- Barriers to HIV/AIDS Care in Rural-Specific Areas of Pennsylvania
- Medical advancement in the field of HIV/AIDS related care has resulted in what used to be an epidemic with a "death sentence" to an incurable disease that is manageable with proper medical and psychosocial attention. Although deemed amendable with various prevention and treatment strategies being in full swing, HIV/AIDS diagnoses still remain stable and consistent. The highest proportion of HIV/AIDS diagnoses are reported in urban areas of the United States, which often shifts the focus away from rural communities. However, a surge in rural diagnoses requires professional attention and new research to assist in understanding and alleviating stressors specific to HIV/AIDS related care in new targeted zones. Individuals with HIV/AIDS who reside in rural areas continue to be an underserved and forgotten population. There are characteristics specific to rural areas that can become barriers and challenges to providing HIV/ AIDS related care and prevention. Specific characteristics can be social, medical, environmental, economic, and/or a combination of these variables. This study identifies and researches rural characteristics that create current barriers for rural individuals living with HIV/AIDS. It then utilizes the information to develop a survey able to be utilized by HIV/AIDS service professionals to effectively tailor interventions to address both rural and urban needs.
- Deferring Antibiotic Prescribing in Nursing Home Residents with Asymptomatic Bacteriuria: A Pilot Study
- Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents; patients are commonly treated even in the absence of signs or symptoms of a UTI being present. This research study's objective is to reduce the amount of unnecessary antibiotic prescribing and assess the impact of educational interventions in nursing home residents that have asymptomatic bacteriuria (ASB). The design of this research study is quasi-experimental. The setting is Butler Memorial Hospital, a non-profit organization and an independent community hospital with 296 beds located in rural Pennsylvania.
- Does a Hypertension Guideline Assist Providers with Perceived Confidence with Hypertension Management in a Retail Setting?
- This study evaluates the impact of training on providers' confidence about using the MinuteClinic (MC) hypertension (HTN) guideline to conduct HTN management visits in MC. MC providers who participated or did not participate in the training/webex education session provided prior to the commencement of HTN chronic care services were surveyed and their confidence scores measured. T-test analysis did not show any statistically significant difference between the Trained group and the Non-Trained group. Factors enabling the lack of significant difference between the two groups and suggestions for further studies are discussed.
- Hospice Patients' Comfort Level and Family Members' Self-Reported Satisfaction
- The goal of the study was to find out whether there was a relationship between hospice patients' comfort level and family members' self-reported satisfaction. The study was conducted in a hospice care facility in the northeastern county of Maryland. Participants were family members comprised of spouses and children of the patients. All Forty-two family members who were given the survey questionnaires, completed them making the return rate 100%. Kristjason's FamCare questionnaire was used to evaluate family members' comfort level. The lowest mean was 4.44, item 4 on the questionnaire, and the highest mean was 4.95, which was item 12 on the questionnaire. The Cronbach's alpha was 0.92 which displayed high level of reliability of the FamCare scale with this sample. An acceptable Cronbach's alpha value is 0.7 (Janicak, 2017). As a result, the value of 0.92 is considerably higher than acceptable levels. The Pearson's r correlation coefficient was calculated to assess the relationship between patients' comfort level and family members' self-reported satisfaction. We used the item #1, "satisfied with the patient's pain control", as a proxy for comfort. We then took a mean of all the other items, minus item #1.The correlation between Item #1 and the mean of the other items is r = .685. The p = .025.
- "I Have Something to Tell You," The Augmentative and Alternative Communication Project
- A social-learning group was used to train caregivers of school-age augmentative and alternative communication (AAC) users. Training was aimed at the caregiver of emergent AAC users and occurred in the home and community settings using a modeling strategy. Instruction was primarily delivered in three 15-minute training sessions using Facebook. In addition to social media instruction, the caregiver-child teams met with other participants to practice and implement newly learned skills during community activities. Meetings were approximately 1-hour in length and included coaching and feedback. A single subject AB design was used to evaluate the effects of community instruction on caregiver AAC modeling. Frequency of caregiver modeling is the dependent variable measured by direct observation. Moduledevelopment utilized behavior skills training techniques consisting of (a) instruction (b)modeling (c) practice (d) feedback and coaching in the community setting.
- Improving Blood Pressure Control and Patient Satisfaction: An Improvement Project in a Primary Care Clinic
- In the United States, approximately 100 million people are living with hypertension (high blood pressure) with 38% increase in its related deaths during the period of 2005-2015. The prevalence of hypertension related deaths are expected to rise partly due to the growing aging population, who are more susceptible to the disease. Hypertension has placed a huge healthcare burden on families and the general healthcare system as well. In response to these challenges, the American Medical Association (AMA) has recommended steps such as ensuring accurate blood pressure measurement, acting quickly to treat patients with hypertension, and working collaboratively with the patient to formulate a treatment plan. These steps form the basis of the Measure Accurately, Act Rapidly, and Partner with Patients (MAP) intervention. Despite the overall impact of MAP intervention on healthcare service delivery, few studies have been done to explore its effectiveness in managing hypertension. The current study, therefore, examined the effectiveness of MAP intervention in improving high blood pressure control and patient satisfaction. A total sample of 30 patients diagnosed with primary hypertension was included in the study. The results indicated a statistically significant improvement in both high blood pressure and patient satisfaction after six weeks of the intervention program. The study concluded that the MAP intervention strategy was effective in improving blood pressure control. The study recommended further investigations to determine the specific constructs of effective intervention.
- Improving Clinic Attendance Through Text Message Reminders to Homeless Patients with Chronic Health Conditions
- Research question: What is the effect of text message reminders on clinic attendance for homeless patients who attend two Los Angeles Christian Health Centers (LACHC) clinics in Los Angeles, California. Objective: The objective of this study is to determine the effectiveness of short message service (SMS) for healthcare appointments to increase clinic follow-up attendance of homeless people in these two clinics. Methods: This was a pilot study using a quasi-experiment designed to measure clinic attendance after the initiation of SMS reminders for clinic visits. The study evaluated the impact of text message reminders to homeless patients by using pre/post testing design. Conclusion: The SMS text reminders significantly increased the follow-up attendance and reduction in no-show rates.
- Incidence of Clostridium Difficile Infection in Skilled Nursing Facility Residents Treated with Antibiotics Compared to Treatment with Antibiotics and Probiotics
- Clostridium difficile is a microbe that may cause a severe intestinal infection in vulnerable individuals such as those who are ill and taking antibiotics, or the elderly living in skilled care facilities. Use of probiotic supplements have shown in some studies to decrease the incidence of Clostridium difficile infection (CDI). Does the use of probiotic supplements in residents of a skilled nursing facility in western Pennsylvania receiving antibiotic therapy reduce the incidence of CDI? This retrospective study reviewed electronic medical records of 164 residents in a skilled nursing facility, including residents receiving antibiotics, and those receiving antibiotics and probiotics. Limitations included the size of the study sample, the age and condition of the patient including possible previous CDI history, and the time frame of transposition of laboratory analysis results to the electronic medical record. Results revealed a statistically significant difference in the rate of antibiotic-related diarrhea between patients receiving antibiotics and those receiving antibiotic therapy with probiotic supplements. In this study, no patients receiving probiotics and antibiotics were positively diagnosed by laboratory analysis with CDI. This study indicates the need for further studies related to use of probiotic supplements in patients receiving antibiotic therapy.
- Open Access Colonoscopy Quality Improvement: A Doctor of Nursing Led Initiative
- Colorectal cancer is a leading cause of death in the United States with colonoscopy fundamental to any colorectal cancer screening program. Open access colonoscopy allows procedures to be performed in a timely manner to detect adenomas. The efficacy of adenoma detection is largely dependent on the quality of colonoscopy bowel preparation. Adenoma detection rate of open access screening colonoscopies and quality of split dosed bowel preparation was measured in a rural private gastroenterology practice in Central Pennsylvania using the 2017 Registry Individual Measure Flow created by the Centers for Medicare & Medicaid Services (CMS) noting the quality of bowel preparation at the time of review. Open access screening colonoscopy reports were reviewed for ICD-10 codes for 3 risk factors for colorectal cancer, age 50 years and greater, and CPT codes for colonoscopy procedure without modifiers resulting in early termination of the procedure. The annual adenoma detection rate of open access screening colonoscopy patients who me the inclusion criteria was 44.47 % with 96.7% of open access screening colonoscopies rated to have optimal bowel preparations. These findings suggest that open access screening colonoscopy can be a timely, patient-centered method of effective, high quality colorectal cancer screening.
- Patient Portal Engagement at a Pediatric Office: Reasons Why Individuals Are Not Using the Patient Portal
- This descriptive study explores the reasons individuals bringing their child(ren) to the pediatric office are not using the patient portal. There was negligible use of the patient portal as shown by a retrospective review of data usage reports via the eClinicalWorks software. Additionally, staff reported that they still answered many calls for information (immunization records, lab results, medication refills, appointment scheduling, and care-related questions), all of which were easily obtained through the portal. The objective of this study is to determine the reasons why individuals bringing the child(ren) to a rural pediatric practice in Central Pennsylvania are not using the patient portal.