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As of May 2022, there have been more than 80 million confirmed cases of COVID-19 across the United States, and over two million cases in Arizona. The pandemic has had a devastating impact on local, national, and global economies. This brief features the findings from data collected from a survey administered to Arizona residents in April of 2021, as well as national statistics, to understand some of the economic consequences of COVID-19 and its impacts on Arizona households.
Implementation of a Suicidal Ideation Treatment Algorithm in a Military Medicine Primary Care Clinic
Meatless Monday is an initiative that encourages actionable steps toward the reduction of meat consumption by asking participants to eat meat-free on Mondays. Many organizations, cities, schools, and correctional facilities have implemented Meatless Monday initiatives as a push to improve environmental sustainability, human health, and the welfare of animals. Such initiatives provide an opportunity to educate consumers on the health benefits of a plant-forward diet, the environmental impact of meat production, animal welfare issues, the innovation of non-meat proteins, and to engage stakeholders in gaining more control over their food choices. This report offers a summary of seven Meatless Monday initiatives throughout the U.S., highlighting best practices and notable challenges of implementing and maintaining such an initiative in three different contexts: local government, school systems, and non-profit or volunteer-led organizations. This report was conducted through an extensive look at previous research, news articles, and marketing materials, as well as interviews with stakeholders in six mid-sized U.S. cities.
The goal of this report is to present an overview of the federal workforce and the opportunities that exist for younger generations to be employed by the federal government. We explored what is preventing younger generations from seeking and securing federal employment and shed light on the benefits, value, and opportunities of federal jobs for the younger generation. The report provides a better understanding of how and what policies, for better or worse, influence federal recruitment and hiring processes. We examined the 20-year history and evolution of the federal job portal, USAJOBS, to understand what information is critical to provide an applicant to successfully complete and submit an application for a federal job. We also reviewed the role of the U.S. Office of Personnel Management (OPM), and its responsibility to provide agencies guidance and support in implementing government orders and policies. With research, data, and interview insights, we developed a tangible guide for young job seekers to use to navigate USAJOBS. This guide provides applicable tips gathered from experiences of first-hand users and federal human resources specialists to help prospective applicants decipher federal job announcements and to strategically and completely prepare their applications and resumes to secure federal employment.
Based on these findings, we encourage younger generations, including students and recent graduates, to seek federal jobs not only because ofthe numerous employment benefits, but because of the value and impact younger generations will have in being a federal employee.
Background and Significance: CRC is the second leading cause of cancer-related deaths in the United States among men and women. Current CRC screening rates remain low, even with advanced screening options available. Meaningful Use sets specific objectives for health care providers to achieve. Documenting CRC screening status and recommending CRC screenings to patients is one of the objectives of Meaningful Use and is considered a Clinical Quality Measure (HealthIT.gov). Factors that lead to CRC screening include primary care providers (PCPs) raising the topic, involving support staff, involving patients in the decision-making process, and setting alerts in electronic health records (EHRs).
Methods: The Health Belief Model and Ottawa Model of Research Use helped guide this project. The project took place at a private primary care practice. The focus was on patients between the ages of 50 and 75 years old meeting criteria for CRC. Five PCPS and five medical assistants (MAs) chose to participate in the study. Participants were given pre and post Practice Culture Assessment (PCA) surveys to measure perceptions of the practice culture. The project included a three-part practice change: PCP and MA education about CRC screening guidelines, EHR documentation and reminders, and a change of patient visit workflow which included having MAs review patient's CRC screening status before they were seen by the PCP and handing out CRC screening brochures when appropriate. PCPs then ordered the appropriate CRC screening, and the MA documented the screening in the EHR under a designated location. CRC Screening Project Evaluation Forms were completed by MAs after each patient visit.
Outcomes: No significant difference from pre to post survey satisfaction scores were found (t (8) = - 1.542, p= = .162). Means of quantitative data were reported from the CRC screening evaluation forms; N=91. The most common method of screening chosen was colonoscopy, 87%. A strong correlation was found (r (-.293) = .01, p<.05) between receiving a CRC brochure and choosing a form of screening. Meaningful Use scores pre and post project are pending.
Conclusion: Patients are more likely to choose a screening method when the topic is raised in a primary care setting. Continued staff education on workflow is important to sustain this change. Further research is needed to evaluate cost effectiveness and sustainability of this practice change.
Background: Asthma is a chronic illness that impacts 10.9% of the pediatric population in Arizona. Poor asthma understanding and management leads to high-utilization of emergency rooms and urgent care clinics, negatively impacting the healthcare economy. Poor asthma management also leads to decreased health outcomes and impacts on the child’s academic functioning, mental health, and overall quality of life. Current evidence supports use of written asthma action plans (WAAP) and inhaler/spacer instruction to improve asthma management.
Methods: The intervention was an evidence-based educational session provided to the staff of a military, pediatric primary care clinic in southwest Arizona regarding the use of WAAP, the Asthma Control Test (ACT) and integrated inhaler/spacer instruction. Chart reviews were conducted to evaluate the documentation of use of WAAP, ACT, and inhaler/spacer education.
Results: Charts were collected from pre-intervention (n = 33) and post-intervention (n = 18). Data analysis demonstrated a statistically significant higher use of WAAP (U = 0.008, p < 0.05, d = 0.83). Although there was not a statistically significant change in use of ACT tool, Cohen’s value (d = 0.48) suggested a moderate positive effect. A Pearson correlation coefficient was also calculated for the relationship between use of ACT tool and use of WAAP, demonstrating a moderate positive correlation (r (49) = .372, p < .01).
Conclusions: An evidence-based education session for pediatric staff members is a cost-effective and simple method of improving pediatric asthma management practices.
Background and Purpose:
Depression in older adults is a significant problem that often goes undetected and untreated in primary care. The U.S. Preventive Services Task Force recommends screening adults for depression in primary care to increase detection, so it can be adequately managed. Despite this recommendation, screening rates in primary care are low. The purpose of this project was to implement a screening intervention and examine the effect of screening on the treatment of depression in older adults.
Methods:
The screening intervention was implemented as an evidence-based project in a small primary care practice. Consenting adults ≥ 65 years of age were screened with the Patient Health Questionnaire-9 (PHQ-9). Research indicates the PHQ-9 is valid and reliable for older adults. A post-screening chart audit was conducted to collect data and analyze the outcome of screening related to treatment.
Conclusions:
A total of 38 participants were screened. Five (13.2%) participants had a positive screening, two received treatment during the follow up period. The number of participants who were treated after a positive screening was significant (p= .040).
Implications for Practice:
Screening can increase detection and treatment of depression and reduce the associated illness burden in the older adult population.
The chronic nature of substance use disorder requires continuity of care after residential treatment. Only a small proportion of patients, however, adhere to aftercare follow-up plans and the relapse rates remain between 40- 80% within a year post-discharge. Synthesis of evidence showed that facilitated referral (FR) significantly increased follow- up adherence and resulted to positive outcomes. The study aimed to examine the effectiveness of FR in improving access, follow-up adherence and engagement to aftercare services, and relapse rate after a month post- discharge.
After the Institutional Review Board approval, 30 participants were recruited in two residential treatment facilities. Questionnaires, the Assessment of Warning Signs of Relapse and Health leads surveys were utilized to collect data. Data were analyzed using descriptive statistics, McNemar, and Wilcoxon signed rank tests. Results showed that FR significantly increased access to many community aftercare services (p<.05). A significant reduction in relapse risk post-intervention was also noted (Z= -3.180, p= .001). Additionally, most participants discharged with scheduled appointments followed-up and had continued engagement with aftercare services. Eight participants maintained sobriety and 18 were lost to follow-up a month post-discharge, while four relapsed in the facility.
Overall, FR increased access to needed aftercare services and significantly decreased the relapse percentage risk post-discharge. FR is a promising intervention that can be implemented for practice. Future research is recommended to further examine the correlation with follow-up adherence and continuous engagement to aftercare services, and relapse rate at 30 days after discharge.
Methods: Primary care providers have an opportunity to screen for sleep disorders as part of the intake process during an office visit. The Functional Outcomes of Sleep Questionnaire (FOSQ), has been proposed as guide to determine if a sleep disorder is affecting quality of life. This descriptive study randomly recruited 20 participants from a community health center. A 10-question survey was given to individuals over the age of 18 who can write and speak English and either have a body mass index (BMI) over 30, hypertension (HTN) or diabetes type II (DMII). Demographic information evaluated included age, gender, HTN, DMII, BMI>30, marital status, sleeping alone, employment type, race, type of insurance, how many times do they wake up at night, the average number of hours slept per night and does the person work night shift.
Results: The study used a qualitative approach with a descriptive methodology; statistical analysis consisted of proportions, means and standard deviation to describe the study population. Participant age ranged from 33 to 72 years (M=50.1, SD= 11.32). Sixty percent were both female and married/living with partner. Despite being married/living with partner, 50% slept alone. A Mann-Whitney U test showed that there was a significant difference in four of the questions in the FOSQ-10 in which functional outcomes were not affected by being sleepy or tired.
Conclusion: The FOSQ-10 may serve a role in identifying patients who might benefit from a sleep study. The inclusion of a sleep disorder screening tool may increase the specificity and sensitivity of the intervention and the ability to yield data that will objectively measure disordered sleep.