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Feasibility of Implementing an Erectile Dysfunction Screening Tool in a Primary Care Setting
Başlık:
Feasibility of Implementing an Erectile Dysfunction Screening Tool in a Primary Care Setting
Yazar:
Manaen, Mercy Atieno, author.
ISBN:
9780355992984
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (178 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Marie Fongwa Committee members: Linda Crawford; Ellen Silver.
Özet:
Problem and Significance: Erectile Dysfunction (ED) affects satisfactory sexual function and performance due to the inability to consistently achieve and/or maintain an erection. Research shows that ED and cardiovascular disease (CVD) share similar risk factors. In addition, several medical conditions are linked to ED. Screening for ED is suboptimal in primary care settings despite reports that 49% of men younger than 40 years of age and 52% of men older than 40 years suffer from ED.
Purpose of the Study: The purpose of this translational research project (TRP) was to test the feasibility of implementing an ED self-report screening tool in a local community clinic among men ≥18 years old. The specific purpose and the population intervention comparison outcome time (PICOT) question was Can the use of a self-report screening tool by adult men presenting with ED symptoms increase the timely assessment and diagnosis of ED by health care providers (HCPs)?
Theoretical Framework: The IOWA Model of Evidence-Based Practice (Titler et al., 2001) provided insights on facilitating the introduction, implementation, and evaluation of practice change through the use of an ED self-assessment tool. Theory of Planned Behavior captured the HCPs' behavioral change, while the IOWA model, the theoretical support for this study, embraced the steps in implementing ED in clinical practice.
Methods: A mixed methods and comparative study was conducted in two health clinics in Southern California. The target population was adult male patients 18 years and older. The Sexual Health Inventory for Men (SHIM) was the screening tool. The SHIM is a self-assessment tool that patients completed during a clinical visit before an encounter with their HCPs. The SHIM measures the absence or presence of ED and its severity. The effectiveness of the implementation was determined by (a) an increase in the rate of ED diagnoses in 4 weeks of implementation compared to the rate of ED 4 weeks before implementation of the SHIM and (b) whether participants' self-reported SHIM scores of ≤ 22 (indicating ED) corresponded to the recorded ED diagnoses on patients' electronic health record.
Data Analysis: Data analysis was as follows: (a) descriptive statistics were used to analyze sociodemographic data on age, race/ethnicity CVD risk factors (hypertension, diabetes, hyperlipidemia, obesity, illicit drug use, and cigarettes smoking); (b) t-test for continuous variable was used to compare the mean differences in age between those with and those without ED; and (c) chi-square test was used to examine the differences between the relationship of categorical variables of modifiable and non-modifiable CVD risk factors on ED.
Results: A total of 53 patients with a mean +/- SD age of 42 +/-10 years (range 20 to 60) participated in the study. The SHIM mean score was 18 with a standard deviation (SD) score of 6; a score of ≤ 22 indicates ED. The racial/ethnic groups were re-categorized as Hispanic and Non-Hispanic; the majority of the participants (56.6%) self-identified as Latino/Hispanic Americans. Based on the SHIM scores, those with hypertension and diabetes were significantly more likely to have ED than those without hypertension and/or diabetes (p = .001 and p = .028, respectively). There were no significant differences in being diagnosed with ED, based on the SHIM score. No other demographic variables were associated with ED.
Using the SHIM significantly increased the ED diagnosis rate in the 4 weeks following its implementation. Of the 53 men who completed the SHIM, 32.08% (n = 17) were diagnosed with ED by the HCPs, compared to only 1.72% (n = 5) of those who did not complete the SHIM, z = 8.31, p < .001. This higher diagnosis rate among patients who completed the SHIM increased the overall monthly diagnosis rate for ED from 2.04% in the month prior to its implementation to 6.40% in the month during its implementation, a significant increase even though only 15% of the patients seen actually completed the SHIM, z = 2.98, p < .01.
Conclusions and Implications for Clinical Practice: The SHIM was feasibly implemented in a local community clinic to self-screen for ED among adult men. This study's results showed that utilizing the SHIM as an ED screening tool in the primary care setting can increase ED assessment and diagnosis rates by HCPs. Moreover, screening for ED with the SHIM in the primary care setting can be used to initiate discussions between HCPs and patients regarding sexual health and modifiable CVD risk factors. There is a need for future research to examine if early diagnosis of ED improves sexual functioning and health-related quality of life.
Notlar:
School code: 1323
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
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XX(678360.1) | 678360-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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