Community Medicine
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30807
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Browsing Community Medicine by Author "Gibson, John"
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Item Approach to End-of-Life Care Planning in the Outpatient Setting(2022) Jackson, Garrett; Randell, David; Hadley, Lesca; Gibson, JohnPurpose: Advance care planning (ACP) can prepare individuals to receive medical care aligned with their values and experience; however, ACP can be uncomfortable and taboo topic for many patients and thus, a time-consuming conversation for providers. As of 2017, only 1 in 3 of U.S. adults had any type of advanced care directive. Family Practice Associates of Abilene is a primary care clinic that serves an aging demographic with an increased need to address the issues of end-of-life care. Their short-term goal was to increase the initiation of advanced care planning (ACP) by patients 65+ years from October 1, 2021- December 17, 2021; the long-term goal is to see an increased follow-through of patients creating their ACP directives and documents. Methods: For the month of October all patients 65+ years were questioned regarding their ACP status and documented as: complete, desire to initiate, do not wish to initiate. Starting November 1, 2021, all patients 65+ years were first engaged with an educational pamphlet or conversation via the certified medical assistant or medical student prior to the physician encounter. Verbal confirmation of their ACP status was documented as: complete, desire to initiate, do not wish to initiate. Results: From November 1st - December 17th, there was a >70% increase in the verbal confirmation of the desire to initiate ACP from among eligible patients as compared to prior the implementation. In addition, many of the patients were encouraged to initiate follow-up of their concerns or questions by scheduling their Medicare Annual Wellness visit with the front office post-visit. Conclusion: This approach allowed for brief, multidisciplinary interactions around ACP that adapted to the time-limited care model seen in the outpatient setting1. Future steps could include reviewing the EMR system to quantify how many of the patients followed up on their verbal desire by scheduling a Medicare Annual Wellness exam.Item Providing healthcare to rural populations with Real Time Remote Telementored Ultrasound(2022) Wyszynski, Katy; Hadley, Lesca; Gibson, JohnIntroduction University of North Texas HSC medical students learn Point of Care Ultrasound (POCUS) in clinical settings as part of their curriculum. In 2021, students provided healthcare screenings and ultrasound scans to hundreds of patients in underserved rural communities in West Texas. Students utilized Butterfly's teleguidance technology to perform complex scans for the first time by using Remote Telementored Ultrasound (RTMUS) which allows a two-way video call, so that a remote practitioner visualizes the ultrasound scan and the probe location on the patient in real time. Methods We encountered a 62-year-old female with a 2/6 systolic ejection murmur. She noted a history of congenital heart disease diagnosed at birth, but the patient was unsure of the diagnosis and has not seen a cardiologist in many years. POCUS was performed on the patient. Results This patient had grossly normal cardiac POCUS examination. However, one anatomical location at the base of the patient's interventricular septum appeared thin. From her medical history and cardiac imaging, the remote practitioner approximated that she had a previous ventricular septal defect at birth that closed spontaneously. Discussion POCUS is a valuable tool in rural settings for patient management. Using RTMUS, trained physicians and students can bring advanced technology to remote settings using experts in distant locations, allowing ultrasound to serve as an adjunct to the physical exam even in places where healthcare inequalities commonly exist. With the expansion of this technology, RTMUS has the potential to provide ultrasound technology to underserved populations globally.