Improving Vaccination Documentation Rates Among Patients With Breast Cancer Through Patient Outreach.

BACKGROUND: Patients with cancer are at high risk for infection-related morbidity and mortality; vaccinations reduce this burden. In 2021, vaccination documentation rates were low at an academic medical center breast clinic. OBJECTIVES: The purpose of this pilot quality improvement project was to evaluate an education intervention to increase vaccination documentation among patients with breast cancer. METHODS: During a 16-week period, the 4 Pillars™ Practice Transformation Program was implemented. The oncology nurse navigator assessed and documented vaccination history, discussed recommendations with the provider, and recommended concurrent vaccinations. Within a two-week period, the oncology nurse navigator completed and documented vaccination follow-up via telephone. FINDINGS: Vaccination follow-up and documentation for influenza, shingles, and pneumococcal vaccines increased substantially. Findings indicate that an education and outreach program can increase vaccination documentation rates among patients with breast cancer.

The Problem of Missed Mental Healthcare Appointments.

Missed appointments are a problem in all types of outpatient clinics including those providing mental healthcare. A review of literature was conducted to explore the problem of missed appointments in mental health and identify methods that have been used to improve attendance. Study results demonstrate that patients miss appointments for many reasons. Common reasons for missed appointments in the articles reviewed were the interval between scheduling and appointment day, forgetting, being discharged against medical advice, and problems with substance abuse. Effective in reducing no-shows was contact via phone, mail, or text messaging. No articles were found related to the use of positive reinforcement in reducing no-shows, which is an area to consider for further research. Clinicians may identify techniques from this review applicable to their particular clinical setting to improve clinic attendance.

Attention to medical conditions during mental health clinic visits.

With increased attention being devoted to the metabolic effects of antipsychotic medications, it becomes apparent that efforts need to be made to ensure that patients receiving treatment for a mental illness receive appropriate evaluation and treatment of their medical conditions as well. The individual provider may assist by offering relevant screenings, helping patients take responsibility for their own health, decreasing barriers to treatment, enlisting the assistance of support staff, making appropriate referrals, and collaborating with other providers.

Detection of depression in primary care.

OBJECTIVE: The first purpose of this study was to examine the variables related to the diagnosis of a depressive disorder and associated with referral to a mental health clinician. The second purpose was to examine the level of agreement of the primary care provider's diagnosis of depression with that of the mental health clinician. METHODS: The design was a retrospective, case-control study (n = 162). Data were analyzed with descriptive statistics and logistic regression. RESULTS: Referred patients tended to be Caucasian, middle-aged or older men who had a history of depression, were experiencing depressive symptoms and/or an acute or chronic stressor, had a diagnosis of cardiovascular disease or cerebrovascular accident, and were taking a greater number of medications. Mental health clinicians agreed with the primary care clinicians' diagnoses of depression 76% of the time. CONCLUSIONS: Primary care clinicians accurately diagnosed depression for the majority of patients and appropriately referred them for psychiatric care.

Prevalence of diabetes mellitus in patients receiving depot neuroleptics or clozapine.

This retrospective study compared the prevalence of diabetes mellitus/hyperglycemia between patients receiving treatment with clozapine (n = 24) and patients receiving treatment with depot (n = 27) neuroleptics in a Department of Veterans Affairs outpatient mental health clinic in the Mid-Atlantic region. Of the clozapine cases without a history of diabetes/hyperglycemia, 27.7% developed diabetes after initiation of clozapine. There were no new cases of diabetes/hyperglycemia in the depot group after initiation of depot neuroleptic. All patients receiving neuroleptic treatment should be monitored for changes in weight, lipid, and glucose levels so that appropriate preventive and therapeutic measures can be promptly initiated.