Family Practice Nursing Commons^™

Implementation Of Point-Of-Care Tick-Borne Disease Powerplan™ And Algorithm For Early Detection And Treatment Of Tick-Borne Diseases, Ashley Pinkham

DNP Scholarly Projects

Abstract

Local Problem: The Concord Hospital system, serving 30+ communities, is situated in the heart of New Hampshire surrounded by densely wooded forests, lakes, and mountains and is a mecca for camping, vacationing, and sightseeing, doubling its population of 1.6 million residents during spring, summer, and fall months. Despite the serenity, there is a predator that lingers among the hiking trails and lake shorelines. From January 2021 through August 2022 there were a total of 41 hospitalizations from tick-borne diseases, some with life threatening symptoms. Unfortunately, nearly half (43%) of patients presented to their primary care provider first where the …

Strengthening New Hampshire’S Primary Care Workforce Pipeline: Utilization Of Alternative Scheduling Models, Elizabeth Harrison

DNP Scholarly Projects

Abstract

BACKGROUND: Traditional clinical scheduling coupled with the current reimbursement system have created systematic barriers leading to decreased clinical education opportunities. Alternative scheduling models such as longitudinal integrated clerkships, one preceptor to two students and wave scheduling have the potential to eliminate these barriers and provide financial gains and increased access to care.

INTERVENTION: Interventions to meet this quality improvement project's objectives included (1) pre-intervention planning (2) focus groups, (3) video presentations and (4) a pilot program of alternative scheduling models in clinical practice.

RESULTS: A pilot program utilizing the alternative scheduling models increased the relative value units (RVU) of …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Addressing Barriers To Colorectal Cancer Screening In A Federally Qualified Health Center: A Quality Improvement Project, Tania Centra

DNP Scholarly Projects

Abstract

Background: Colorectal cancer (CRC) is a leading cause of death from cancer in the United States, despite the availability of several high-quality screening options. Multiple barriers to CRC screening have been identified, including cost (non-insured), younger age, racial or ethnic minority, recent immigration to the U.S. (non-English speaking), fear or distrust of the healthcare system and rural residence. Addressing health equity within underserved populations requires improved access to CRC screenings per evidence-based guidelines.

Local Problem: The mean CRC screening rate for the designated Federally Qualified Health Center (FQHC) was 33.7% for the 5 months preceding this quality improvement (QI) …

Increasing Awareness Of Personal Harm Reduction Interventions In The Clinical Setting: A Quality Improvement Project, Shawn Theberge

DNP Scholarly Projects

Abstract

The ever-rising concern for safety in the healthcare setting has become increasingly prevalent and levels of hostility and violence more publicly visible. Over the last decade both patients and clinicians have been targeted in healthcare facilities at record levels. These incidents have created an environment of not only risk but increased anxiety and feelings of uncertainty for most clinical personnel. The study will initially measure clinician’s viewpoint of the clinical setting that they work in; and over the span of the project, track and evaluate the effects of the interventions on clinicians’ overall feelings and perceptions. The expected outcome …

Quality Of Life And Symptom Sharing Among Women With Athletic Urinary Incontinence, Hailey Stevens

Honors Theses and Capstones

Abstract

Introduction Women have a 2-3.5 times greater chance of urinary incontinence (UI) during exercise. Some high-impact activities are particularly provocative including gymnastics, trampoline, and volleyball. Athletic UI can cause frustration, worry, and embarrassment for women, negatively influencing their quality of life and sports performance. Methods This secondary analysis aimed to compare UI frequency with the amount of frustration, worry, and embarrassment (F/W/E) experienced by athletic and active women with UI. Data regarding the frequency of UI, management strategies, amount of F/W/E, and demographics from the Active Women’s Incontinence Screening Tool (AWIST) was analyzed. Data analysis was performed in Excel …

Increasing Rates Of Urine Albumin Creatinine Ratio Ordering By Providers In Diabetics In Adult Primary Care: A Quality Improvement Initiative, James Ehrlich

DNP Scholarly Projects

Background: The rising incidence of diabetes within the United States and worldwide has led to increased diabetes related morbidity and mortality. As the leading cause of end stage renal disease (ESRD), more attention needs to be placed on increasing rates of diabetic nephropathy screening. The vast majority of diabetics are treated in primary care, positioning primary care as a center focus for diabetes related screening and treatment.

Local problem: Low rates of diabetic nephropathy screening were noted at an academic medical center affiliated primary care clinic. A quality improvement initiative was elicited to increase the number of urine microalbumin creatine …

Using A Psychopharmacology Education Program To Increase Primary Care Provider Comfort With Treating Basic Psychiatric Disorders, Latesha Reed

DNP Scholarly Projects

BACKGROUND: Almost 1 in 5 people have been diagnosed with a mental health illness but the supply of psychiatric providers does not meet patient’s needs. Multiple reasons contribute to this shortage and nurse practitioners are part of the solution. Even with nurse practitioners specializing in psychiatric mental health there is still a shortage. Primary care is where most patients first present their mental health issues.

METHODS: Literature review informed the development of the educational intervention presented to the primary care providers using a digital, asynchronous learning format. A gap analysis of organizational needs and weaknesses was used to determine the …

Electronic Reminders To Improve Medication Adherence In Diabetes: A Quality Improvement Project, Lisa Wilson

DNP Scholarly Projects

BACKGROUND: Diabetes often contributes to many co-morbid conditions and their complications. Non-adherence to medications is common in patients with chronic disease. The project aimed to improve medication adherence through the implementation of electronic messaging. The project was set in a private medical practice within a critical access hospital. Participants were patients of the practice with diabetes.

METHODS: Baseline assessment included review and documentation of HgBA1cs, prescription requests, and past medical history. The development of an intervention to improve medication adherence utilizing electronic reminders was based on Bandura’s (1989) Social Cognitive Theory and Ajzen’s (1991) Theory of Planned Behavior.

INTERVENTION: The …

Depression Screening And Care Management In Diabetes Patients At Rural Health Clinics In Primary Care: Quality Improvement, Marcy Doyle

DNP Scholarly Projects

Depression is one of the leading causes of disease and disability, often found in patients with long-term chronic physical conditions such as diabetes. Collaborative care, which includes care managers, has shown to improve depression outcomes in patients; usual care has been shown to be inadequate. This quality improvement project screened patients with diabetes for depression. Patients with an elevated depression screening score were provided care management support and rescreened every two weeks to evaluate depression symptoms. A small cohort of patients from two rural health clinics participated in the improvement project. The practices noted improvement in depression screening; patients who …