Primary Care Commons^™

The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer

Evidence-Based Practice Project Reports

Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …

Effects Of An Obstructive Sleep Apnea Screening Program On Providers' Adherence, Kelsie A. Tokarczyk

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) is a widely prevalent chronic disease estimated to affect 22 million Americans, with 80 percent of moderate to severe cases undiagnosed (American Sleep Apnea Association [ASAA], 2017). Unmanaged OSA has been associated with numerous detrimental health outcomes including hypertension, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular conditions (ASAA, 2017). The purpose of this evidence-based practice project was to determine if the implementation of a screening protocol would affect providers’ adherence to screening for OSA. The Theory of Planned Change was used as a guide to optimize providers’ adherence to the protocol at a family …

Restricted Access And Delays To Hcv Treatment Among Medicaid Patients In Louisiana, Morris M. Kim, Keanan M. Mcgonigle

Journal of Health Disparities Research and Practice

Background: Many people living with chronic Hepatitis C Virus (HCV) have seen delays in accessing treatment or been denied entirely due to Medicaid restrictions requiring patients to meet certain criteria prior to receiving approval for medication pre-authorization.

Methods: This study identified a cohort of Medicaid-insured patients with chronic HCV infection within New Orleans, LA. Patient medical records were reviewed and information regarding HCV care was gathered. This study sought to determine the degree to which HCV care was delayed for this population and describe common reasons for prior-authorization denials for direct-acting antiviral (DAA) medications.

Results: For this population of Medicaid-insured …

Evidence-Based Toolkit For Reduction Of Overdose Risk In Primary Care Patients On Opioid Therapy, Katelin A. Aris

Doctoral Projects

Introduction: Opioids are powerful pain killing medications that can be highly addictive and can cause risk for overdose and even death (Michigan Prescription Drug and Opioid Task Force, 2015). Many primary care providers treat patients with acute and chronic pain, although it is recognized that many receive inadequate training in pain management and feel unprepared in the complexities of caring for these patients (Becker, Bair, Picchioni, Starrels, and Frank, 2018). To treat these patients safely, provider education and adherence to guidelines put forward by these initiatives is essential.

Methods: An evidence-based prescribing toolkit was devised using guidance from the literature …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Ovalbumin-Sensitized Mice Have Altered Airway Inflammation To Agriculture Organic Dust, Kristi J. Warren, John D. Dickinson, Amy J. Nelson, Todd A. Wyatt, Debra J. Romberger, Jill A. Poole

Journal Articles: Internal Medicine

Agriculture exposures are associated with reducing the risk of allergy and asthma in early life; yet, repeated exposures later in life are associated with chronic bronchitis and obstructive pulmonary diseases. The objective of this study was to investigate the airway inflammatory response to organic dust extract (ODE) in mice with established ovalbumin (OVA)-induced experimental asthma. C57BL/6 mice were either OVA sensitized/aerosol-exposed or saline (Sal) sensitized/aerosol-challenged. Both groups were then subsequently challenged once with intranasal saline or swine confinement ODE to obtain 4 treatment groups of Sal-Sal, Sal-ODE, OVA-Sal, and OVA-ODE. Airway hyper-responsiveness (AHR) to methacholine, bronchiolar lavage fluid, lung tissues, …

“Build A Bridge So You Can Cross It:” A Photo-Elicitation Study Of Health And Wellness Among Homeless And Marginally Housed Veterans, Keri L. Rodriguez, Lauren M. Broyles, Michael A. Mitchell, Melissa E. Wieland, Gala True, Adam J. Gordon

The Qualitative Report

As part of a photo-elicitation interview study, we aimed to describe homeless and marginally housed Veterans’ experiences with health and wellness, health decisions, and health-related behaviors. Twenty Veterans receiving Veterans Affairs Homeless Patient-Aligned Care Team care took photographs depicting health and wellness, then used their photographs to discuss the same topics in 30-60 minute audio-recorded, semi-structured photo-elicitation interviews. Transcripts were analyzed using template analysis. Veterans described eight dimensions related to their health and wellness; physical, social, and environmental were most commonly discussed, followed by emotional, intellectual, spiritual, occupational, and financial wellness. Photographs contained literal and metaphorical depictions that were positively-oriented, …

Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes

Dignity: A Journal of Analysis of Exploitation and Violence

Drs. Tro Kalayjian (Tapan, New York) and Brian Lenzkes (Santee, California) talk to Matt about his struggles with food, pornography, and alcohol addiction, and how changing his diet contributed to his recovery from his addictions. This report is excerpted from the audio podcast LowCarbMD, Episode 13 (https://itunes.apple.com/us/podcast/low-carb-md-podcast/ ), January 30, 2019). This podcast has filled us with immense hope for those struggling with addiction.

Defining Patient-Oriented Research For The Average Person (And Potential Research Partner), Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this introduction to the first issue of 2019, the editor-in-chief of Journal of Patient-Centered Research and Reviews offers additional context to the findings of Kaur and Pluye (p. 7), who methodically formalized an operational definition of patient-oriented research for the purposes of searching bibliographic databases. A possible succinct, lay definition of patient-oriented research for the average “person on the street” is proposed.

Confidential Care For Adolescents In The U.S. Health Care System, Priya R. Pathak, Adriana Chou

Journal of Patient-Centered Research and Reviews

In providing care for adolescents, maintaining confidentiality should be considered a human right and an evidence-based component of quality care. Unfortunately, complexities in the U.S. legal and health care systems have created a setting in which confidential care is inaccessible to many adolescent patients. Federal laws provide a minimum standard for confidentiality protections, but variations in state legislation relating to minor consent, special health care services, and confidentiality exemptions create large variability in adolescent confidentiality rights across the country. In certain contexts, such as consensual sexual activity, legal provisions may not align with professional ethical standards in adolescent care. In …

Enhancing The Effectiveness Of Special Olympics Minnesota’S Health Promotion Programming, Avery R. Bajema, Laura Marie Hayes, Kelsey B. Kostreba, Shelly Winslow

All Electronic Theses and Dissertations

Nearly 3% of the world’s population have an intellectual disability. A link exists between intellectual disability and higher rates of chronic and preventable diseases, which is partially attributed to lack of health education geared toward individuals with intellectual disability. Health promotion programs can provide health-related resources and education. Health promotion programs are often standardized, making it challenging to meet the various learning needs of individuals with intellectual disability. Special Olympics is the largest organization that provides health-related programming for those with intellectual disability. In Minnesota, the Special Olympics branch known as Health Promotion has reported difficulty with meeting the goal …

Preimplantation Genetic Diagnosis: Physician Assistants' Perspectives, Understandings, And Ethical Considerations, Sarah K. Barnes, Samantha J. Caron, Claire E. Johnson

All Electronic Theses and Dissertations

While factors contributing to rates of approval and disapproval of preimplantation genetic diagnosis (PGD) have been studied at length, the perspective of Physician Assistants’ (PA) approval and disapproval of PGD has not been studied, nor the common reasons why PAs approve or disapprove of PGD. The first goal of this study was to identify approval and disapproval rates of PGD amongst PAs. The next goal was to identify common reasons PAs approve or disapprove of PGD utilization. Members of the California Academy of Physician Assistants [CAPA (CA)] and Kansas Academy of Physician Assistants [KAPA (KS)] completed an adapted, electronic survey …

A Qualitative Examination Of Vaccine Hesitancy Among Mothers, Alicia L. Benner, Annie Vasterling, Teia Wolter

All Electronic Theses and Dissertations

Vaccine hesitancy describes the reluctance to vaccinate or the delay of vaccines (World Health Organization [WHO], 2017a). Various factors contribute to vaccine hesitancy for patients (Salmon, Dudley, Glanz, & Somer, 2015), and multiple sources are used by patients to gain vaccine information (Salmon et al., 2015), making it difficult for healthcare providers to address vaccine hesitancy. This research was conducted to identify factors that cause mothers to be vaccine hesitant and information sources used to support the mothers’ vaccination beliefs. Phone interviews were conducted with twelve vaccine hesitant mothers. Participants were asked if the following factors contributed to their vaccine …

An Overview Of Diabetes And Community Health Concerns In Guatemala, Jennifer A. Davidson, Halie M. Higgins, Alex Krona, Danny R. Luna

All Electronic Theses and Dissertations

Type 2 diabetes mellitus (T2DM) has emerged as a worldwide epidemic in recent years. Rates of this disease continue to rise annually. While many countries have adequate access to prevent and treat T2DM, developing countries often lack education and resources to combat the diabetes epidemic. This shortcoming results in alarming rates of uncontrolled T2DM cases among individuals in developing countries, namely, Guatemala. Additionally, the lack of resources in Guatemala results in a myriad of other health disparities beyond T2DM including deficiencies in sanitation and adequate nutrition. This community service project specifically aims to address the disproportionate burden of T2DM, sanitation, …

Identification Of Medical Distress By Washington County Correctional Officers: A Community Service Project, Laura Driscoll, Lauren Gimmestad, Mary Gritton

All Electronic Theses and Dissertations

Throughout the United States incidence of suicide, cardiovascular disease (CVD) and drug withdrawal is increasing. Not only are these issues prevalent in the general population, but are also a regular cause of medical distress within the walls of correctional facilities (Centers for Disease Control, 2017b). At Washington County Jail, correctional officers are often the first responders in cases of medical distress (R. Heinin, personal communication, October 16th, 2018). It is for this reason that correctional officers are required to undergo mandatory training regarding medical care. The Washington County Jail Commander felt that current correctional officer training could be improved upon …

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 …