal Articles and Abstracts

BACKGROUND: Pre- and perinatal nutritional status defines the development of adult metabolism and energy balance in humans. Young children in poor households are disproportionately more vulnerable to food insecurity given the cumulative impact of chronic stress on susceptibility to chronic diseases as an adult. Qualitative studies focusing on the experience of food insecurity in Latin America are scarce. In Argentina, although socioeconomic indicators improved in the aftermath of the 2001ecomomic crisis, the disadvantaged provinces in the north continue to bear the burden of historical inequities. The study was conducted among Primary Health Care patients in the city of San Salvador ...

Intravenous Glucocorticoids Provide No Additional Benefit Over Oral Glucocorticoids In Chronic Obstructive Pulmonary Disease Exacerbation, Alexander C. Waselewski

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of de Jong YP, Uil SM, Grotjohan HP, Postma DS, Kerstjens HA, van den Berg JW. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132(6):1741-1747. doi: 10.1378/chest.07-0208

Early Oral Refeeding In Acute Pancreatitis Reduces Length Of Hospital Stay, Sylvie B. Polsky

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Lariño-Noia J, Lindkvist B, Iglesias-García J, Seijo-Ríos S, Iglesias-Canle J, Domínguez-Muñoz J. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: A randomized open-label trial. Pancreatology. 2014;14(3):167-173. doi: 10.1016/j.pan.2014.02.008.

Exploring The Role Of Ceftaroline In The Treatment Of Community-Acquired Pneumonia, Zachary Meyer

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of File TM Jr, Low DE, Eckburg PB, Talbot GH, Friedland HD, Lee J, Llorens L, Critchley IA, Thye DA, FOCUS 1 investigators. FOCUS 1: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia. J Antimicrob Chemother. 2011 Apr;66 Suppl 3:iii19-32. doi: 10.1093/jac/dkr096

The Role Of Primary Care Nurses In Addressing Unmet Social Needs, Susan Natale

Graduate School of Nursing Dissertations

PURPOSE

The purpose of this study was to explore how primary care registered nurses address unmet social needs in patients.

SPECIFIC AIMS

• Explore how RNs in a safety-net, primary care setting develop an awareness of and address patient's unmet social needs.
• Describe how information about unmet social needs are integrated into nursing assessment and intervention activities, and are shared with other members of the health care team.
• Describe the challenges primary care RNs face when addressing unmet social needs.

FRAMEWORK

Critical caring theory provided the framework for this study.

DESIGN

This study used a descriptive, qualitative design. Semi-structured interviews ...

Racial/Ethnic Disparities In Diabetes Care And Outcomes: A Mixed Methods Study, Yhenneko J. Taylor, Marion E. Davis, Rohan Mahabaleshwarkar, Melanie D. Spencer

Journal of Health Disparities Research and Practice

Limited research has examined racial/ethnic differences in diabetes care and outcomes among primary care patients. This study examined racial/ethnic differences in diabetes care and outcomes among an ambulatory patient population and explored patient perceptions of the patient-provider relationship to inform strategies to improve care delivery. Using data from 62,149 adults with diabetes who received care within Atrium Health in 2013, regression models assessed associations between race/ethnicity and the following outcomes: glycated hemoglobin (HbA1c) tests, low density lipoprotein (LDL) and blood pressure (BP) screening, foot and eye exams, and HbA1c, LDL, and BP control. Eleven patients with ...

Using Clinical Decision Support Within The Electronic Health Record To Reduce Incorrect Prescribing For Acute Sinusitis, Regina Ginzburg, Justin J. Conway, Eve Waltermaurer, Wendy Song, Samantha P. Jellinek-Cohen

Journal of Patient-Centered Research and Reviews

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis.

Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health ...