Primary Care Commons^™

A Community Outreach Project Addressing Mental Health, Obesity, And Asthma In Underserved Saint Paul Youth, Anna Ehnstrom, Ellie Hoopman, Caitlin Olson

All Electronic Theses and Dissertations

Due to a lack of resources, awareness, and reinforcement of information, underserved youth are predisposed to unique health concerns. The health disparities prevalent among children living in poverty are many, but the topics of focus for this community outreach project include mental health, obesity, and asthma. Supplemental health education curriculum has the potential to alleviate the health disparities prevalent among such a vulnerable population (Thomas & Aggleton, 2016). To address the health disparities present specifically among underserved youth in St. Paul, MN, the group partnered with the after-school tutoring program at Central Baptist Church to provide education on the topics …

Smoking In The Homeless Population: Implementation Of A Smoking Cessation Program At The Union Gospel Mission Men’S Campus In St. Paul, Minnesota, Benjamin James Hageman, Chandler R. Hutton, Matthew Schull, Nathaniel Van Loon

All Electronic Theses and Dissertations

The health consequences of smoking disproportionately impact the homeless population. The homeless population has a higher rate of smoking (70%) than the general population (21%) and has a 5-fold decrease in smoking cessation success rates (Baggett & Rigotti, 2010). However, the percentage of homeless smokers who wish to quite is comparable with non-homeless populations (84% to 82% respectively) (Baggett, Lebrun-Harris, & Rigotti, 2013). The purpose of this community service project was to alleviate some of the smoking cessation barriers that homeless populations face, allowing them to pursue better health and greater independence. By partnering with the homeless shelter, Union Gospel …

Significance Of Spirituality Among Individuals With Intellectual And Developmental Disabilities, Carlee N. Hunter, Sarah E. Kivisto

All Electronic Theses and Dissertations

Previous literature has demonstrated a relationship between spirituality and positive health outcomes in the general population. However, little research has been done on the role spirituality plays in the lives of individuals with DD (intellectual and developmental disabilities). The purpose of this study was to identify the prevalence of spirituality in IDD individuals and involvement in spiritual activities. This was done with the goal of identifying potential barriers preventing the optimal practice of spirituality in the lives of those with disabilities. This study targeted IDD individuals living in a residential group home setting by collaborating with ACR Homes, a residential …

Understanding Public Perception Of Telemedicine, Carolyn Majkrzak, Sarah Strenke, Katie Vraspir

All Electronic Theses and Dissertations

The healthcare system in the United States is struggling to meet the needs of a growing patient population amidst the burden of provider shortages and rising costs, where no simple or easy answer exists. However, telemedicine has emerged as a possible solution with well documented benefits such as increasing provider coverage and saving costs. Despite the proven benefits, many people do not use telemedicine and there is little data to answer why it is underutilized. Therefore, this study sought to understand the public’s perception of telemedicine service. It was hypothesized that gender, age, number of children in the household, education …

Education And Support For Patients And Families With Pediatric Chronic Kidney Disease: A Community Service Project, Dulcey Amaia Milek, Emily Josephine Petersen, Aimie Beth Seehafer

All Electronic Theses and Dissertations

With any chronic illness, there may be difficulties that arise such as symptom control, medical management, and resource and support availability. In addition, pediatric populations may require more complex care due to the child’s continuing development, the need for family involvement, and the eventual transition into adult healthcare. With that, the purpose of the community service project was to provide education and support for families living with pediatric chronic kidney disease (CKD), a chronic illness that affects children worldwide. By working with the National Kidney Foundation (NKF), the research team was able to build an educational track for the pediatric …

Patient Disclosure Of Complementary And Alternative Medicine And The Patient-Provider Relationship, Kathryn V. Ortmann, Norsha Scheil, Thomas Stearns

All Electronic Theses and Dissertations

Complementary and alternative medicine (CAM) is becoming increasingly prevalent in the United States, with notable usage of supplements, deep breathing exercises, and chiropractic care. Despite this influx of CAM, nearly half of patients do not report their CAM use to their medical provider (Jou & Johnson, 2016). Disclosing these practices to a medical provider is pertinent to patient safety, as a number of potential drug interactions and side effects are associated with different CAM practices. Current literature illustrates specific provider attributes help facilitate an open dialogue with patients, or more specifically, a positive patient-provider relationship. This research study examines if …

The Effect Of Patient Education On Oral Contraceptive Adherence Rates, Brook M. Anderson, Anmol G. Clairmont, Lydia Lutz

All Electronic Theses and Dissertations

We would like to acknowledge our project chair, Jeanne Szarzynski, PA-C, for dedicating her time, expertise, leadership and patience to truly guide the success of our research project. We appreciate her incredible insight, knowledge and skill in literature as well as clinical research to support our research project. Recognition to Barbara Leafblad, CNM, is also appropriate for her time and effort as a reader throughout the project. A very special thank you is appropriated to Lisa Naser, PA-C, and Wallace Boeve, PA-C, for lending their time and professional skills to editing this paper and providing invaluable feedback, with their help, …

Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt

Physician Assistant Scholarly Project Posters

Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Nutrition Education For The Underserved Youth Within The Greater Twin Cities Area Through The Insports Foundation, Paige D. Deters, Allison Kaper, Maura Romanshek

All Electronic Theses and Dissertations

It has been examined that poor access to nutritious foods and limited opportunities for physical activity is prevalent among children from underserved families. These deficiencies contribute to increasing childhood obesity rates and emphasize the need for early interventions. Establishing nutritional literacy and understanding the importance of an active lifestyle in early childhood can lead to long-term health benefits and reduction in chronic disease later in life (HHS & USDA, 2015; Tsai et al., 2011; Wang et al., 2011). The InSports Foundation serves as a comprehensive non-profit organization that addresses many of these issues by providing children from underserved families with …

Prevalence Of Mental Health Stigma Among Practicing Pas In Regard To Personal Experience And Patient Exposure, Bailey J. Hanson, Allison Hoy, Madeline Lieberson

All Electronic Theses and Dissertations

Stigmatizing attitudes can be destructive to both the emotional and physical wellbeing of individuals living with mental illness. In fact, individuals with a mental illness are more likely to be seen as responsible for their illness and more likely to be falsely accused of a violent crime (Rüsch, Angermeyer, & Corrigan, 2005). Current research on mental health stigma in healthcare has involved a variety of occupations, but published research has yet to examine stigma held by physician assistants (PAs). This research study attempted to answer the following question: What effect, if any, does personal experience with a family member, friend, …

An Evaluation Of Home-Based Primary Care (Hbpc): Impact On Cost And Outcomes And Patient Satisfaction In The United States And Abroad, Isaac Pierre

Theses and Graduate Projects

Over the past century, the role of medical home visits in patient care has undergone significant changes. Historically, physicians routinely delivered medical care to sick patients in their own homes. In 1930, for example, such calls represented 40% of physician-patient encounters. As healthcare providers developed an increasing reliance on technology and as payment models began to prioritize volumes and efficiency, the provision of health care shifted to hospitals and office-based settings. An analysis of house calls in 1972 found that the number of in-home visits amounted to a mere 5% of physician-patient encounters and these rates continued to decrease to …

An Evaluation Of The Refugee Experience Of Liminality And The Impact Of Best Practice Models Of Care, Hanna Erickson

Theses and Graduate Projects

Globalization presents massive challenges for healthcare providers and the blend of language, expectation and cost creates increased risk for all patients. Refugees are among the most vulnerable of populations when overall health outcomes are measured and access to healthcare is analyzed.1 This is due to rapid modernization of health care systems and the fact that refugees are typically leaving a volatile place of origin and migrating to a wealthier, more stable country where different modalities are used to access care. Women of childbearing age comprise a huge portion of refugees and will be the population of focus examined here.

A …

Interventions In Reducing Weight Bias In Healthcare Providers And Preservice Students, Nora Powers

Theses and Graduate Projects

Weight bias is harmful to patients and pervasive in healthcare providers and healthcare students. Effective interventions to reduce weight bias in healthcare providers and students are urgently needed and would improve patient care and patient outcomes. A literature review of current research on interventions to reduce weight bias in healthcare professionals and students was conducted to evaluate strategies for efficacy. Twenty articles investigating weight bias reducing interventions in healthcare providers and students were analyzed. Five primary strategies are currently used: self- reflection and awareness of one’s own bias; empathy building experiences; the influence and experiences of others; narratives of and …

Lipophagy And Alcohol-Induced Fatty Liver, Li Yang, Changqing Yang, Paul G. Thomes, Kusum K. Kharbanda, Carol A. Casey, Mark A. Mcniven, Terrence M. Donohue

Journal Articles: Internal Medicine

This review describes the influence of ethanol consumption on hepatic lipophagy, a selective form of autophagy during which fat-storing organelles known as lipid droplets (LDs) are degraded in lysosomes. During classical autophagy, also known as macroautophagy, all forms of macromolecules and organelles are sequestered in autophagosomes, which, with their cargo, fuse with lysosomes, forming autolysosomes in which the cargo is degraded. It is well established that excessive drinking accelerates intrahepatic lipid biosynthesis, enhances uptake of fatty acids by the liver from the plasma and impairs hepatic secretion of lipoproteins. All the latter contribute to alcohol-induced fatty liver (steatosis). Here, our …

The Lake Clinic Cambodia, A Medpeds Experience . . ., Jeremy Jennings, Jennifer Watts

Posters

Describes global health learning experience providing ambulatory care in Cambodia.

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

Quickcough: An Instrumentational Proximal Airway Clearance Technique (Act) For Select Patients With Neuromuscular Disease (Nmd), Sean X. Sullivan, Russell K. Catania, Madison K. Plaster, Sydney E. Kandray, Mariah Costa

Williams Honors College, Honors Research Projects

Patients with neuromuscular disease (NMD) requiring tracheostomy and mechanical ventilation secondary to respiratory failure encounter increased difficulty in removing pulmonary secretions from the airways. To combat issues associated with current treatment modalities for insufficient cough efficacy (cost, poor mobility, discomfort, lack of evidence), we have developed an instrumentational proximal airway clearance technique (ACT) which augments a manual proximal ACT developed by a client with NMD. QuickCough is a 3D-printed PLA attachment to the tracheostomy apparatus which has demonstrated its ability to facilitate pressure changes necessary to increase patient’s peak cough flow (PCF) by providing a stronger exsufflation for the patient. …

The Effect Of Provider Education On Copd Screening Rates In The Primary Care Setting, Kelli Craig

DNP Projects

BACKGROUND: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality in the United States. With early detection, COPD is a treatable disease, highlighting the need for an effective screening measure. The COPD Population Screener Questionnaire (COPD-PS) is a valid, accurate questionnaire that can identify individuals likely to have COPD.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy and screening rates of COPD using the COPD-PS screening tool among primary care providers.

METHODS: This study was a single-center, pre/post implementation study to evaluate …

Career Regret Among Physician Assistants: A Comparative Survey Of Primary And Specialty Care Careers, Talia Sierra, Jennifer Forbes, Michael Nelson

Internet Journal of Allied Health Sciences and Practice

Purpose: This study investigated if career regret varies among physician assistants (PAs) practicing in primary and specialty care fields. This information may assist practicing and aspiring physician assistants when selecting or changing their career path.

Methods: A survey was emailed to 5,000 primary and specialty care physician assistants. Items indicating career regret were compared between primary and specialty care groups.

Results: Eight hundred and thrity-four (16.7%) completed surveys were received back. Career regret is similar between primary and specialty care physician assistants, with low reports from both groups. No statistical significance was found between primary care and specialty care groups …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Assessment Of Patient-Centered Approaches To Collect Sexual Orientation And Gender Identity Information In The Emergency Department: The Equality Study, Adil H. Haider, Rachel R. Adler, Eric Schneider, Tarsicio Uribe Leitz, Anju Ranjit, Christina Ta, Adele Levine, Omar Harfouch, Danielle Pelaez, Lisa Kodadek

Section of General Surgery

Importance: Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.
Objective: To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting.
Design, setting, and participants: This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to …

Resilience Training For Va Primary Care Providers, Elizabeth A. Recupero

Instructional Design Capstones Collection

Physician burnout syndrome is epidemic within the U.S. healthcare system. Burnout is defined by three main criteria: emotional exhaustion, depersonalization, and a low sense of personal accomplishment, and its prevalence is highest among primary care providers. The VA’s All Employee Survey (AES) demonstrates that more than 50% of physicians working for the VA Healthcare System exhibit at least one of these symptoms. The literature discusses that this syndrome can be improved by increasing physician resilience. This capstone project first analyzed the need for resiliency training among VA primary care providers. After the needs analysis, an online training that encompassed mindfulness …

Patient Barriers For Weight Management Among African American Women, Owen Bowie, Jennifer Kusch, George L. Morris Iii, Tracy Flood, Jessica Gill, Renee E. Walker, Ron A. Cisler, Jennifer T. Fink

Journal of Patient-Centered Research and Reviews

Purpose: The primary aim of this study was to assess the perceptions of local African American women who are overweight or obese using semi-structured focus groups to identify barriers to weight management and factors that support strategy success. The secondary aim of this study was to determine recommendations for patient-centered weight management interventions established specifically for African American women in the Milwaukee-area community.

Methods: Three semi-structured focus groups to explore barriers to weight management were performed among women patients. Participants (N = 41) were recruited via email, postal mail, and phone as available from an academic medical center in Milwaukee, …

Impact Of A Boot Camp Translation Intervention On Self-Management Support In Primary Care, Donald E. Nease Jr., Jeanette M. Daly, L. Miriam Dickinson, Douglas H. Fernald, David L. Hahn, Barcey T. Levy, Leann C. Michaels, Matthew J. Simpson, John M. Westfall, Lyle J. Fagnan

Journal of Patient-Centered Research and Reviews

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools.

Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager …

Patient Self-Management: Tools And Barriers, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In his issue introduction, the editor-in-chief of the Journal of Patient-Centered Research and Reviews comments on the theme of patient self-management of chronic diseases and the related articles published therein. Illnesses such as cardiovascular disease, diabetes, epilepsy, arthritis, asthma, and obesity often require patients to administer their own medication daily or adhere to strict dietary restrictions. Progress is being made on the process of implementation and evaluation of patient self-management tools in primary care practices. Barriers to self-management tool implementations in clinics, as well as their use by individual patients, must be understood and addressed.

Implementing Community-Created Self-Management Support Tools In Primary Care Practices: Multimethod Analysis From The Insttepp Study, Douglas H. Fernald, Matthew J. Simpson, Donald E. Nease Jr., David L. Hahn, Amanda E. Hoffmann, Leann C. Michaels, Lyle J. Fagnan, Jeanette M. Daly, Barcey T. Levy

Journal of Patient-Centered Research and Reviews

Purpose: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools.

Methods: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case …

How To Translate Self-Management Support Tools Into Clinical Practice, Matthew J. Simpson, Jeanette M. Daly, Douglas H. Fernald, John M. Westfall, Leann C. Michaels, Barcey T. Levy, David L. Hahn, Lyle J. Fagnan, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients.

Methods: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks’ Self-management Tools Through Engaging Patients and …

Adapting Boot Camp Translation Methods To Engage Clinician/Patient Research Teams Within Practice-Based Research Networks, Lyle J. Fagnan, Matthew J. Simpson, Jeanette M. Daly, Leann C. Michaels, David L. Hahn, Barcey T. Levy, Douglas H. Fernald, John M. Westfall, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective.

Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …