Browsing by Subject "Primary care"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
Item Content Validation of a Tool for Assessing Risks for Drug-Related Problems to be Used by Practical Nurses Caring for Home-Dwelling Clients Aged ≥65 years: a Delphi Survey(European Journal of Clinical Pharmacology, 2014-05-14) Dimitrow, Maarit S.; Mykkänen, Sanna I.; Saija N. S., Leikola; Kivelä, Sirkka-Liisa; Lyles, Alan; Airaksinen, Marja S. A.Abstract Purpose Home care services are becoming a critically important part of health care delivery as populations are aging. Those using home care services are increasingly older, more frail than previously, and use multiple medications, making them vulnerable to drug-related problems (DRPs). Practical nurses (PN) visit homedwelling aged clients frequently and, thus, are ideally situated to identify potential DRPs and, if needed, to communicate them to physicians for resolution. This study developed and validated the content of a tool to be used by PNs for assessing DRP risks for their homedwelling clients aged ≥65 years. Methods The first draft of the tool was based on two systematic literature reviews and clinical experience of our research group. Content validity of the tool was determined by a threeround Delphi survey with a panel of 18 experts in geriatric care and pharmacotherapy. An agreement by ≥80 % of the panel on an item was required. Results The final tool consists of 18 items that assess risks for DRPs in home-dwelling aged clients. It is divided into four sections: (1) Basic Client Data, (2) Potential Risks for DRPs in Medication Use, (3) Characteristics of the Client’s Care and Adherence, and (4) Recommendations for Actions to Resolve DRPs. Conclusions The Delphi process resulted in a structured DRP Risk Assessment Tool that is focused on the highest priority DRPs that should be identified and resolved. The tool also assists the PNs to identify solutions to these problems, which is a unique feature compared to similarly purposed prior tools.Item The Impact of a Provider Dementia Education Program on Dementia Screening, Documentation of Dementia Diagnosis, and Community Referral In a Rural Primary Care Setting(2019-05-14) McIntosh, Michele; Seldomridge, Lisa; Nursing; Doctor of Nursing PracticeProblem Statement: Primary care providers’ lack of knowledge regarding dementia screening, diagnosis, and treatment can lead to missed or delayed dementia diagnosis, inadequate care planning, and a lack of referral to community resources. Purpose: To evaluate the effectiveness of a provider dementia education program in improving early identification of dementia and community service referral for individuals age 65 and older in a rural primary care practice. Methods: A two-month pre-intervention chart review of patients presenting for initial or subsequent Annual Wellness Visits (AWV) was conducted. Data on documentation of dementia diagnosis, screening, type of screening tool used, advance care planning discussion, and community service referrals were collected. A one-hour dementia education program was implemented for all providers followed by data collection for two months for evidence of increased screening and identification of those with dementia as well as review of their use of other healthcare services. Results: Of the 253 charts reviewed pre-intervention, seven individuals had a documented dementia diagnosis. No newly diagnosed patients were identified. Post-intervention, 10 individuals had a documented dementia diagnosis. One patient had findings of new cognitive impairment based on Mini-Cog testing and was referred for further dementia work-up. There was no documentation of referrals to community resources. Significance: Although the educational session raised awareness among providers of the importance of using cognitive screening tools routinely during AWV to improve early identification of dementia, changing practice requires a longer period of time. However, this project improved interprofessional collaboration between the hospital, primary care office, and Alzheimer’s Association.Item Implementing the Heikes Screening Tool for Prediabetes and Type 2 Diabetes for Adult Patients in a Rural Primary Care Clinic(2022-03) Bland, Laura; Keenan, Anastacia; Hardisty, Vicki; Nursing; Doctor of Nursing PracticeThe problem identified showed inconsistencies in screening for prediabetes and type 2 diabetes by primary care providers at a primary care office in rural Maryland. After a complete literature review, a standardized screening process for identifying those at risk for prediabetes and type 2 diabetes was the solution to this problem. The purpose of this project was to standardize a screening process for prediabetes and type 2 diabetes. A standardized screening process was created to assure all patients meeting criteria for the American Diabetes Association (ADA) screening guidelines were screened properly for risk while delivering the standard of care to all patients. The goal was to increase screening by practitioners. This will aid in early diagnosis of the disease, thus leading to a decrease in diabetic related complications. Heikes screening tool was implemented using a standardized process involving an inclusion and exclusion checklist created by the ADA to identify those needing further screening. If a patient met inclusion criteria, a Heikes screening tool was completed. The patient’s risk was then identified from the screening tool and discussed in real time with the patient. Heikes screening tool was evaluated and measured by how many additional patients could be captured for being at risk with the use of a standardized screening process. The Heikes screening tool and process created a more standardized approach to identifying patients at risk for prediabetes and type 2 diabetes. Descriptive and inferential statistics were used to analyze this screening process. There was a final sample of 40 participants using convenience sampling. The screening process was able to identify and screen 22.5% of participants that had not been previously screened as evidenced by a chart review or patient reporting. The data also revealed participants who had a waist circumference of 38.4in or more had a 6.65% higher risk of being in the high-risk category for diabetes development through the Heikes screening tool (p < 0.001).Item Increasing Patient Engagement in Primary Care following Transitional Care(2021-05) Emerson, Ally; Barnes, Annette; Stewart, Rosalyn; Webster, Debra; Nursing; Doctor of Nursing PracticeOverutilization of emergent care for primary health needs in the United States leads to poor utilization of resources, avoidable hospital readmissions, and costs an estimated 17 billion dollars annually. Issues impacting transition of care can cause incomplete follow-up and continued patient reliance on the emergency department (ED) for healthcare. Ensuring timely follow-up and engagement in primary care for patients discharged from acute care are major goals to reduce this economic burden and ensure effective care coordination. Transitional care provided by an after-care clinic (ACC) offers solutions to increase patient follow-up and coordinate entry, or engagement, in primary care. An ACC provided by a regional, urban health system has reduced overutilization and readmissions; however, engagement into primary care following acute care remains a challenge for the low income and uninsured population serviced. This Doctor of Nursing practice (DNP) project implemented evidence-based practice (EBP) interventions of intra-appointment social determinants of health (SDOH) screening and post-appointment nurse-directed reminder phone calls to increase patient engagement in primary care following a transitional care appointment. Engagement was defined as completion of one primary care appointment within three months after the patient’s initial ACC visit. With the coronavirus (COVID-19) pandemic, continuity of care was provided with the addition of telemedicine; and although ACC staff hours were reduced and roles shifted, adding EBP to the bundled-care, interdisciplinary team approach for patients under the age of 40, who were uninsured or Medicaid insured, was cost effective and increased engagement in primary care.Item Integrating Palliative Care Screening into Primary Care(2018) Holland, Nalynn; Hinderer, Katherine; Nursing; Doctor of Nursing PracticeProblem Statement: As patients with chronic, life-limiting conditions live longer, it is important to continuously evaluate quality-of-life. The lack of initiation of a palliative care consult at the time of diagnosis with a chronic, life-limiting condition results in an increase in disease burden and functional decline. Purpose: The purpose of this project was to determine if the implementation of a palliative screening and referral process in the primary care setting as compared with usual care (subjective physician referrals without standard screening tool) would help to increase the number of palliative care referrals and patient access to palliative care service. Methods: A multi-step exploratory project design was used with convenience sampling. This project encompassed: 1.) collection of aggregate data; 2.) development of a palliative care staff educational program; 3.) implementation of a palliative screening tool; 4.) development of a process for referring patients to palliative care; and 5.) provision of improved access to palliative care services for eligible patients. Results: Descriptive and inferential statistics explored overall provider compliance with use of the palliative care screening tool and comparisons of the number of patients who met criteria for palliative care referrals to the number of actual referrals. A total of 410 patients were seen, which included 448 visit encounters. The majority were female (61%, n=252) and Caucasian/White (81%, n=331). Age ranged from 18 to 99 years. Screening compliance was 33% (goal of 100%). Twenty patients met criteria for a palliative care referral. However, only 9 referrals were actually made. Due to low yield of referrals, correlations between palliative care referrals and demographic variables such as: age, gender, insurance, and diagnosis were not possible. Significance: The increased integration of palliative care knowledge into the primary care setting helped to facilitate palliative care referrals. Based on the literature reviewed and data collected from this DNP project, the recommendation remains for more studies to be conducted on the use of palliative care screening tools in the primary care setting.Item Use of a Standardized Telehealth Visit Tool to Improve Care Outcomes of Veterans in Home-based Primary Care(2022-04) Talley, Chrystal; Barnes, Annette; Bradley, Beverly; Nursing; Doctor of Nursing PracticeIn the United States, approximately two million homebound, older adults have chronic health conditions and disabilities. Providing primary care to this high-risk population is challenging and requires evidence-based strategies to address higher treatment noncompliance, lower medication adherence, decreased continuum of care, higher risk for hospitalizations, and disproportionately high healthcare costs. This project implemented evidence-based practice (EBP) of a standardized telehealth visit tool to increase access to primary care for homebound veterans. Anticipated outcomes included an increase in telehealth visits, holistic documentation, and a decrease in emergency room (ER) visits post-implementation. A synthesis of literature highlighted best practices during telehealth visits to include utilization of a standardized tool. A telehealth visit tool was developed to guide visits conducted by nurse case managers and other providers in a home-based primary care (HBPC). During a three-month period, telehealth visits were offered to all veterans enrolled in the HBPC program located in the Northeast region in the United States. Data including demographics, number of telehealth visits, tool usage, and number of ER visits and hospitalizations with diagnosis were analyzed pre- and postimplementation. Telehealth visits improved access to care for homebound veterans with a 373.3% increase in the total number. The standardized tool assisted nurse case managers and providers to maximize the benefits of and promote continuity of primary care using telehealth. Hospitalizations and ER visits did not decrease, perhaps due to the short implementation period, an increase in COVID-19 cases, and the high-risk population’s multiple comorbidities.