Publication Date

2023

Document Type

Dissertation/Thesis

First Advisor

Muzaffar, Henna

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Health Studies

Abstract

In GERD management, PPIs (Proton Pump Inhibitors) represent a significant discovery in gastroenterology medicine and have become widely overused in the United States. For GERD management in outpatient settings, a new, feasible, acceptable approach is needed to diagnose earlier, phenotype the disease accurately, and have structured follow-up to reduce PPI overuse. This study aims to evaluate and compare the feasibility, acceptability, and clinical effectiveness of the Advanced Practice Nurse (APN)- led virtual Clinically Integrated Practice (CIP) model against the traditional office-based model among patients with gastroesophageal reflux disease. A comparative between-group study design was used to compare the feasibility and clinical effectiveness of the two models of care. The study data was from patients seen at the Northwestern Medicine Esophageal Center between June 1, 2021, to June 30, 2022. Semi-structured patient interviews were conducted to understand the APN-led virtual CIP program acceptability. A total of 78 subjects, 39 from the office-based model and 39 from the APN-led virtual CIP model, were randomized, selected based on inclusion and exclusion criteria, and were also matched based on type of PPI use (Omeprazole). To test the difference between the follow-ups in the two groups, an independent-samples t-test was conducted, which did not result in a statistically significant difference in follow-ups, t (76) = .647, p= .519. When comparing the means of post-treatment PPI use in two groups, the results of the paired-samples t-test indicated that the APN-led virtual CIP model was different than the office-based model in lowering the dose of PPI, t (38) = 4.671, p < .001. The association between the models in terms of utilization was not statistically significant, χ2 (1) = .057, p = .812. The association in retention between the two groups was also not statistically significant, χ2 (1) = .463, p = .496. Therefore, we failed to reject the null hypothesis, meaning neither model led to greater utilization or retention. Qualitative data from patient interviews were analyzed using QSR International’s NVivo 12 software and a thematic analysis methodology to evaluate the perceived acceptance of the APN-led virtual CIP program. Eleven themes were identified regarding program acceptance and knowledge improvement in GERD patients. All patients (n = 8) reported that the APN-led virtual CIP model was convenient and saved them time compared to an office-based model. A majority (75%) of the participants acknowledged that the APN-led virtual CIP model addressed their problems similar to the office-based model, and the care was superior to a physician provider in an office-based model. An even more substantial majority (87.5%) reported being fully satisfied with the APN-led virtual CIP program. The education provided by the APN provider was significant enough to reduce the PPI dose in 75% of participants when they followed the diet and lifestyle recommendations, suggesting that the advice empowered them to self-manage their GERD. These results show that the APN-led virtual CIP model can improve PPI use in a subset of GERD patients after 12 months of treatment. Patients who utilize such a program are highly satisfied with the structure, process, and outcome.

Extent

185 pages

Language

en

Publisher

Northern Illinois University

Rights Statement

In Copyright

Rights Statement 2

NIU theses are protected by copyright. They may be viewed from Huskie Commons for any purpose, but reproduction or distribution in any format is prohibited without the written permission of the authors.

Media Type

Text

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