Assessing Readiness to Change of a High Fall Risk Patient: A Case Report

2012 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Alexandra Lee ◽  
Julia Neily ◽  
Peter Mills ◽  
Cheryl Coutermarsh ◽  
Melissa Gates-Cantrell

The case report discusses a patient with an extensive history of falls living in the community. The patient’s medical record was analyzed, and an informal interview was conducted with the patient to provide an overview of his care provided by the Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) program from June 2008 to February 2011. The report will also apply the transtheoretical model of behavioral change to discuss the behavior change process of a high fall risk patient. Applying this model to the high fall risk population may assist with decreasing the frustration of clinicians and caregivers, as it acknowledges the “smaller gains” with fall prevention.

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 543-544
Author(s):  
Thomas Teasdale ◽  
Judith Howe ◽  
Carol Rogers

Abstract For several decades, the history of interdisciplinary education and the development of AGHE initiatives have been closely linked. The need to educate colleagues on methods and benefits of interdisciplinary/ interprofessional cooperation toward service and research of aging has never waned. In this presentation we (a) highlight how AGHE has performed as a potent incubator for progress in this area and (b) use a few examples to illustrate how notable resulting efforts have improved geriatric care. For example, early and significant infusion of federal funds for gerontology training programs supported multi-disciplinary university-based centers, the Veterans Health Administration created interprofessional geriatric training programs, foundations such as John A. Hartford and Josiah Macy founded team training and interprofessional education programs, and the Health Resources and Services Administration funded Geriatric Education Centers and Geriatric Workforce Enhancement Programs. Efforts to advance interdisciplinary/interprofessional education have been fruitful and AGHE’s role as an incubator continues to evolve.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bonnie J. Wakefield ◽  
Kariann Drwal ◽  
Monica Paez ◽  
Sara Grover ◽  
Carrie Franciscus ◽  
...  

Abstract Background Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. Methods This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. Results Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. Conclusion Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.


2018 ◽  
Vol 178 (5) ◽  
pp. 715 ◽  
Author(s):  
David W. Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Claire S. Duvernoy ◽  
Daniel E. Forman ◽  
...  

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 739-740
Author(s):  
Eve Gottesman ◽  
Helen Fernandez ◽  
Judith Howe

Abstract During COVID-19, many training programs pivoted to virtual formats. For the Rural Interdisciplinary Team Training (RITT) Program, funded by the Veterans Health Administration as part of the Geriatric Scholars Program, there were unique challenges. Given a history of successful accredited in-person, team-based workshops for staff at rural and remote clinics, program developers needed to quickly devise a plan for an effective virtual training for team members working separately from each other. Without the ability to provide in-person education and training, rapid pivoting to virtual modalities was essential for ongoing education of those providing care for older adults. Using a web-based platform, team members and expert trainer facilitation, participants engaged in lively discussions and reflection using the chat feature. RITT adapted the curriculum to better meet the needs of busy healthcare providers working during the pandemic, including increased discussion of how COVID affects older Veterans. Three virtual RITT workshops were held between March 2020 and February 2021 with 64 participants from 12 rural clinics and medical centers. Over 90% of participants agreed or strongly agreed that they were satisfied with the virtual workshop, comparable to those participating in the in-person workshop in earlier years. Similar to others, we have found that the ability to flex a curriculum has benefits to both learners and educators and increases the reach of educational opportunities in gerontology and geriatrics. Particularly in rural areas where travel may be challenging, a virtual format may be a desirable long-term solution for the RITT program.


2019 ◽  
Vol 40 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Megan E. Gately ◽  
Scott A. Trudeau ◽  
Lauren R. Moo

Video telehealth can increase access to home-based care, thus allowing older adults to maintain functional independence and age-in-place. This is particularly salient for persons with dementia whose cognitive changes increase home safety risk. Little is known about the technological and safety challenges of in-home assessment via video. This feasibility study explored the process and resource requirements of a remotely delivered telehealth occupational therapy home safety evaluation from a Veterans Health Administration (VHA) site. A total of 10 caregivers of veterans with dementia received home safety evaluations using videoconferencing technology using a variety of portable computing devices. Most telehealth evaluations experienced technological difficulties, but formal technical support was only required twice. Videoconferencing is a feasible service delivery option for home safety evaluations; however, infrastructure must support technological needs and client or provider gaps in knowledge. Implications for non-VHA settings and other interventions using videoconferencing are discussed.


2017 ◽  
Vol 13 (2) ◽  
pp. 77 ◽  
Author(s):  
Michael A. Grasso, MD, PhD, FACP ◽  
Zachary D. W. Dezman, MD, MS ◽  
Clare T. Grasso, PhD Candidate in Computer Science ◽  
David A. Jerrard, MD

Objective: This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA).Design: The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions.Main Outcome Measures: The percentage of ED visits that culminated in the receipt of a prescription for an OPM.Results: There were 6,721,134 emergency medical visits by 1,708,545 individuals during the study period. An OPM was prescribed during 913,872 visits (13.6 percent), and 407,408 individuals (27.5 percent) received at least one OPM prescription. Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3 percent in 2015. The percentage of prescriptions limited to 12 pills increased from 25.0 to 32.4 percent. The heaviest users (top 1.5 percent, n = 7,247) received an average 602.5 total doses, and had at least 10 ED visits during the study period. The most frequently prescribed OPMs were acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone. Receiving a prescription was associated with younger patients, musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a history of mental illness, a history of substance abuse, prior heavy prescription OPM use, and lower participation in outpatient services.Conclusions: The writing of OPM prescriptions after an ED visit is on the decline in the VA. Compliance with prescribing guidelines is increasing, but is not yet at goal.


2021 ◽  
Vol 32 (3) ◽  
pp. 150
Author(s):  
Nuri Fitriasari ◽  
Tenny Setiani Dewi ◽  
Etis Duhita Rahayuningtyas

Pendahuluan: Lidah dalam filosofi medis dipercaya sebagai barometer kesehatan rongga mulut maupun tubuh secara keseluruhan. Permukaan mukosa lidah kadang memperlihatkan gambaran yang berbeda dari kondisi normal sehingga disebut variasi normal. Geographic tongue dan fissured tongue merupakan suatu variasi normal yang asimptomatik namun dapat menjadi simptomatik ketika dipengaruhi suatu kebiasaan baru yang bersifat mengiritasi seperti setiap hari mengkonsumsi makanan yang memiliki rasa pedas yang ekstrim. Tujuan laporan kasus ini memaparkan tentang kelainan pada variasi normal lidah yang dipicu oleh kebiasaan baru konsumsi makanan tersebut pada seorang pasien remaja. Pasien juga kemudian diketahui dalam kondisi anemia. Laporan kasus: Seorang wanita berusia 18 tahun berobat ke Poliklinik Ilmu Penyakit Mulut RSUP.Dr Hasan Sadikin dengan diagnosis geographic tongue disertai fissured tongue. Pasien mengeluhkan sakit pada lidah dan terasa mati rasa serta nyeri seperti tertusuk-tusuk, terutama jika terkena makanan pedas, sejak satu tahun yang lalu. Terdapat riwayat mengonsumsi makanan yang pedas dan panas hampir setiap hari. Hasil pemeriksaan penunjang hematologi menunjukkan pasien dalam kondisi anemia. Penatalaksanan yang dilakukan meliputi instruksi menjaga kesehatan rongga mulut, pemberian preparat Fe, B12, dan asam folat, serta obat kumur. Pasien menunjukkan perbaikan dalam  pengobatan selama 3 minggu. Simpulan: Kondisi variasi normal pada lidah yang semula asimtomatik dapat menjadi simtomatik akibat iritasi makanan panas dan pedas, pada pasien dengan kondisi anemia.Kata kunci: Geographic tongue, fissured tongue, variasi normal lidah, makanan pedas dan panas, anemia. ABSTRACTIntroduction: In medical philosophy, the tongue is believed to be a barometer of the oral cavity’s health and the body as a whole. The mucosal tongue surface often shows a different feature from normal conditions, thus called normal variation. Geographic tongue and fissured tongue are normal variations that are asymptomatic but can become symptomatic when influenced by new irritating habits such as daily food consumption with an extremely spicy taste. This case report was aimed to describe abnormalities in normal tongue variation triggered by the new habit of consuming such foods in a teenage patient. The patient was also found to be anaemic. Case report: An 18-year-old woman went to the Oral Medicine Polyclinics of Dr Hasan Sadikin Hospital with a geographic tongue diagnosis accompanied by the fissured tongue. The patient complained of a sore tongue and felt numbness and soreness like being prickly, especially when exposed to spicy food, since one year prior. There was a history of spicy and hot foods consumption almost every day. The results of the haematology examination showed that the patient was in an anaemic condition. The treatment included instructions for maintaining oral health, administration of Fe, B12, folic acid preparations, and mouthwash usage. The patient showed improvement after treatment for three weeks. Conclusion: The condition of normal tongue variation, which initially asymptomatic, can become symptomatic due to irritation of hot and spicy food in anaemic patients.Keywords: Geographic tongue, fissured tongue, normal tongue variations, hot and spicy food, anaemia.


2015 ◽  
Vol 30 (4) ◽  
pp. 337-343 ◽  
Author(s):  
Maria L. Claver ◽  
Tamar Wyte-Lake ◽  
Aram Dobalian

AbstractIntroductionVeterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults.ProblemThis study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities.MethodsThis project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques.ResultsPractitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training.ConclusionVariability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs’ abilities to assist their patients and their caregivers in preparing for a disaster.ClaverML, Wyte-LakeT, DobalianA. Disaster preparedness in home-based primary care: policy and training. Prehosp Disaster Med. 2015;30(4):17.


Sign in / Sign up

Export Citation Format

Share Document