10th Annual Primary Care Summit Poster Presentations
Breastfeeding Continuation Rates in a Residency Associated Outpatient Clinic: A Quality Improvement Project
Background: Nationally, there’s a steady decline in exclusive breastfeeding (EBF) from birth to six months of age. Objectives: Our project aims to evaluate our clinic’s EBF rate and support EBF. Methods: Multisite implementation of breastfeeding support to be used during wellness exams. Project included developing breastfeeding resource materials and breastfeeding toolkit. EMR infant feeding template was created to help providers screen for breastfeeding difficulties, provide education and refer to lactation. Results: Our clinic has a higher rate of EBF in the first 2 weeks of age. The greatest decline in EBF occurs between 2 weeks and 1 month. MHS Family Medicine rate is similar to the national and Connecticut rates. Only 27% of reported breastfeeding challenges were referred to a lactation consultant. Conclusion: Since the EBF rate drops precipitously during the first month, prenatal education maybe helpful in setting expectations. Breastfeeding moms need the most support in the first month. Download
Conscientious EKG Use During Annual Screening Physicals in Multiple Primary Care Offices in Connecticut
Purpose:To evaluate whether primary care physicians in Connecticut order EKGs conscientiously based on ASCVD risk scores during annual screening exams. Methods: Last ten annual physicals at seven primary care sites were analyzed for EKG use and ASCVD risk scores. Results were analyzed using Fisher’s Exact test. Results: Fifty-two subjects included. No-EKG group had ten subjects (six female), mean age 51.3. EKG group had 2 subjects (27 female), mean age 56.8. Mean 10-year ASCVD Risk Score was 17.34% and 11.30%, for No-EKG and EKG groups respectively. No significant differences between EKG and No-EKG groups when grouped by 10% ASCVD risk (Exact p=0.725). No significant differences when EKG and No-EKG groups were grouped by No-Risk-Factors and Any-Risk-Factors (Exact p=0.190). Discussion: At observed sites, 60% of EKGs obtained during annual physicals were performed on low-risk patients. Substantial variation exists between practices. Continued physician and patient education is needed to improve adherence to Choosing Wisely recommendations. Download
Developing a Clinical-Academic Partnership to Increase Nurse Practitioner Students’ Readiness to Practice in Medically Underserved Areas
With the increased number of patients seeking primary care under the Affordable Care Act and the existing shortage of community providers, there is a substantial gap in access to primary care in CT. Nurse practitioners (NPs) can help to bridge this gap. Quality clinical experiences are needed in medically underserved areas (MUAs) as graduates are more likely to seek employment following graduation in sites similar to where they trained. A clinical-academic partnership was developed toassure NP graduates will say “I CAN” provide high-value care for patients in MUAs upon graduation. The partnership provides preceptor training programs, increased support to preceptor-student dyads through faculty check-ins and site visits, development of an asynchronous online onboarding program, and expanded clinical experiences for students.
Developmental Screening, Surveillance, and Linkage to Services in Pediatric Practices; An analysis of Plan-Do-Study-Act Quality Improvement Methodology
Ongoing quality improvement of developmental screening during routine well child visits can ensure that children are connected to resources in a timely manner. The objective of this study is to determine whether a quality improvement activity using “Plan, Do, Study, Act” (PDSA) methodology improves the rates of developmental screening, surveillance, and connection to follow up services for children with developmental concerns. Statistical analysis of retrospective data from pediatric practices in Connecticut, California, Washington and Kentucky determined changes in screening, surveillance, and referral rates over the course of a 6-month quality improvement period. Qualitative analysis of the PDSA sheets identified obstacles to screening, including language barriers, administrative inefficiencies, and lack of documented billing for the developmental tests. The study analysis addresses important practice and policy level opportunities to improve early detection and intervention for children at risk of development delays within Connecticut’s system of services.
From the community to the clinic and back: How CHWs address social determinants of health by enhancing patient engagement
Introduction: Patient engagement in primary care has been a persistent challenge. Inattention to the social determinants of health (SDOH) is a cause and consequence of disengagement, especially among socially-disadvantaged patients. Multidisciplinary primary care teams employing community health workers (CHWs) represent an emerging, albeit incompletely understood paradigm with the potential to establish strong community linkages and better address patient needs. Methods: Semi-structured interviews with CHW-utilizing primary care practices were conducted, coded, transcribed, and thematically analyzed. Results: CHWs build deep connections with communities and establish longitudinal relationships with patients, giving them nuanced insights into patient care. Emotional investment allows CHWs to engage with patients more meaningfully compared to episodic clinical encounters. This engagement is critical in fostering patient trust and in ensuring patients remain connected to clinical and social services resources. Conclusion: CHW-inclusive approaches to care delivery can help practices better address SDOH by improving and sustaining patient engagement.
The Impact of Telemedicine on Experience of Care for Patients with Type I or II Diabetes Mellitus in the United States: A Scoping Review
Introduction: This study examines and maps evidence on the impact of telemedicine in relation to the patient experience of individuals with type I or II Diabetes Mellitus (DM), in the United States. Methods: We performed literature searches with PubMed and Current Nursing and Allied Health Literature. Searches included all peer-reviewed publications prior to April 15th, 2016. Quality of studies was not evaluated. Results: Searches resulted in 484 articles. After applying inclusion and exclusion criteria, 33 articles remained. Published articles addressed the following domains: patient education 93% (31/33); patient satisfaction 88% (29/33); healthcare access 54% (18/33); quality of life 18% (6/33). Seventy-two percent (21/29) of satisfaction studies and 33% (2/6) of quality of life studies documented statistically significant positive results. Conclusion: Although literature shows patient satisfaction with telemedicine, future summative studies should evaluate quality of individual studies as well as healthcare access and quality of life in relation to telemedicine.
Prevalence of Geriatric Depression Screening in a Primary Care Setting
15-20% of geriatric patients suffer from depression going as high as 37% after critical care hospitalization. Depression should be screened by primary care physicians (PCP) as per USPSTF’s recommendation. The prevalence of annual depression screening (PHQ2 or PHQ9) of geriatric patients from 7 primary care sites around Connecticut were recorded. Each patient’s demographics, past medical history, medications, substance abuse, and living conditions were recorded. 25% of the patients were not screened for depression, of which one did have a psychiatric history. 71% had multiple comorbidities. 46% had a history of psychiatric history. Patients living alone or at a nursing home were more likely to be depressed than patients living with family (57% vs 26%, p=0.073). Females more than males (36% vs 6%, p=0.025) and those living away from family were more likely to be depressed. PCPs should integrate an EMR alert methods to increase depression screening amongst elderly patients.
The Relationship Between Body Mass Index in Children and Insurance Type, Parental Eating Concern, Asthma, and Allergies
The objective of this study was to examine the relationship between body mass index (BMI) percentile and insurance type, parental eating concern, asthma status, and allergy status among children 2-5 years old. Multiple variables were evaluated from a data set of 870 de-identified health assessment records provided by the Child Health and Development Institute of Connecticut. A crosstab analysis was conducted for each variable, along with a Pearson Chi-Square test giving a 2-sided asymptotic significance p-value. Among children with BMIs in the overweight/obese category, we found significant differences between children insured by HUSKY Health (26%) compared to children with commercial insurance (15.9%) (n=489, p=0.007), children with asthma (22.1%) compared to children without asthma (14.8%) (n=850, p=0.041), and children with known allergies (7.8%) compared to children without known allergies (16.7%) (n=831, p=0.041). The difference between children with parental eating concerns (3.7%) compared to children without parental eating concerns (18.1%) was nearly significant (n=646,p=0.054).
Social Determinants and Barriers to Optimal Health Outcomes and Compliance in a Medically Underserved Population in Chennai, India
This study utilized a survey containing sociodemographic and Likert scale questions to assess some of the social determinants of health in hypertensive and/or diabetic adult patients at the Free Medical Centre in Chennai, India. 351 responses were collected from 396 eligible patients. 67.3% reported an education level of middle school or below. 62.1% were worried about their health, 53.5% admitted to knowingly making decisions injurious to their health, and 57.3% admitted that they forget to take their medications. Over 80% reported that they did not understand their diagnoses or the role of their medications. Stress was a common theme. 26.7% reported violence at home. This survey sheds light on social barriers to compliance and management of health among patients diagnosed with chronic conditions. There appears to be a large need for counseling and education to improve patient health literacy. Future studies may focus on the efficacy of such interventions.
Socioeconomics effects Prevalence of Multiple Sclerosis
The cause of multiple sclerosis (MS) is unknown. It is known that the majority of people who are diagnosed with MS are of northern European ancestry (Wade, 2014). This inspired Dr. Steve Simpson Jr. and his colleagues to conduct a meta-analysis of MS case studies to determine why people of northern European ancestry are diagnosed with MS the most. This research team derived a theory that latitude is significantly associated with the prevalence of MS (Simpson et al., 2011). The association between latitude and MS prevalence is a spurious relationship. Many highly developed countries are located on or near the 55° latitude line. Highly developed countries have advanced medical systems, contributing to more MS diagnoses. The purpose of my research project was to collect data to visually show how most MS cases are found within highly developed countries that are coincidentally concentrated on or near the 55° latitude line.