Browsing by Author "Pereira, Katherine"

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    Retrospective Chart Review of the Triage Algorithm for Psychiatric Screening (TAPS) for Patients Who Present to Emergency Departments With Psychiatric Chief Complaints
    (Journal of Emergency Nursing, 2018-01) Schieferle Uhlenbrock, Jennifer; Hudson, John; Prewitt, Judy; Thompson, Julie A; Pereira, Katherine
    © 2017 Emergency Nurses Association. Introduction: There is a growing number of mental health illnesses (MHIs) in the nation and no standardization of the medical screening examination (MSE) in the emergency department. Many health care organizations are at the tipping point of discarding a battery of laboratory workups. A triage tool-specific to psychiatric chief complaints and cost effective-is needed for the emergency department. Methods: A nonexperimental, retrospective overlay of the Triage Algorithm for Psychiatric Screening (TAPS) onto previous psychiatric patients' records was performed to determine the sensitivity and specificity of the TAPS in ruling out acute medical illness. The laboratory test results, length of stay (LOS), and cost of treatment for all psychiatric patients were examined to determine if there was a correlation with their TAPS scores or if the use of the TAPS would have resulted in efficient care and cost savings. Results: This study shows the TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in a community hospital setting with an on-site inpatient psychiatric unit. The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0). As such, the TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing. Implications for Practice: The results of this project represent a valuable step forward in improving the triage of adult patients who present to the emergency department with psychiatric chief complaints. A reproducible study of the TAPS method was the next practice step in determining feasibility. Use of the TAPS tool can be a method to decease costs and ED crowding. For research and quality improvement projects in the future, addiction chief complaints should be treated as a separate category from psychiatric or medical complaints, as they meet the criteria of both.Image 1 Contribution to Emergency Nursing Practice •The TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in community hospital settings with on-site inpatient psychiatric units.•The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0).•Addiction chief complaints was a confounding variable because these patients often had mental health complaints in addition to medical complaints. The TAPS tool is a simple and cost-effective tool to use in the emergency department during triage.•The TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing.
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    Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics.
    (Contemporary clinical trials, 2013-09) Crowley, Matthew J; Bosworth, Hayden B; Coffman, Cynthia J; Lindquist, Jennifer H; Neary, Alice M; Harris, Amy C; Datta, Santanu K; Granger, Bradi B; Pereira, Katherine; Dolor, Rowena J; Edelman, David

    Background

    Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension.

    Methods

    Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness.

    Results

    Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending.

    Conclusions

    If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings.