Family Practice Nursing Commons^™

Examining The Feasibility Of Integrating An Alcohol Detoxification Protocol Within Primary Care, Emily A. Miller, Dnpc, Bsn, Rn

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

Purpose: Medically supervised, in-home alcohol detoxification is safe, efficacious, cost-effective, and satisfying for patients. However, it remains underutilized within primary care practices. This feasibility study aimed to examine clinician perceptions of adopting a standardized outpatient alcohol detoxification protocol at a rural primary care clinic where no internal protocol exists.

Methods: An ambulatory alcohol detoxification protocol was created using the American Society of Addiction Medicine guideline on alcohol withdrawal management and presented to 38 providers and 11 nurses. Twelve participants (six providers and six nurses) completed a modified version of the Implementation Process Assessment Tool. The instrument measured stakeholder perceptions of …

Behavioral Intervention Education For Pediatric Functional Constipation: A Feasibility Project, Meredith Brady, Jean Pelski Ph.D., Aprn, Nnp-Bc

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

Background: Functional constipation (FC) is a common condition frequently seen in pediatric primary care, with an estimated median prevalence of 16% among pediatric patients (Mugie et al., 2011). Standard care for this condition is typically limited to laxative therapy, however evidence supports improved outcomes for patients who also receive behavioral intervention education. Purpose: The purpose of this quality improvement study was to assess the feasibility of implementing a standardized intervention strategy in a primary care setting for pediatric patients with FC to inform a future pilot study. Methods and interventions: This feasibility study was completed in three steps. 1) A …

Improving Food Insecurity Screening And Utilization Of Services For Veterans, Elizabeth Farah, Jason Garbarino, Mary Alberty

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

Background: 27% of all veterans are food insecure. From 2018-2020, only 1% of veterans seeking care at the VA in White River Junction, VT were identified as food insecure. As a result, an overwhelming number of eligible veterans are not getting vital resources to become food secure.

Purpose: Provide education to interdisciplinary primary care teams about food insecurity, how to use the screening tool effectively, and what resources are available to veterans both within the VA system and in the community.

Methods: Quantitative data was obtained from the food insecurity screener to determine how many veterans were being screened positive …

Marijuana Vaping In Adolescents: Evaluating Provider Knowledge And Practices To Improve Screening And Referral To Treatment, Holly T. Whitcomb

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

Background: Vaping is a public health epidemic. Adolescents are using cannabis electronic vapor products at increasing rates. In teens, rising E-cigarette and vaping product use associated lung injury (EVALI), tetrahydrocannabinol (THC) intoxication and addiction are concerning. Primary care providers are in a unique position to screen and discourage adolescents from vaping, yet barriers to screening and referral to treatment exist.

Objective: This project provided education on vaping trends, Screening, Brief Intervention, and Referral to Treatment (SBIRT), and Screening to Brief Intervention (S2BI) with the goal of improving screening and brief intervention of at-risk adolescents among primary care providers.

Methods: The …

The Impact Of A Pediatric Home Visit Program: A Quality Assessment Analysis, Jenna Durkee, Jean Pelski Phd

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

Background: Bringing a newborn home from the hospital can be a time of excitement, but also stress for new parents. This can include financial strain, lack of sleep, and preparations necessary to care for their new arrival. During this transition time, home visit support has demonstrated decreased parental stress and increased confidence in their new parenting roles. In response to these benefits, a pediatric home visit program holds promise for new parents.

Purpose: This quality assessment project evaluated a pediatric office’s home visit program for parental role and pediatric office satisfaction. Based on the analysis, recommendations for improvement were provided. …

Routine Screening For Binge Eating Disorder In Primary Care, Chantel B. Tousignant, Rn, Dnpc, Jennifer Laurent, Ph.D., Aprn

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

Background: Estimated prevalence of Binge Eating Disorder (BED) in the United States is 2- 3%, and 5% in the primary care setting. BED is associated with multiple comorbidities and is therefore a public health concern. Effective strategies to improve screening, diagnosis and management exist, but are underutilized. This project aimed to enhance BED screening and diagnosis while optimizing disease management. Methods: Routine screening for BED was completed using the 7-Item Binge Eating Disorder Screener. Patients were screened regardless of visit type and follow-up was offered to those screening positive. BED prevalence was assessed pre and post-implementation. Surveys were used to …

Integrating Community Into Middle School Sexual Education, Sierra Miller, Margaret Aitken

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

Problem Statement: Most middle school sexual education does not include parents or community members. Evidence shows family and community attitudes towards sex and sexuality are significant factors in adolescent risky sexual and health practices.

Background: Comprehensive sex education (CSE) reduces risky sexual practices and negative health outcomes. National and local organizations have identified CSE as a public health goal. CSE works best when culturally relevant and the community is involved.

Methods: Interviews with the health educator identified community needs. Resources were created in line with the current curriculum focusing on sex education, its importance, and how to talk about …

Evaluating Patient And Provider Knowledge Of Safe Pharmaceutical Disposal Procedures In Vermont Through A Public Health And Environmental Lens, Emily R. Straley

Family Medicine Clerkship Student Projects

Patient and provider knowledge of safe pharmaceutical disposal procedures is crucial from both a public health and environmental standpoint. Unfortunately, studies have shown that Vermont residents are largely unaware of safe drug disposal programs in their communities. This project evaluated patient knowledge of drug disposal practices and awareness of safe pharmaceutical disposal procedures at Hinesburg Family Medicine. A short phrase was created to better disseminate information about safe drug disposal in Hinesburg, which can be added to a patient’s after visit summary. Many patients report never discussing medication disposal with their physician. Therefore, increased provider communication regarding leftover and unused …

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 …

Evidence Based Treatment For Excessive Alcohol Consumption And Concurrent Hypertension, Kimberly Ann Ward

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

Purpose. Excessive alcohol consumption is a preventable risk factor for hypertension, heart disease, and stroke. Though alcohol-related deaths number 88,000 annually in the U.S., alcohol use has the lowest treatment rate of behavioral health disorders at 10%. Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase awareness of the hypertension and excessive alcohol use connection and promote screening of alcohol consumption.

Methods A protocol for improving alcohol screening and concurrent hypertension management was developed including: in-person educational presentations; patient education materials; and the use of motivational interviewing. Practice change was assessed …

Telehealth Visits For Common Concerns In A Primary Care Setting: Establishing A Protocol, Erin M. Leighton

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

Background: Barriers to accessing healthcare in Vermont include: weather conditions, rurality, lack of public transportation systems, and busy schedules. Telehealth mitigates these barriers, providing a safe and effective option on par with in-person visits, while lowering overall healthcare costs and increasing patient satisfaction. This project aimed to expand telehealth visits in a nurse practitioner-run primary care practice, via designing effective protocols and educating clinicians on telehealth use, requirements, documentation, and billing in order to complete telehealth visits successfully.

Methods: Infrastructure for telehealth: a workflow protocol, patient education materials, procurement of technological resources including iPads, and necessary, HIPAA compliant, secure accounts. …

Blood Pressure Management Education, Lauren G. Gernon, Cara Rathmell

Family Medicine Clerkship Student Projects

The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.

Impact Of An Ehr-Based Tool On Copd Management In Primary Care, Nancy Ann C. Kelly Rn

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

Background: GOLD (2017) guidelines provide evidence based recommendations for treating COPD, although their employment in clinical practice is inconsistent. Lack of a standardized method to view COPD specific information within the EHR during patient encounters complicates visits and development of GOLD-guided treatment plans. Our goal is to determine the impact of an EHR-based tool on relevant COPD disease measurements (spirometry rates, pneumococcal vaccination rates and COPD Action plans)

Methods: An EHR-based tool (SmartPhrase) was developed and released to providers to facilitate GOLD(2017) guideline reference during patient encounters. Computer based instructional videos of GOLD (2017) guidelines and EHR-based tool …

Exploring Evidence-Based Mental Health Prevention Programs To Build Resiliency In College Students, Elizabeth Anderson

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

Purpose: Mental health diagnoses and utilization of services are increasing amongst college students. Mental health prevention programs can cultivate resiliency traits that are protective of mental health. The purpose of this project is to assess for the need of a mental health prevention program at a small urban-college in Vermont and make program recommendations based on staff and student needs.

Methods: A needs assessment project was conducted at the college student health center. Separate needs surveys were created and distributed to students and student wellness staff. Student resiliency was assessed using the Brief Resiliency Scale, a validated tool. Literature review …

The Implementation Of Telehealth In Disease Management At Patient-Centered Medical Home, Mirsada Nurkanovic

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

Purpose: Telehealth (TH) and video conferencing in the patient-centered medical home (PCMH) can bridge geographical gaps between patients and providers, by eliminating the inconveniences of leaving the house and traveling to appointments. The evidence indicates that TH also: provides clinical benefits in high-risk patients¹, improves glucose control², improves quality of life and reduces ED visits and hospitalizations for patients with COPD³, enables self-care of patients with heart failure⁴, reduces risk of admission for patients with asthma⁵, improves medication adherence⁶, results in potential cost savings⁷, and provides …

Diabetes Type Ii Quality Improvement Using The My Own Health Report, Lynn Bennett Mcmorrow Fnp-C

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

Diabetes Mellitus Type II Quality Improvement Using the My Own Health Report

Lynn Bennett McMorrow

Rationale: To maintain Primary Care Medical Home status, Cold Hollow Family Practice (CHFP) is mandated to perform continuous quality improvement for chronically ill patients. To achieve this goal at CHFP, a formal quality improvement (QI) process using a validated health risk assessment tool, My Own Health Report (MOHR) was used to engage patients with Type 2 Diabetes (T2D) in dialogue regarding self change behaviors. The goal was to improve patient self-care management as evidenced by decreased HbA1c readings or weight as compared to non-participating patients, …

Standardizing The Process For Diagnosing Attention Deficit Hyperactivity Disorder (Adhd) In The Primary Care Setting, Louise Rosales

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

Standardizing the Process for Diagnosing

Attention Deficit Hyperactivity Disorder (ADHD) in the Primary Care Setting

Louise Moon Rosales, MSN, APRN

Purpose. Attention deficit hyperactivity disorder (ADHD) is a common problem that primary care providers diagnose and treat. Yet, there is a current lack of standardization to diagnose ADHD in many primary care settings. This purpose of this project was to standardize the process of diagnosing ADHD through introduction of screening instruments. Objectives included: assessment of clinician knowledge and attitudes about ADHD, implementation of a clinician-directed educational intervention, and development of a work flow procedure to standardize the diagnostic process.

Methods. …

Waiting Room Health Promotion For Older Adults In Rural Primary Care, Emma G. Kopecky

College of Nursing and Health Sciences Nursing Master Project Publications

Background: Advances in health care technology have lead to adults living longer than in previous decades. Longer life expectancy in combination with the aging of the Baby Boomer generation is predicted to result in rapid and exponential growth among the older adult population. Adults in the U.S. over the age of 65 have on average five or more chronic illnesses, many of which are often poorly managed. Older adults who experience chronic diseases often report decreased quality of life, limitations in functional ability, loss of independence, and periods of decline and increasing disability. Health promotion efforts can help in delaying …

The Role Of The Community Health Worker: An Educational Offering, Kameron Escajeda

College of Nursing and Health Sciences Nursing Master Project Publications

Reducing health disparities among underserved and minority populations are an ongoing challenge for the United States’ health care system. The Affordable Care Act proposes the addition of a Community Health Worker (CHW) to the health care workforce to serve as a liaison between community and health services as a possible solution to improve quality and health outcomes in underserved populations. The newly formed health care team created in collaboration with the Visiting Nurse Association of Chittenden and Grand Isle Counties will welcome the CHW as a new team member to help improve the care and coordination of services for New …