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Optimizing Drug Prior Authorization Procedures For Primary Care, Lydia S. Vorsteveld

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Title and Abstract

1. 1. Title

Optimizing Drug Prior Authorization Procedures for Primary Care

1. 2. Abstract

Background:

Medication prior authorization (MPA) is a cost containment strategy utilized by health plans. The payer, or health plan requires providers to obtain prior approval for plan coverage of a drug prescription. The list of drugs requiring MPA varies among health plans and is subject to frequent change. From 2007 to 2013 Medicare Part D increased MPA requirements by 38 percent (Hoadley, Summer, Hargrave, & Cubanski, 2014).

Methods:

Pre and post interventional surveys of primary care staff were used to gather descriptions of current MPA …

Improving First Dose Administration Of The Hpv Vaccine For Adolescents In A Pediatric Primary Care Clinic, Scarlett Mikesell-Pierce

DNP Projects

BACKGROUND: Nationwide more than 90% of cervical cancer cases are caused by the human papilloma virus (HPV). Cervical cancer can be largely prevented by administration of the HPV vaccine for children before becoming sexually active. However, vaccination rates in the United States, remain low at 60%, and only 39.7% through series of completion, despite the strong evidence to support the effectiveness of the HPV vaccine. Research indicates a clinician’s recommendation, providing information and opportunity for discussion about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. This study addresses the barriers to parent/caregiver intent to …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Evaluation Of Emergency Department Use By Adult Patients With Established Primary Care Provider, Sherry Tolentino

DNP Projects

BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only …

The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Family Nurse Practitioner Mentoring Relationships' Impact On Organizational Commitment, Patricia Bartley-Daniele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family nurse practitioners (FNPs) are vital primary care providers who are responding to increased primary health care needs in the United States. Organizational commitment is reflective of workplace relationships that foster professional development, innovation, and outcome achievement. An organizationally committed FNP workforce is essential to achieving primary health care goals.

Mentorship has been proposed as a strategy to foster FNP organizational commitment. Mentoring has been characterized as a teaching-learning relationship. The mentor can serve as a guide to foster graduate FNP practitioner transition into primary care practice. Types of mentoring relationships occur in formal workplace settings or develop as informal …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

Perceptions Of A Dedicated Education Unit In The Mississippi Delta, Jacquelyn Felecia Brownlow

Doctoral Projects

The highest health care disparities in the country plague the Mississippi Delta. A weakened economy, minimal access to healthcare and an outdated traditional clinical learning environment place enormous strains on nursing education in this area to provide more nurses. The office of Nursing Workforce reported a 14% to 16% nursing turnover in the Delta compared to the national average of 13.5%. As a result, the health care organization has encountered high nurse turnover, increased staffing shortages, and a decrease in nursing quality indicators. As an effort to improve clinical education and bridge gaps between education and practice, several schools in …