Primary Care Commons^™

Getting To The Heart Of The Problem: Blood Pressure Management Through Medication Adherence, Mallory G. Livengood

Evidence-Based Practice Project Reports

Clinical hypertension affects one in four adults globally, making it the most common chronic condition. Despite its widespread impact, hypertension can be prevented, as it represents the most modifiable risk factor in preventing cardiovascular disease. The primary purpose of this evidence-based project was to determine whether a one-month follow-up with a healthcare provider improved medication adherence through enhanced hypertension management. Twelve eligible participants were selected from a primary clinic located in Northwest Indiana, based on their newly initiated anti-hypertensive medications or who required a medication adjustment due to poor hypertension management. Each participant’s preferred method of communication was noted, and …

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. …

Increasing Medication Adherence In Those With Hypertension, Holly Kimiecik

Evidence-Based Practice Project Reports

Hypertension is a chronic condition characterized by persistently elevated blood pressure and remains a significant contributor to morbidity and mortality in the United States. According to the Centers for Disease Control and Prevention (2024), approximately 47.7% of U.S. adults have hypertension, yet only about one in five achieve blood pressure control below 130/80 mm Hg. Medication adherence plays a critical role in managing hypertension and preventing complications. Adults aged 18 years and older prescribed antihypertensive medications from a primary care clinic in Valparaiso, Indiana, participated in this six-week quality improvement intervention. Evidence from a comprehensive literature review supports combining patient …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Quality Improvement (Qi) Project Aimed At Reducing 30-Day Hospital Readmissions For Patients With Congestive Heart Failure (Chf) Through Checklist Implementation, Gary Gutierrez

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Congestive Heart Failure (CHF) remains a leading cause of preventable 30-day hospital readmissions,

especially in outpatient and transitional care settings. This quality improvement (QI) initiative was

launched within a private internal medicine practice in Essex County, New Jersey, to address this issue

by implementing a standardized CHF management checklist. The checklist focused on four key

components: (a) comprehensive medication reconciliation, (b) tailored patient education, (c) timely

follow-up appointments, and (d) improved interdisciplinary communication. By integrating evidence-

based practices into a structured workflow, the QI project aimed to improve care coordination,

empower patients to manage their condition, and reduce preventable …

Preserving What Matters: A Multimodal Approach To Maintaining Fat-Free Mass During Anti-Obesity Medication Based Weight Loss, Sarah Gore

Evidence-Based Practice Project Reports

Weight loss is often associated with reductions in fat-free mass (FFM), which can negatively impact metabolic rate, thermoregulation, bone density, functional capacity, and overall quality of life (Roth et al., 2022; Sedlmeier et al., 2021). This Evidence-Based Practice project aimed to reduce FFM loss in adults prescribed anti-obesity medications (AOMs) for weight management through a targeted, multimodal intervention. Twenty-two patients beginning AOM treatment at a family practice in northwest Indiana were invited to participate, with 19 consenting to enroll. Each participant received personalized guidance, including tailored calorie and protein intake goals to support a hypocaloric, high-protein diet, alongside evidence-based aerobic …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Early Childhood Caries In The Primary Care Setting, Rieley M. Hull

Evidence-Based Practice Project Reports

Early childhood caries (ECC) is the most prevalent chronic childhood disease and, if untreated, can lead to significant long-term health and social consequences, posing a substantial healthcare burden (AAPD, 2023; ADA, 2023; USPSTF, 2021; WHO, 2022). This evidence-based practice (EBP) project aimed to implement a multi-modal intervention to reduce ECC risk factors, prevent new dental caries, and halt the progression of existing dental caries. Conducted in a pediatric primary care setting in West Michigan, the project included patients five and under who received an oral examination and dental caries risk assessment following the AAP’s guidelines. Based on their oral health …

A Multimodal Intervention To Improve Treatment And Clinical Outcomes In Children With Recurrent Otitis Media, Daniel Courtaney

Evidence-Based Practice Project Reports

Acute otitis media is the number one cause for primary health care visits and antibiotic prescriptions in the pediatric population (El Feghaly & Jackson, 2023). Upwards of 27% of children experience multiple episodes of otitis media (OM) that meet recurrent otitis media (ROM) diagnosis criteria (Pelton & Marchisio, 2023). Guided by the Iowa Model (Iowa Model Collaborative, 2017), the project’s purpose was to implement a multimodal intervention to decrease recurrent OM and repeat clinic visits. A comprehensive literature search of 5 databases yielded 16 sources ranging from levels I-IV (Melnyk & Fineout-Overholt, 2023). Using the AGREE II and JBI Critical …

Patient Education And Health Literacy Effects On Statin Use And Adherence, Ian M. Smith, Richard G. Olarsch, Alison M. Mancuso

Rowan-Virtua Research Day

Background: While the use of statins (HMG-CoA reductase inhibitors) plays a significant role in the prevention of cardiovascular disease, it is estimated approximately 60% of patients who would benefit from a statin are receiving these medications. Current research suggests that a preference for life-style intervention over medical management, concern over medical adverse reactions, and a lower perceived risk of cardiovascular events is associated with statin non-adherence.

Methods: An IRB-approved paper survey was administered to patients aged 18 to 89 at an ambulatory primary care clinic for non-acute visits. Qualtrics was utilized to collect, store, and process data. Information elicited from …

The Effect Of Using Pelvic Floor Exercises Administered Through A Smartphone Application In Postpartum Women With Pelvic Floor Dysfunction, Elizabeth A. Russell

Evidence-Based Practice Project Reports

Pelvic floor dysfunction (PFD) affects 50% of postpartum women and can lead to pelvic pain, stress urinary incontinence, fecal incontinence, pelvic organ prolapse, or sexual dysfunction (Grimes, 2023). The purpose of this evidence-based practice project was to determine if the implementation of pelvic floor exercise (PFE) as guided by a smartphone application, to improve adherence and technique of exercises, will improve PFD symptoms and quality of life (QOL). At an OBGYN clinic in northern Indiana, all women who presented for their 6-week postpartum appointment were screened for PFD with the Pelvic Floor Distress Inventory (PFDI-20) and QOL with the Pelvic …

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

A Multimodal Approach To Decreasing Hesitancy Of The Influenza Vaccine In The Family Care Setting, Carley J. Ellenberger

Evidence-Based Practice Project Reports

The uptake of the influenza vaccine is the most effective and proactive action an individual can take to defend themselves against the influenza outbreak each season; therefore, it is recommended that everyone at least six months of age and older should receive the annual flu vaccine (CDC, 2022; WHO, 2023). Unfortunately, influenza vaccine hesitancy is demonstrated on a global level affecting the uptake compliance annually each influenza season despite the millions of people that experience influenza symptoms annually (CDC, 2022, WHO, n.d.; Healthy People 2030, n.d.). The PICOT question for this project was in adults, over the age of 18, …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

A Prescription For Diabetes Self-Management Education: Best Practice For Persons With Type Ii Diabetes Mellitus, Ashley J. Milcarek

Evidence-Based Practice Project Reports

Diabetes self-management education and support (DSMES) programs have been shown to improve patient outcomes and lower hemoglobin A1c (Hgb A1c) levels in those who are diagnosed with type two diabetes mellitus (T2DM). However, these programs are often underutilized and have low referral rates, despite the known benefits (Powers et al., 2020). The purpose of this patient-centered EBP project was to evaluate the effectiveness of a patient-driven questionnaire, completed by patients with T2DM during routine office visits, in increasing the percentage of patients referred to DSMES by their provider. Specifically, this project addressed the following PICOT question: In adults who have …

The Effect Of Implementing Behavioral Counseling For Elevated Ldl Levels, Blake L. Hansen

Evidence-Based Practice Project Reports

Hyperlipidemia is a key risk factor in cardiovascular mortality, and is prevalent in approximately 38% of American adults (CDC, 2022b). Cholesterol levels are intensified by unhealthy lifestyle choices, which means a change in lifestyle behaviors could prevent cardiovascular related deaths (WHO, 2022). The PICOT question for this project was: In adults aged 20 years or older in the primary care setting who have elevated low-density lipoprotein (LDL) levels (P), does the implementation of behavioral counseling on lifestyle modifications (I) compared to current practice (C) decrease LDL levels (O) over a 10- to 12- week period (T)? Fourteen participants from a …

Advance Care Planning: An Evidence-Based Practice Project, Gabrielle Alanna Harvey

Evidence-Based Practice Project Reports

Advance care planning (ACP) is a topic that can be difficult for patients and providers to discuss due to lack of time, knowledge, communication skills, and discomfort surrounding the subject (Barkley et al., 2019; Hafid et al., 2021; Halpert et al., 2022; Marin, 2022). Delayed or absent ACP discussions may lead to nonbeneficial care, increased healthcare costs, end of life suffering and increased post-death family distress (Halpert et al., 2022; O’Hanlon et al., 2018). The purpose of this evidence-based practice (EBP) project was to increase the discussions and documentation regarding ACP in a family practice setting. The PICOT question guiding …

The Outcome Of A Multidimensional Intervention Strategy For The Management Of Generalized Anxiety Disorder In An Internal Medicine Setting, Nicholas Davidson

Evidence-Based Practice Project Reports

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 …

Diet, Exercise, Self-Monitoring, Technology, And Motivational Interviewing For Weight Loss In Adults, Ashleigh D. Warburton

Evidence-Based Practice Project Reports

Obesity, an epidemic in the United States (US), affected 42.4% of adults as of 2017-2018 (Hales, 2020). Comorbidities associated with obesity, such as cardiovascular disease, cancer, and diabetes (Orringer et al., 2020), are some of the leading causes of death in the US (Kochanek et al., 2020). The purpose of this evidence-based practice (EBP) project was to answer the following PICOT question: In adult patients aged 19 years or older who are considered overweight or obese as measured by body mass index (BMI) of ≥ 25 kg/m2 (P), how effective is diet and exercise combined with self-monitoring, a phone application, …

A Multimodal Approach To Decreasing Hesitancy And Increasing Uptake Of The Covid-19 Vaccine In The Family Care Setting, Meghan Zwierzynski

Evidence-Based Practice Project Reports

Since December 2019, the coronavirus disease 2019 (COVID-19) has swept across the world, infecting and killing millions of people, making it one of the worst pandemics in history (WHO, 2021). However, the rates of confirmed cases and deaths have slowed since the discovery of the COVID-19 vaccine. The purpose of this evidence-based practice (EBP) project was to decrease vaccine hesitancy and increase uptake of the COVID-19 vaccine in the family care setting. The Iowa Model-Revised (Iowa Model Collaborative, 2017) is a practical, effective multi-step change process that acted as a guide for the EBP project. A review of literature showed …

The Efficacy Of Tailored Text Messages To Improve Medication Adherence And Lifestyle Changes For Patients With Type 2 Diabetes Mellitus, Vanessa B. Silverio

Evidence-Based Practice Project Reports

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by increased amounts of glucose in the blood, and is the seventh leading cause of death in the United States (United Health Foundation [UHF]), 2021). T2DM can be effectively treated with medication and behavioral lifestyle modifications. Even small improvements in glycemic control can reduce the risk for debilitating complications such as heart disease, stroke, kidney disease, sepsis, and retinopathy (Wang et al., 2021, Haider et al., 2019). The purpose of this evidence-based practice (EBP) project was to identify the most effective intervention for improving medication adherence, lifestyle changes, and hemoglobin …

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Empower You: An Adult Type 2 Diabetes Mellitus Management Program With Utilization Of A Mobile Phone Application, Kelsey Jahn

Evidence-Based Practice Project Reports

In 2018, 34.2 million Americans had diabetes and there continues to be 1.5 million Americans diagnosed with diabetes every year (ADA, 2018). Due to this increasing prevalence, self-management of type 2 diabetes mellitus (T2DM) is essential to disease management. The PICOT question for this project was: In adults with T2DM with a hemoglobin A1C (HbA1C) greater than 8% in a diabetes specialty clinic (P), what is the effect of a multimodal smartphone application (I) compared to prior nonuse of the application (C) on average blood glucose readings (O) over an 8-week period (T)? The project was completed in a large, …

Back To The Basics With Smart Goals: A Multimodal Intervention For Adults Who Have Type 2 Diabetes, Alyssa L. Snyder

Evidence-Based Practice Project Reports

Diabetes, the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2020a) and the ninth leading cause of death worldwide (World Health Organization [WHO], 2020), has increased by 70% over the last two decades (WHO, 2020). Type 2 diabetes (T2D), the most prevalent type accounting for 90% to 95% of diagnosed cases (CDC, 2020a), affects individuals of all ages and often results in major health problems including stroke, heart attack, and kidney disease. The purpose of this patient-centered, evidence-based practice (EBP) project was to evaluate the effectiveness of a multimodal intervention on hemoglobin …

Walking Is Worthy: Walking For Hypertension, Ashleigh Y. Peterson

Evidence-Based Practice Project Reports

Elevated blood pressure (BP), or hypertension (HTN), can cause a cascade of detrimental effects to the body. It is associated with increased risk of stroke, angina, myocardial infarction, heart failure, peripheral artery disease, end-stage renal disease, and abdominal aortic aneurysms (Whelton et al., 2018). HTN is also a major risk factor for the development of cardiovascular disease (CVD), which is the United States’ (U.S.) leading cause of death in men and women (U.S. Preventive Services Task Force [USPSTF], 2020). The PICOT question for this project was: does an eight-week (T) structured walking program utilizing a smartwatch for step counts and …

Increasing Physical Activity In Women With Obesity To Promote Weight Loss, Ashley N. Kohler

Evidence-Based Practice Project Reports

Obesity is a chronic disease associated with a multitude of lifelong chronic illnesses. Obesity impacts more than 42% of the United States population (CDC, 2021b). Physical inactivity is a major determinant of obesity (Muerer et al., 2019). The purpose of this evidence-based practice (EBP) project was to promote a greater reduction in body mass index (BMI) of the participants enrolled in an existing wellness program at the EBP practice site by increasing the physical activity level of the participants compared to standard protocol. The existing wellness program’s standard protocol included diet modifications, physical activity encouragement, and medication management. The EBP …

Increasing Vaccination Rates In Pregnancy Using A Multifaceted Approach Including Patient Education And Reminder/Recall Interventions, Jas Tiara Mcgee

Evidence-Based Practice Project Reports

Given the global tragedy that this most recent pandemic has caused, more attention has been given to the devastating outcomes that the spread of infectious disease outbreaks can have. Similar to those with comorbid conditions, pregnant women are also extremely vulnerable to infectious diseases, as disease manifestation does not only affect the mother, but the fetus as well. Thus, the prevention of both the influenza virus and pertussis are two major goals when providing care for this population. Preventing both of these disease processes during the intrapartum period helps to ensure optimal wellness for both mother and baby and overall …

The Effect Of Implementing A Generalized Anxiety Disorder Protocol For Anxiety And Depression Symptoms In The Primary Care Setting, Bailey J. Hinman

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is very prevalent in the United States with 5.7% of citizens affected (National Institute of Mental Health [NIMH], 2017). This number is expected to be even higher because individuals avoid care due to stigma of mental illness (Andrews et al., 2018). GAD can have significant implications such as decreased ability to function, decreased quality of life and increased risk of suicide (Fong, 2018; Lizarondo, 2018). The purpose of this project was to improve outcomes for adult patients with GAD in the primary care setting by improving treatment to follow best practice recommendations. The Johns Hopkins Evidence …

Consequence Of Patient Education On Health Habits, Esha M. Patel, Adarsh Gupta

Rowan-Virtua Research Day

Hypothesis: Patients who participate in an specific health habit do so due to a lack of knowledge about the consequences of that choice.

Goal: Correlate patient participation in specific health habits with their knowledge of the consequences of these choices. Understand why patients continue to participate in specific habits and what influences their decision. The end goal of my project is to provide insight to encourage physicians to evaluate patient’s health education and get physicians to try to apply consequences of these habits on the patient’s life to help them understand health outcomes.

Conclusion: This study showed more correlations between …

Efficacy Of Diabetes Self-Management Education Administered Via Telehealth For Adults With Uncontrolled Diabetes, Tanner Free

Evidence-Based Practice Project Reports

Patient’s with a diagnosis of diabetes require significant lifestyle modification and education. The need for patient education has led to the development of diabetes self-management education (DSME) classes. Unfortunately, utilization of DSME classes is only 5% among Medicare beneficiaries and 6.8% among privately insured patients (Centers for Disease Control [CDC], 2018). The purpose of this evidence-based practice (EBP) project was to implement DSME via telehealth and assist with goal formation to help patients with uncontrolled diabetes achieve glycemic control by increasing access to crucial education. The intervention consisted of bi-weekly calls for a period of 3 months. Participant data were …

Hypertension Management: Improving Medication Adherence Through The Use Of Daily Text Messages, Gaelle Bulabula

Evidence-Based Practice Project Reports

Hypertension (HTN) is the leading cause of hospitalization and is responsible for approximately 50% of cardiovascular and cerebrovascular events (Al-Noumani, et al., 2018). Uncontrolled HTN can lead to comorbidities including ischemic heart disease, renal disease, or life-threatening arrythmias (World Health Organization [WHO], 2019). The leading cause of HTN is medication non-compliance (Varleta, et al., 2017). The purpose of this evidence-based practice project was to determine the effectiveness of daily text messages on antihypertensive medication adherence. A comprehensive review of literature generated ten high-level evidence studies demonstrating that daily text messages near each medication dosing time is best practice for improving …