Class of 2014 Abstract / Specific Aims: The purpose of this study is to compare frequency of pharmacy services available in ambulatory care practice between adult and pediatric populations and to identify factors that affect the availability of such practice settings between the two populations in the United States. Methods: This study was a descriptive survey study that was distributed nationally. Participants were recruited using two electronic listservs registered with the American College of Clinical Pharmacy (ACCP), the Pediatric PRN listserv and Ambulatory Care PRN listserv. A total of 126 participants completed and submitted the electronic questionnaire. This descriptive survey study collected data through an online questionnaire distributed to adult and pediatric ambulatory care pharmacists. Descriptive variables, demographic variables, categorical variables, and ordinal data were analyzed by calculating frequencies, percentages, and averages. Main Results: The majority of participants specialize in diabetes (n = 51, 40.5%), anticoagulation (n=42, 33.3%), hypertension (n=42, 33.3%), hyperlipidemia (n=40, 31.8%), and asthma (n=32, 25.4%). Adult care was greater than pediatric care in diabetes (Adult: n=54, 42.83%; Ped: n=14, 9.53%), anticoagulation (Adult: n=46, 43.66%; Ped: n=6, 4.76%), hypertension (Adult: n=44, 34.94%; Ped: n=8, 6.34%), hyperlipidemia (Adult: n=42, 33.34%; Ped: n=3, 2.39%), and asthma (Adult: n=35, 27.78%; Ped: n=28, 22.23%). Averages of 4.88 hours of hours per week and 5.21 years of experience were obtained for provision of pediatric care in the ambulatory care setting. Conclusion: In conclusion, availability of ambulatory care services for pediatric patients is dramatically less than those available for adults. Generalized structure for location of clinics, billing for services, and funding for positions may increase the opportunity for provision of adult and pediatric ambulatory care services.

The ambulatory care facility is a new phenomenon in the British Columbia health care delivery system. Therefore, not only is its planner faced with the uncertainty of predicting future need, but also the perplexity of not having the very basis for his predictions: past utilization data from existing facilities. Moreover, there is no real agreement on what services should be provided in an ambulatory care facility. This thesis attempts to at least partially allay these uncertainties by setting down a format for planning an ambulatory care facility in and for the community of Delta, B. C. The planning method was divided into four parts: ambulatory care definition, data assemblage, data projection and facility simulation. Delta practitioners and several health care consultants co-operated in the production of an exhaustive list of medical, surgical and dental procedures defining ambulatory care. In accordance with this list, data was assembled regarding the number of ambulatory procedures regularly performed for Delta residents, by Delta practitioners. Medical and surgical data was taken from Provincial Department of Health computer data files; while dental data was gathered by questionnaire. The data trend for each procedure was then projected to the Target Years 1978 and 1982. Following these initial steps, a General Purpose Simulation System (G.P.S.S.) analysis was performed on the data gathered. Other information required for the simulation was gathered through questionnaires to Delta practitioners and private conferences with health care consultants. The results from the simulation were expressed in "work areas" (i.e. examination rooms, stretcher-beds, etc.) required in the major departments or service areas. The simulation analysis could only be completed for the Surgical Day Care Services area, because the data from Provincial computer data files, relevant to other departments or service areas, was found to be insufficient. The main problem encountered was an imprecise identification of patients' geographic origin; which in some instances made it impossible to identify procedures performed for Delta residents. Detailed suggestions for improving the method are presented in the Discussion. However, one should at least do the following: endeavour to use more than two years of data to project the trend in the Provincial computer data files; and explain the questionnaires circulated to practitioners by giving individual person-to-person instructions, rather than group verbal and individual written instructions. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Class of 2008 Abstract / Objectives: To describe a pharmacist-based treatment adherence program at an HIV ambulatory care clinic setting; to describe the patient population that the pharmacist provided services to from 2005 to 2007; and to describe the clinical outcomes of the program. Methods: A retrospective chart review of 381 patients enrolled in the pharmacist-based treatment adherence program from 2/01/05 to 03/01/2007. Inclusion criteria: HIV positive; greater than or equal to 18 years of age; a medical record; and enrollment in the treatment adherence program. The program provided support, education, and clinical management. Results: Patients were predominately male (86%), ages 45-64 (58%) or 25-44 (38%), identifying as Caucasian (57%) or Hispanic (31%), with psychiatric (50%) or substance abuse (39%) comorbidities (with 25% reporting both comorbidities). Baseline HIV viral loads were compared at four different follow-up periods: 90-180 days, 181-365 days, greater than 365 days, and the entire period of follow-up through the pharmacist-based HIV treatment adherence program. At baseline 34% of the patients had an undetectable HIV viral load (< copies/mL) and a mean CD4 count of 340. All follow-up periods reported significant improvements. At follow-up >365 days, 76% of the patients had undetectable virus (p<0.001) and a mean CD4 count of 442 (p<0.001). There were no significant results when viral load and mean CD4 counts were examined within the context of number of pharmacist visits and SA and/or psychiatric comorbidities. Conclusions: Patients in the pharmacist-based treatment adherence program showed significant improvements in CD4 count and percent of patients with undetectable virus from baseline to all follow-up periods. The magnitude of the improvement increased during each follow-up period suggesting an additive effect of continued enrollment in the program.

Behavioral counseling is integral for the overall health of individuals with a mental health diagnosis. For instance, diabetic patients treated with cognitive behavioral therapy (“CBT”) for depression have been shown to have better glycemic control and patients with coronary artery disease treated with CBT for stress management have decreased risk for recurrent myocardial infarction. Above all, for nearly all mental health diagnoses, behavioral counseling is an effective treatment strategy for achieving remission. In primary care, mental health therapy oftentimes starts with a referral to a counseling center or psychiatric professional. With strong patient commitment, behavioral therapy can ultimately improve health outcomes and the day to day functioning for that patient. Unfortunately, the initial step can be the most difficult and the journey never begins. In our clinic, a residency clinic in a semi-rural area with a high percentage of underinsured, we noticed that a lower than preferred number of patients that we refer to our most accessible behavioral counseling center do not even schedule their first appointment. Additionally, we are limited by a scarcity of affordable psychiatric resources and this counseling center is often our only option for referral. For this purpose, we implemented the following changes consecutively to the referral process. First, our in-house referrals coordinator made the first appointment, instead of the patient having to call themselves. Next, we took this a step further, and an employee from the counseling center came onsite to initiate the intake process on the day of the referral or at the patient’s convenience. We then measured their success by comparing the percentage of patients that completed the intake process before and after each implementation. There was a statistically significant increase in the mean percentage of intakes completed after each intervention. We conclude that although the reason patients are unable to follow-up with a behavioral health referral is often multi-factorial, simplifying the process for the patient seems to help a great deal. While this is encouraging, more evaluation is needed to determine if patient outcomes are improved, and if these interventions are cost effective and sustainable options.

The purpose of this study was to determine the indicators of customer satisfaction and service success of a newly established paediatric outreach nursing service. Referring agents and care recipients were both consumers of the paediatric outreach nursing service. Both groups of consumers were surveyed to determine their satisfaction with the service delivery. Two satisfaction survey tools were developed to measure customer satisfaction. The tools were piloted and refined prior to distributing them. Both tools had a series of closed-ended questions and 3 open-ended questions. Eight service indicators were developed. These were designed to test the effectiveness of the service provided. The service indicators were piloted over two periods of three months and then modified based on the findings of the pilot period. The Paediatric Outreach Service (POS) is a positive service model for health care delivery. The survey results indicated that stakeholders were generally satisfied with the service delivery. When measured against service indicators that were developed for POS, the service performance was above average, with some opportunity to improve practice. Underpinned by a family-centered framework, POS has the capacity to empower children and their families in the planning and implementation of a management plan for the child’s illness. Such empowerment may lead families to practice better healthcare, develop better health-seeking practices and ultimately lead to healthier children. The results from this study has implications for nursing practice. The data obtained from this study may be useful to service providers considering commencing a paediatric outreach nursing service. Data may also be useful for existing service providers to use in order to review the aspects that consumers value against the service they currently provide. Keywords ambulatory care; paediatrics; home-nursing; community; evaluation; satisfaction; success; indicators

Thesis (M.P.H.)--University of Michigan, 1947.

LICL has E-Thesis 0023 ; please contact computer services. Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.H.S.A.)--University of Michigan, 1981.

Thesis (M.H.S.A.)--University of Michigan, 1977.