Primary Care Commons^™

Improving Provider Adherence To Adolescent Depression Screening: Implementation Of A Standardized Phq-A Workflow In Pediatric Primary Care, Taylor P. H. Wamser

Student Scholarly Projects

Practice Problem: Adolescent depression is frequently under identified in pediatric primary care because of inconsistent implementation of routine depression screening despite national recommendations. This practice gap may delay diagnosis and treatment which may increase the risk of adverse mental health outcomes.

PICOT: The PICOT question that guided this project was: In pediatric primary care providers, how does the implementation of a standardized PHQ-A (Patient Health Questionnaire for Adolescents) workflow compared to informal screening practices affect provider adherence to depression screening guidelines over 12 weeks?

Evidence: Current evidence and national clinical practice guidelines support routine adolescent depression screening using validated tools …

The Geography Of Faces, Faith Abraham

be Still

The Geography of Faces takes its title from the idea that a face, seen across decades, becomes a kind of landscape—something you learn to read not at a glance but through accumulated return visits. For Dr. Vasquez, an older physician who has seen so much, her patients' faces are the territory she has spent a lifetime learning to navigate.

The patients are chosen to represent different dimensions of that longevity. They show affection built on years of small battles, continuity across a family, autonomy that is respected. Together, these patients make the case that primary care is less about problems …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Evaluating The Impact Of A Standardized Intimate Partner Violence Screening Tool In A Clinical Setting, Dylan Bogucki

Evidence-Based Practice Project Reports

Intimate partner violence (IPV) is defined as any act of violence, including physical, sexual, stalking, or psychological aggression by an intimate partner, former or current. Despite being preventable, IPV remains a leading nonobstetric cause of morbidity and mortality among women, which highlights the need for systematic screening in clinical settings. The purpose of this quality improvement project is to identify women who have previously experienced or are currently experiencing IPV and to connect them with appropriate resources. Twenty-one studies were identified, all demonstrating moderate to high methodological quality and supporting the need for routine IPV screening in women’s health settings. …

Rates And Predictors Of Intention To Get Preventive Screenings Among Individuals In Recovery From Substance Use Disorders, Afsha Hossain, Ban A. Majeed, Lia Pierson Bruner

Journal of the Georgia Public Health Association

Background: Individuals with substance use disorders (SUDs) are at greater risk for chronic disease but often face barriers to access and uptake of preventive screenings, so the aim of this study was to identify rates and predictors for intention to get preventive screenings among residents at two recovery centers.

Methods: We used a cross-sectional survey (N=95, response rate 51%) to determine previous screening rates and the intention to get recommended preventive screenings among residents of two long-term recovery programs in Athens, GA, using bivariate analysis with chi-square to look for associations with intention.

Results: Prior use of preventive health services …

An Exploratory Study Of Social Determinants And Pediatric Lead Exposure In Chemung County, Ny, Jenna Mccracken, Anika Stundtner, Megan Kerbag, Madison Desantis, Jennifer Coseo, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Background: Lead exposure in children is a persistent public health concern due to its irreversible neurological and developmental effects. Children under 6 years old are particularly vulnerable due to frequent hand-to-mouth activity and increased environmental exposure. Existing literature suggests a relationship between adverse social determinants of health (SDOH), such as low parental education and residence in high-poverty areas, and elevated pediatric blood lead levels (BLLs). This study, subsidized through a community service grant from Excellus Blue Cross Blue Shield, aimed to examine the association between BLLs and SDOH among children screened at the ACCEL Community Health Clinic in Chemung County, …

Implementing An Anxiety Management Bundle In Long-Term Nursing Facilities, Sundan G. Bryson

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

There is currently a gap in accurate screening and treatment of anxiety in Long-Term Care (LTC) nursing facilities. The question for this quality improvement project was: Will implementing interventions for long-term care residents aged 65 and older improve anxiety screening, non-pharmacological interventions, and mental health referrals by 10% compared to current practices? Interventions to enhance anxiety screening included the Geriatric Anxiety Scale-Long Term Care (GAS-LTC) tool to assess and score anxiety. In addition, a Non-Pharmacological Intervention (Non-PI) tool was created to evaluate interventions performed by facility staff. Referrals to the mental health care provider were submitted if a resident scored …

What The Stethoscope Can’T Hear: A Book Review Of Every Patient Tells A Story, Faith Abraham

be Still

My love for reading has always shaped the way I see people and stories. Through books, I’ve learned to listen deeply to characters, voices, and emotions. That same curiosity drives how I approach medicine and the humanities. Reading reminds me that every person carries a story worth understanding, and that healing often begins with paying attention.

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Transforming Primary Care: Innovative Post Graduate Pa Training For Real-World Solutions, Kenneth Botelho, James Ali

Lynchburg Journal of Medical Science

The ongoing crisis in primary care demands innovative and scalable strategies to prepare and retain advanced practice providers. This article introduces the Primary Care Practitioner (PCP) Program, a conceptual postgraduate training model designed for certified physician associates/assistants (PAs) who aim to serve in underserved and rural communities. The program integrates advanced clinical training, leadership development, telehealth competencies, VR-enhanced simulation, and evidence-based strategies to promote provider resilience. Rooted in systems-based thinking and real-world applicability, the PCP Program culminates in capstone projects that encourage innovation in care delivery and population health.

Aligned with national frameworks such as the HRSA Primary Care Training …

Binge Eating Disorder: A Clinical Review, Michell Mcdiffett Mshs, Pa-C

Lynchburg Journal of Medical Science

Binge eating disorder (BED) is the most common eating disorder (ED) in the United States (U.S.) and is characterized by recurrent episodes of eating a larger than normal amount of food in a discrete period of time and includes a sense of loss of control over food intake. BED is often comorbid with serious somatic and psychiatric disorders and is associated with reduced quality of life and excess mortality. Some consider BED a public health concern due to frequent co-occurrence with obesity and worse outcomes in those populations. The diagnosis is often delayed due to shame and underreporting of symptoms …

Prenatal Substance Exposure And Positive Developmental Delay Screening Among Patients In Foster Care, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Understanding Obesity Risk In Intellectual And Developmental Disabilities: Key Diagnoses And Factors, Elizabeth Kolaski, Wendy Aita, Jennifer Lecomte, Andrea Iannuzzelli

Rowan-Virtua Research Day

Background:

Individuals with intellectual and developmental disabilities (IDD) have obesity rates nearly twice those of the general population, leading to higher rates of diabetes, hypertension, sleep apnea, and reduced quality of life.¹ Genetic syndromes such as Prader-Willi syndrome (PWS) and conditions like autism spectrum disorder (ASD) and Down syndrome (DS) feature distinct mechanisms driving weight gain.² The burden of obesity in IDD exacerbates health disparities and strains caregivers and healthcare systems.³ Yet, comparative obesity prevalence and its drivers across specific IDD diagnoses remain poorly characterized.⁴

Hypothesis:

Obesity prevalence and underlying risk factors differ among IDD diagnoses …

Comparison Of Patient Retention Of Pcl-5 Vs. Caps-5 In A Study On Tracking Ptsd Symptoms After A Mobile App Intervention, Kaylea Shoulders, Deep Patel, Muntaha Rana, Anne C. Jones

Rowan-Virtua Research Day

Background: Due to mental health provider shortages, primary care providers are seeing more patients with mental health concerns.1 Due to the COVID-19 pandemic, mental health concerns increased requiring primary care to adapt new multidisciplinary interventions to assist patients.2 When assessing patients for PTSD, either the CAPS-5 or PCL-5 can be used, but they have different qualities that may affect retention.

Hypothesis: The PCL-5 will have a higher retention due to the ease of administration.

Methods: Providers identified eligible patients at the Rowan-Virtua family medicine office in Sewell. Upon consent, the CAPS-5 or PCL-5 was administered, and then the PTSD Coach …

Assessing The Impact Of The Covid-19 Pandemic On Mental Health In Patients Presenting To A Student-Run Free Clinic, Sabah Iqbal, Kirsten Carlberg, Emily Reilly, Jessica Ivanov, Victoria Youssef, Lily Roessler, Maikel Monsour, Nils Brolis

Rowan-Virtua Research Day

Background

Mental health is an important part of patient care, therefore it is imperative to understand how it’s recognized and treated. Socioeconomic status and the COVID19 pandemic contribute to disproportionate incidences of mental illness^{1, 2, 10, 11, 12}. This study uses data from a student-run clinic, the Rowan-Virtua Community Health Center (RVCHC), to examine disparities in mental health needs and screenings among the local population.

Hypothesis

It was hypothesized that underserved populations are at a disadvantage when it comes to both mental health screenings and treatment due to restricted access to healthcare and other unmet needs. Additionally, the …

Produce Prescription Policy Project For The Securement Of A Grant To Address Food Insecurity For Low-Income Type Ii Diabetic Patients, Isabel D. Garcia-Gallegos

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This policy-focused Doctor of Nursing Practice (DNP) quality improvement (QI) project aims to secure grant funding through the Gus Schumacher Nutrition Incentive Program (GusNIP) to implement a produce prescription program at a community clinic in Texas. The program targets low-income adults (18-65 years) with type II diabetes who experience food insecurity and are affected by Medicaid non-expansion.

BACKGROUND

Texas’ decision not to expand Medicaid has exacerbated food insecurity among low-income residents, particularly those managing type II diabetes. This decision creates a healthcare policy gap that this project aims to address with a food-as-medicine program.

METHODOLOGY

Using the Plan-Do-Study-Act (PDSA) …

Evaluating Engagement In Health Care And Substance Use Disorder Services Among People Who Use Drugs, Tiffany Mckenney, Kevin Cobty, Divya Boorle, Julie Gleason-Comstock

Medical Student Research Symposium

An urban community-based organization conducted a study to examine demographics of individuals who use drugs and their approaches to risk reduction. A substantial proportion reported encountering significant barriers to accessing substance use disorder (SUD) services.

In collaboration with a state survey, the community organization recruited a convenience sample of individuals who actively used drugs, examining substance use patterns, healthcare access, and barriers to SUD services. Community health workers facilitated outreach efforts, focusing on harm reduction engagement, and healthcare access.

Data were collected from 55 individuals. 51% identified as male, 48% as female, and 2% as LGBTQIA+. 67% identified as White/Caucasian, …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Fostering Cognitive Complexity In Behavioral Health Providers: Perspectives From Supervisors In Integrated Primary Care, Katherina Nako

Counseling & Human Services Theses & Dissertations

The integration of behavioral health into primary care settings, known as Integrated Primary Care (IPC), offers a holistic approach to addressing both physical and mental health needs (Ramanuj et al., 2019). Efforts to expand access to mental healthcare have contributed to the growing presence of IPC settings (Martin 2017), with mental health providers, such as mental health counselors, joining these teams as Behavioral Health Providers (BHPs; Blount, 2017). However, the unique complexities of IPC often leave BHPs feeling underprepared, largely due to the traditional training frameworks emphasized in many graduate counseling programs. The need for BHPs to adapt to the …

Mental Health Stigma As A Barrier To Care, Whitney Grant

Regis University Student Publications (comprehensive collection)

Abstract

Mental health stigma is a major barrier to care. The mental health stigma as a problem is relevant due to its influence on increasing the burden of mental health issues due to a lack of help-seeking, contributing to increased healthcare costs, and increasing adverse health outcomes. Currently there is no action consistently taken to assess or address this stigma in the primary care setting. Healthcare professionals can help to reduce the perceptions of stigma and lessen stigma as a barrier to care. A quality improvement project was implemented to evaluate if an education intervention by a primary care provider …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Understanding Provider Competency In Gender Affirming Care, Vanessa Castle, Lindsay Gietzen

Pacific Journal of Health

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual plus (LGBTQ+) individuals, especially transgender patients, face many healthcare disparities. It is extremely important for them to have access to high-quality healthcare, particularly Gender Affirming Care (GAC), to support their well-being and mental health. However, many healthcare providers, including clinical social workers, NPs, PAs, and MDs lack proper training to offer GAC. The current training opportunities available are often basic and lack comprehensive, detailed information. To reduce healthcare barriers for the transgender and gender-diverse community, we must have comprehensive training on GAC available for providers so they can treat their patients with …

Comprehensive Community Medicine, Alexander Walther

Capstone Projects and Master's Theses

Comprehensive Community Medicine (CCM) is a theoretical framework designed to address the complex needs of individuals with dual diagnoses of mental illness and substance use disorders (SUDs). Dual diagnosis is highly prevalent, particularly among populations experiencing homelessness, and is associated with poorer health outcomes and increased healthcare service utilization. Structural inequities, including a fractured healthcare system, exacerbate the challenges faced by this vulnerable group. Research indicates that effective care for dually diagnosed individuals requires a layered approach addressing clinical, systemic, legal, and housing barriers.

The development of CCM has been informed by interviews with local stakeholders, including County EMS board …

Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu

Journal of Mind and Medical Sciences

Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …

Impact Of Covid-19 Lockdown On Patient-Provider Electronic Communications, Michael A Hansen, Rebecca Chen, Jacqueline Hirth, James Langabeer, Roger Zoorob

Faculty, Staff and Students Publications

BACKGROUND: SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature.

METHODS: All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during …

The Impact Of Health Status On Health Care Utilization Of Children In Foster Care, Jill Mcleigh, Gunjan Singh, Rong Huang

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …