Medicine and Health Sciences Commons^™

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …

Implementation Of The Nurse Care Manager In Integrated Care: A Systematic Report, Elizabeth Adams

DNP Qualifying Manuscripts

Introduction: The collaborative care model (CCM) is an effective model for improving depression symptoms in patients in a primary care (PC) setting. An essential role in this model is the care manager (CM), and nurses have been effective in this role. However, there remains a question of how to best design, train, and implement this nurse CM role in PC.

Objectives: The purpose of this review is to provide readers with a critical description of what processes for training and implementation of a collaborative nurse CM role have been be successful in the literature, specifically as it pertains to supporting …

Screening, Brief Intervention, And Referral To Treatment For Alcohol Misuse In Primary Care, Sai-Han Ackerman Yu

Doctor of Nursing Practice

An annual average of 88,000 deaths in the United States from 2006 to 2010 has been attributed to alcohol misuse, defined as risky or heavy alcohol consumption. Heavy or risky alcohol use for all adults aged 65 and older and for women aged 18 and older is defined as consuming more than 7 drinks per week and/or 3 drinks per day. For men aged 18 to 65 years of age, heavy or risky alcohol use is defined as consuming more than 14 drinks a week and/or 4 drinks a day. Chronic alcohol misuse increases the incidence of heart problems, cognitive …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …

Primary Care Physician Delivered Brief Behavioral Intervention For Adult Obesity And Associated Health Conditions, Julia C. Huston

Dissertations

Obesity is a chronic health condition with prevalence rates that have continued to rise steadily over the past 30 years to the point that it has now been declared a global epidemic and a serious public health concern. Obesity is associated with significant physical and economic costs, primarily resulting from co-occurring health conditions that increase the risk of morbidity including type II diabetes, hypertension, dyslipidemia, stroke, coronary heart disease, and respiratory problems. Despite the dissemination of several obesity treatments, including pharmacotherapy, lifestyle modification, and bariatric surgery, the prevalence and severity of obesity continues to rise. Federal guidelines recommend the use …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Primary Care, Elizabeth Segura

Dissertations

Abstract

Problem: The Patient Centered Medical Home (PCMH) is a model of care that improves the quality and experience of care and decreases cost. Use of a validated depression screening tool for adult patients is a PCMH certification requirement. The purpose of this quality initiative was to obtain baseline data when a depression screening tool was utilized among adult patients in an internal medicine clinic within a Midwestern public health department.

Methods: This was a quality improvement project utilizing a descriptive and observational design. A retrospective medical record review was used to assess the rate of depression screening utilizing the …

Multimodal Pain Management For Older Adults In Primary Care, Bina Solanky

DNP Qualifying Manuscripts

Persistent pain affects 50% to 75% of adults of the age of 65 and it is often underreported and undertreated in primary care. This manuscript discusses how nurse practitioners and other primary care providers can manage persistent pain in older adults utilizing nonpharmacological methods in addition to standard pharmacological treatments.

A Common Goal: Primary Care And Psychiatry Improve Depression Detection And Outcomes, Katherine Kilkenny

Doctor of Nursing Practice Final Manuscripts

Background: Major Depressive Disorder (MDD) affects over 15 million (6.7%) adult Americans. While one in four primary care patients suffer from depressive symptoms, MDD is accurately diagnosed as little as 25% of the time.

Purpose: Implementation of an evidence-based protocol outlining the process for screening, behavioral health referral, and the role of a collaborative care team would improve detection and treatment of adult MDD patients in the ambulatory setting.

Process: A systematic Patient Health Questionnaire (PHQ-9) based screening protocol was implemented. Every new and existing patient completed the PHQ-9 during scheduled primary care appointments. If a patient scored 15 or …

What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling

Doctor of Nursing Practice Final Manuscripts

Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).

Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to …

The Effect Of Algorithm Implementation In The Family Practice Setting On The Pain And Recovery Of Acute Low Back Pain Patients, Joan Caito

Evidence-Based Practice Project Reports

Nearly $86 billion is spent annually in healthcare costs for Americans with low back pain (Lee, McAuley, Hübscher, Allen, Kamper, Moseley, 2016). Additionally, the burden on the economy due to loss in productivity incurs approximately $114 billion dollars of lost revenue annually (Lee et. al., 2016). Patients with an acute low back injury inadequately treated may become a chronic issue. Only 50% of patients who experience back pain symptoms for 12 months will return to work (Petit, Fouquet, & Roquelaure, 2015). The purpose of this project will be to implement an evidence-based algorithm to standardize acute low back pain care …

Assessing Readiness For Group Therapy In Primary Care: An Initial Survey Exploring Need, Philip Randall

Electronic Theses and Dissertations

Primary care providers have become the front line of treatment for mental health in the United States. Group interventions have been argued to be an effective way to treat more patients with fewer resources, which could reduce the burden of psychopathology on primary care settings. Group therapy faces many barriers to successful implementation in primary care, including site constraints, provider perceptions, population needs, and recruiting difficulties. A survey was developed to assess primary care providers’ perspectives on these areas and distributed via online survey to practitioners in Appalachia; 28 providers responded. No hypotheses were supported, likely a result of the …

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year Public Use …

A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin

Evidence-Based Practice Project Reports

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …

Improving Adolescent Risk Assessment In A Primary Care Setting, Kristin N. Vanderwell

Doctoral Projects

Adolescent risk-taking behaviors contribute significant risk to the current and future health of adolescent patients and have a significant annual cost to society. A primary care practice in western Michigan had no standardized practice related to the screening, evaluation, and response to adolescent-risk taking behaviors. As a result, only three of the fourteen providers were consistently following national guidelines for screening, evaluating, and responding to adolescent risk-taking barriers. The providers cited lack of time and lack of knowledge as barriers to following guidelines. The purpose of this quality improvement project was to address the health care needs of the adolescent …

Enhancing Elderly Advance Care Planning Experience At A Primary Care Clinic, Oi Shan Wong

Doctoral Projects

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants' satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit.

Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group ( …

Proposal Defense: Improving Patient Portal Adoption In Primary Care, Melissa Wagner

Doctoral Projects

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?”

Objectives: The purpose of this project is to identify whether an electronic patient educational video …

Structure, Process, And Outcomes: The Foundation For Continuous Quality Improvement In Primary Care, Mark A. Contreras

Doctoral Projects

Healthcare within the United States is notoriously fragmented and inefficient. Contemporary innovations for policy, reimbursement, and care delivery are consistently directed towards the promotion of value based care (Bates, 2010). These initiatives routinely coalesce around the promising potential of a robust primary care system. The Patient-Centered Medical Home (PCMH) model is increasingly becoming the standard of quality care and use of this model by healthcare providers is poised to bring about a paradigm shift towards value-based care (Henderson, Princell & Martin, 2012).

This scholarly project incorporated an evidence based approach to establishing continuous quality improvement in a primary care office …

Implementation Of Evidence-Based Culturally Adapted Interventions, Collaborative Care, And Change Management For Improved Mental Health Outcomes In A Community-Based Safety-Net Clinic, Laura E. Hall

Doctoral Projects

Mental health disorders are prominent and devastating in the United States. They are more prevalent in low-socioeconomic and minority groups with lower rates of diagnosis and treatment in these populations. Primary care settings are the foremost location for screening, diagnosis, and treatment for common mental health disorders but do not always provide adequate care due to limitations of time, knowledge, and resources. Evidence has shown that collaborative care models can provide more effective treatment for behavioral health services through a team-based approach to holistic patient care. This project focused on implementing culturally adapted, collaborative care models to improve mental health …

Primary Care-Related Emergency Department Use, Tiffany Wetz

Theses & Dissertations

Primary care-related emergency department use has become a focal point in the United States considering health reform and changes made to the delivery model and reimbursement mechanisms. Emergency departments serve as critical access points within the United States delivery system because important medical resources are made available for all members within the community. However, a gap in the literature exists due to a lack of consensus regarding factors that influence emergency department use for primary care-related health needs. The purpose of this study was to understand the relationship between demographic, social, economic, geographic, and need factors that influenced use of …

Exploring Quality Improvement For Diabetes Care: A Multiple Case Study Of Primary Care Teams In First Nations Communities In Canada, Meghan Fournie

Electronic Thesis and Dissertation Repository

Clinical quality improvement (QI) teams from First Nations communities across Canada participated in an 18-month QI collaborative program called the TransFORmation of IndiGEnous Primary HEAlthcare Delivery (FORGE AHEAD) clinical QI initiative. Community-based participatory research and multiple case study methodologies were utilized to explore the experience of two clinical QI teams from diverse primary care settings in First Nations communities as they engaged in developing and implementing changes in practice to improve the quality of diabetes care. This study provides insight into how clinical QI teams drew upon multiple sources of knowledge and information to inform their QI activities, the importance …

Integrative Medicine In Primary Care, Ashley M. Bjornerud

Physician Assistant Scholarly Project Papers

Integrative medicine (IM) is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health (Rakel, 2017). Commonly, integrative medicine is associated with complementary and alternative medicine therapies (CAM). These are two separate entities. CAM is one of the modalities used in integrative medicine.

The review of the literature on IM analyzed studies in primary care settings in all parts of the world. Definitions of IM and CAM are evaluated. Defining what IM is and how to incorporate this approach in …

The Impact Of Interprofessional Collaboration On Diabetes Outcomes In Primary Care Settings, Charette Coleman Deloach

Walden Dissertations and Doctoral Studies

Inadequate interprofessional collaboration (IPC) and communication among health care professionals are associated with medical errors and mortality. Guided by the theory of goal attainment and the chronic care model, a systematic review was conducted to explore the evidence related to whether interprofessional collaborative primary care can have a positive effect on health outcomes for patients living with diabetes (PLWD). The systematic review followed the Joanna Briggs Institute method for systematic reviews and results were complied with the PRISMA evidence-based minimum set for reporting. Data were analyzed to identify if IPC positively impacted the health outcomes of PLWD, as evidenced by …

Health Literacy In A Primary Care Setting, Ashley Newman

DNP Projects

BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was …

Appraisal Of Depression Among Individuals With T2dm Not On Insulin Therapy, Beverly Woods

DNP Projects

Abstract

BACKGROUND: Type 2 diabetes (T2DM) is a complicated disease process that affects more than 15 percent of adults in the state of Kentucky, with a national average of 9.4%. Individuals with diabetes are at increased risk for micro and macro neurovascular complications. Depression is a common co-morbidity and potentially affects their ability to manager this complex disease.

PURPOSE: The purpose of this study was to examine the prevalence of depression in a group of patients with T2DM, not on insulin therapy. Further, relationships between depression and blood glucose monitoring, Hgb A1c, other co-morbidities, number of medications taken, and demographics …

The Effect Of A Provider Education Program On Tobacco Use In An Adult Population In The Primary Care Setting, Sunita Gurung

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effectiveness of an education session to promote adherence to the United States Preventive Services Task Force (USPSTF) recommendation and Clinical Practice Guidelines for Treating Tobacco Use and Dependence by providers.

METHODS: A retrospective and prospective record review was used to evaluate an education session for providers in tobacco use screening, providing cessation counseling, prescribing medication for tobacco cessation, and sending out referrals for tobacco cessation at one primary care clinic in Louisville, KY. Education sessions were held from August 1, 2018 to August 14, 2018. The sample consisted of 200 …

Impact Of Medical Scribes In Healthcare: A Systematic Review, Eryn Johnson

Theses and Graduate Projects

Background: The utilization of medical scribes has increased significantly in healthcare facilities over the last ten years. Medical scribes are hired to assist providers with documentation in the electronic health record (EHR). The purpose of this systematic review is to evaluate how scribes impact productivity/throughput, revenue, provider satisfaction, and patient satisfaction in healthcare.

Methods: A database search from January 2000 to May 2017 of PubMed, Google Scholar, and Academic Search Premier was done using the keywords medical scribe, scribes, and healthcare. Based on inclusion criteria, this review includes studies from 5 emergency departments, 2 primary care clinics, and 1 cardiology …

Home-Based Primary Care: Impact On Cost And Patient Satisfaction, Sarah R. Tupper

All Graduate Theses, Dissertations, and Other Capstone Projects

The aging American population means more people will need healthcare than ever before. Many of these people are or will be Medicare beneficiaries who are predicted to be completely or mostly homebound at some point in time. This literature review was conducted to investigate Home-based Primary Care (HBPC) and whether or not this care delivery model has impacts on cost and patient satisfaction when compared to traditional outpatient encounters. A comprehensive and robust search of the literature was conducted using four different healthcare literature databases. Relevant articles were included if the site of care was ambulatory or office-based and if …

Intimate Partner Violence: A Systematic Literature Review, Shailynn Shipley

All Graduate Theses, Dissertations, and Other Capstone Projects

Intimate partner violence (IPV) and domestic violence have devastating effects on the health and well-being of people exposed to abuse. It is known that up to 75% of IPV episodes occur after a woman leaves her abuser, and women who seek help are most likely to suffer aggravated assaults or murder when trying to leave an abusive relationship (Cook & Nash, 2017). IPV screening has been well-studied as evidenced by the prolific research literature, however a synthesis of primary care actions that support the safety and well-being of women experiencing IPV is lacking. This systematic review compares traditional primary care …

Access To Primary Care In Pennsylvanian Rural Townships, Ann Eneh

Walden Dissertations and Doctoral Studies

Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using …