Primary Care Commons^™

Improving Healthcare Provider Knowledge In Acute And Primary Transgender Health Needs: The Implementation Of A Clinical Education Program With Urgent Care And Emergency Room Staff And Providers, Tonia Lower

Doctor of Nursing Practice Scholarly Projects

The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement …

Why Didn’T I Know? Perspectives From Adult Children Of Elderly Parents With Dementia, Debbie Conner, Julie Postma, Catherine Van Son

All Faculty and Staff Scholarship

Purpose: Approximately 27 million adults are living with undiagnosed dementia worldwide. The purpose of this study was to learn about the experiences of adult children of elderly parents who were ultimately diagnosed with dementia.

Data sources: A descriptive qualitative design was used for identifying if there were prodromal signs or symptoms that preceded the more commonly known warning signs of dementia. Twelve, 60-min interviews were conducted over the telephone.

Conclusions: The overarching theme was: “Why didn't I know?” Subthemes were “We ignored it because we didn't want it to be,” “We thought it was grief,” and “They wouldn't diagnose dementia.” …

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …

Proceedings Of 2016 Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 42nd annual Aurora Scientific Day research symposium, held May 25, 2016, in Milwaukee, Wisconsin. Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, students and other allied health professionals affiliated with Aurora Health Care, a not-for-profit health system comprised of integrated hospitals and clinics across eastern Wisconsin and northeastern Illinois.

Recruiting And Retaining Individuals With Serious Mental Illness And Diabetes In Clinical Research: Lessons Learned From A Randomized, Controlled Trial., Stephanie W. Kanuch M.Ed., Kristin A. Cassidy Ma, Neal Dawson Md, Melanie Athey Ms, Edna Fuentes-Casiano Mssw, Martha Sajatovic Md

Journal of Health Disparities Research and Practice

Abstract: Recruitment and retention of individuals with serious mental illness (SMI) and comorbid diabetes mellitus (DM) in research studies can be challenging with major impediments being difficulties reaching participants via telephone contact, logistic difficulties due to lack of transportation, ongoing psychiatric symptoms, and significant medical complications. Research staff directly involved in recruitment and retention processes of this study reviewed their experiences. The largest barriers at the macro, mediator, and micro levels identified in this study were inclement weather, transportation difficulties, and intermittent and inaccessible telephone contact. Barrier work-around practices included using the health system’s EHR to obtain current phone numbers, …

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners And Physician Assistants., Guillermo V Sanchez, Adam L Hersh, Daniel J Shapiro, James F. Cawley, Lauri A Hicks

Prevention and Community Health Faculty Publications

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Antiretroviral Therapy For The Prevention Of Hiv-1 Transmission., Myron S. Cohen, Ying Q. Chen, Marybeth Mccauley, Theresa Gamble, Mina C. Hosseinipour, Nagalingeswaran Kumarasamy, James G. Hakim, Johnstone Kumwenda, Beatriz Grinsztejn, Jose H.S. Pilotto, Sheela V. Godbole, Suwat Chariyalertsak, Breno R. Santos, Kenneth H. Mayer, Irving F. Hoffman, Susan H. Eshleman, Estelle Piwowar-Manning, Leslie Cottle, Xinyi C. Zhang, Joseph Makhema, Lisa A. Mills, Ravindre Panchia, Sharlaa Faesen, Joseph Eron, Joel Gallant, Diane Havlir, Susan Swindells, Vanessa Elharrar, David Burns, Taha E. Taha, Karin Nielsen-Saines, David D. Celentano, Max Essex, Sarah E. Hudelson, Andrew D. Redd, Thomas R. Fleming

Journal Articles: Internal Medicine

BACKGROUND: An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

METHODS: We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 …

Primary Health Care: Potential Home For Family-Focused Preventive Interventions, Laurel K Leslie, Christopher J Mehus, J David Hawkins, Thomas Boat, Mary Ann Mccabe, Shari Barkin, Ellen C Perrin, Carol W Metzler, And 4 Others

Pediatrics Faculty Publications

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable …

Toll-Like Receptor 4 Signaling Pathway Mediates Inhalant Organic Dust-Induced Bone Loss., Elizabeth Staab, Geoffrey M. Thiele, Dillon Clarey, Todd A. Wyatt, Debra J. Romberger, Adam D. Wells, Anand Dusad, Dong Wang, Lynell W. Klassen, Ted R. Mikuls, Michael J. Duryee, Jill A. Poole

Journal Articles: Internal Medicine

Agriculture workers have increased rates of airway and skeletal disease. Inhalant exposure to agricultural organic dust extract (ODE) induces bone deterioration in mice; yet, mechanisms underlying lung-bone crosstalk remain unclear. Because Toll-like receptor 2 (TLR2) and TLR4 are important in mediating the airway consequences of ODE, this study investigated their role in regulating bone responses. First, swine facility ODE stimulated wild-type (WT) bone marrow macrophages to form osteoclasts, and this finding was inhibited in TLR4 knock-out (KO), but not TLR2 KO cells. Next, using an established intranasal inhalation exposure model, WT, TLR2 KO and TLR4 KO mice were treated daily …

Motivation And Retention Of Physicians In Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan, Sayed Masoom Shah, Shehla Zaidi, Jamil Ahmed, Shafiq Ur Rehman

Community Health Sciences

BACKGROUND:

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan.

METHODS:

An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental …

The Carefirst Patient-Centered Medical Home Program: Cost And Utilization Effects In Its First Three Years, Alison Cuellar, Lorens A. Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley Kells, Iwona Kicinger, Len M. Nichols

Health Policy and Management Faculty Publications

Background

Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective

To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Design

We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized …

Improving Collaboration Between Pharmacists And Physicians, Paras Patel

BU Well

Physicians and pharmacists have differing but complementary roles that can optimize patient care when structured effectively. Unfortunately, these two professionals are not collaborating well enough, as patient outcomes, especially in relation to medication adherence, continue to decline. Coordinated care of patients can improve by expanding bidirectional communication and sharing additional patient information with each other. It will be necessary to continue to promote collaborative care in the educational and training stages of these professionals’ careers to build trust and understanding of professional scope. Ultimately, the healthcare infrastructure will have to continue to progress to make collaboration more available and valuable …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones, 2016 to 2019

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations …

Vitamin D Supplementation: Preventing Fractures, Courtney L. Carn, Michael S. Doherty

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the ability of vitamin D supplementation in preventing musculoskeletal fractures. Methods: Systematic literature review using Google Scholar search terms “vitamin D supplementation” and “preventing hip fractures” from 2006-2015. Only RCTs, meta-analysis, and clinical guidelines were included. Results: Our search resulted in one meta-analysis and two randomized controlled trials. Conclusion: The summation of our investigation into vitamin D deficiency and the presence of musculoskeletal fractures has proven to be relatively inconclusive. The resulting data from our three studies did not provide any definitive proof that improved vitamin D levels correlates with better bone health.

Want To Lose Weight? Commercial Weight Loss Programs Vs. Primary Care, Jessica Jacobson, Katherine Chui

Physician Assistant Capstones, 2016 to 2019

Context Overweight and obesity rates are on a continuous incline in the United States leading to increased rates of diabetes, cardiovascular disease and death. Much of the healthcare costs are going into treating this disease; therefore, it is vital to find effective weight loss treatments in both the primary care and community settings to reduce the prevalence of overweight and obesity and subsequent healthcare costs.

Objective To assess whether primary care-based therapy or commercial weight loss programs help overweight and obese patients lose 5% of their weight from baseline.

Design, Setting and Participants A systematic review of four randomized control …

Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose

Community-acquired pneumonia (CAP) is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP), i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP.

Methods

We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not improve …

A Quality Improvement Collaborative To Improve Pediatric Primary Care Genetic Services., Michael L. Rinke, Amy Driscoll, Natalie Mikat-Stevens, Jill Healy, Elizabeth Colantuoni, Abdallah F. Elias, Beth A. Pletcher, Ruth S. Gubernick, Ingrid Larson, Wendy K. Chung, Beth A. Tarini

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To investigate if a national pediatric primary care quality improvement collaborative (QIC) could improve and sustain adherence with process measures related to diagnosis and management of children with genetic disorders.

METHODS: Thirteen practices in 11 states from the American Academy of Pediatrics' Quality Improvement Innovation Networks participated in a 6-month QIC that included regular educational opportunities, access to genetic professionals, and performance feedback. The QIC identified 11 aims related to improving diagnosis and management of children with genetic disorders. The practices evaluated adherence by reviewing patient records at baseline, monthly for 6 months (active improvement period), and then once …

Generational Differences In Practice Site Selection Criteria Amongst Primary Care Physicians., Christopher Duffrin Phd, Mches, Molly Cashion Mph, Doyle M. Cummings Pharmd, Lauren Whetstone Phd, Jonathon Firnhaber Md, Gary Levine Md, Ricky Watson Md, Msph, Aaron Lambert Md

Marshall Journal of Medicine

ABSTRACT

Background and Objectives: Generational differences are often viewed as shaping the overall attitudes and actions of different age cohorts. It is essential to understand the motivations and generational differences in primary care physicians for efforts to recruit, retain, and educate the future physician workforce. Determining what factors most influence different generations of primary care physicians when choosing a practice site is essential to build our future primary care system. This study examined generational differences in the factors that attracted primary care physicians to their current practice.

Methods: A survey instrument was mailed to all active members of the North …

Trends In Vaccination Rates Amongst Young Children And The Factors Affecting Parent Decisions, Kaitlyn C. Baldridge, Janna Bjoin, Katherine Pool

All Electronic Theses and Dissertations

Problem: Throughout the United States, there has been an increasing trend in the number of parents refusing to vaccinate their children. Studies have shown that since the upward trend of refusal to vaccinate has started, there has been an increase in outbreaks of preventable diseases. In Minnesota, there have been no studies to evaluate how many parents are refusing vaccinations for their children or the reasons why. Purpose: This study will evaluate how many parents with children ages five and under are choosing to vaccinate their children or refusing vaccination, and the reasons behind their choice to vaccinate or not. …

The Knowledge And Attitude Of Bethel's Undergraduate Population On Sun Protective Behaviors, Sarah R. Beddow, Chelsea V. Domeier, Karien Wilson

All Electronic Theses and Dissertations

OBJECTIVES: To compare the attitude and knowledge of health science majors versus non-health science majors of the Bethel University undergraduate population. BACKGROUND: Despite public education about the use of sunscreen and skin cancer protection, researchers are still finding a gap in public knowledge. Sun exposure education is crucial and must happen during childhood and adolescence because these are the times people receive the most UV exposure. Repeat sunburns during childhood can double an individual's risk of developing melanoma in adulthood. METHODS: This was a pre-experimental design single evaluation via a survey. The following research questions were investigated in our research …

Antihypertensive Medication Adherence In The Twin Cities, Jacob J. Clairmont, Taylor J. Cunningham, Krista M. Nauman

All Electronic Theses and Dissertations

A retrospective study of antihypertensive medication adherence was conducted on patients’ demographics data at Eastside Health Clinic in St. Paul, MN. The study sought to determine whether or not interventional means were needed to improve adherence to antihypertensive medication based on serial blood pressure measurements collected over the course of 6 clinic visits. The study found that patients were consistently more non-adherent than adherent in every category assessed, yet there was an overall decrease in mean systolic and diastolic blood pressure. Based upon these findings, it can be concluded that while individual adherence rates were imperfect for each demographic category …

Knowledge Of Behaviors That Contribute To A Healthy Pregnancy In Women Aged 18-25, Sarah K. Coffey, Rebecca Jennings

All Electronic Theses and Dissertations

Knowledge of behaviors that contribute to a healthy pregnancy may enhance the overall pregnancy experience. However, there are currently no studies that evaluate where discrepancies exist between current recommendations of behaviors contributing to healthy pregnancies and knowledge of those behaviors in women ages 18-25. The objective of this study was to determine where those discrepancies exist. Survey data of women’s knowledge was compared to current recommendations set forth by the American College of Obstetricians and Gynecologists (ACOG). The behaviors assessed included alcohol consumption, cigarette smoking, sleeping, caloric intake, exercise, caffeine intake, weight gain, and folic acid intake. This knowledge was …

An Analysis Of Immunization Understanding In Undergraduate Students At Bethel University, Jeff Dahlquist, Steven D. Lindblom

All Electronic Theses and Dissertations

This investigation studied the level of understanding of the nature of immunizations and vaccine preventable diseases in undergraduate students at Bethel University. Immunization literature demonstrates a significant lack of understanding in the general population in relation to the nature of vaccine preventable diseases and the immunizations used to counter them. Furthermore, the literature concludes that such a grossly inadequate understanding of the nature of vaccine preventable diseases may precipitate dire epidemiological consequences. This investigation was a pre-experimental design and utilized a short questionnaire administered one time to a sample population of 171 subjects over 18 years of age who were …

Anterior Cruciate Ligament Reconstruction: Which Graft Is Best To Prevent Re-Tear?, Katherine Ann Eslinger, Brittany Kapala, Noelle Kreofsky

All Electronic Theses and Dissertations

The three most widely used graft choices currently employed in anterior cruciate ligament (ACL) repair are: patellar tendon autograft, hamstring tendon autograft, and cadaver tendon allograft. The purpose of this study is to examine the efficacy of each of these 3 graft choices (patellar tendon autograft, hamstring tendon autograft and cadaver tendon allograft) and determine which graft is less prone to re-tear. The study was implemented using a quantitative design process. The patient data was obtained and analyzed via Facebook survey. All identifying patient information was removed. Patients were included based on whether or not their ACL reconstruction was performed …

Cardiovascular Strain In Overweight 5k Runners, Sara Geier, Polly Hendel

All Electronic Theses and Dissertations

Previous research is vast and varied regarding how exercise affects the physiology of the cardiac system. Many studies have found adverse effects to the heart in ultra-endurance athletes, but fewer studies have focused on overweight populations. Hamer and Boutcher (2006) observed abnormal post exercise cardiovascular changes in obese individuals when compared to individuals of normal body mass index (BMI) but, were unable to draw any definitive conclusions from the results. With Americans facing an obesity epidemic and healthcare providers increasingly prescribing regular exercise routines to combat it, definitive conclusions regarding the topic of healthy long-term exercise in overweight and obese …

Diabetes Education For The Hispanic Population, Nohemi I. Haben, Misty M. Schmitz

All Electronic Theses and Dissertations

The purpose of this study is to investigate the effects, if any, of utilizing Spanish language on the efficacy of an education program for type 2 diabetes among the Hispanic population in the twin-cities Minneapolis/St. Paul metro area. In the United States adult Hispanics over the age of twenty have a 5.2% higher incidence of type 2 diabetes than Non-Hispanic Whites, a number that keeps rising despite preventability. In this study, a diabetes education program was delivered in Spanish based on material developed by the Centers for Disease Control and Prevention and the National Diabetes Education Program. The program focused …

Minnesota Healthcare Barriers To The Medically Underserved, Ashley C. Hoffmann, Amanda Walters

All Electronic Theses and Dissertations

Quality medical services and patient oriented satisfaction are important factors in a healthcare setting. Barriers preventing such factors are more prevalent in medically underserved areas (MUAs) ( Brems, Johnson, Warner, & Roberts, 2006 ). The purpose of this study was to identify barriers in the care of patients within Minnesota MUAs. The study was conducted by an online survey emailed to Minnesota Academy of Physician Assistant (MAPA) members, and only members who were currently employed in a Minnesota MUA county had valid data collection. Twelve barriers to healthcare were listed on the survey and required the MAPA members to grade …

Dietary Supplements: A Consumer Profile Of Knowledge And Use, Sarah J. Kucera, Yen Nguyen

All Electronic Theses and Dissertations

Alternative medicine, in the form of dietary supplements, is appealing to Americans. Supplements have been marketed as being natural promoters of general well-being, healing, and disease prevention. Even with minimal regulation and research, the majority of supplement use is self-prescribed, fueling an industry last estimated at $32.5 billion in 2012. The study explored the degree of consumer knowledge with regards to regulation, appropriate indications and dosages, and potential adverse effects of various dietary supplements. The study also sought to evaluate the relationship between supplement knowledge and demographic information as well as the extent of discussion about supplement use with a …

Individual Physician Assistant's Spirituality And Job Satisfaction, Kyle J. Smisek, Kelsa L. Hovelson, Mali D. Langlie

All Electronic Theses and Dissertations

The factors that contribute to job satisfaction have been studied extensively. Additionally, in the healthcare setting, the influence of spirituality has been a topic of substantial research. However, few studies have researched a physician assistant’s individual spirituality and its influence on job satisfaction. The goal of this study was to first identify the effect, if any, between the spirituality of a PA and his or her perceived job satisfaction, and second, to determine where spirituality ranks among the various factors that influence job satisfaction. In addition, the study addressed whether there appears to be a connection between one’s spirituality and …