The Development of a Diabetes Group Visit Program In a University-Based, Primary Care Clinic

Objectives: This study was conducted to determine the feasibility of a group visit program for diabetes education and management led by a primary care provider in a primary care clinic setting. Intervention Design: A review of the literature about group visits for many diseases including diabetes is reported. Using this information, we designed a diabetes education program using a group visit model. The curriculum was based on the National Standards for Diabetes Self-management Education and used the theory of stages of change and principles of active, adult learning. Methods: 32 subjects with Type II diabetes were recruited to enroll in the program over the course of eight months. Outcome measures included HgbA1c, body mass index, blood pressure, quality of life, and self-efficacy. Changes were measured at baseline, eight weeks, and six months. Results: Clinical outcomes demonstrated trends towards improvement with a 0.16% drop in HgbA1c at six months. Attitudes about diabetes and self-efficacy improved immediately after the sessions but returned to baseline at 6 months. Quality of life showed minimal improvement. Conclusions: A group visit program for diabetes education and management led by a primary care provider is feasible. Key implementation issues included limited patient recruitment and poor attendance rates. Future research is needed to study the development of a group model for continuing management of diabetes in primary care.Master of Public Healt

Evaluating the Impact of a Team-Based Model of Primary Care on Provider Burnout and Patient Experience

Background: To assure high quality, safe, affordable, and accessible health care, organizations are embarking on quality improvement initiatives to work toward the triple aim of patient satisfaction, improving the health of populations, and reducing the cost of care. Description of the Problem: Primary care is the backbone of the health care system, but it is a challenging environment with high rates of clinician burnout. Clinician burnout undermines the ability of organizations to meet the triple aim. Innovative new care delivery models are needed that can meet the triple aim while also mitigating burnout. Available Knowledge: A PRISMA review of the literature examined care delivery models which improve quality of care. The most promising strategy identified was the advanced team-based model of care. Specific Aims: The specific aim of this project was to implement an innovative, team-based model of primary care. The primary objectives were to describe patient satisfaction with the care model, to maintain patient experience, and to reduce provider burnout while maintaining or improving productivity. Context: The project was implemented in a small family practice clinic in a semi-rural community in Wisconsin. The practice is within one of nine regions of one of the largest health systems in the United States. Intervention: An advanced team-based model of care was implemented, which involved nurses taking on a broader set of clinical care tasks as care-team coordinators, to achieve a fuller scope of practice, with staffing model change from 1 NP:1 MA: 0.75RN to 1 NP:1 MA: 1.75 RN. Results: In the first three months of a team-based care implementation, patient experience as measured by Press Ganey surveys was either maintained or improved. Patient acceptance of the model on a brief post-encounter survey showed significant improvement in patient perception of the visit when a care-team coordinator was involved in the visit. Provider burnout was measured with “work after clinic” hours and chart closure time, surrogate measures for burnout, with both factors decreasing in the three months post-implementation. Productivity was measured using work RVUs per contact hour and panel risk adjusted score, both of which showed increases in the first 3 months of implementation. Discussion: The design of this project included a comparison group to evaluate measures with and without care team coordinator involvement which established statistically significant improvements with patient overall satisfaction with care. While previous team-based care studies have demonstrated improvement in patient satisfaction, provider burnout, and revenue potential in months or years after implementation, this work suggests that benefits may occur much sooner. Immediate return on investment may help remove barriers to implementation

Improving Assessment, Documentation, and Ordering of Diabetic Retinopathy Screenings in a Primary Care Clinic

Abstract BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS). PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or type 2 diabetes mellitus in a primary care setting through provider reminders and patient education. METHODS: This project was a single-center, mixed methods quality improvement project that took place at a family medicine clinic in central Kentucky and was guided by the FOCUS-PDSA model for improvement. A quality improvement (QI) team conducted two PDSA cycles involving 1) family medicine resident education and 2) manually updating the EMR to reflect up to date DRS. A DNP student led a focus group to further identify barriers and facilitators to assessing, documenting, and ordering DRS. A third PDSA cycle incorporating provider and staff reminders as well as patient education was implemented. Data was gathered through retrospective chart reviews between July and October 2020. RESULTS: Descriptive data was reviewed for PDSA cycles one and two. Descriptive data showed that provider education did not improve documentation and manual review of the EMR to identify results from ophthalmology was effective. There were no significant differences found in PDSA cycle three for assessment (p=0.35), documentation (p=0.99), or ordering (p=0.48) of DRS after intervention. Statistically significant results were found for the association between assessing for DRS and having an annual review completed (p=0.002). CONCLUSIONS: Findings suggest that DRS rates could improve with a more robust EMR system, having a reminder system in place, and having annual reviews completed that included DRS. Future investigation should include comparison of these variables and their influence on provider assessment, documentation, and ordering of DRS. Keywords: diabetic retinopathy, screening, quality improvemen

The Effectiveness of Counselors as Care Managers in Improving Self-Management and Medical Outcomes in Persons with Poorly Controlled Diabetes

This study investigated whether providing counselors as care managers to individuals who were having difficulty managing their Type II diabetes improved their self-management, health, and functioning. Counselors used the Motivational Interviewing Model and met weekly over a six month period with patients who had Type II diabetes who had been identified as not functioning well in managing their disease. The success of the intervention was determined by a number of measures including physical symptoms of patients; patients\u27 perceptions of the care they received; and patients\u27 self-efficacy in managing their diabetes. The results of this study suggested that providing counselors as care managers had a positive effect on the functioning of poorly functioning diabetes patients

Impact of Physical Activity Vital Sign Screening on Physical Activity Counseling and Referrals in Primary Care

Background/Purpose: Physical Activity Guidelines for Americans recommend 150-300 minutes of moderate-intensity physical activity each week for adults; however, half of the adults do not meet this goal, which leads to increased chronic health conditions and poor health outcomes. The physical activity vital sign (PAVS) screening tool is an evidence-based assessment tool associated with increased physical activity counseling, which can lead to increased physical activity and improved patient outcomes. Objective: The purpose of this study was to examine the impact of PAVS screening on physical activity counseling and referrals in primary care. Methods: This prospective study took place in a small primary care clinic providing care to women. Physical Activity Vital Sign screening was implemented to examine the effect of PAVS screening on the rate of physical activity counseling and referral to exercise promotion programs. The intervention consisted of provider education and implementation of PAVS screening during annual wellness exams. Six primary care providers working in the clinic were given pre- and post-intervention surveys. Baseline and post intervention data of providers’ physical activity counseling and referrals was obtained via chart review. Results: The sample consisted of six Caucasian female primary care providers. Five out of six providers chose to participate in the baseline survey and four in the post intervention survey. In the pre survey (N=5) agreed that a visual aid listing current physical activity guidelines would be helpful and they liked the PAVS screening tool. Barriers to physical activity screening and counseling were time to have the conversation (100%) and patients’ disinterest (50%). Prior to the intervention, 49% of patients had documented exercise counseling vs. 64.3% after the intervention (p = 0.15). Similarly, referrals to exercise/weight loss clinic increased from 2% to 7.1% (p = .208). Patients who received exercise counseling had a significantly higher BMI 2 compared to those who did not (M = 32.7, SD = 8.6 vs. M = 28.5, SD = 6.8, p = .003), suggesting high BMI was a trigger for exercise counseling and referral rather than activity levels. Conclusions: Our findings support established evidence that the PAVS screening is a valuable screening tool and is appropriate for use in a primary care setting. Universal physical activity screening is recommended, and providers should be cautious about relying on BMI as the cue to action for physical activity counseling and referral. The limitations of this study are discussed and suggestions for future research are presented

Development and Feasibility Testing of a Supervised Pharmacy Student-Led Medication Review of Patients with Diabetes in Primary Care.

Introduction: The expected outcomes from medicines are, frequently not realised due to adverse reactions, inappropriate prescribing and patient failure to take their therapy as intended. Whilst medication review provided by pharmacists is designed to address these issues evidence for the effectiveness is weak, and sometimes counterintuitive. Reasons postulated are poor study design, inappropriate intervention location and limited consultations skills demonstrated by pharmacists. This thesis is designed to develop, feasibility test and pilot a supervised medication review service for patients with type 2 diabetes (T2DM) in primary care provided by undergraduate pharmacy students as part of their undergraduate education. Method: Literature review and focus groups were undertaken to refine the intervention. Ethical approval was obtained. Medication reviews were undertaken within the medical practices and supervised by a primary care based pharmacist. Students reviewed patient’s medicines and then one-to-one medication reviews with two patients. A range of outcome measures were utilised and tested. Recruitment and attrition rates were recorded. Patient and practitioner acceptability of the intervention and education experience was obtained. Results: 5 medical practices were recruited, from which 133 patients with T2DM consented to participate with 67 randomised to the intervention group. Thirty-two students undertook 58 medication reviews with patients. Patients reported satisfaction with student-led medication reviews and information received about medicines. No improvement in patient reported medication adherence or clinical outcomes were identified. The mean change in quality of life and patients’ satisfaction with information about medicines was significantly greater in the intervention group. Pharmacy students reported increased confidence and improved communication skills. Discussion and conclusions: The feasibility and pilot study provided data which would enable delivery of a future definitive trial. The intervention was deemed acceptable by patients and demonstrated improved quality of life and satisfaction with information about medicines. Educational benefits of this study were also observed

Baystate Medical Practices Annual Report - 2017

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1001/thumbnail.jp

A study examining depression and bipolar support alliance online peer support groups

The current study examined the experiences of individuals who participated in one or more online peer support group (OPSG) sessions organized by Depression and Bipolar Support Alliance (DBSA) in order to elucidate whether participants experience higher levels of quality of life as associated with their participation in OPSG. Participants ranged in age from 18 to 79 and were primarily White/Caucasian and female. Participants completed a survey, which consisted of a demographics questionnaire and the Quality of Life Enjoyment and Satisfaction Questionnaire- Short Form. Data were collected using Qualtrics and analyzed using SPSS. No statistical significance was found regarding differences in quality of life according to whether participants attended a DBSA group in the past two months. However, results indicated that participants who were married or in a committed relationship indicated a significantly higher quality of life score (F(4, 91) = 3.89, p = .006) than other groups. The results of the present study were inconsistent with the current literature, which suggests a link between quality of life and participation in peer support. Additional unmeasured variables may have contributed to a null finding. In conclusion, results indicate that online peer support groups, specifically DBSA Online Peer Support Groups, may be unrelated quality of life

Physicians' role in patient ergonomics: a pilot study

With the ever-increasing rate of the integration of technology, and office workers making up the largest single sector of occupations, many workers are spending an increasingly large portion of their work time in the prolonged sitting or standing position and while on computer-based systems. Evidence-based research suggests that increased sedentary time is associated with diabetes, hypertension and other mortality causing diseases such as cardiovascular disease. There is a lack of occupational medicine considerations, specifically ergonomics, incorporated into the patient plan of care in the primary care setting. This is likely due to the decreased number of physicians specializing in occupational medicine (OM), and the lack of OM education in medical school curriculum. The current time constraints of the medical system may make the integration of additional screening seem unreasonable. With the introduction of occupational therapy as a contributing member of the primary care team, the burden of ergonomic training and education for at-risk patients can be reduced. Through participation in the Physicians’ Role in Patient Ergonomics workshop, a 20-minute online video aimed at explaining the connection between occupational risks and common health issues seen in the primary care setting, physicians can learn about the implications of occupational risks on patient health, and how to utilize brief screening questions and decision trees to efficiently determine which patients may benefit from ergonomic education and training