Health Care Service Disparity: Factors Associated With The Distribution Of Primary Care Physicians, Robert L. Morgan

Senior Honors Projects, 2010-2019

Primary care physicians operate on the front lines of health care. Although primary care physicians play a critical role in improving health outcomes, workforce trends in the United States show a growing shortage of primary care physicians as demand for primary care rises. In conveying the importance of primary care physicians, the worsening physician shortage, the inequitable distribution of providers, and the lackluster institutional response thus far, this paper calls into question the effectiveness of current indicators used to identify underserved areas and provide appropriate government assistance. Through the use of data from the 2010 census and American Medical Association …

Community-Level Factors Associated With Health-Related Quality Of Life Among Older Adults, Yu-Hsiu Lin

Theses and Dissertations

Objective: Health-related quality of life (HRQOL) and well-being is a new topic area for Healthy People 2020 in the U.S. In a broad-based literature review, more research explored individual level factors of HRQOL, and few focused on older adults. Multilevel analysis was seldom adopted to investigate the relationship between area-level socioeconomic or social environment factors and HRQOL. In lieu of the traditional Chapter 4 (Results) and Chapter 5 (Conclusion), two manuscripts representing the two specific research aims are included. The main aim of first manuscript was to explore the association between area deprivation, area health resources and older adults’ HRQOL. …

Medicaid Discontinuity Among Adults With Cardiovascular Disease Or High Risk Conditions: Associations With Medication Adherence And Health Care Utilization, Kiraat Divyang Munshi

Theses and Dissertations (ETD)

BACKGROUND: Medicaid coverage among adults is often characterized by discontinuity – loss of Medicaid coverage, and churning, or entering and exiting Medicaid – over short durations. Little is known about the impact of having discontinuous Medicaid coverage on access to care, preventive care, pharmacotherapy, primary care, and hospitalizations, among non-elderly adults with cardiovascular disease (CVD) or high-risk conditions.

OBJECTIVES: This dissertation employed a three empirical research papers approach to pursue the following aims: (1) characterize the adult subpopulations with CVD or conditions placing them at high risk for CVD who lack continuous Medicaid coverage, and examine the characteristics associated with …

Feasibility Of A Peer Support Oriented Dialectical Behavior Therapy Skills Training Massive Open Online Course For Emotion Dysregulation, Rachel Gill

Senior Theses

Public interest in mental health care modernization has steadily gained momentum since ratifying The United States Health Care Affordability Act (U.S. Office of the Legislative Counsel, 2010). Furthermore, with 1 in every 1000 people seeking online support for mental health issues (DeAndrea & Anthony, 2013), research concerning the development of virtual mental health applications is critical to ensure science guides their innovation. To this end, this study explores the feasibility of a mental health intervention that unites the experiential, recovery-oriented, and self-determined values of mental health peer support (Kaufman et al., 2014) with dialectical behavior therapy skills training (DBT-ST) (Linehan, …

A Community-Based Participatory Approach To Understanding Health Beliefs, Policies, Barriers, And Solutions Related To The Health Disparities Of Marshallese Cofa Migrants In Arkansas., Pearl Anna Mcelfish

Graduate Theses and Dissertations

Public policies have different effects on different populations groups and can perpetuate health disparities among some populations. My research utilizes community-based participatory approach to research in the examination of one unique population: the Marshallese. This dissertation research presents three papers that are part of a cohesive research agenda predicated on community-based participatory research (CBPR) to facilitate policy-oriented learning. My research can be used to inform health policy, health care services, and health education. Chapter Two presents the article titled: Health Beliefs of US Marshallese Regarding Type 2 Diabetes.

This article explores the research question: what health beliefs related to diabetes …

Survival Outcomes And Treatment Utilization Among Patients With Known And Unknown Primary Tumours In Ontario., Chong Sung Kim

Electronic Thesis and Dissertation Repository

I identify two cohorts of cancer patients with known and unknown primary tumours. Cancer of unknown primary (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Using the Ontario Cancer Registry, Same Day Surgery/Discharge Abstract Database and Ontario Health Insurance Plan, a novel linkage strategy was developed to cross-validate diagnoses. I found CUP patients represent a significant portion of all metastatic cancers. CUP patients with histological confirmed disease, squamous cell histology, or metastases localized to nodal regions had significantly better survival than other CUP patients. Knowledge of the primary …

Economics Of Fixed-Dose Combination Drugs Approved In The United States, Jing Hao

Doctoral Dissertations

Patent is the most important form of intellectual property protection for new drugs. Patent extension and market exclusivity currently serve as major regulatory incentives to promote new drugs. Combination drug, or fixed-dose combination (FDC) are formulations that contain two or more active ingredients in a single pill. FDCs, especially combinations of singe drugs that are already in the market, are common strategy for brand-name drug companies to extent the patent and exclusivity life. The substitution of single drug products that soon have generic alternatives with newer, brand-name combinations lead to potential increases in pharmaceutical expenditures and raises concerns on economic …

Physical Activity Levels And Health Of Passamaquoddy Tribe At Indian Township, Michael R. Best

Electronic Theses and Dissertations

This study focuses on reporting the occupational, household, transportation and leisure time physical activity of the Passamaquoddy Tribe at Indian Township. This study also focuses on health measures and the presence of chronic disease and how they are affected by physical activity, risk factors, and other health related measures.

An interview-administered questionnaire, developed by the CDC, was given to participants age 25-44 years old, with one small change. The original Intertribal Heart Project (ITHP) questionnaire used a shortened version of the WHO’s Monica Optional Study of Physical Activity (MOSPA), in order to reduce the time it takes to administer the …

The Sixties Scoop Among Aboriginal Veterans: A Critical Narrative Study, Munira Abdulwasi

Electronic Thesis and Dissertation Repository

This study explored the experience of Aboriginal Veterans adopted and/or fostered during the Sixties Scoop using critical narrative inquiry. The objectives were to: 1) understand the lived experience of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) explore any health needs expressed by Aboriginal veterans adopted and/or fostered during the Sixties Scoop, and 3) provide recommendations for the implementation of health services and programs to assist this group of Aboriginal veterans with their health needs. Eight individual interviews were conducted with participants in Kitchener-Waterloo, London, Ottawa, Winnipeg, and Vancouver. All interviews were audio-taped, transcribed verbatim, and analyzed using …

Exploring The Career Pathways, Professional Integration And Lived Experiences Of Regulated Nurses In Ontario, Canada, Godfred O. Boateng

Electronic Thesis and Dissertation Repository

In the context of an enduring shortage of nurses, this study explores the career pathways and experiences of immigrant and Canadian-born nurses in two Ontario cities utilizing a qualitative research design consisting of 70 in-depth interviews. Differences in career entry and experiences of workplace conflict across immigration status and race are explored.

First, I explore successful immigrants’ pathways into the nursing profession and their social and economic integration into the Canadian economy in light of the traditional assimilation and segmented assimilation theories. The study reveals distinct career pathways taken by foreign-born nurses and Canadian born nurses. While Canadian-born nurses have …

The Impact Of Gasoline Prices On Medical Care And Costs Of Motor Vehicle Injuries, He Zhu

Theses & Dissertations

Background Traffic safety has placed a tremendous economic and social burden on individuals and nations. Gasoline prices have been linked to traffic safety in the recent studies. Higher gasoline price may prompt people to reduce expenses by changing travel distance and frequency, transportation mode, or driving behaviors.

Objective This study aims to examine the relationship of gasoline prices to hospital utilization and cost for motorcycle and non-motorcycle motor vehicle injuries in the United States.

Methods Data on inpatient hospitalization for motor vehicle injuries were obtained from the 2001-2010 Nationwide Inpatient Sample, which is part of the Healthcare Costs and Utilization …

Confidence And Connectedness: A Mixed Methods Study On Patients Managing Co-Occuring Physical And Behavioral Health Conditions, Peter Young Fifield

All Theses And Dissertations

Treating chronic illness is becoming increasingly team based, yet most team building concepts relate to the team as a dichotomous unit: the medical team and the patient. Patients are expected to be “engaged” and “activated” members of the team, yet there is a gap in knowledge regarding how patients most effectively integrate into the team. Exacerbating the complexity of patient as team member is the multifaceted, ever-changing mood state of patients with co-occurring medical and mental health conditions. The medical field is well aware of the correlations between mental health and chronic illnesses. The purpose of this study is to …

Predictors Of Appropriate Referral To Total Knee Arthroplasty: A Validation Study, Samuel J. Malian

Electronic Thesis and Dissertation Repository

Approximately 45% of referrals from primary care physicians to arthroplasty surgeons are inappropriate. Currently, Canadians are waiting over three months for consultation with an arthroplasty surgeon. Reducing the proportion of inappropriate referrals will reduce the wait time to first consultation with an arthroplasty surgeon. This study’s objective was to validate a model that identified patient-reported predictors of appropriate referrals to arthroplasty. We screened 258 patients attending their first consultation with an arthroplasty surgeon. Participants completed the questionnaires prior to their appointment and the surgeon detailed each consultation outcome on a standardized form. We constructed our validation model using the same …

Socially Constructing Drug Addicts From The Poor: A Critical Discourse Analysis, Kalynn Susan Amundson

Graduate Theses and Dissertations

Welfare drug testing was authorized by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, and has subsequently garnered extensive legislative interest in numerous states. This policy raises several questions, which are the subjects of the two journal articles and one manuscript included in this dissertation.

The first article addresses the question of a possible confluence of War on Drugs and Welfare Reform policies as evidenced through welfare drug testing policy, and indicated by continuity in policymakers’ rhetoric. This study examines federal-level policymakers’ debate discourse in these two policy streams. The analysis finds themes of the Social pathology, …

Development And Preliminary Validation Of A Nonmedical Prescription Drug Motives Questionnaire, Lauren Ashleigh Milner

Graduate Theses and Dissertations

The prevalence of nonmedical prescription drug (NMPD) use continues to increase among emerging adult populations; however, little is known about the motivations behind this use. The current study aimed to extend previous research by developing and validating the first known comprehensive NMPD motives measure. As such, the primary focus of the current study was to examine evidence for the reliability and validity of the NMPD Motives Questionnaire by assessing the factor structure, internal consistency, and construct validity of the motives scale. Participants were drawn from a larger study of college student substance use behaviors and attitudes (N = 1,427; Mage= …

Psychotherapy In Family Medicine, Saadia N. Hameed

Electronic Thesis and Dissertation Repository

Abstract

Aim: To explore the perspectives and practice of psychotherapy of family physicians, and analyze Ontario’s mental health policy documents within the context of psychotherapy.

Methods: In the first study descriptive qualitative methodology was used. Eighteen family physicians were interviewed and the results were presented thematically. In the second study, a policy analysis of Ontario’s mental health policy documents was conducted. The qualitative policy analytic methodology of Peter et al. was used.

Findings: Psychotherapy is an effective treatment of mental illness and is practiced by family physicians. Lack of training and time are barriers, while patient needs and …

Pearl Harvesting Autism, Mariya Gruntovskaya

Electronic Thesis and Dissertation Repository

This thesis addresses the difficulties of on-line information searching as it relates to the topic of autism. A review of existing search strategies is presented and their limitations are discussed. A new method for deriving a set of search-terms for comprehensive searching, Pearl Harvesting, was tested here to determine the necessary search terms (i.e., synonym ring) for ERIC and PsycINFO databases. Once discovered and validated, a synonym ring can be copied and pasted directly into the search box of the database, providing a simple, thorough and time saving way of conducting on-line research in the field. This easily used method …

Policy Considerations For Community Health Workers In An Era Of Health Reform, Sara Kahn-Troster

Muskie School Capstones and Dissertations

In order to better understand how CHWs are being integrated in state health reform initiatives, including facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health, the author, working in collaboration with the National Academy for State Health Policy (NASHP), developed a nation-wide scan of CHW policy activity, published online as State Community Health Worker Models in February, 2015. The CHW chart gives a comprehensive look at how states are utilizing CHWs as part of quality improvement, health care reform, and expanded models of public health.

Evidence Informed Checklist Increase Patient Experience Of Quietness During A Hospital Stay, Monica Alborg

Muskie School Capstones and Dissertations

This checklist is made to be used by staff at hospitals, especially nurse managers and quality improvement specialists. A staff member can pick and choose what items on the checklist are feasible to implement within their organization. Ongoing quality improvement strategies are suggested in the checklist to remain abreast of ways to mitigate noise in hospitals.

Effects Of Dehydration On Changes In Arterial Stiffness With Passive Heating, Az Satterfield

Health, Human Performance and Recreation Undergraduate Honors Theses

Context: There is an inverse relationship between baseline arterial stiffness and the change in arterial stiffness with passive heating. However, it is unknown whether this relationship is affected by dehydration. Objective: To investigate the effect of acute dehydration on arterial stiffness during passive heat stress. Design: Two randomized counter-balanced trials. Setting: Laboratory. Patients or Other Participants: Eleven healthy males (age=24.5 ± 2.8 years, body mass=76.6 ± 9.1 kg, body fat=16.8 ± 6.4%). Interventions: In one trial subjects were dehydrated (DE) and in another euhydration (EU) was maintained during passive heating to a 1.5°C increase in body temperature. Subjects were euhydrated …

Texas Physicians' Awareness And Utilization Of Genetic Services, Callie L. Jenevein

Dissertations & Theses (Open Access)

The number of disorders for which genetic testing is available has increased nearly 500% in the past 15 years. Access to the majority of genetic tests and services hinges on physicians’ ability to identify patients at risk for genetic disease and provide appropriate testing and counseling or refer to genetic specialists. Recent research demonstrates the need for referrals to genetic specialists by showing that many physicians lack skills required to perform appropriate genetic services, such as making proper risk assessments, providing genetic counseling, ordering genetic testing and interpreting results. However, little research exists on physicians’ awareness and utilization of genetic …

The Impact Of Resource Availability On Patterns Of Discharge To Inpatient Rehabilitation After Stroke In Ontario, Canada, Matthew J. Meyer

Electronic Thesis and Dissertation Repository

Stroke is a leading cause of death and disability in Canada. As patients, their families, and their friends adjust to life after stroke, organized rehabilitation can play an important role in functional recovery and improving quality of life. Best-practice recommendations suggest that moderately-to-severely impaired patients receive care in an inpatient rehabilitation unit and more mildly impaired patients in out-of-hospital settings (outpatient clinics or in-home). However, data from Ontario (Canada’s most populous province) suggest that post-stroke rehabilitation resources in both settings may be lacking. This has led to concern that some patients may be receiving rehabilitation that is not appropriate for …

The Impact Of The Veterans Health Administration's Home Based Primary Care On Health Services Use, Expenditures, And Mortality, Melissa Castora-Binkley

USF Tampa Graduate Theses and Dissertations

Background: Among patients with multiple chronic conditions, care coordination and integration remains one of the major challenges facing the U.S. health care system. A home-based, patient-centered primary care program has been offered through the Veterans Health Administration (VHA) since the 1970s for frail veterans who have difficulty accessing VHA clinics. The VHA Home Based Primary Care (VHA HBPC) aims to integrate primary care, rehabilitation, disease management, palliative care, and coordination of care for frail individuals with complex, chronic diseases within their homes. Early research suggested that VHA HBPC was associated with positive outcomes (e.g., reduced resource use and patient satisfaction). …

The Role Of Occupational Therapy In Primary Care, Priti Patel

Occupational Therapy Doctorate Capstone Projects

The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …

Unicondylar Knee Arthroplasty In The Inpatient Vs Outpatient Setting: Impact On Process Time, Quality Outcomes, And Patient Satisfaction, Ibrahim Zeini

Electronic Theses and Dissertations

The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA …

La Paradoja Hispana Epidemiológica: Investigando Las Preconcepciones Y Generalizaciones, Maya H. Sandalow

CMC Senior Theses

En los Estados Unidos, los latinos suelen tener menos acceso a la educación, el trabajo, y el seguro médico en comparación con los blancos no-latinos, pero aun así el grupo parece superar ciertos obstáculos de la salud. Las estadísticas de la población latina muestran mayor longevidad y otras tasas favorables en comparación con los blancos no-latinos. Los expertos han titulado esta contradicción “La Paradoja Hispana Epidemiológica”.

Desafortunadamente, la investigación de la paradoja está llena de generalizaciones y presuposiciones erróneas sobre la población latina diversa. Esta tesis investiga los participantes que producen generalizaciones sobre la supuesta paradoja para mostrar que estas …

Assessment Of Organizational Readiness: Parent Advisory Councils In A Children's Hospital Within A Hospital, Suzanne R. Springate

DNP Projects

Background: A children’s hospital within a hospital (CHWH) in the Midwest region of the United States established a strategic goal to become the preferred provider for children in the region. Outcomes in patient and family experience had fallen short of established organizational expectations. Recognizing that parent advisors are an essential component of patient and family centered care, the strategic plan called for integrating parents into formal, advisory roles.

Purpose: The purpose of this practice improvement project was to perform an assessment of organizational readiness to incorporate parents into formal advisory roles at this CHWH.

Methods: A cross-sectional survey design was …

Evidence-Based Hospitals, David R. Bardach

Theses and Dissertations--Epidemiology and Biostatistics

In 2011 the University of Kentucky opened the first two inpatient floors of its new hospital. With an estimated cost of over $872 million, the new facility represents a major investment in the future of healthcare in Kentucky. This facility is outfitted with many features that were not present in the old hospital, with the expectation that they would improve the quality and efficiency of patient care. After one year of occupancy, hospital administration questioned the effectiveness of some features. Through focus groups of key stakeholders, surveys of frontline staff, and direct observational data, this dissertation evaluates the effectiveness of …

Is Conflict A Factor In A Population's Quality Of Life? A Comparative Study Of University Students In The Palestinian Territories And Jordan, Yara Asi

Electronic Theses and Dissertations

As nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken in an effort to understand how long-term conflict manifests itself in noncombatant populations. However, existing studies focus primarily on indicators within the …

Bringing Bpa To Light: Determination Of Bisphenol A In Thermal Receipt Paper Water Samples And Lake Water Samples Using Fluorescence Spectrophotometry, Bailey Chitwood

Honors Theses

Bisphenol A (BPA) is a chemical that is commonly used in harder plastic products, in the lining of food cans, and in thermal receipt paper. The usage of BPA in common products has become a concern for humans, especially for infants and young children, because of its effects as an endocrine disrupter. BPA has been linked to diabetes, cardiovascular disease, obesity, and certain developmental disorders. Because of the possible effects of BPA on the development of infants and young children, the use of BPA in baby bottles and other baby products has been outlawed. However, BPA is still used in …