Improving Exercise Prescribing in a Rural New England Free Clinic: A Quality Improvement Project

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Improving Exercise Prescribing in a Rural New England Free Clinic: A Quality Improvement Project

Leavitt, Patricia - Dissertation

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title: Improving Exercise Prescribing in a Rural New England Free Clinic: A Quality Improvement Project

creator: Leavitt, Patricia

subject: Dissertations, Academic.

description: The purpose of this quality improvement (QI) project was to improve exercise prescribing frequency and quality in a rural New England free clinic. The project implemented prescribing guidelines from the American College of Sports Medicine (ACSM) and the American Academy of Family Physicians (AAFP) using the prescribing mnemonic “FITT-PRO” (Frequency; Intensity; Type; Time; and PROgression).Sedentarism, a major contributor to chronic disease and disability, is highly prevalent in the United States, with women, elders, minorities and those living in poverty and in rural settings suffering disproportionately. Primary care provider advice can improve patient exercise rates, yet providers world-wide under prescribe exercise. Prior to this QI intervention, providers at Leavitt’s Mill Free Health Center documented exercise prescribing infrequently (32%). Health center patients also reported a low frequency (36 %) of leisure time physical activity.Nine clinic provider and staff members (100% of clinic personnel) participated in semi-structured interviews to explore provider caring patterns, assess educational needs, and delineate practice and community barriers and facilitators to exercise prescribing. Project interventions included an education program focusing on the use of ACSM and AAFP exercise prescribing guidelines and the adoption of exercise prescribing support and documentation tools.Analysis of the semi-structured interviews was conducted using qualitative descriptive methods. Chart audits (52 pre-intervention and 40 post-intervention) compared documentation frequency and quality of exercise prescribing documentation reflected by the FITT-PRO elements. Prescribing patterns were correlated with patient demographics.Overall exercise prescription frequency increased significantly from 34.6% in the pre-intervention group to 65.0% in the post-intervention group (p<.05). The use of some FITT-PRO elements (frequency, intensity and timing) improved significantly (p<.05). Prescriptive elements that remained lacking in the post-intervention group included specification of exercise type and progression of the exercise program. Further study is needed to determine root causes for these variations. In the post-intervention group, prescribers selectively prescribed to more females than males (p=.04), but did not selectively prescribe exercise based upon patient BMI or chronic illness burden. Valuable insight was gained into the providers’ perspective of the challenges faced by this population regarding an active lifestyle. Further study from the patient perspective is warranted.

publisher: Simmons College (Boston, Mass.)

contributor:

date: 2014

type: Text

format: 1 PDF (88 Pages)

identifier: td_np_2014_pl

source:

language: English

relation:

coverage:

rights: Material from the Simmons University Archives collections are made available for study purposes only. For more information, or to request rights to reproduce or reuse any material, contact the University Archives at archives@simmons.edu.

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