Primary Care Commons^™

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Cirrhosis For The Pcp, Krys Foster, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Understand the morbidity and mortality associated with Cirrhosis in the United States
• Recognize etiologies and clinical presentation of cirrhosis
• Identify decompensated cirrhosis and approaches to treatment and monitoring

Agenda

• Definition and Epidemiology
• Etiologies
• Clinical Presentation
• Diagnosis and Evaluation/Classification
• Management of Compensated Cirrhosis
• Decompensated Cirrhosis & Complications
• ○ Portal Hypertension ○ Varices ○ Ascites ○ SBP ○ Hepatorenal Syndrome ○ Hepatic Encephalopathy
• Secondary Prevention and Long Term Management
• Conclusions

Vaccines, Children, And The Public Health Trust, Christopher Chambers, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Review the impact of immunizations on the public health over the past 50 years.
2. Childhood Vaccines Now
3. Describe the challenges associated with trying to eliminate “immunizable” diseases. Examples: Invasive Pneumoccal Disease, Neisseria meningitis
4. The Future

Accelerating Primary Care Transformation At Jefferson (Jeffapct): Reflections From A Five- Year Hrsa Grant, Christine A. Arenson, Md, Amy Cunningham, Phd, Mph, Samantha Kelly, Ma, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

JeffAPCT Overview

Five year HRSA-funded grant (7/1/15-6/30/20)

Leadership team from Family Medicine, Internal Medicine, Physician Assistant Program

• Objective 1: To improve/ expand primary care and population health curriculum across the continuum of primary care providers and trainees (students, residents, and practitioners)
• Objective 2: To create an enhanced, sustainable model of primary care physician faculty development for PCMH Transformation
• Objective 3: To create a new, sustainable model of faculty development for community-based primary care preceptors (MD/DO, PA, NP, others)

The Effects Of Motivational Interviewing For Those Afflicted With Opioid Addiction, Kathy Roberts

Evidence-Based Practice Project Reports

Substance use disorders are a worldwide problem, according to the Center for Disease Control (CDC) there were 70,237 drug overdose deaths that occurred in the United States in 2017, of which 47,600 were opioid related. Illinois had a 14.3% increase of opioid deaths from 2016-2017 (CDC, 2017). Numerous interventions exist to address this health concern, yet evidence shows that Motivational Interviewing (MI) was the most efficient and effective way to promote behavioral change. The purpose of this EBP project was to provide evidence that MI increased referrals and promoted compliance with appointments to treatment programs. The sample for this project …

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …

Goals Of Care 101, Alexandra Evans, Do, Adam Pennarola, Md, Elham Siddiqui, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Hospice and Palliative Medicine - Alexandra Evans, DO

Approaching Goals of Care in the Outpatient World - Elham Siddiqui, MD

Inpatient Goals of Care Discussion - Adam Pennarola, MD

Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger

Evidence-Based Practice Project Reports

Adolescent alcohol consumption is a serious health problem in the United States. Alcohol is the most widely used substance, and it continues to be the drug of choice for adolescents (CDC, 2018). Over 7 million adolescents and approximately 30 percent of high school students in the U.S. that admit to drinking more than a few sips of alcohol in the past 30 days (NIAAA, n.d.). Underage alcohol use can lead to many complications such as social, school, and legal problems, and when initiated early in life is associated with the development of alcohol use disorder (NIAAA, n.d.). The purpose of …

Efficacy Of A Mobile Application In A Chronic Kidney Disease Population, Jennifer R. Zamora

Evidence-Based Practice Project Reports

Chronic kidney disease (CKD) is associated with high healthcare costs, poor health outcomes and low quality of life (Donald et al., 2018). The US CKD prevalence is 15%, costing Medicare $79 billion in 2016 (United States Renal Data System, 2018). Self-management could reduce CKD burden (Jeddi, Nabovati, and Amirazodi, 2017). Mobile technology offers a low-cost, ease-of-access platform for chronic disease self-management (Whitehead & Seaton, 2016), potentially slowing disease progression and improving health outcomes (Jeddi, 2017). The purpose of this project was to utilize a CKD-specific mobile application, CARELogiQ, to facilitate symptom management; increasing patient satisfaction and decreasing hospitalizations and ER …

A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Barriers To Integrated Primary Care And Specialty Mental Health Services: Perspectives From Latinx And Non-Latinx White Primary Care Patients, Elizabeth A. Anastasia

Graduate Theses and Dissertations

High need, low access, and rising health care costs reveal the inadequacies of the current mental health system in the U.S. Racial/ethnic minorities, including Latinxs, face substantial disparities in accessing mental health treatment compared with non-Latinx Whites. Integrated primary care (IPC) offers an alternate model for meeting mental health needs by providing care in a way that is accessible to the general population. Though it has been suggested that IPC may reduce health disparities by decreasing barriers to mental health treatment, empirical data relevant to this question are limited. A series of three studies were conducted using a mixed methodology …

Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper

Evidence-Based Practice Project Reports

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

Effectiveness Of A Multi-Component Intervention Program For Treating Childhood Obesity, Suzy Free

Evidence-Based Practice Project Reports

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Factors Associated With Urgent Care Reliance And Outpatient Health Care Use Among Children Enrolled In Medicaid., Rebecca R. Burns, Elizabeth R. Alpern, Jonathan Rodean, Therese Canares, Brian R. Lee, Matt Hall, Amanda Montalbano

Manuscripts, Articles, Book Chapters and Other Papers

Importance: Urgent care (UC) centers are a growing option to address children's acute care needs, which may cause unanticipated changes in health care use.

Objectives: To identify factors associated with high UC reliance among children enrolled in Medicaid and examine the association between UC reliance and outpatient health care use.

Design, Setting, and Participants: A retrospective cohort study used deidentified data on 4 133 238 children from the Marketscan Medicaid multistate claims database to calculate UC reliance and outpatient health care use. Children were younger than 19 years, with 11 months or more of continuous Medicaid enrollment and 1 or …

Sti & Prep Updates, Marshal Miller, Md, Aahivs, Sunny Lai, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Apply key findings from the DISCOVER trial to PrEP clinical decision-making
• Understand the gaps in PrEP research for cisgender women and adolescents
• Understand the use of on-demand pre-exposure prophylaxis
• Review Current treatment recs and emerging data on Gonococcal and Chlamydial infection
• Discuss diagnostic and management options for non-gonococcal urethritis