5 research outputs found
Does pre-ordering tests enhance the value of the periodic examination? Study Design - Process implementation with retrospective chart review
<p>Abstract</p> <p>Background</p> <p>To evaluate the value of a pre-ordering process for the pro-active scheduling and completion of appropriate preventive and chronic disease monitoring tests prior to a periodic health examination (PHE).</p> <p>Methods</p> <p>A standardized template was developed and used by our nursing staff to identify and schedule appropriate tests prior to the patients PHE. Chart reviews were completed on all 602 PHE visits for a 3-month interval in a primary care setting. A patient satisfaction survey was administered to a convenience sample of the PHE patients.</p> <p>Results</p> <p>Of all the patients with tests pre-ordered, 87.8% completed the tests. All providers in the division used the process, but some evolved from one template to another over time. Most patients (61%) preferred to get their tests done prior to their PHE appointment. Many of our patients had abnormal test results. With this process, patients were able to benefit from face-to-face discussion of these results directly with their provider.</p> <p>Conclusions</p> <p>A pre-order process was successfully implemented to improve the value of the PHE visit in an internal medicine primary care practice using a standardized approach that allowed for provider autonomy. The process was accepted by patients and providers and resulted in improved office efficiency through reduced message handling. Completion of routine tests before the PHE office visit can help facilitate face-to-face discussions about abnormal results and subsequent management that otherwise may only occur by telephone.</p
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Improving Osteoporosis Screening Rates in a Primary Care Practice
Background: Osteoporosis is a prevalent condition that is often overlooked until a fragility fracture occurs. Screening for bone loss with dual-energy X-ray absorptiometry (DXA) scans is underutilized in the primary care setting. Direct communication with at-risk patients, offering self-referral for DXA screening, has been demonstrated to be the most effective intervention in increasing DXA screening rates.
Purpose: The goal of this DNP project was to improve bone density screening rates in a primary care practice by inviting patients at greatest risk of osteoporosis to schedule a DXA without a provider order.
Methods: After a review of the electronic medical record, letters and educational brochures were mailed to 261 eligible patients, including women age 50 and over and men age 70 and over, with instructions to schedule a DXA scan. Patients whose DXA results revealed osteoporosis or osteopenia with a high risk of fracture were invited for in-person educational counseling and medication management.
Results: Sixty-seven (25.6%) patients completed a DXA scan within three months of receiving the letter. Number of correct items on an abbreviated version of the Osteoporosis Knowledge Assessment Tool (OKAT) tool improved from 5.55 (SD 3.3) before counseling to 10.18 (SD = 2.2) after counseling. Three months after the intervention, 475 (66.3%) of patients in the practice were appropriately screened for osteoporosis, compared with 398 (55.6%) three months prior to the intervention.
Discussion: The implication for nurse practitioners is the need to advocate for primary and secondary prevention of osteoporosis as well as educate themselves about screening guidelines, lifestyle recommendations and medication options for treating osteoporosis