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Improving the Care Transition to Outpatient Aftercare Services Following Addiction Treatment

Description

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- u…

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.
ContributorsTenorio, Roxanne Carla R. (Author) / Moffett, Carol (Thesis advisor)
Created2018-04-29
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Improvement of Obesity Management in Primary Care: Self-Efficacy, Readiness for Change, and Provider Education

Description
Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight…

Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight and health. Primary care providers (PCP) have limited knowledge of current evidence in obesity treatment. The project guides the form of tools to help identify the patients' self-efficacy, change readiness, and insurance reimbursement. Methods: Expedited IRB approval was obtained, allowing for data analysis from completed de-identified screenings, surveys, and medical records gathered between September 2022 and April 2023. Screenings including Weight Efficacy, Lifestyle long-form (WEL-LF), and Stages Of Change Readiness And Treatment Eagerness Scale In Overweight And Obesity (SOCRATES-OO) were used to assess the effectiveness of the treatment plan. Russwurm and Larrabee's model for evidence-based practice change was chosen for the project's framework. The provider was given a guide for obesity management with tips for billing insurance. A convenience sample of eight patients met with the providers over three months as part of their obesity management treatment plan. Results: The pre and post-screenings collected from the remaining participants (n=8) showed no statistical differences. However, the satisfaction and feedback survey from patients (n=8), provider (n=1), and office staff (n=4) showed improved quality of care and greater confidence in the provider's part in initiating and managing their patient's chronic obesity. Conclusion: Improving PCPs' knowledge of Obesity treatment improves patient care. Expanding this project to a larger scale and disseminating the information can impact patients' lives positively. Keywords: Obesity; self-efficacy; readiness for change; stages of change; primary care, Weight Efficacy Lifestyle questionnaires
ContributorsBrock-Andersen, Marian (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
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Can You See Me? Primary Care Provider Education to Satisfy the Visually impaired

Description
Vision impairment has affected 2.2 billion people globally, with 12 million people affected in the United States; more than 700,000 Californians experience visual impairment or blindness (VI/B). Causes of VI/B can be prevented with early identification and intervention. This project aims to identify perspectives of the VI/B, use this insight…

Vision impairment has affected 2.2 billion people globally, with 12 million people affected in the United States; more than 700,000 Californians experience visual impairment or blindness (VI/B). Causes of VI/B can be prevented with early identification and intervention. This project aims to identify perspectives of the VI/B, use this insight to build and improve the knowledge/skills of the primary care provider (PCP). A quantitative study, utilizing the Theory of Interpersonal Relations alongside the Star Model of Knowledge Transformation, incorporated pre-intervention questionnaires for the VI/B and the intention of pre- and post-intervention questionnaire for the PCP. After consenting, the VI/B completed the Patient Satisfaction Questionnaire-18 (α = 0.87) and Visual Functioning Questionnaire-25 (α = 0.95) surveys via telephone. An interventional video discussing visual acuity and screening, legal blindness versus visually impaired, leading causes of blindness, common ophthalmic drops and their side effects, helpful hints, and resources for the visually impaired was created. Deidentified results were analyzed with descriptive analysis and Pearson correlation. Currently, 30 voluntary, consented VI/B members have completed the pre-surveys. The overall average patient satisfaction score was 46.73 with financial aspect and communication with the most positive evaluation. Unfortunately, their PCPs have not responded. The PCP questionnaire will be distributed to the ophthalmologist partner’s healthcare organization. The needs of VI/B community are poorly identified and addressed in primary care; thus, the educational video was created to address the perceived gaps. Improved provider knowledge and enhanced patient care can enhance patient satisfaction with the delivery of care.
ContributorsVillayuran, Diane R. (Author) / Moffett, Carol (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-29
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Advance Care Planning: How Do We Get to Completion?

Description
Advance care planning (ACP) is the act of deciding ones wishes at the end-of-life and making those wishes known. Healthcare providers rely on these wishes to provide end-of-life care. Despite the impact ACP has on quality of life at the end-of-life, most conversations remain undocumented. Even when ACP conversations take…

Advance care planning (ACP) is the act of deciding ones wishes at the end-of-life and making those wishes known. Healthcare providers rely on these wishes to provide end-of-life care. Despite the impact ACP has on quality of life at the end-of-life, most conversations remain undocumented. Even when ACP conversations take place, completion rates remain at an all-time low. This report explored the impact of appointment call reminders and patient portal messages on advance directive (AD) completion and documentation in the EHR. Following completion, a primary care practice experienced an increase in ACP conversation and ACP completion in the EHR. This report will discuss the methods utilized to improve ACP completion.
ContributorsDaily, Stephanie M. (Author) / Mangold, Kara (Thesis advisor)
Created2019-04-28