Evidence-Based Outcomes: Nurse Practitioner-Run Asthma/COPD Clinic for Indigent Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/150391
Type:
Presentation
Title:
Evidence-Based Outcomes: Nurse Practitioner-Run Asthma/COPD Clinic for Indigent Patients
Abstract:
Evidence-Based Outcomes: Nurse Practitioner-Run Asthma/COPD Clinic for Indigent Patients
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Goolsby, Mary
P.I. Institution Name:University Health Care System
Objective: The Asthma/COPD clinic was designed to provide ongoing health care to medically indigent persons diagnosed with asthma and/or COPD. The objectives of the clinic included improving the health status and quality of life of enrolled patients by providing consistent, individualized, and evidence-based care. After an extensive review of the literature, clinic practices were designed to reflect current research regarding care of asthma and COPD. For instance, the majority of patients are diagnosed with asthma and their care is largely informed by the NHLBI Expert Panel’s Guidelines for Diagnosis and Management of Asthma, supplemented by updates of the literature review and provider clinical judgment. The overall objective of this ongoing outcome study is to identify the outcomes of care provided by a nurse practitioner to patients enrolled in an evidence-based Asthma/COPD Clinic. Design: Baseline and outcome data is collected on patients enrolled in the Asthma/COPD Clinic during their initial visit and at three and six months following enrollment. During the first visit, an initial plan is determined and implemented, typically including educational, diagnostic, and therapeutic components. Prescriptions and necessary equipment is funded by indigent health grants, pharmaceutical company programs, and samples. Patients are scheduled for follow-up at what ever interval is appropriate and follow-up intervals vary from a few days to a few weeks. Care is adjusted at follow-up plans, based on the patients’ responses to the initial or subsequent strategy. Sample: The sample involved in this ongoing outcomes study include all patients who are enrolled in the Asthma/COPD clinic and who are able and consent to participate in the extensive data collection procedures. The patients who have been rarely excluded from the study include only persons who have been deemed to be emotionally or cognitively inappropriate for informed consent decisions or completion of the varied outcome instruments described below. Physiologic outcome is collected on all patients enrolled in the clinic. To date, over 80 patients are enrolled in the outcome measurement. Setting: The setting of the outcome study is the aforementioned indigent patient Asthma/COPD Clinic, which is supported by and based in a health care system in Eastern Georgia. The clinic is housed in the clinic area of a 612-bed regional hospital. The Asthma/COPD clinic functions independent of other clinics, yet is located in the general medicine clinic. Names of Variables or Concepts: The independent variable for this outcome study is the health care provided and/or coordinated by the clinic’s nurse practitioner. The outcome measures include quality of life, emotional status, functionality, use of medications, pulmonary function, and cost associated with unplanned utilization of emergency care. Measures/Instruments: At baseline, 3, and 6 months, data is collected using a form which is a compilation of several instruments. It includes researcher designed portions to elicit standard information on use of medications, self-monitoring history, recent ER visits or hospitalizations, and tobacco use. The status of the patients’ asthma and/or COPD are classified. The form also includes standardized instruments including a Quality of Life Visual Analog Scale (QOL), the Modified Dyspnea Index (MDI), Center for Epidemiology Depression Scale (CEDS), and the SF-36 Health Survey (SF-36 SF). Finally, physiologic measures are recorded including pulse oximetry, PEF, FEV1, and breath sounds before and after a six-minute walk. Findings: The majority of the patients have consistently kept scheduled appointments and demonstrated improvement in all measures, although some improvement has not been at a level of statistical significance. Those measures which have shown a statistically significant improvement are: QOL, MDI, CEDS, COPD classification, self-monitoring with peak flow meter, and use of the ER for unplanned, respiratory-related problems. Conclusions: The outcomes measured through this project identify a positive response to nurse practitioner-provided evidence-based care. The findings have been useful, on an individual basis, to determine subsequent needs of specific patients. On an aggregate basis, the findings have helped to justify the clinic to the hospital’s administrators, other care providers, and potential funding agencies. The clinic has been successful in obtaining a $30,000 grant from Merck to help with costs associated with managing patients with asthma and solicits funds to cover the costs of providing patient with certain equipment such as nebulizers and enrollment in pulmonary rehab and smoking cessation classes. Implications: The findings demonstrate the successful implementation of an evidence-based clinic for medically indigent patients and its cost-effectiveness in reducing use of more costly ER and inpatient care by the population served. They support the importance of including content on evidence-based practice in nursing curricula and the need for further outcome studies.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEvidence-Based Outcomes: Nurse Practitioner-Run Asthma/COPD Clinic for Indigent Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150391-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Evidence-Based Outcomes: Nurse Practitioner-Run Asthma/COPD Clinic for Indigent Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Goolsby, Mary</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University Health Care System</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">moolsby@uh.org</td></tr><tr><td colspan="2" class="item-abstract">Objective: The Asthma/COPD clinic was designed to provide ongoing health care to medically indigent persons diagnosed with asthma and/or COPD. The objectives of the clinic included improving the health status and quality of life of enrolled patients by providing consistent, individualized, and evidence-based care. After an extensive review of the literature, clinic practices were designed to reflect current research regarding care of asthma and COPD. For instance, the majority of patients are diagnosed with asthma and their care is largely informed by the NHLBI Expert Panel&rsquo;s Guidelines for Diagnosis and Management of Asthma, supplemented by updates of the literature review and provider clinical judgment. The overall objective of this ongoing outcome study is to identify the outcomes of care provided by a nurse practitioner to patients enrolled in an evidence-based Asthma/COPD Clinic. Design: Baseline and outcome data is collected on patients enrolled in the Asthma/COPD Clinic during their initial visit and at three and six months following enrollment. During the first visit, an initial plan is determined and implemented, typically including educational, diagnostic, and therapeutic components. Prescriptions and necessary equipment is funded by indigent health grants, pharmaceutical company programs, and samples. Patients are scheduled for follow-up at what ever interval is appropriate and follow-up intervals vary from a few days to a few weeks. Care is adjusted at follow-up plans, based on the patients&rsquo; responses to the initial or subsequent strategy. Sample: The sample involved in this ongoing outcomes study include all patients who are enrolled in the Asthma/COPD clinic and who are able and consent to participate in the extensive data collection procedures. The patients who have been rarely excluded from the study include only persons who have been deemed to be emotionally or cognitively inappropriate for informed consent decisions or completion of the varied outcome instruments described below. Physiologic outcome is collected on all patients enrolled in the clinic. To date, over 80 patients are enrolled in the outcome measurement. Setting: The setting of the outcome study is the aforementioned indigent patient Asthma/COPD Clinic, which is supported by and based in a health care system in Eastern Georgia. The clinic is housed in the clinic area of a 612-bed regional hospital. The Asthma/COPD clinic functions independent of other clinics, yet is located in the general medicine clinic. Names of Variables or Concepts: The independent variable for this outcome study is the health care provided and/or coordinated by the clinic&rsquo;s nurse practitioner. The outcome measures include quality of life, emotional status, functionality, use of medications, pulmonary function, and cost associated with unplanned utilization of emergency care. Measures/Instruments: At baseline, 3, and 6 months, data is collected using a form which is a compilation of several instruments. It includes researcher designed portions to elicit standard information on use of medications, self-monitoring history, recent ER visits or hospitalizations, and tobacco use. The status of the patients&rsquo; asthma and/or COPD are classified. The form also includes standardized instruments including a Quality of Life Visual Analog Scale (QOL), the Modified Dyspnea Index (MDI), Center for Epidemiology Depression Scale (CEDS), and the SF-36 Health Survey (SF-36 SF). Finally, physiologic measures are recorded including pulse oximetry, PEF, FEV1, and breath sounds before and after a six-minute walk. Findings: The majority of the patients have consistently kept scheduled appointments and demonstrated improvement in all measures, although some improvement has not been at a level of statistical significance. Those measures which have shown a statistically significant improvement are: QOL, MDI, CEDS, COPD classification, self-monitoring with peak flow meter, and use of the ER for unplanned, respiratory-related problems. Conclusions: The outcomes measured through this project identify a positive response to nurse practitioner-provided evidence-based care. The findings have been useful, on an individual basis, to determine subsequent needs of specific patients. On an aggregate basis, the findings have helped to justify the clinic to the hospital&rsquo;s administrators, other care providers, and potential funding agencies. The clinic has been successful in obtaining a $30,000 grant from Merck to help with costs associated with managing patients with asthma and solicits funds to cover the costs of providing patient with certain equipment such as nebulizers and enrollment in pulmonary rehab and smoking cessation classes. Implications: The findings demonstrate the successful implementation of an evidence-based clinic for medically indigent patients and its cost-effectiveness in reducing use of more costly ER and inpatient care by the population served. They support the importance of including content on evidence-based practice in nursing curricula and the need for further outcome studies.</td></tr></table>en_GB
dc.date.available2011-10-26T10:23:22Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:23:22Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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