Medicine and Health Sciences Commons^™

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Physical Medicine & Rehabilitation Referrals In Cancer Patients, Bhumik Patel, Venkateswar Venkataraman, Deanna Janora, Jack Goldberg

Rowan-Virtua Research Day

Physical Medicine and Rehabilitation (PM&R) can address functional limitations in various conditions, including cancer. Cancer rehabilitation aims to address functional impairments resulting from both the disease itself and its treatments, striving to optimize physical, social, psychological, and vocational functioning. Existing literature indicates that PM&R services significantly benefit cancer patients by improving their overall quality of life. Studies have found that optimal utilization of PM&R services can increase the Functional Independence Measure (FIM) in cancer patients. Current National Comprehensive Cancer Network and American Cancer Society guidelines emphasize the importance of incorporating PM&R services into oncology care to enhance the function and …

Program Curricula For Preparing Medical Professionals On Early Childhood Mental Health, Socio-Emotional Development, And Adverse Childhood Experiences In Primary Care Settings: A Phenomenological Study, Jesutomilola O. Olayemi

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Primary care settings serve as the frontline for addressing the holistic well-being of individuals and particularly for children, they play a pivotal role in shaping early childhood experiences. Pediatric primary care physicians are pivotal in addressing the scarcity of mental health resources for children aged zero to five. There is limited knowledge regarding the competence of pediatric primary care providers in providing developmentally appropriate mental health care in early childhood. Therefore, this phenomenological study examined how early childhood mental health, social-emotional development, and adverse childhood experiences and their related screening practices were integrated into the curricula for preparing prospective pediatric …

Management Of Macrovascular Diabetic Complications: A Single-Center Case Series Analysis Of Consecutively Attending Patients In Primary Care, Sanda Maria Crețoiu, Mihaela Adela Iancu, Laura Maria Condur, Teodor Salmen, Andreea Steriu, Ana Maria Alexandra Stănescu, Irina Anca Eremia, Cristina Mihaela Olariu, Eliza Elena Cinteză, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

Introduction. The prevalence of diabetes mellitus is increasing, with type 2 diabetes (T2DM) being a major health priority for any public health system. Increased arterial stiffness in patients with diabetes will lead to the appearance of vascular complications. Increased arterial stiffness in patients with diabetes usually leads to vascular complications. Any earlier diagnosis of impaired macrovascular evidence may lead to improved outcomes in patient care. The objective of our study was to assess and evaluate the finger-toe pulse wave velocity (ftPWV), as a measure of arterial stiffness, in order to assist with early detection of macrovascular diabetic complications. Materials and …

Clinical Efforts Double Disparity For Nonphysician Urim Faculty: Implications For Academic Family Medicine, Stacy A. Ogbeide, Deepu George, Adrian Sandoval, Yajaira Johnson-Esparza, Maria Montanez Villacampa

School of Medicine Publications and Presentations

With a new definition of high-quality primary care and the shift in nonphysician faculty’s role as core faculty members in family medicine residency programs, new attention is needed on the delineation of clinical efforts and clinical efforts disparities across disciplines (eg, psychology, marriage and family therapy, pharmacy) within departments of family medicine. Additionally, those who identify as underrepresented in medicine (URiM), specifically those who are nonphysician faculty, are dually impacted by the clinical efforts double disparity. This paper examines the current landscape of clinical efforts in academic family medicine for physician faculty and nonphysician faculty as well as discusses how …

Implementation Of Provider-Made Follow-Up Appointments For Depression In Primary Care, Rebecca Vaughn

Epsilon Sigma at-Large Research Conference

Implementation of provider-made follow-up appointments for depression in primary care

Rebecca Vaughn

College of Nursing, East Tennessee State University; Whitson Hester School of Nursing, Tennessee Technological University

Author Note

Rebecca Vaughn https://orcid.org/0009-0007-0731-3316 College of Nursing, East Tennessee State University

There are no conflicts of interest to disclose.

Corresponding concerning this manuscript should be addressed to Rebecca Vaughn

108 Reed Mill Lane Monroe TN 38573

Zrev2@etsu.edu

Abstract

Depression is a common condition diagnosed and managed in primary care.

Follow-up is inconsistent and low in these settings, creating a gap in care that

impacts management, adherence to treatment, and patient outcomes. The …

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Implementation Of An Evidence-Based Toolkit To Improve Colorectal Cancer Screening In A Federally Qualified Health Center, Stephanie Mckithan

Doctoral Dissertations and Projects

The change in payor fee-for-service to value-based care is creating an opportunity for primary care clinics nationally to adjust their focus to meeting key clinical quality measures during patient encounters. Colorectal screening is one of such quality measures. Previous research has shown that early detection saves lives. The guidelines have lowered the recommended age of initial screening to 45 due to the incidence of colorectal cancer in younger patients. But with all the objectives that need to be met in the limited time of the visit, how can nurse practitioners improve their efficiency? This evidence-based project assessed the implementation of …

Use Of A Primary Care Dataset To Describe ‘The Real Picture’ Of Diabetes In Kimberley Aboriginal Communities, Caitlyn S. White, Kimberley Seear, Lorraine Anderson, Emma Griffiths

Journal of the Australian Indigenous HealthInfoNet

Objective
Aboriginal communities are impacted by high rates of diabetes, however these are currently underestimated by national data sources used by policy and decision makers to inform allocation of health resources. We aimed to estimate diabetes prevalence and screening coverage using primary care electronic medical record data.

Methods
A cross-sectional audit was conducted using primary care data from Aboriginal regular Aboriginal Community Controlled Health Service (ACCHS) clinic attendees aged 15 years and over (n=1763) in five remote communities in the Kimberley region. Main outcome measures were overall diabetes prevalence; age-specific diabetes prevalence; prevalence of pre-diabetes; and screening rates among patients …

Addressing Weight In Primary Care: Perspectives Of African American Young Adults With Serious Mental Illness, Sang Qin, Lindsay Sheehan, Janis Sayer, Kristin S. Williams, Julius Mercer, Ashley Scott, Tevin Anderson

Journal of Human Services Scholarship and Interprofessional Collaboration

Young adults with serious mental illness (SMI) experience disproportionate rates of physical illness. Morbidity and mortality are even worse for young African Americans with SMI, especially those who are overweight. Primary care physicians (PCPs) have an important role in addressing weight management. Current research explored these young patient’s perceptions of weight management and how PCPs can best address their weight concerns. Using community-based participatory research, we interviewed 25 African American aged 18-30 who were overweight and had a SMI. Results revealed 1) patient perceptions around weight and 2) patient preferences. Participants identified both positive and negative aspects of being overweight, …

Establishing The First Student-Run Clinic To Provide Free Health Care To A South Texas Colonia, John Nicholas Cauba, Andrew B. Callan, Beatriz Tapia

Research Symposium

Purpose: The purpose of the University of Texas Rio Grande Valley School of Medicine Student Run Clinic is to bridge the healthcare gap in the local colonias by providing excellent, compassionate primary care to all who enter our doors, free of charge. We also work to connect our patients to low-cost, high-quality services in the area like women’s health visits, appointments with social workers, and dental services. Additionally, we offer medical students’ opportunities from their first year to serve an underserved population and get hands-on experience with patients.

Many patients in colonias face challenges like limited transportation options and a …

Development Of Solitary Keratoacanthoma From A Cutaneous Wart, Joshua M. Ninan, Veronica Salazar

Research Symposium

Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.

Case Presentation: 48-year-old Caucasian female …

A Building Block Approach To Implement A Telehealth Clinic And Improve Primary Care Access In The Philippines: A Large-Scale Pilot Project, Annalicia Pickering, Wardah Rafaqat, Adi Balk, Milton Chen, Limuel Abrogena, Shuhan He, Mary Showstark, Alexander Davis, Aidan Chen, Jarone Lee

Ateneo School of Medicine and Public Health Publications

A limited number of healthcare workers and cost constraints encumber primary care access in the Philippines. To test telehealth as a low-cost and effective solution, a large-scale digital health clinic was implemented in the selected urban and rural communities. In collaboration with local authorities, our pilot telemedicine clinic was implemented for 3 days in January 2023. Patients were registered, and their vitals were assessed before they were seen by a remote US-based licensed physician who provided treatment rec-ommendations. Medical devices with real-time streaming capabilities, such as electronic stethoscopes, were utilized to enhance remote examinations. A total of 322 patients were …

Integrating Primary Care, Shared Decision Making, And Community Engagement To Facilitate Equitable Access To Multi-Cancer Early Detection Clinical Trials, Cheryl L. Thompson, Adam H. Buchanan, Ronald E. Myers, David S. Weinberg

Department of Medical Oncology Faculty Papers

Effective implementation of cancer screening programs can reduce disease-specific incidence and mortality. Screening is currently recommended for breast, cervical, colorectal and lung cancer. However, initial and repeat adherence to screening tests in accordance with current guidelines is sub-optimal, with the lowest rates observed in historically underserved groups. If used in concert with recommended cancer screening tests, new biospecimen-based multi-cancer early detection (MCED) tests could help to identify more cancers that may be amendable to effective treatment. Clinical trials designed to assess the safety and efficacy of MCED tests to assess their potential for reducing cancer mortality are needed and many …

Increasing Patient Awareness And Education Surrounding Prescription Weight Loss Medications, Anirudh A. Hirve

Family Medicine Clerkship Student Projects

Obesity is a growing problem in the United States. While it remains important for clinicians to emphasize health supportive behaviors including dietary modification and exercise when counseling patients, the advent of new weight loss medications has created a need for patient education materials regarding these interventions for a growing number of patients who request them at primary care visits. This project created a smart phrase in the electronic medical record summarizing weight loss medications currently available on the market to transform patient counseling and enable better shared decision making between patients and providers.

Integrating Behavioral Health Into Family Medicine: Improving Access To Specialty Care Using A Collaborative Care Model, Christina Stephens

DNP Scholarly Projects

Primary care, an extensive of family medicine remains a key access point for patients entering the healthcare system. Accessing medical care and specialty psychiatric services is limited in rural communities. Patients often find exhaustive wait times, untimely referrals, and reliance on emergency services for crisis management. The primary care provider is able to help their community improve access to behavioral health care by using a collaborative approach. This quality improvement initiative used the framework produced by the AIMS Center at the University of Washington and adopted for use creating an 8-week intensive program in a family medical practice located in …

The Role Of Primary Care Providers In Maintaining Weight Loss By Preventing Behavioral Relapse, Hayden R. Blanchard

Capstone Showcase

Supporting patients in optimizing health by treating obesity remains a relevant goal for primary care providers. While weight loss is frequently achieved with behavioral modification, maintaining weight loss by avoiding behavioral relapse is much more difficult. Patient may lose weight by reducing overall energy intake, incorporating intensive behavior change programs, utilizing pharmacotherapy as needed and, in certain cases, undergoing bariatric surgery. With a focus on behavior change and maintenance, primary care providers can support patients by planning more frequent follow up appointments, at least every one to three months. In these visits, PCPs can: focus on reenforcing lifestyle change principles …

Examining The Impact And Implementation Of Protected Administrative Time On Provider Well-Being And Service Delivery Indicators Within A Multi-State Network Of Primary Care Medical Practices, Lauren Junge-Maughan

Electronic Theses and Dissertations

Background:

Primary care is integral to achieving high-quality health outcomes for the population and decreasing healthcare costs. However, primary care clinicians suffer from conflicting demands, impossible expectations, and burdensome processes. With burnout and mental fatigue increasing, leadership must find innovative programs to implement in their organizations. This mixed-methods research study assessed the impact of one such intervention, protected administrative time (PRAT), on improving provider well-being.

Purpose:

The first aim was to evaluate the association of PRAT on the service delivery indicators of primary care clinicians’ productivity, average appointments per day, patient satisfaction (likelihood to recommend), clinician time to the next …

Evaluation Of Nutritional Guidance From Providers For Patients With Type 2 Diabetes In A Primary Care Setting, Whitney Rice

DNP Projects

Background: Adherence to diet is a challenging part of managing type 2 diabetes mellitus (T2DM). Guidelines recommend including a registered dietician and/or a diabetes educator. While this is the gold standard, there are barriers to implementation in primary care. The Starting the Conversation (STC) diet recall tool can aid primary care providers (PCPs) in providing brief nutrition counseling for patients with T2DM. Purpose: To evaluate the perceptions and practices of PCPs regarding dietary education and documentation for patients with T2DM after provider education and initiation of the STC tool. Methods: This was a quality improvement project using a quasi-experimental pretest …

Health Impacts Of Remote Work, Tin Nhan Nguyen

Family Medicine Clerkship Student Projects

Remote work has increased in frequency in the past few years with a notable rise in Connecticut. While working from home has certain benefits, it can also increase the risk of certain physical and mental health issues. An educational pamphlet on the health impacts of remote work with suggestions to reduce negative effects was developed and distributed to community members.

Increasing Annual Depression Screening For Adults In A Primary Care Setting, Sandy Zachery, Sheryl Winn, Flor Culpa-Bondal

Graduate Research Showcase

Increasing Annual Depression Screening for Adults in a Primary Care Setting

Background:

Depression is a mental illness that's common worldwide, which can cause an individual to function poorly in society and can progress to suicide. Because of several barriers, patients in a primary care environment are not being seen or treated for depression. Even though the U.S. Preventive Services Task Force (USPSTF) recommends that all adults in primary care receive annual depression screening that delivers effective treatment with the correct diagnosis and accurate follow-up, patients are still not being screened for depression.

Purpose:.

This project aims to improve …

Osteopathic Manipulative Treatment (Omt) Utilization In The Primary Care Setting, Ceferino Cruz, Afsha Rais

North Texas Research Forum 2024

INTRODUCTION: Osteopathic Manipulative Treatment (OMT) is a skillset used to help diagnose and treat patients with a wide range of musculoskeletal complaints and can also be used as adjunctive treatment modalities for other organ systems. The project is designed to increase OMT usage across 3 clinical sites in our residency program to improve the quality of care provided to our patients. OBJECTIVES: Integrate OMT review into longitudinal clinical education. Address the shortage of faculty members that can precept OMT across all three sites. METHODS: The metrics being tracked are various OMT CPT codes ranging from 98925 to 98929 …

Bridging The Gap For Hiv Education In Primary Care Setting, Oregon Mcdiarmid, Lindsay Porter

North Texas Research Forum 2024

No abstract provided.

Blood Eosinophil-Guided Oral Prednisolone For Copd Exacerbations In Primary Care In The Uk (Starr2): A Non-Inferiority, Multicentre, Double-Blind, Placebo-Controlled, Randomised Controlled Trial, Sanjay Ramakrishnan, Helen Jeffers, Beverly Langford-Wiley, Joanne Davies, Samantha J. Thulborn, Mahdi Mahdi, Christine A'Court, Ian Binnian, Stephen Bright, Simon Cartwright, Victoria Glover, Alison Law, Robin Fox, Adam Jones, Christopher Davies, David Copping, Richard E. K. Russell, Mona Bafadhel

Research outputs 2022 to 2026

Background: Systemic glucocorticoids are recommended for use in chronic obstructive pulmonary disease (COPD) exacerbations; however, there is increased harm associated with their use. We hypothesised that the use of eosinophil biomarker-directed oral prednisolone therapy at the time of an exacerbation of COPD was effective at reducing prednisolone use without affecting adverse outcomes. Methods: The studying acute exacerbations and response (STARR2) study was a multicentre, randomised, double-blind, placebo-controlled trial conducted in 14 primary care practices in the UK. We included adults (aged ≥ 40 years), who were current or former smokers (with at least a 10 pack year smoking history) with …