Primary Care Commons^™

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Marshall Journal of Medicine

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Severity Of Depression, Anxious Distress And The Risk Of Cardiovascular Disease In A Swedish Population-Based Cohort., Aysha Almas, Yvonne Forsell,, Romaina Iqbal, Imre Janszky,, Jette Moller

Department of Medicine

Background: Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association.

Methods: We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20–64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases.

Findings: Overall increased odds ratios of 1.5 to 2.6 were seen …

Research Design Creates Ambiguity Related To Efficacy Of Sickle Cell, Chronic Disease Specialty Clinic, Scott J. Dawsey

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Koch KL, Karafin MS, Simpson P, Field JJ. Intensive management of high-utilizing adults with sickle cell disease lowers admissions. Am J Hematol. 2015 Jan;90(3):215-219. doi:10.1002/ajh.23912

Landscape Analysis Of Multi-Sectoral Initiatives For Under-Nutrition In Pakistan, Zulfiqar Ahmed Bhutta, Albertha Nyaku, Jane Keylock, Shehla Zaidi, Jai Das

Community Health Sciences

Mapping of Multi-Sectoral Initiatives for Nutrition in Pakistan, Challenges faced, Opportunities, and potential for Cross- Sectoral Synergies.

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Improving Hand Hygiene Compliance To Reduce Clabsi Rate In Oncology Icu, Lorenzo D. San Pedro

Master's Projects and Capstones

The aim of this project is to reduce the rate of central line associated blood stream infection (CLABSI) occurrence in oncology ICU by 50% by the last quarter of 2015. This study was conducted in ICU to assess adherence to the facility’s hand hygiene (HH) protocol among the staff nurses and allied healthcare workers. The facility is best known as a non-profit cancer treatment center and designated as a Comprehensive Cancer Center. Evidence showed that hand hygiene is the most effective way of preventing CLABSI, one of the most common types of infection in ICU microsystem. The project utilized The …

Using Education And A Prevention Protocol Tool To Decrease The Incidence Of Pressure Ulcers In A Nursing Home, Kristina L. Scalzitti

Evidence-Based Practice Project Reports

Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about …

Diabetes Type 2 Self-Management Education Program: Short Messaging From Patient Portal To Web-Enabled Device, Lynn S. Holcomb

Evidence-Based Practice Project Reports

Only one in eight adults with diabetes reaches target goals for disease management, which can lead to clinical complications, costly both economically and in quality and duration of human life. The standard of care is a quarterly 15-minute face-to-face visit-- arguably inadequate to impart self-care knowledge. The purpose of this EBP project was to deliver a 30-day diabetes self-management education program (DSMEP) utilizing widely accessible web-based technology to facilitate adults with diabetes to reach targeted goals. Using the Chronic Care Model as a framework, the DSMEP design was based on an extensive literature review of the delivery of DSMEP in …

The Effect Of An Educational Intervention On Oral Anticoagulation Therapy Knowledge In Primary Care, Elizabeth D. Deck

Evidence-Based Practice Project Reports

It is estimated that three million people in the United States are on oral anticoagulation therapy (warfarin). Populations studied have been found in therapeutic range 64% of the time (Pernod, Labarere, & Bosson, 2008). The low percentage of therapeutic range is attributable to (a) adherence, (b) monitoring infrequency, (c) Vitamin K antagonists, and (d) the effects of aging and comorbidities. The purpose of this evidence-based practice (EBP) project was to examine whether an educational intervention would improve the knowledge of patients receiving warfarin therapy. Roy’s model for patient adaptation and the Stetler Model for EBP were used as frameworks for …

Anal Cancer Risk Factor Management Practices And The Barriers And Facilitators Of Addressing Anal Health In The Hiv Primary Care Setting, Crystal Martin Walker

Theses and Dissertations (ETD)

Background: The incidence of anal cancer is only 1-2 per 100,000 people in the general population, but in people living with HIV and AIDS (PLWHA), the incidence is far greater by about 80 times. This is a striking disproportion, and it is vital for the healthcare provider and healthcare system to become more attentive to the risk of anal cancer in high-risk populations such as PLWHA. There are a number of modifiable risk factors for anal cancer in PLWHA such as smoking, non-adherence to antiretroviral therapy (ART), and risky sexual behaviors. The HIV primary care provider (HIV PCP) plays a …

One Final Goodbye, Dennis Baumgardner

Journal of Patient-Centered Research and Reviews

N/A

Mindfulness-Based Stress Reduction And Transcendental Meditation: Current State Of Research, Adam Holt

Journal of Patient-Centered Research and Reviews

This article summarizes the current state of meditation research, specifically focusing on mindfulness-based stress reduction and transcendental meditation. Despite significant methodological problems with the studies reported to date on the subject, there is consistent evidence that meditation can produce changes in the nervous system and physiology of the meditator, and can help with various psychological markers of well-being. Regarding improvement in specific clinical diseases, research is generally mixed and preliminary. Strong recommendations cannot be made based on current evidence, and further studies are needed. In general, there is a stronger body of evidence supporting mindfulness-based stress reduction than for transcendental …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

The Effects Of Nutrition And Physical Activity Education On Knowledge And Glycemic Control Among Persons With Type 2 Diabetes, Alexandra Harris

Evidence-Based Practice Project Reports

Diabetes affects millions of people worldwide. Approximately 29.1 million people or 9.3% of the United States population has diabetes (Centers for Disease Control (CDC), 2014). Diabetes was the seventh leading cause of death in the United States in 2010 and is projected by the World Health Organization (WHO) to be the seventh leading cause of death globally by 2030. The purpose of this evidence-based project was to provide nutrition and physical activity education in an effort to improve diabetes knowledge and glycemic control among persons with type 2 diabetes. Hemoglobin A1c levels and Diabetes Knowledge Test scores were compared from …

Hepatitis C Virus Infection Screening Test Compliance At Primary Care Clinic, Talal Alzahrani, Brandon Rieders, Mohammed Fadlalla, Jason Gendell, Anne Cioletti

GW Research Days 2015

Introduction:

Hepatitis C Virus (HCV) is the most common cause of liver cirrhosis and hepatocellular carcinoma, and is the leading cause of liver transplantation in the US. About 3.2 million individuals are chronically infected with HCV. Most of these patients are unaware of their infection because they are largely asymptomatic. Approximately three-fourths of them were born between 1945-1965. Furthermore, with the advances in HCV treatment, it is imperative to identify chronically infected individuals in order to avert the long-term, costly, sequelae of the virus. The U.S. Preventive Services Task Force recently recommended a one-time screening test for HCV for those …

Cost Of Primary Health Care In Pakistan, Muhammad Ashar Malik, Wahid Gul, Saleem Per Waiz Iqbal, Farina Abrejo

Community Health Sciences

Background: Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan.

Method: Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005 –06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits …