Abstract WP450: Stroke Support Group Partnership With Community Wellness Program Provides Education and Interventions Improving Self-Care Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nancy M Stoll ◽  
Keyword(s):  
Blood Pressure ◽  
Social Services ◽  
Support Group ◽  
Social Worker ◽  
Well Being ◽  
Blood Chemistry ◽  
Primary Care Providers ◽  
Lifestyle Behaviors ◽  
Care Providers ◽  
Wellness Program

Background and Purpose: The purpose of this program is to offer education and support with attention to post acute transitions. The multidisciplinary team: social worker, dietician, and registered nurse encourage the development of attainable behaviors and activities. Methods: The participants, (311), enrolled in the free three month program of 12 sessions. Upon enrollment blood chemistry, weight, Body Mass Index, and blood pressure are measured and recorded. Subsequent visits include weight and blood pressure measurements. The program is designed to promote a one to one relationship to foster lifestyle behaviors. These consults assist with goal identification and promote self-management. Nutritional education includes healthy eating guidelines. The social worker leads sessions on navigation of social services, financial wellness, accepting change, awareness of emotions, and stress triggers. Stroke prevention, personal risk factors, living with disabilities, importance of care coordination and transition of care are discussed with emphasis on following up with primary care providers and specialists. Results: Participants share results such as increase in physical activity, and feelings of well-being. In 2017 and 2018, outcomes include: 266 of the participants (86% of 311 totals) began the program with a BMI > 25. 145 participants lost a total of 792 pounds with small changes in diet and exercise. 134 participants began the program with a BP > 140/90 mmHg or a diagnosis of hypertension. Of these, 118 or 88% achieved a BP reading of ≤ 140/90 mmHg by their post program evaluation. In the first year of the program, 73 participants (46% of 158) began exercising regularly for the first time. In addition, class evaluations and narratives reveal positive lifestyle and behavioral changes for participants and their families Conclusions: In conclusion, partnering a stroke support group with a wellness program provides an effective collaboration pooling resources and knowledge supporting the patient and caregiver.

Abstract TP206: The Influence of Contextual Factors on Gaps in Hypertension Management for Veterans with TIA/Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Edward J Miech ◽  
Teresa M Damush ◽  
Ava B Keating ◽  
Gregory W Arling ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Contextual Factors ◽  
Primary Care Providers ◽  
Minor Stroke ◽  
Medical Attention ◽  
Hypertension Management ◽  
Cerebrovascular Event ◽  
Care Providers ◽  
Provider Perspectives

Introduction: Many patients with TIA/minor stroke do not achieve goal blood pressure their cerebrovascular event, thereby remaining at high risk for future events. Understanding the influence of contextual factors associated with post-event hypertension management may inform future intervention studies. Methods: As part of a national, observational study of TIA/minor stroke care across the Veterans Health Administration (VHA), in-person site visits were conducted at participating VHA medical centers in 2014-15. Semi-structured interviews were used to elicit provider perspectives about local practices related to the care of TIA/minor stroke patients. Study team members systematically applied codes transcribed files using qualitative, categorical, and quantitative descriptive codebooks. Investigators used Thematic Content Analysis and mixed-methods matrix displays to analyze coded data, generate, and then validate findings. Results: Seventy interviews were obtained from staff at 14 sites. Several contextual factors appeared to influence post-event hypertension care delivery for patients after a TIA/minor stroke. Neurologists reported that they perceived no direct responsibility for managing post-event blood pressure and were uncertain whether recommendations regarding blood pressure management were being implemented in primary care. Primary care providers expressed hesitancy about titrating antihypertensive medications post-event, citing concerns about permissive hypertension. Providers also reported that poor blood pressure control was not as salient to patients as symptoms, leading some patients to not adhere to their antihypertensives or not feel a sense of urgency in seeking prompt medical attention. VHA facilities did not have protocols to guide providers in the treatment of post-TIA/minor stroke hypertension, with centers expressing little compulsion to develop them. Conclusions: Multiple contextual factors at the provider- and system-levels were identified as barriers to achieving post-cerebrovascular event hypertension control; these data have informed the design of a recently funded vascular risk factor intervention.

Introduction

2017 ◽  
Author(s):  
David Bolton
Keyword(s):  
Mental Health ◽  
Northern Ireland ◽  
Social Services ◽  
Social Worker ◽  
Well Being ◽  
Conflict Processes ◽  
Post Conflict ◽  
Personal Experiences ◽  
The Impact ◽  
Health And Well Being

In the Introduction, the author describes the background to the book and his personal experiences of violence in Northern Ireland - as a social worker and health and social services manager in Enniskillen and Omagh. He addresses the impact of loss and trauma linked to conflict and the implications for mental health and well-being. The structure of the book is outlined and the author sets the rest of the book in the argument that the mental health of conflict affected communities should be an early and key consideration in peace talks, politics and post-conflict processes.

scholarly journals Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Gina Agarwal ◽  
Magali Girard ◽  
Ricardo Angeles ◽  
Melissa Pirrie ◽  
Marie-Thérèse Lussier ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Social Housing ◽  
Cardiovascular Health ◽  
Primary Care Providers ◽  
Care Providers ◽  
Health Awareness ◽  
Awareness Program ◽  
Ed Visits ◽  
Cluster Randomized

Abstract Background The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors’ housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. Methods/design This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50–200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. Discussion It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. Trial registration ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.

Crohn's Disease — More Than a Chronic Illness

1985 ◽  
Vol 33 (12) ◽  
pp. 604-609
Author(s):  
Roberta Messner ◽  
Sylvia Gardner ◽  
Susan Lewis
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Interpersonal Relationships ◽  
Well Being ◽  
Primary Care Providers ◽  
Chronic Inflammatory Bowel Disease ◽  
Care Providers ◽  
Care Needs ◽  
Positive Effects ◽  
Optimal Health

Crohn's disease is a chronic, inflammatory bowel disease which may occur in single or multiple areas of the entire GI tract from the mouth to the anus. This multifaceted disorder is manifested by various unpredictable health disturbances, affecting its victims' physical and psychosocial well-being. Individuals with Crohn's disease present a multitude of nursing challenges as they often lack the positive effects of proper nutrition, physical activity, emotional expression, interpersonal relationships, and family life. Nurses are the primary care providers who can comprehensively address the varied and complex health care needs of individuals with Crohn's disease. The core theme is the belief that it is essential for these individuals to maintain a sense of control in the midst of an altered lifestyle. Occupational health nurses can assist employees with Crohn's disease to develop a variety of physical and psychosocial strategies to cope with the unpleasant, even repugnant, aspects of a disease for which there is no known cure. The promotion of optimal health, based on the nursing process, is the objective toward which the unique efforts of nursing are directed.

Satisfaction and Well-Being of Primary Care Providers in Managed Care

2002 ◽  
Vol 25 (2) ◽  
pp. 239-254 ◽  
Author(s):  
Donald K. Freeborn ◽  
Roderick S. Hooker ◽  
Clyde R. Pope
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Well Being ◽  
Primary Care Providers ◽  
Care Providers

Lessons Learned from Designing and Leading Multidisciplinary Diabetes Educational Groups

2014 ◽  
Vol 36 (2) ◽  
pp. 160-172 ◽  
Author(s):  
Bethany Glueck ◽  
Brett Foreman
Keyword(s):  
Diabetes Care ◽  
Well Being ◽  
Primary Care Providers ◽  
Health Condition ◽  
Lessons Learned ◽  
Care Providers ◽  
Care Models ◽  
Educational Groups ◽  
Education Support ◽  
Licensed Professional Counselor

Diabetes is a serious health condition that significantly impacts physical and emotional well-being. Working with primary care providers, clinical mental health counselors have an opportunity to contribute to its efficacious treatments. Researchers and clinicians have suggested a multidisciplinary approach to diabetes care may be useful. To increase knowledge and awareness about the use of collaborative care models for diabetes care, the authors—a licensed professional counselor and a family physician—share lessons learned from their experiences designing and cofacilitating a series of multidisciplinary-led diabetes groups in 2007, 2008, and 2009. The series covered education, support, and self-management techniques related to diabetes care. All 57 participants were asked to complete a program evaluation survey. All 29 participants who did so (100%) reported having a better understanding of diabetes, and 21 (71%) reported applying what they had learned (e.g., increasing exercise and making better nutritional choices). Implications for counselors in practice and research are discussed.

scholarly journals Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers (Preprint)

2018 ◽  
Author(s):  
Sarah Rodriguez ◽  
Kevin Hwang ◽  
Jing Wang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Focus Group ◽  
Care Setting ◽  
Primary Care Setting ◽  
Visual Display ◽  
Primary Care Providers ◽  
Critical Value ◽  
Care Providers ◽  
Home Based

BACKGROUND There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. OBJECTIVE The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. METHODS A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. RESULTS The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. CONCLUSIONS The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes.

scholarly journals Monitoring Older Adult Blood Pressure Trends at Home as a Proxy for Brain Health

2021 ◽  
Vol 13 (3) ◽  
Author(s):  
Nicole Cassarino ◽  
Blake Bergstrom ◽  
Christine Johannes ◽  
Lisa Gualtieri
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Design Thinking ◽  
Digital Health ◽  
Primary Care Providers ◽  
The United States ◽  
Warning Signs ◽  
Care Providers ◽  
Brain Health ◽  
At Home

Even when older adults monitor hypertension at home, it is difficult to understand trends and share them with their providers. MyHealthNetwork is a dashboard designed for patients and providers to monitor blood pressure readings to detect hypertension and ultimately warning signs of changes in brain health. A multidisciplinary group in a Digital Health course at Tufts University School of Medicine used Design Thinking to formulate a digital solution to promote brain health among older adults in the United States (US). Older adults (aged 65 and over) are a growing population in the US, with many having one or more chronic health conditions including hypertension. Nearly half of all American adults ages 50-64 worry about memory loss as they age and almost all (90%) wish to maintain independence and age in their homes. Given the well-studied association between hypertension and dementia, we designed a solution that would ultimately promote brain health among older adults by allowing them to measure and record their blood pressure readings at home on a regular basis. Going through each step in the Design Thinking process, we devised MyHealthNetwork, an application which connects to a smart blood pressure cuff and stores users’ blood pressure readings in a digital dashboard which will alert users if readings are outside of the normal range. The dashboard also has a physician view where users’ data can be reviewed by the physician and allow for shared treatment decisions. The authors developed a novel algorithm to visually display the blood pressure categories in the dashboard in a way straightforward enough that users with low health literacy could track and understand their blood pressure over time. Additional features of the dashboard include educational content about brain health and hypertension, a digital navigator to support users with application use and technical questions. Phase 1 in the development of our application includes a pilot study involving recruitment of Primary Care Providers with patients who are at risk of dementia to collect and monitor BP data with our prototype. Subsequent phases of development involve partnerships to provide primary users with a rewards program to promote continued use, additional connections to secondary users such as family members and expansion to capture other health metrics.

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