Scholarship & Research
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Item Increasing statin utilization in patients at high risk of atherosclerotic cardiovascular disease in remote physiological monitoring program(Montana State University - Bozeman, College of Nursing, 2023) Ottemoeller, Christopher Michael; Chairperson, Graduate Committee: Lindsay BenesStatement of the problem: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide costing the United States an estimated $200 billion a year. Dyslipidemia, a leading risk factor for ASCVD, is well controlled by statin medications. Despite high efficacy, low cost, and a favorable safety profile, statins are underutilized. A healthcare facility in Montana aimed to increase utilization of statins in high-risk populations through pharmacist chart reviews. Methods: The quality improvement case manager at the healthcare facility conducted a review of patient charts to identify those at high risk for ASCVD who were not receiving statin therapy based on MIPS #438 recommendations. The case manager identified patients that would benefit from a statin and referred them to a pharmacist for a medication chart review. The pharmacist then called the patient to complete a medication chart review and sent recommendations for medication changes to the patient's primary care provider (PCP). Results: Twenty-two patients were initially identified for statin therapy with 13 deemed eligible. Six of them (46%) agreed to a pharmacist chart review and were contacted by the pharmacist, all of whom agreed to statin therapy. The pharmacist made an average of two additional medication changes recommendations per review. Thus far, three patients followed up with their provider and started statin and one patient completed a repeat lipid panel. Conclusion: Pharmacist outreach can increase statin utilization in patients at high-risk of ASCVD. Further research should focus on improving statin tolerability and ability to contact patients.Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.Item The efficacy of the coronary patient's hospital record in research(Montana State University - Bozeman, College of Professional Schools, 1970) Sprague, Mildred Grow; Chairperson, Graduate Committee: Rita M. DarraghItem An evaluative study of the myocardial infarction patients' expressions of their needs and their responses about the health teaching they received(Montana State University - Bozeman, College of Professional Schools, 1969) Pesanti, Linda CatherineItem A descriptive survey of coronary nursing education among professional nurses in Montana(Montana State University - Bozeman, College of Professional Schools, 1968) Oka, Betty McDougallItem A survey of a selected number of myocardial infarction patients to determine their needs upon leaving the coronary care unit(Montana State University - Bozeman, College of Professional Schools, 1972) Foley, Mary Kaye ParkerItem A descriptive survey of rural emergency room nurses' knowledge and role perception of advanced cardiac life support(Montana State University - Bozeman, College of Nursing, 1980) Ellis, Daniel JosephItem Cardiac patient education and its relationship to knowledge, anxiety, and health perception(Montana State University - Bozeman, College of Nursing, 1982) Kubinec, Florence OlgaItem Coronary Vasospasm : signs, symptoms, risk factors and management(Montana State University - Bozeman, College of Nursing, 2009) Glover, Jessica Colleen; Chairperson, Graduate Committee: Christina SieloffRegistered nurses in the acute care setting are presented with the opportunity to interact with patients suffering from chest pain. One etiology behind chest pain, difficult to differentiate from the more common atherosclerosis, is coronary vasospasm. This health problem can be successfully identified based upon the presenting signs, symptoms, and risk factors. Nurses can then participate in carrying out medical and nursing management for this condition. An opportunity for continuing education is needed to update nursing knowledge. A review of professional literature was conducted and consistent themes derived that led to the development of a teaching project consisting of a pre and post evaluation, teaching slides, and a participant evaluation. This teaching project was designed to equip registered nurses, employed within a regional hospital, to recognize the signs, symptoms, and risk factors of coronary vasospasm as well as general medical and nursing management strategies. The teaching project was then made available to participants for a period of fourteen days via a computerized learning system available within the facility. The pre and post tests were then evaluated for differences in median and mean scores. Improvements in overall scores, as well as on the individual questions presented on the tests, were documented. These results lead to the conclusion that knowledge of the signs, symptoms, risk factors, medical, and nursing management increased following completion of the teaching project. Implications for future nursing practice, education, and research include the development of a teaching and evaluation tool that could be made available for continuing education on a larger scale to reach additional registered nurses.Item Barriers to participation in cardiac rehabilitation : a rural perspective(Montana State University - Bozeman, College of Nursing, 2007) Echeverri, Rebecca Chloe; Chairperson, Graduate Committee: Charlene WintersCardiovascular disease is a significant health problem in rural states and complicated by the lack of access to specialized health care services such as cardiac rehabilitation programs. Researchers have documented that education, counseling, and behavioral interventions are important elements of cardiac rehabilitation (CR) that lead to decreased mortality and increased quality of life. Despite the known benefits of participation, only 10-20% of eligible persons in the United States participate in CR. While evidence exists to partially explain participation in cardiac rehabilitation programs, a major limitation of most studies reported in the literature is that they were conducted primarily in large urban areas. As a result, findings from these studies cannot be generalized to rural dwellers resulting in limited research examining participation in cardiac rehabilitation amongst rural persons.