Since the start of the COVID 19 pandemic there has undoubtedly been an increase in social distancing orders, isolation, and overall general stress. The current outbreak has been proven to have a heavy impact on issues involving mental health. Social distancing mandates contributed to isolation, which in turn caused a surge in psychiatric disorders, either newly onset or exacerbating preexisting conditions (Torales, et al, 2020). Due to significant alterations in daily life, an increase in physical inactivity has already been proven to lead to deterioration of cardiovascular health (Pecanha et al, 2020). Stay at home orders have prevented otherwise healthy people from keeping up their daily exercise and eating habits, contributing to a heightened amount of mental health and hypertensive related issues.<br/>In addition to these health concerns, the pandemic has put stress upon pharmaceutical management practices. Drug utilization surges have led to an impact on patient care and management which requires careful measures to be taken to reduce the inflow of sick patients (Badreldin and Atallah, 2020). A global drug shortage has been a result of these drug utilizations. Understanding the alterations in the usage of specific medications such as prescription psychotropics, antihypertensive drugs, and antidiabetic agents can aid in population management and drug shortages.
Implementation of a Suicidal Ideation Treatment Algorithm in a Military Medicine Primary Care Clinic
Advanced Practice Registered Nurse Led Transitional Care Program in an Accountable Care Organization
Background: Hospital readmissions place a heavy financial burden on patients, families, and health care systems. Readmissions can be reduced or prevented by providing a safe transition through care coordination and enhanced communication. Research demonstrates implementation of APRN led home visits (HV) along with telephonic follow-up are cost effective and can be utilized for reducing readmissions among HF patients.
Methods: A program was designed with an ACO and carried out in a family practice clinic with a group of seven HF patients older than 50 years who were at risk of readmission. Interventions included weekly HV with supplemental telephonic calls by the APRN student along with a physician assistant for 12 weeks. Readmission data was collected. QOL and SCB were measured using “Minnesota Living with Heart Failure Questionnaire” (MLHFQ) and “European Heart Failure Self-Care Behavior Scale” respectively. Data was analyzed using descriptive statistics and the Friedman Test.
Outcomes: There were no hospital readmissions at 30 days and the interventions demonstrated a positive effect on QOL, self-care management and satisfaction (χ2 = 30.35, p=.000). The intervention had a large effect on the outcome variables resulting in an increase in QOL and SCB scores post-intervention (ES= -1.4 and -2 respectively).
Conclusions: TCP designed with an ACO, carried out in a primary care setting has a positive effect on reducing hospital readmissions and improving QOL, SCBs, and patient satisfaction among HF patients. TCPs are not revenue generating at outset due to reimbursement issues, however future considerations of a multidisciplinary team approach with convenient workflow may be explored for long-term feasibility and sustainability.
Funding Source: American Association of Colleges of Nursing and the Centers for Disease Control and Prevention with support of the Academic Partners to Improve Health.
Purpose: This evidence-based practice (EBP) project was a gap analysis that surveyed 156 caregivers at an urban PACE program in the Midwest to examine caregiver demographics, caregiver burden, caregiver interest in support services, and the relationship between these variables to guide the development of caregiver programs.
Methods: Caregiver Assessments were administered to 156 caregivers via telephone or in person. The assessment included caregiver demographics, interest in caregiver services, and the 12-item Zarit Burden Interview (ZBI-12) to assess caregiver burden. The ZBI-12 has good reliability and validity as indicated by a Cronbach’s alpha of 0.88 and a correlation with the full version ZBI scores of 0.95. Results were analyzed using descriptive statistics, the Pearson r correlation test, the Wilcoxon signed rank test, and the Mann-Whitney U test on SPSS version 25. This project was approved by the Arizona State University IRB.
Results/Outcomes: Of 171 eligible informal caregivers of program participants living outside of an institution, 156 completed the survey, 3 refused, and 12 were unreachable. Most informal caregivers surveyed were Caucasian (69.5%) females (66%), children of the care recipients (45.5%), caring for people with dementia (40.6%), with some college education (37.2%), who earned $10,000-$25,000 annually (38.7%), provided over 30 hours of care per week (55.8%), and averaged 61.4 years old (SD=7.7). The average ZBI-12 score was 12.15 (SD=9.04), indicating a moderate level of burden. The most common stressors indicated by caregivers were activities of daily living (ADL) assistance (63.5%) and the time commitment involved in caregiving (57.7%). Correlates to high burden score included: limited time, aggressive behavior, financial stress, grief, assistance with ADLs, wandering behavior, toileting assistance/incontinence, and lack of sleep. Respite care was identified by 42.9% of those surveyed as the most helpful resource provided by PACE. 55.1% and 50.6% of caregivers indicated an interest in educational sessions and support groups respectively, if these services were offered in the future.
Conclusion: Through the exploration of caregiver demographics, factors correlated to increased burden, and caregiver interest in support services, the results from this EBP project provide guidance to programs, particularly other PACE programs, seeking to proactively mitigate caregiver burden through support services. The results indicate that respite care, educational sessions, and support groups should be prioritized when developing informal caregiver support services.