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Access to Healthcare Among Those Experiencing Homelessness: A Depression Screening Project

Description

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health.

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.

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Date Created
  • 2020-05-04

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Introduction of a Medical Patient Portal to the Uninsured Patient

Description

Purpose: The purpose of this evidence-based practice project was to improve participation by increasing registration on to a medical patient portal to an uninsured population. Medical patient portals have the

Purpose: The purpose of this evidence-based practice project was to improve participation by increasing registration on to a medical patient portal to an uninsured population. Medical patient portals have the potential to provide patients with timely, transparent access to health care information and engage them in their health care process and management. This may result in improved disease management outcomes.

Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.

Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).

Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.

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Created

Date Created
  • 2019-05-03

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Implementation of a Culturally-Tailored Diabetes Education Program in a Medically-Underserved Community Health Clinic

Description

Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their

Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their DM needs. Evidence suggests that using a culturally-tailored approach to DM education can uniquely improve health outcomes in this population. The purpose of this evidence-based practice (EBP) project was to improve glycemic control in a medically underserved Hispanic community through a culturally-tailored DM education program.

Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.

Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).

Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.

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Date Created
  • 2018-04-23