Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.
Suicide has become a national concern due to the increasing rates across the country. The 2012 National Strategy for Suicide Prevention aims to improve the area of clinical prevention. Emergency departments (ED) play a key role in addressing this effort as they have multiple opportunities to connect with patients who are at risk. There exists a high-risk period of time immediately following a patient’s discharge from emergency care. To address this period of concern, a review of the literature was conducted on the effectiveness of follow-up contacts as a means to prevent suicide and suicide related attempts in this at-risk population.
Based on this review, a follow-up intervention was proposed to increase patients’ social support and knowledge on suicide prevention through a safety plan and the use of caring postcards. The aim was to evaluate the degree to which implementation of a safety plan and follow-up using postcards reduces suicide risk in the ED. ED suicide prevention practices such as safety planning and caring contacts with postcards have shown to be feasible and cost-effective methods to reduce patients’ risk of suicide as they provide education and address the high-risk period of time after discharge.
Using a quasi-experimental pre and post-test design, English speaking adults 18 years of age and older, admitted to an ED in the Phoenix Metropolitan area with suicidal ideation, were voluntarily recruited for two weeks. The self-rated Suicidal Behaviors Questionnaire-Revised (SBQ-R) was used as a baseline assessment along with the introduction of a safety plan. Participants were then followed with the receipt of postcards with caring messages over a two-week period, and a final SBQ-R. The SBQ-R has shown beneficial reliability and validity measuring suicidality in the adult population. Data from the pre-SBQ-R was analyzed using descriptive statistics as no post-SBQ-Rs were received. Outcomes for this project included a reduction in suicidal ideation and suicide risk.
This project provides insight into the implementation of a safety plan and follow-up intervention in the ED and their attempts to reduce acute suicide risk as well as highlight the value that post-ED support provides.
Keywords: suicide, prevention, safety plan, caring messages, postcards, emergency department, follow-up, contacts, brief intervention
Randomized controlled trials and systematic reviews of paired education involving both diet and activity recommendations have shown significant reductions in the advancement of adult (age 18 to 80) prediabetes to type 2 diabetes mellitus (T2DM). Paired education on diet and activity has been effective for persons from diverse races, ethnicities, and levels of education. For this project, the paired education focused on the dietary guidance of the Whole 30 plan and the current exercise/activity recommendations of the American Diabetes Association (ADA). The ADA recommends 30 min 5 x week or 60 min 3 x week of exercise, with no more than 48 hours between exercise occurrences.
Ten adults with HbA1C between 5.7%-6.4%, levels specified by the ADA as prediabetes, were invited to participate in the project at an outpatient wellness practice. Participants took a pretest on basic food and activity knowledge, received educational sessions on the Whole 30™ plan and activity recommendations from the ADA, then completed a posttest. Participants were scheduled for one month follow ups. At the 3 month follow up appointment, repeat HbA1C was drawn. Most of the patients (7/10) completed return appointments at the 3-month time frame. Statistically significant results were seen in diet and exercise knowledge using a paired T-test. Clinically significant reductions were seen in HbA1C averages as well as weight, BMI, and glucose levels.
Introduction and Background: Drowning is the leading cause of preventable injury death in Arizona for children under five years old. Tailored education has demonstrated efficacy in behavior change and knowledge retention. The purpose of this evidence-based project was to evaluate if tailored education improved knowledge and self-reported behaviors related to pediatric drowning. The Elaboration Likelihood Model provided the framework for this project.
Methods/Experimental Approach: The prospective pilot project was conducted using the Iowa Model of Evidence Based Practice. Parents with children under five years, presenting with low acuity complaints in a pediatric emergency department were approached. A baseline assessment identified high-risk behaviors and a custom education plan was delivered to parents. Outcome variables were measured at baseline and three weeks after initial assessment.
Results: The average parent age was 29 (M = 28.5; SD = 6.35) years. Participant (n=29) responses were analyzed using descriptive statistics. Participants (n = 27, 93%) reported likelihood to change behaviors and 29 (100%) perceived the tailored intervention as relevant. Secondary outcome variables were not measured at three weeks due to a lack of survey response.
Conclusions: Parents reported a high likelihood of behavior change when water safety education was tailored and relevant to their child. The tailored intervention evoked positive interaction and receptivity from parents and suggested a high motivation to make a behavior change. The effect of the intervention could not be tested due to the lack of follow-up and post data collection. The design of this evidence-based project is quantifiable and replicable in a low-acuity setting, which allows for future evaluations of self-reported behavior change and knowledge improvement.
Funding: No sponsorship or financial conflict of interest.