Medicine and Health Sciences Commons^™

Perceptions And Experiences Of Adopting A Technology Based Intervention For Alcohol Screening And Referral To Treatment In Primary Care, Sonya L. Lachance

Doctoral Dissertations

Alcohol abuse is a significant concern in the United States. Today in the U.S., 15.1 million adults ages 18 and older, have been identified as having an alcohol use disorder. Alcohol abuse and binge drinking are highest amongst college students. More than 58.0 percent of college students admit to regular binge drinking or heavy alcohol use every month. Left unaddressed, this leads to negative health consequences later in life. The United States Preventive Services Task Force states that there is strong evidence that screening patients in primary care can reduce alcohol use disorder. Though screening, brief intervention, and referral to …

Increasing Adherence To Measurement-Based Depression Management In Primary Care, Renad Saadat

Doctor of Nursing Practice

Background and Review of Literature. Approximately 11 million Americans 18 years or older experienced a severe symptom of depression leading to impairment in 2017. The severity of depressive symptoms is often miscalculated in primary care as measurement-based tools for the diagnosis and ongoing reassessment varies. Purpose. The purpose of the project was to increase provider adherence in using the patient health questionnaire-9 (PHQ-9) for ongoing evaluation of the severity of depressive symptoms in patients with depression at a primary care clinic in San Antonio, Texas. Objectives. The main objective of this Doctor of Nursing Practice project is …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Missed Appointment Rates And The Implication On Primary Care Practice, Kelly Martin

Dissertations

Problem: Missed appointments cost primary care facilities money and resources through lack of utilization. When patients fail to attend their scheduled appointment the providers are non-productive when they could be seeing other patients that are potentially moved to other days, sending patients to other providers, or worse sending patients to the prompt care or the Emergency Department for care. The missed appointment rate at Office A Primary Care is approximately ten percent, while Office B has a nearly 11% missed appointment rate. Both facilities make reminder calls to patients the day before their appointments to remind them of their appointment …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

Identifying, Adapting, And Implementing A Weight Management Program In Rural Primary Care, Gwenndolyn Porter

Theses & Dissertations

Rural adults are at heightened risk for obesity, yet evidence‐based interventions lack consistent translation into clinical practice. This multi-phase study addresses this gap. First, a systematic review and meta-analysis of rural adult weight loss interventions were conducted to assess overall impact. Though few studies reported participant representativeness, meta‐analyses revealed a significant weight reduction among interventions. Second, 10 focus groups were conducted with primary care (PC) staff to determine the feasibility of implementing a weight-management program through PC. Differences in responses among rural, micropolitan, and metropolitan was also assessed. Thematic analyses revealed rural PC currently lacks the capacity to manage patient …

Patient Knowledge And Perception Regarding Antibiotic Misuse In Primary Care, Aimee Cockerham, Megan Mcdaniel, Hannah Mcmillin, Kelly Nash, April Robinson

MSN Research Projects

The Centers for Disease Control (CDC) and Prevention’s 2019 Antibiotic Resistant Threats Report shows that antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year. This equates to at least one infection every 11 seconds and one death resulting from antibiotic resistance every 15 minutes. The CDC states that there were almost twice as many deaths each year from antibiotic resistance compared to statistics reported in 2013 (CDC, 2019a). Proper antibiotic use is the responsibility of the provider and the patient. Patient knowledge should consist of how to prevent antibiotic misuse, …

Examining Provider Perceptions And Roles Associated To Breastfeeding Support And Medical Management In Primary Care, Meghan Ganio Molinari

Graduate Theses

Background: Human milk is recommended as the exclusive source of nutrition for all infants in the first six months of life. Current rates of exclusive breastfeeding at six months are well below the public health recommendations (24.9% as of 2015). New mothers may experience many challenges which impact both breastfeeding initiation and duration rates in the postpartum period. Studies indicate that breastfeeding rates improve when women receive a combination of prenatal education coupled with postnatal support. Primary care practitioners in outpatient settings have a unique opportunity to provide lactation education, support, and medical management for their patients to improve …

Implementing Standardized Chlamydia Screening In A College Health Center, Lacey Ehrenfeuchter

Nursing (graduate) Student Scholarship

Background: Chlamydia trachomatis (CT) is the most common reportable sexually transmitted infection (STI) in the United States. Despite regulatory agencies’ recommendations, routine CT screening is not being performed in many high-risk settings. Problem: The burden of undetected CT infections is substantial to patients and the healthcare system. There is a lack of consensus regarding an effective standardized CT screening strategy and screening rates remain suboptimal. Methods: A standardized CT screening, testing, and treatment process was implemented in Spring of 2020 and compared to screening rates pre-intervention in Spring 2019. Intervention: A 3-question sexual health screening questionnaire (SHSQ) was administered to …

Can A Brief Online Intervention Change Low-Income Caregivers’ Reported Use Of Spanking? A Randomized Controlled Trial, Hilary L. Richardson

Dissertations

Spanking is commonly used by parents (64-94%) in the United States as a strategy for managing undesirable child behaviors. Research has found that the use of spanking is particularly high among young mothers, low-income parents, and African American families. Decades of literature on the use of spanking has identified abundant detrimental outcomes for children such as increased externalizing behaviors, decreased long-term compliance, and less guilt following misbehavior, as well as serious outcomes in adulthood such as depressed mood and alcohol/drug use. There is also a risk for spanking to escalate to physical abuse. Thus, safer, more effective discipline strategies are …

Alcohol Misuse And Abuse Among College Students: An Implementation Of A Screening Program., Tiffany Slaughter Newcomb

Doctor of Nursing Practice Papers

Excessive alcohol use in the United States creates serious economic, health, and mortality problems (CountyHealthRankings, 2018). College students experience high rates of use, binge drinking, and 20% of college students meet the criteria for alcohol use disorder [AUD] (NIH, 2014). Screening by healthcare providers (HCPs) in the student health setting is critical and a recommended strategy for reducing negative consequences of alcohol use experienced by college students (US Preventive Services Task Force, 2018).

Aims: The objective of this project was to implement an alcohol screening program among college-age undergraduate students in a university student health center.

Methods: HCPs …

Serious Mental Illness And Rural Primary Care: Provider Training, Attitudes, And Opinions, Lydia Eisenbrandt

Electronic Theses and Dissertations

Healthcare resources are especially limited in rural regions of the US. The lack of Primary Care Providers (PCPs) and mental/behavioral health services is problematic, as there are high rates of behavioral and medical concerns within rural populations. Special populations, such as rural persons with Serious Mental Illness (SMI), are medically complex and represent a vulnerable and underserved population. Healthcare outcomes for persons with SMI are poor compared to the general population and commonly lead to premature death. Various barriers prevent this population from accessing optimal healthcare, especially in rural areas, due to negative perceptions/stigma, a lack of understanding from PCPs, …

Improving The Rates Of Smoking History Documentation In The Electronic Medical Record., Megan Mccleese Vitellaro

Doctor of Nursing Practice Papers

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare …

Occupational Therapy As Part Of A Team-Based Approach In Primary Care Settings, Lydia Royeen

Dissertations

The purpose of this project was to study issues related to occupational therapists integrating into primary care settings, as part of a team-based approach and to best meet the needs of the clients.

This is a mixed methods study that examined quantitative and qualitative data for members of the primary care team and occupational therapists working in primary care clinics. The Team Climate Inventory-14 (Kivimaki & Elovainio, 1999) was selected as the quantitative measure because it examines themes related to team functioning, which include vision, participative safety, task orientation, and mutual support. Participants completed a semi-structured interview that examined themes …

Implementation Of The Edinburgh Postnatal Depression Scale In A Midwest Primary Care Clinic, Amanda Lee

Doctor of Nursing Practice Projects

Recent data from the World Health Organization reveals that the prevalence of postpartum depression is about 13%. Research portrays that untreated postpartum depression can have a detrimental impact on maternal and child outcomes. The American Academy of Pediatrics recommends integrating postpartum depression screening at the 1-, 2-, 4-, and 6-month well-child visits. The purpose of this project was to increase early identification of women with postpartum depression (PPD) by increasing the frequency of the Edinburgh Postpartum Depression Scale (EPDS) and evaluating the adherence of the recommended protocol at a Midwestern Primary Care clinic. The healthcare staff received training that included …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

Increasing Chlamydia Trachomatis And Neisseria Gonorrhea Screening Among Women 15 To 24 Years Old Using A Multifaceted Approach, Mackenzie Shireman

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC) (2017a) estimates that one-quarter of sexually active people are between 15 and 24 years old, but account for half of 20 million sexually transmitted diseases (STD) reported annually in the United States. Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) are the most common reportable STDs (CDC, 2018). The purpose of this project was to increase CT/NG screening rates among sexually active, nonpregnant women 15 to 24 years old within the primary care setting through colleague education, routine sexual history taking, and indicated testing. A 30-minute colleague in-service was provided to educate clinical …

Creating Opportunities For Personal Empowerment: A Project Evaluation, Ann L. Cudney

Doctoral Projects

Introduction: 66% of individuals in the United States who experienced a major depressive episode in the last year saw a general practitioner or family doctor and not a psychiatrist or psychotherapist (Center for Behavioral Health Statistics and Quality, 2018). Many primary care providers treat with medication, however, a combination of medication and psychotherapy is associated with better results (Anxiety and Depression Association of America, n.d.). A Midwestern faith-based healthcare organization implemented a pilot cognitive behavioral therapy program at a family medicine residency clinic to improve mental health care.

Objectives: The purpose of this project was to evaluate if the implementation …

The Effect Of The Screening, Brief Intervention, Referral To Treatment (Sbirt) Model On Adult Depression In An Outpatient Setting, Genevieve E. Sweeney

Doctoral Projects

Depression is one of the most common chronic conditions in the world. Despite this, depression continues to be under-screened, inaccurately assessed and diagnosed, and poorly treated in outpatient settings. Many providers solely rely on clinical judgement instead of a screening tool or evidence-based toolkit when a patient presents with depression symptoms, resulting in underdiagnosis and inappropriate treatment. Utilization of resources can help a provider appropriately screen, diagnose and treat an individual with depression. Screening, Brief Intervention, Referral to Treatment (SBIRT) is an evidence-based model intended to improve these measures. Studies from the literature support the efficacy of the SBIRT model …

Analysis Of Billings Data To Evaluate Patterns Of Mental Health Services In Primary Care And Emergency Departments By Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada, Thy H. Vu

Electronic Thesis and Dissertation Repository

Treating mental illness in primary care improves access to care, but it is unclear how to encourage family physicians to provide adequate mental health services. One approach may be changing how they are remunerated. The objectives of this thesis were to: 1) review the literature on the association between physician remuneration and provision of mental health services, and 2) assess the impact of blended capitation, compared to blended fee-for-service (FFS), on mental health services provision in Ontario. The review found that capitation appears to be associated with fewer services compared to FFS; however, studies of ED visits for mental health …

The Effect Of Care Coordination On Hemoglobin A1c For Type 2 Diabetes Patients, Lee Ann Hinsky

Electronic Theses and Dissertations

The purpose of the study was to test the impact of care coordinator visits by primary care registered nurses on serum hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes. In the study, the researcher compared 2 groups of type 2 diabetes patients—those who had care coordinator visits from registered nurses and those who did not—through retrospective data collection and analysis from the patients’ electronic medical record from July 2018 through December 2018. An independent samples t test was used to compare the means of the intervention and control groups’ change in HbA1c levels. The intervention and control groups …

Improving Behavioral Health And Social Determinants Of Health Screening In Primary Care, Caitlin Gerity Ba, Rn, Dnpc

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

Purpose: Detection and intervention of depression, substance use disorder, and social determinants of health (SDOH) in primary care improves quality of life, prevents complications, reduces health care costs and inequities, and leads to health promotion. This project aimed to increase behavioral health and SDOH screening rates in primary care through implementation of a screening process utilizing validated patient questionnaires.

Methods: A pre-intervention assessment was conducted with Providers A and B. A process was then developed for screening patients at annual exam visits, utilizing the Patient Health Questionnaire (PHQ)-2, the Single Alcohol and Substance Abuse Screening Questions, and a SDOH Questionnaire. …

Evidence Based Treatment For Excessive Alcohol Consumption And Concurrent Hypertension, Kimberly Ann Ward

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

Purpose. Excessive alcohol consumption is a preventable risk factor for hypertension, heart disease, and stroke. Though alcohol-related deaths number 88,000 annually in the U.S., alcohol use has the lowest treatment rate of behavioral health disorders at 10%. Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase awareness of the hypertension and excessive alcohol use connection and promote screening of alcohol consumption.

Methods A protocol for improving alcohol screening and concurrent hypertension management was developed including: in-person educational presentations; patient education materials; and the use of motivational interviewing. Practice change was assessed …

The Effect Of A Sun Damage Simulation Photography App On The Skin-Protective Behavior Intentions Of Women With Children Age 18 Or Younger, James Bowlds

DNP Projects

Abstract

Background: Skin cancer is the most common form of cancer diagnosed in the U.S. annually, despite being a largely preventable disease through the limitation of ultraviolet radiation exposure. Attempts to decrease its incidence have focused on appearance-based interventions. These have been effective at improving sun-protective behaviors among various subpopulations including people of color. Anecdotal observations suggest mothers more frequently utilize sun protection for their children than on themselves.

Purpose: The purpose of this project was to gain an understanding of the sun protection practices and beliefs of Caucasian and African American mothers, to assess the response to an appearance-based …

Medication Reconciliation In An Outpatient Clinical Setting, Tilena Martin

Walden Dissertations and Doctoral Studies

Medication reconciliation is a fundamental step in the delivery of safe care, because if it is not done correctly, it can set the stage for medication errors. Medication reconciliation has been shown to alleviate safety issues that lead to mortality, falls, and adverse drug reactions. The project question examined how in-service training can improve the knowledge of nurse practitioners and medical assistants about medication reconciliation. The project was guided by Knowles’ theory of adult learning and Rosswurm and Larrabee’s health belief model. A 1-hour educational module was prepared, and all participants completed the training prior to a discussion period. Sources …

Millennial Attitudes Toward Telehealth: An Integrative Literature Review, Hannah Gwyneth Y. Tabora

Honors Undergraduate Theses

Purpose: The primary purpose of this research was to explore individuals born in the millennial generation’s likelihood of using telehealth and virtual office visits as a replacement for face to face provider interactions. The secondary purpose was to examine the feasibility and access of treatable conditions and ailments in a virtual environment.

Methods: A literature review exploring millennials and telehealth was performed using various databases with search terms combined to include: ‘millennials*’, ‘telehealth*’, ‘telemed*’, ‘finance*’, ‘primary care*’, ‘healthcare*’, ‘health knowledge*’, ‘literacy*’, ‘education*’, ‘misinformation*’. The data was conformed into tables that synthesized the relationship between the millennial generation and their access …

Active Rehabilitation In Sports-Related Concussions: An Educational Intervention For Primary Care Providers, Lior Habinsky

Doctor of Nursing Practice Projects

Background and Review of Literature: Sports-related concussion (SRC) is a form of traumatic brain injury caused by a blow to the head and remains a prevalent issue across the 11-18-year-old age group within the United States. Historically, total physical and cognitive rest has been the preferred method to help individuals recover after suffering a concussion. However, recent data have shown that incorporating active rehabilitation or aerobic exercise therapy as part of acute post-concussion treatment is safe. Further investigation into these methods could provide valuable insight into prognosis as well as promote clinical recovery.

Purposes/Goal: This project involved delivering an educational …