Primary Care Commons^™

Home-Based Primary Care: Impact On Cost And Patient Satisfaction, Sarah R. Tupper

All Graduate Theses, Dissertations, and Other Capstone Projects

The aging American population means more people will need healthcare than ever before. Many of these people are or will be Medicare beneficiaries who are predicted to be completely or mostly homebound at some point in time. This literature review was conducted to investigate Home-based Primary Care (HBPC) and whether or not this care delivery model has impacts on cost and patient satisfaction when compared to traditional outpatient encounters. A comprehensive and robust search of the literature was conducted using four different healthcare literature databases. Relevant articles were included if the site of care was ambulatory or office-based and if …

Integrative Medicine In Primary Care, Ashley M. Bjornerud

Physician Assistant Scholarly Project Papers

Integrative medicine (IM) is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health (Rakel, 2017). Commonly, integrative medicine is associated with complementary and alternative medicine therapies (CAM). These are two separate entities. CAM is one of the modalities used in integrative medicine.

The review of the literature on IM analyzed studies in primary care settings in all parts of the world. Definitions of IM and CAM are evaluated. Defining what IM is and how to incorporate this approach in …

Improving Early Child Developmental Screenings In A Primary Care Setting: A Quality Improvement Project, Marlischa Jackson

Doctor of Nursing Practice

A dramatic growth of physical, motor, cognitive, communication, emotional, and social development will occur during the 3 years of life. Of children ages 3-17 years of age, 13% have some type of developmental or behavioral condition that goes undiagnosed before the age of 10. Children with multiple health and social risk factors, or those with chronic health disorders, are at greater risk to develop early child delays or disabilities. In the U. S., developmental screenings are only completed 21% of the time during well-child visits. Therefore, the purpose of this quality improvement project was to increase the adherence of health …

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.

Improving Chronic Pain Management Processes In Primary Care Using Practice Facilitation And Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative, Roberto Cardarelli, Sarah Weatherford, Jennifer Schilling, Dana King, Sue Workman, Wade Rankin, Juanita Hughes, Jonathan Piercy, Amy Conley-Sallaz, Melissa Zook, Kendra Unger, Emma White, Barbara Astuto, Bobbi Stover

Journal of Patient-Centered Research and Reviews

Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services.

Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state’s clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s) and workflow processes. Charts for 695 patients with chronic …

A Coal Miner With Weakness, Fatigue, Nausea, Fever, Chills, Night Sweats And Dyspnea, Larry Nichols

Marshall Journal of Medicine

Delayed or missed diagnoses are a constant hazard in primary care. This is the case report of a 51-year-old coal miner, who presented as an ambulatory outpatient on a Friday with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea. Chest x-ray on Saturday showed pneumonia and pleural effusion, while blood testing showed renal failure, but these results were not known by his physician until Monday, when he was hospitalized with severe sepsis due to fatal Austrian syndrome of pneumococcal pneumonia, endocarditis and meningitis. Analysis of the delay of diagnosis in this case suggests the possibility that a weekend effect …

The Effect Of Routine Adult Phq-2 Depression Screen And Scheduled Follow-Up Protocol In The Primary Care Setting, Alex F. Bikowski

Evidence-Based Practice Project Reports

Healthy People has projected depression to be the primary cause of disability by 2020; therefore routine depression screening has been prioritized as a national healthcare initiative. The purpose of this Evidence-Based Practice (EBP) project is to demonstrate that routine implementation of the 2-item Patient Health Questionnaire (PHQ-2) depression screener, along with a scheduled follow-up protocol for adults in the primary care setting, can improve current mental health practices regarding the identification of depression by clinicians. The evidence supports use of the PHQ-2 for routine adult depression screening, as long as a scheduled follow-up protocol is available for positive screens. This …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

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.” …

Bone Health Promotion For Youth: A Primary Care Intervention, Kay G. Wilson

Doctor of Nursing Practice Projects

Obese youth have high rates of vitamin D and calcium deficiencies and are at risk for developing osteoporosis. Clinical guidelines are needed in primary pediatric care services to promote bone-healthy behaviors. The aim of this project was to: a) implement the infrastructure and processes for physiological monitoring, consistent parameter-based vitamin D & calcium supplementation, family education, and coaching, and b) evaluate the impact of bone promotion changes on patients and parents and the primary care delivery system. The project outcomes included modest gains in bone health awareness among staff, patients, and families. In addition, modifications to clinical pathways and related …

Improving Access To Primary Care For Aboriginal Babies In Western Australia: Study Protocol For A Randomized Controlled Trial, Dan Mcaullay, Kimberley Mcauley, Rhonda Marriott, Glenn Pearson, Peter Jacoby, Chantal Ferguson, Elizabeth Geelhoed, Juli Coffin, Charmaine Green, Selina Sibosado, Barbara Henry, Dorota Doherty, Karen Edmond

Research outputs 2014 to 2021

Background:

Despite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary …

Assessment Of Obesity Management In A Primary Care Setting, Katie Diffenderfer

DNP Projects

Purpose: The purpose of this study was to evaluate the current practices related to obesity in the primary care setting in University of Kentucky’s Healthcare System. The specific aims were to: 1) Determine the proportion of obese patients who had an ICD-9/10 diagnosis code for obesity, 2) Determine the proportion of obese patients who received interventions related to their obesity, 3) Determine whether obesity diagnosis and interventions varied based on patient demographics, and 4) Compare actual obesity interventions to those outlined in the clinical practice guidelines.

Methods: A retrospective chart review of male and female patients between the ages of …

Should Primary Care Physicians Address Sleep To Improve Weight Loss In Obese Patients? A Clin-Iq, Kjersti E. Knox

Journal of Patient-Centered Research and Reviews

Obesity is a commonly encountered problem in the primary care setting. Simultaneously, sleep is seen to hold an increasingly important role in many components of health and wellness. A review of the literature was performed to determine if improving sleep positively impacts weight loss in obese adults. The evidence reviewed suggests that improving patients’ sleep may initially improve patient weight loss; however, current studies do not show a sustained statistically significant impact. Until higher powered and higher quality studies are completed, there are no clear evidence-based guidelines for primary care physicians to follow regarding sleep and obesity.

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

The Effect Of An Educational Intervention On Oral Anticoagulation Therapy Knowledge In Primary Care, Elizabeth D. Deck

Evidence-Based Practice Project Reports

It is estimated that three million people in the United States are on oral anticoagulation therapy (warfarin). Populations studied have been found in therapeutic range 64% of the time (Pernod, Labarere, & Bosson, 2008). The low percentage of therapeutic range is attributable to (a) adherence, (b) monitoring infrequency, (c) Vitamin K antagonists, and (d) the effects of aging and comorbidities. The purpose of this evidence-based practice (EBP) project was to examine whether an educational intervention would improve the knowledge of patients receiving warfarin therapy. Roy’s model for patient adaptation and the Stetler Model for EBP were used as frameworks for …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

Primary Care Providers’ Knowledge And Experience With Pediatric Acute Watery Diarrhea And Hemolytic Uremic Syndrome, Krista Marie Cassel

DNP Projects

The purpose of this capstone is to investigate the potential for hemolytic uremic syndrome (HUS) risk reduction in children through the evaluation of current evidence as well as pediatric primary care providers' knowledge and experience with children at risk for HUS. The goals of this capstone are to 1) evaluate the current literature to determine best practice for prevention of HUS, 2) assess primary care provider knowledge of HUS and experience with children with acute watery, and 3) develop a guideline for the initial management and referral of these children at risk for HUS.

Exploring Attitudes Toward Physician-Nurse Collaboration Within A Team-Based Primary Care Environment, Tom Karagiannis Pharmd, C. Coschignano, Sarah E. Hegarty Mphil, L. Polenzani, E. Messina, R. Zoli, Mohammadreza Hojat Phd, Vittorio Maio Pharmd,Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Patient Experience Of Care In A Student-Faculty Collaborative Practice, Rebecca A. Berman, Scott Elman, Pratyaksh Kumar Srivastava, Janine Knudsen, Laura Huppert, Kyle Dempsey, Michael Barnett, Camille Powe, Karen Donelan

Patient Experience Journal

Student Run Clinics (SRCs) are a popular means of caring for the underserved while providing valuable medical education opportunities. Reports of patient experience surveys are rare in this setting. This is troublesome because it is possible that underserved patients, who are more likely to receive care at SRCs, are not receiving the same level of care as at more traditional medical practices. The purpose of this research was to measure patient experience in a student-led medical clinic. The method included the use of patient experience surveys, which were self-administered pre-visit and self- and interviewer administered post-visit. The key results, 100% …

Assessing Blood Pressure Control In Primary Care, Ashley W. Guiliani

DNP Projects

Purpose: To evaluate provider adherence to JNC 7 by assessing documentation of blood pressure control and interventions in the absence of control in order to assist providers in reaching Healthy People 2020 goal of blood pressure control.

Methods: A retrospective chart review was conducted for patients with essential hypertension. Data collected included blood pressure, use of a home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three visits. A provider survey regarding provider barriers to blood pressure control was also completed.

Results: All surveyed providers were aware and …

Practice Characteristics Of Graduates Of East Tennessee State University Quillen College Of Medicine: Factors Related To Career Choices In Primary Care, Ivy A. Click

Electronic Theses and Dissertations

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included …

The Importance Of Examining Movements Within The Us Health Caresystem: Sequential Logit Modeling, Chioun Lee, Stephanie L L. Ayers, Jennie Jacobs Kronenfeld, Jemima A. Frimpong, Patrick A. Rivers, Sam S. Kim

Dartmouth Scholarship

Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., …

From Concierge Medicine To Patient-Centered Medical Homes: International Lessons And The Search For A Better Way To Deliver Primary Health Care In The U.S, Gwendolyn R. Majette

Law Faculty Articles and Essays

This paper will proceed in eight parts. Part II explores why primary care is a critical component of a country's health care delivery system. Part III describes patient and physician dissatisfaction with the current state of primary care delivery in the United States. Parts IV and V describe physician-designed solutions and Congress' responses to them. Part VI describes the role of primary care in the delivery of health services in the international context by focusing on the World Health Organization's Health for All policy and the policies supporting primary care in the United Kingdom, the Netherlands, and Belgium. Part VII …

Primary Care: A Mandatory Requirement For Effective Health Care, Waris Qidwai

Department of Family Medicine

No abstract provided.

The Increasing Number Of Clinical Items Addressed During The Time Of Adult Primary Care Visits, Elmer D. Abbo, Qi Zhang, Martin Zelder, Elbert S. Huang

Community & Environmental Health Faculty Publications

BACKGROUND: Primary care physicians report that there is insufficient time to meet patients' needs during clinical visits, but visit time has increased over the past decade.

OBJECTIVE: To determine whether the number of clinical items addressed during the primary care visit has increased, and if so, whether this has been associated with changes in visit length and the pace of clinical work.

DESIGN: Analysis of non-hospital-based adult primary care visits from 1997 to 2005, as reported in the National Ambulatory Medical Care Survey.

PARTICIPANTS: A total of 46,431 adult primary care visits.

MEASUREMENTS: We assessed changes over time for …

Increasing Readiness To Change Among Smokers In A Primary Care Setting, Sheila F. Collicott

Psychology Theses & Dissertations

This study compared the effectiveness of two brief interventions, direct advice and motivational interviewing, for increasing motivation to quit among male smokers in the pre-contemplation and contemplation stages of change who were primary care patients at an Eastern urban VA medical center. Contrary to expectations, participants receiving motivational interviews did not increase more in readiness to change, motivation, and actions to quit, than those receiving direct advice or a control conversation, nor did they smoke fewer cigarettes per day. As expected, contemplators reported more cutting down and quit attempts than pre-contemplators. Factors that may have limited the effectiveness of interventions …