Margaret Thorman Hartig

Patient satisfaction with nurse practitioner care in primary care.

This quantitative, descriptive pilot study assessed patient satisfaction with care provided by four nurse practitioners using a modified version of the Di Tomasso-Willard Patient Satisfaction Questionnaire. Results indicated high satisfaction with care in all groups, but there were differences among the groups on 26 percent of the items and on three of the five subscales. The implication is that nurse practitioners need to identify and improve those dimensions of care for which patients are less satisfied.

Faculty practice: What do the data show? Findings from the NONPF Faculty Practice Survey

Abstract This article reports on the findings of the NONPF (National Organization of Nurse Practitioner Faculties) Faculty Practice Survey regarding promotion and tenure. Relevant issues related to tenure for practicing faculty are identified and discussed. Faculty practice has become an increasingly important and complex issue for academic institutions in relation to promotion and tenure. The purpose of this article is to examine the role and patterns of practice among tenured and nontenured faculty in academic nursing institutions and the variables associated with faculty promotion and tenure in these institutions. Method: A survey was mailed to the membership of the National Organization of Nurse Practitioner Faculties to examine the differences between practicing faculty who were tenured and those who were nontenured and to identify predictors of tenure. A 50% response rate (N = 452) was obtained. Findings indicate that only 37% of the practicing faculty were tenured, and more than half (51%) reported that practice was not considered in promotion and tenure decisions at their institutions. The predictors of tenure included practice being considered in promotion and tenure and support for practice at the school of nursing level. Data on reasons faculty practice are also presented. Recommendations for including practice in promotion and tenure guidelines are discussed as well as the ramifications of administrative support for practice. Nurs Outlook 2002;50:238-246.

Engaging Faith-Based Resources to Initiate and Support Diabetes Self-Management Among African Americans A Collaboration of Informal and Formal Systems of Care

Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.

The prevalence of impaired glucose metabolism in Hispanics with two or more risk factors for metabolic syndrome in the primary care setting.

Purpose: The purposes of this observational prospective study were (a) to identify the prevalence of undiagnosed impaired glucose metabolism (IGM) including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM) in 55 Hispanic subjects with two or more risk factors for the metabolic syndrome, (b) to examine the association between glucose metabolism and cardiometabolic risk factors (CMRF), including metabolic syndrome components, and (c) to identify predictors of IGM. Data sources: Subjects underwent a physical examination and a 2‐h 75‐g oral glucose tolerance test. Data were analyzed using SAS v9.1 with p ≤ .05 considered significant. Nonparametric tests were applied including Mann‐Whitney‐Wilcoxon test and Spearman correlation coefficient. Stepwise logistic multiple regression was used to predict IGM. Conclusions: Twenty‐five patients (46%) had IGM (18% IFG, 15% IGT, and 13%T2DM). Normal fasting glucose was found in 48% of subjects who had IGM. Lipid abnormalities were present in 98% including elevated triglycerides (TG 66%), total cholesterol (48%), low‐density lipoprotein (68.8%), and low high‐density lipoprotein (67.9%). Twenty‐nine percent had body mass index (BMI) >25 kg/m2 and 62% had BMI >30 kg/m, hypertension (24%), and elevated high‐sensitivity C‐reactive protein (63%), and mean number of cardiometabolic risk factors (#CMRF) was 4.5. Mean values for each risk factor were no different between groups except for #CMRF (p = .0001) and TG (p = .0001). Total #CMRF was the best predictor of IGM. Implications for Practice: The prevalence of IGM is extremely high in Hispanics with metabolic syndrome. Screening for IGM with fasting blood glucose alone underestimates the prevalence of IGM in this population. In subjects with multiple CMRF, screening at lower levels of BMI is warranted.

Case Series of Sexual Assault in Older Persons

In this article, sexual assault of older persons is analyzed in a literature review and case series, and exemplar pseudocases of suspected older person sexual assault are discussed.

Vulnerable Populations: Drug Court Program Clients

Substance abuse and addiction are chronic conditions characterized by an inability to control ones urge to use mood- or mind-altering drugs. Recognition of the association between addictions and crime to support the addiction, along with the relapsing nature of addictions, presents treatment and management challenges for clinicians and frustration for patients and their families. Pressures to reduce the burgeoning jail population have resulted in collaboration between the treatment community and the court--a diversion program called drug court. This article reviews the drug court programs, the clients, and the processes of accountability that direct the progress toward sobriety in the drug court clients. It also argues that the drug court clients have unique health needs requiring interventions best suited for the recovering addict enrolled in a diversion program within the criminal justice system. Nurses have the ability to influence these systems and provide safety-net clinics to drug court clients through outreach, case finding, and culturally and linguistically appropriate care that can ultimately help this population to reach a higher level of wellness.

Review: quality improvement interventions reduce unnecessary prescription of antibiotics for outpatientsCommentary

ED FROM Ranji SR, Steinman MA, Shojania KG, et al. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Med Care 2008;46:847–62. Correspondence to: Dr S R Ranji, University of California San Francisco, San Francisco, CA, USA; sumantr@medicine.ucsf.edu Source of funding: Agency for Healthcare Research and Quality. c Clinical impact ratings: Family/general practice 6/7; Infectious disease 5/7 C O M M EN TA R Y U nnecessary use of antibiotics can have important individual and societal consequences. Reducing use of antibiotics is among the Institute of Medicine’s top 20 priorities for quality care. The quantitative analysis by Ranji et al sought to identify effective interventions for reducing antibiotic prescribing. Several intervention strategies were identified; however, not all trials were eligible for quantitative analysis. The results of trials not included in the analysis complement its findings, with a general consensus that quality improvement interventions are effective. Although no trials offered definitive evidence for the most effective interventions, there were some promising approaches: mass education to inform the community as a whole and active education with decision support that engaged clinicians in the use of algorithms for prescribing. Limited data suggested that adverse outcomes were no more frequent in patients who did not receive antibiotics. This can support clinical decisions to not prescribe antibiotics. Clinicians can reassure patients that they are unlikely to experience serious consequences (including the common and short-term onset of diarrhoea and longer-term effect of antibiotic resistance) if treated without antibiotics and balance that information with the potential for harm and increased costs from unnecessary use of antibiotics. In addition, patient satisfaction was generally not affected by antibiotic prescribing, a factor that may reduce the pressure on clinicians to prescribe antibiotics to meet perceived patient expectations. Margaret Thorman Hartig, RN, PhD, FNP-BC University of Tennessee Health Science Center College of Nursing Memphis, Tennessee, USA 1. Adams K, Corrigan JM, editors. Priority areas for national action: transforming health care quality. Washington, DC: National Academies Press, 2003. Quality improvement EBN January 2009 Vol 12 No 1 27