Medicine and Health Sciences Commons^™

Health Disparities Among Adults With Disabilities, Kirsten Carlberg, Madison Plone, Chrismely Castro, Nayarith Lopez

Rowan-Virtua Research Day

Background: According to the Centers for Disease Control (CDC), 27% of adults in the United States (US) live with a disability. These disabilities are often accompanied by poorer health outcomes with adults with disabilities reporting higher rates of obesity, diabetes, and cardiovascular disease. This review aims to characterize rates of disability among young adults in Camden County, New Jersey.

Methods: Data was collected from the CDC and United States Census and analyzed using Microsoft Excel 365.

Results: In 2022, 9.7% of residents of Camden County aged 18-34 were reported as disabled while the rate was 8.3% of US residents nationwide. …

A Multimodal Intervention To Aid In Smoking Cessation, Lauren Druzbicki

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC; 2023a) notes there are 28.3 million smokers in the United States. In Indiana alone, nearly 29% of adults currently use tobacco, with 19% of the total being cigarette smokers (Indiana Department of Health, 2022). The purpose of this evidence-based practice (EBP) project was to implement a multi-modal intervention to aid in smoking cessation in adults aged 18 and older who are cigarette smokers. The intervention included physician/nurse advise using the ask, advise, refer (AAR) model, the SmokefreeTXT program, and FDA approved smoking cessation medications. The project took place at a primary care …

Association Of Diet Quality With Metabolic (Dysfunction) Associated Fatty Liver Disease In Veterans In Primary Care, Natalia I Heredia, Aaron P Thrift, David J Ramsey, Rohit Loomba, Hashem B El-Serag

Journal Articles

BACKGROUND: Diet is associated with metabolic (dysfunction)-associated fatty liver disease (MAFLD), but the dietary composition associated with MAFLD risk has not been well-examined.

AIM: The purpose of this study was to assess the association of two healthy eating indices with the presence and severity of MAFLD in a sample of Veterans in a primary care setting.

METHODS: This was a single center cross-sectional study using a random stratified sample of Veterans enrolled in primary care. Participants underwent a Fibroscan and completed an interviewer-administered Diet History Questionnaire II from which we calculated the Healthy Eating Index-2015 and Alternate Mediterranean Diet Score. …

A Multimodal Intervention Treatment Plan For Adults With Generalized Anxiety Disorder In Primary Care, Morgan Cullings

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is a debilitating psychological condition that affects 3.1% of the American population and is one of the leading causes of disability (Anxiety and Depression Association of America, 2022; Baxter, 2014). The purpose of this evidence-based practice project was to implement a multimodal intervention to decrease GAD symptoms in adults in the primary care setting. The PICOT question that guided this project was: In adults, over the age of 18, who have been diagnosed with generalized anxiety disorder (GAD), does the combination of digital cognitive behavioral therapy (CBT) through a smartphone application, lifestyle modification education, and pharmacotherapy …

Risk Of Depression In A Suburban Primary Care Setting Before And During The Covid-19 Pandemic, Carman H Whiting, Pouran Yousefi, Jude K A Des Bordes, Nahid J Rianon

Journal Articles

INTRODUCTION: Major depression is a common disorder affecting millions of adults each year. Many population-based surveys showed an increase in the number people with symptoms of depression at the onset of the COVID-19 pandemic. Our aim was to determine and compare the prevalence of depression risk in a primary care setting before and during the COVID-19 pandemic.

METHODS: We conducted a cross-sectional study based on retrospective review of medical records from a large suburban primary care clinic. Records of adults 18 years and older, seen between January 1, 2019 and December 31, 2020 and who had also been screened for …

The Outcome Of A Multidimensional Intervention Strategy For The Management Of Generalized Anxiety Disorder In An Internal Medicine Setting, Nicholas Davidson

Evidence-Based Practice Project Reports

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 …

A Multimodal Approach To Decreasing Hesitancy And Increasing Uptake Of The Covid-19 Vaccine In The Family Care Setting, Meghan Zwierzynski

Evidence-Based Practice Project Reports

Since December 2019, the coronavirus disease 2019 (COVID-19) has swept across the world, infecting and killing millions of people, making it one of the worst pandemics in history (WHO, 2021). However, the rates of confirmed cases and deaths have slowed since the discovery of the COVID-19 vaccine. The purpose of this evidence-based practice (EBP) project was to decrease vaccine hesitancy and increase uptake of the COVID-19 vaccine in the family care setting. The Iowa Model-Revised (Iowa Model Collaborative, 2017) is a practical, effective multi-step change process that acted as a guide for the EBP project. A review of literature showed …

Secondary Stroke Prevention Retrospective Analysis, Mansi Panse, Samantha Plasner, Nasrine Bendjilali

Rowan-Virtua Research Day

Stroke is the leading cause of serious long-term disability among adults in the United States, and there are well recognized modifiable risk factors for stroke. Secondary prevention efforts to reduce the likelihood of recurrent stroke should be top priority in this high-risk patient population. The role of the primary care team in implementing and assisting patients with adherence to secondary prevention efforts is critical. The objective of this retrospective analysis is to examine how successful primary care providers are at implementing secondary stroke prevention guidelines.

Preventing secondary stroke is critical to the welfare of this high-risk population and ultimately saves …

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 …

Implementation Of A Cost-Effective Treatment Algorithm For The Management Of Acne Vulgaris In College Students, Cristina Borsilli

Evidence-Based Practice Project Reports

Acne is one of the most common skin disorders in the United States, occuring in over 5.1 million Americans. Of those with acne, 53.8% are adults between the ages of 18 and 44 years old (American Academy of Dermatology [AAD], 2017). Acne can lead to multiple issues such as scarring, poor self-esteem, anxiety, and depression (Zaenglein et al., 2016). Acne can also negatively impact quality of life (Cengiz & Gurel, 2020). The purpose of this evidence-based project was to develop a cost-effective treatment algorithm for the management of acne vulgaris in adult college students. A literature search determined the best …

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 …

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 …

Drug Susceptibility Patterns Of Mycobacterium Tuberculosis From Adults With Multidrug-Resistant Tuberculosis And Implications For A Household Contact Preventive Therapy Trial, Anne-Marie Demers, Soyeon Kim, Sara Mccallum, Kathleen Eisenach, Michael Hughes, Linda Naini, Alberto Mendoza-Ticona, Neeta Pradhan, Kim Narunsky, Selvamuthu Poongulali, Sharlaa Badal-Faesen, Caryn Upton, Elizabeth Smith, N Sarita Shah, Gavin Churchyard, Amita Gupta, Anneke Hesseling, Susan Swindells, Actg A5300/Impaact I2003 Phoenix Feasibility Study Team

Journal Articles: Internal Medicine

BACKGROUND: Drug susceptibility testing (DST) patterns of Mycobacterium tuberculosis (MTB) from patients with rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant TB (MDR-TB; or resistant to rifampicin and isoniazid (INH)), are important to guide preventive therapy for their household contacts (HHCs).

METHODS: As part of a feasibility study done in preparation for an MDR-TB preventive therapy trial in HHCs, smear, Xpert MTB/RIF, Hain MTBDRplus, culture and DST results of index MDR-TB patients were obtained from routine TB programs. A sputum sample was collected at study entry and evaluated by the same tests. Not all tests were performed on all specimens due to variations …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

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

Articles, Abstracts, and Reports

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 …

Adult Oral Health Access And Advocacy, James Duguay

Family Medicine Clerkship Student Projects

Many adults lack adequate preventative oral healthcare due to multiple factors. Oral health is important due to its effects on systemic health as well as for quality of life issues.

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

The Effect Of Routine Adult Phq-2 Depression Screen And Scheduled Follow-Up Protocol In The Primary Care Setting, Alex F. Bikowski

Evidence-Based Practice Project Reports

Healthy People has projected depression to be the primary cause of disability by 2020; therefore routine depression screening has been prioritized as a national healthcare initiative. The purpose of this Evidence-Based Practice (EBP) project is to demonstrate that routine implementation of the 2-item Patient Health Questionnaire (PHQ-2) depression screener, along with a scheduled follow-up protocol for adults in the primary care setting, can improve current mental health practices regarding the identification of depression by clinicians. The evidence supports use of the PHQ-2 for routine adult depression screening, as long as a scheduled follow-up protocol is available for positive screens. This …

Mindfulness As An Effective Strategy For Anxiety Relief In Adolescent Patients, Desiree N. Dibella

Family Medicine Clerkship Student Projects

Anxiety disorders affect 6.8 million adults over the age of 18 in the United States, and anxiety disorders are the most common mental health illness in children.

Risk Factors for anxiety disorders in young adults include the following: -Shyness, or behavioral inhibition, in childhood -Being of the female sex -Having few economic resources -Exposure to stressful life events in childhood -Anxiety disorders in close biological relatives -Parental history of mental disorders -Elevated afternoon cortisol levels in the saliva Teens and young adults increasingly suffer from anxiety disorders with the CDC reporting the rate of anxiety disorders among 3 to 17 …

A Multimodal Approach To Hypertension: Behavioral Modifications On A Budget, Jayne Manigrasso

Family Medicine Clerkship Student Projects

Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.

Antiretroviral Therapy For The Prevention Of Hiv-1 Transmission., Myron S. Cohen, Ying Q. Chen, Marybeth Mccauley, Theresa Gamble, Mina C. Hosseinipour, Nagalingeswaran Kumarasamy, James G. Hakim, Johnstone Kumwenda, Beatriz Grinsztejn, Jose H.S. Pilotto, Sheela V. Godbole, Suwat Chariyalertsak, Breno R. Santos, Kenneth H. Mayer, Irving F. Hoffman, Susan H. Eshleman, Estelle Piwowar-Manning, Leslie Cottle, Xinyi C. Zhang, Joseph Makhema, Lisa A. Mills, Ravindre Panchia, Sharlaa Faesen, Joseph Eron, Joel Gallant, Diane Havlir, Susan Swindells, Vanessa Elharrar, David Burns, Taha E. Taha, Karin Nielsen-Saines, David D. Celentano, Max Essex, Sarah E. Hudelson, Andrew D. Redd, Thomas R. Fleming

Journal Articles: Internal Medicine

BACKGROUND: An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

METHODS: We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 …

Beta-Blocker Use And Clinical Outcomes In Stable Outpatients With And Without Coronary Artery Disease, Elena Simon Md

Family Medicine Scholarly Works

Clinical Question: Which patients should be placed/kept on beta-blocker therapy?

Bottom Line Answer:

• Randomized control trials show beta-blockers benefit patients with systolic congestive heart failure and for the first three years after a patient has a MI.
• Beta-blocker use may not be associated with lower event rates of CV death, non-fatal MI, stroke of hospitalization in patients even with prior history of MI after 3 years.

Hepatitis C Screening, Stanley Hunter Md

Family Medicine Scholarly Works

Clinical Question: Does screening baby boomers for Hepatitis C decrease mortality and/or save money?

Bottom Line Answer: Age-based screening for hepatitis C is cost effective ($4900 per QALY gained) for those born between 1945 and 1965.

Lyme Disease Prophylaxis: Idsa Guidelines, Kristine Cruz Md

Family Medicine Scholarly Works

Clinical Question: When should patients be given antibiotics for lyme prophylaxis after a tick bite?

Bottom Line Answer: To provide antibiotic prophylaxis for Lyme disease ALL of these criteria should be met:

• Tick identified as an adult or nymphal deer tick
• Attached for > or = 36 hours (by engorgement or time of exposure)
• Treatment started within 72 hours of tick removal
• Local rate of infection of ticks with B. Bourgdorferi >=20% (assumed in Vermont)
• Doxyclycline is not contraindicated

The Importance Of Examining Movements Within The Us Health Caresystem: Sequential Logit Modeling, Chioun Lee, Stephanie L L. Ayers, Jennie Jacobs Kronenfeld, Jemima A. Frimpong, Patrick A. Rivers, Sam S. Kim

Dartmouth Scholarship

Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., …

The Increasing Number Of Clinical Items Addressed During The Time Of Adult Primary Care Visits, Elmer D. Abbo, Qi Zhang, Martin Zelder, Elbert S. Huang

Community & Environmental Health Faculty Publications

BACKGROUND: Primary care physicians report that there is insufficient time to meet patients' needs during clinical visits, but visit time has increased over the past decade.

OBJECTIVE: To determine whether the number of clinical items addressed during the primary care visit has increased, and if so, whether this has been associated with changes in visit length and the pace of clinical work.

DESIGN: Analysis of non-hospital-based adult primary care visits from 1997 to 2005, as reported in the National Ambulatory Medical Care Survey.

PARTICIPANTS: A total of 46,431 adult primary care visits.

MEASUREMENTS: We assessed changes over time for …