Browsing by Author "Rattray, Nicholas"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Assessing the acceptability and feasibility of remote spirometric monitoring for rural patients with interstitial lung disease: a multimethod approach
    (Springer Nature, 2024-02-20) Boente, Ryan D.; Schacht, Sydney; Borton, Rebecca; Vincent, Joseph; Golzarri‑Arroyo, Lilian; Rattray, Nicholas; Medicine, School of Medicine
    Introduction: Interstitial lung disease encompasses a group of rare lung conditions causing inflammation and scarring of lung tissue. The typical method of monitoring disease activity is through pulmonary function tests performed in a hospital setting. However, accessing care can be difficult for rural patients due to numerous barriers. This study assesses the feasibility and acceptability of home spirometry telemonitoring using MIR-Spirometers and the patientMpower home-monitoring platform for rural patients with interstitial lung disease. Methods: Unblinded, uncontrolled, prospective, multiple-methods study of the feasibility and utility of remote monitoring of 20 rural subjects with interstitial lung disease. Study assessments include adherence to twice weekly spirometry for 3 months in addition to mMRC dyspnea and EQ-5D-5L health-related quality of life questionnaires with each spirometry maneuver. Upon completion, subjects were encouraged to complete an 11-question satisfaction survey and participate in semi-structured qualitative interviews to further explore expectations and perceptions of rural patients to telehealth and remote patient monitoring. Results: 19 subjects completed the 3-month study period. Adherence to twice weekly spirometry was mean 53% ± 38%, with participants on average performing 2.26 ± 1.69 maneuvers per week. The median (Range) number of maneuvers per week was 2.0 (0.0, 7.0). The majority of participants responded favorably to the patient satisfaction survey questions. Themes regarding barriers to access included: lack of local specialty care, distance to center with expertise, and time, distance, and high cost associated with travel. Remote monitoring was well perceived amongst subjects as a way to improve access and overcome barriers. Conclusions: Remote spirometry monitoring through web-based telehealth is acceptable and feasible for rural patients. Perceived benefits include overcoming access barriers like time, distance, and travel costs. However, cost, reimbursement, and internet access must be addressed before implementing it widely. Future studies are needed to ensure long-term feasibility and to compare outcomes with usual care.
  • Thumbnail Image
    Item
    Front-line Nursing Home Staff Provide Insight on Advance Care Planning in a Crisis
    (Elsevier, 2022) Kaehr, Ellen; Gowan, Tayler; Unroe, Kathleen; Rattray, Nicholas; Hathaway, Elizabeth; Medicine, School of Medicine
    Introduction/Objective: The dynamic changes stemming from the COVID-19 pandemic brought instability in advance care planning (ACP). ACP includes eliciting and documenting goals, values, and preferences for medical treatments, and requires considerable skill and resources. The goal of this study is to describe the nursing home staff experience with ACP including barriers and facilitators to goals of care discussions, which were revisited for all residents during nursing home COVID-19 outbreaks in 2020. Design/Methodology: This cross-sectional interview-based study interviewed 17 nursing home staff who facilitated ACP with residents and families during an initial COVID-19 outbreak, representing 7 Midwest nursing homes. Semi-structured telephone interviews were conducted (November 2020-April 2021), and included the Patient Health Questionaire-4 (PHQ4) and Impact of Event Scale-6 (IES-6) to explore the emotional impact of the pandemic. Qualitative thematic analysis was carried out to investigate the nursing home staff experience with goals of care discussions including the psychological impact on staff. Results: Nursing home staff described barriers to successful advance care planning in a crisis such as personal protective equipment (PPE), visitor restrictions, and lack of disease specific clinical knowledge. Self-reported stress was high, with 53% of participants screening positive for potential severe depression and anxiety (PHQ-4 total score ≥ 9) and 29% screening positive for possible post-traumatic stress disorder (PTSD) based on the IES-6 (mean score ≥ 1.75). Interview data offered evidence of the sources and nature of psychological impact of a COVID-19 outbreak. Participants experienced decreased stress when they reported increased knowledge, increased experience, decreased mortality, resolution of outbreak, and access to vaccination. Conclusion/Discussion: Nursing home staff described pandemic advance care planning as impersonal and uncomfortable compared to prior experiences. In future crises, maintaining in person conversations or equivalent interactions and supporting staff with adequate clinical knowledge and personal mental health resources is important in ACP.
  • Thumbnail Image
    Item
    Identifying Factors that Impact the Educational Success of Veterans at IUPUI
    (Office of the Vice Chancellor for Research, 2016-04-08) Parrish, Blake K.; Salyers, Michelle P.; Rattray, Nicholas
    Increased post-secondary enrollment among US military veterans using benefits from the Post-9/11 Veterans Educational Assistance Act of 2008 has led to a newfound emphasis on expanded student services on college campuses. We examined academic performance, social support, and mental health through a cross-sectional survey of 101 Veterans who were enrolled in at least one course at IUPUI in the last 12 months in order to identify barriers and facilitators to academic success. In addition to educational outcomes, we also assessed a variety of measures related to community reintegration, quality of life, and resilience. We conceptualized academic success as higher GPA, student status, and lower levels of reported difficulty in reintegration, concentrating in the classroom, and completing coursework. We hypothesized that use of student services and financial aid, involvement with student affairs, perceived social support, encountered barriers, and completion of transition assistance programs were expected to influence success variables. More than half of participants reported experiencing educational barriers unique to their Veteran status, including moderate difficulties with concentration and completing tasks for school. Although high mean scores of grit, resilience, and perceived social support were recorded, high scores of reintegration difficulty suggest that the sample may be at probable risk for post-traumatic stress disorder and substance abuse. Despite these difficulties, most student Veterans did not report using Veteran specific resources, with only one in ten participants reporting any use of campus-based adaptive education services and psychological services. No significant difference was found between groups utilizing or failing to utilize 6 separate sources of financial aid, 6 services, and 9 types of student affairs. Our findings suggest potential ways to enhance current support programs. Future research that tracks longitudinal change and explores student experience in-depth may help explore mechanisms related to the academic success of military Veterans.
  • Thumbnail Image
    Item
    Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation
    (BMJ, 2022-09-08) Rattray, Nicholas; Damush, Teresa M.; Myers, Laura; Perkins, Anthony J.; Homoya, Barbara; Knefelkamp, Christopher; Fleming, Breanne; Kingsolver, Andrea; Boldt, Amy; Ferguson, Jared; Zillich, Alan; Bravata, Dawn M.; Biostatistics, School of Public Health
    Background: Early evaluation and effective communication to manage transient ischaemic attacks (TIA) may lead to a reduction of up to 70% in recurrent events for patients with TIA/minor stroke, along with reduced costs and lengths of hospital stay. Methods: We conducted a single site pilot evaluation of a clinical pharmacy programme to improve medication management among TIA patients. The programme included a structured protocol, online identification tool, and a templated discharge checklist. Primary effectiveness measures were change in systolic blood pressure (SBP) 90 days post discharge and prescription of high/moderate potency statins. Contextual aspects and clinical perspectives on the implementation process were evaluated through prospective semistructured interviews with key informants. Results: The analysis included 75 patients in the preimplementation group and 61 in the postimplementation group. The mean SBP at 90 days post discharge was significantly lower in the post implementation period (pre implementation, 133.3 mm Hg (SD 17.8) vs post implementation, 126.8 mm Hg (16.6); p=0.045). The change in SBP from discharge to 90 days post discharge was greater in the postimplementation period (15.8 mm Hg (20.5) vs 24.8 mm Hg (23.2); p=0.029). The prescription of high/moderate potency statins were similar across groups (pre implementation, 66.7% vs post implementation, 77.4%; p=0.229). Front-line clinicians involved in the pilot study reported positively on the acceptability, appropriateness and feasibility of implementing the protocol without additional cost and within current scope of practice. Conclusions: Implementation of a clinical protocol outlining medication management and provider communication to ensure rapid postdischarge treatment of TIA patients was associated with SBP improvements. The pilot evaluation demonstrates how clinical pharmacists may play a role in treating low frequency, high stakes cerebrovascular events where early treatment and follow-up are critical.