Introduction: In the United States (US) autism spectrum disorder (ASD) affects one in every 100 adults. Yet, Advanced Practice Registered Nurses (APRNs) are often unaware of the existence of this debilitating condition in adults. Consequently, at least 40% of this underserved population are not diagnosed with the condition. This knowledge deficit is due in part to the spectrum nature of the disorder, fragmented screening practices, weak evidence-based recommendations, generational upbringing, and the geographical locale of childhood.

Significance: In the US, ASD lacks evidence-based guidelines as the focus is primarily on children. A comprehensive literature review identified several crosscutting themes in ASD among adults; specifically, provider-level barriers, recommendations for healthcare provider education, treatment strategies, legal and ethical considerations, autism-specific challenges, and the long-range impact associated with aging.

Methods: Utilizing Mezirow’s transformative learning theory, an educational intervention was developed for a Central Florida APRN organization. Instructional methods included a 50-minute lecture using a PowerPoint presentation, and question and answers along with supporting handouts. Pre-test and post-test surveys were administered to assess knowledge retention. Data analysis included frequencies, central tendencies, and test score improvements.

Results: Thirty-four participants completed the intervention. Analysis indicated a 41.4% average improvement in knowledge from pre-to-post-test scores. Participants displayed the greatest improvement in knowledge about referral resources with 79% amelioration between pre-and-post score averages. Those with a formal education in ASD exhibited the highest pre-test score average (50.3%). Those having a close friend or family member with ASD demonstrated the greatest average improvement (48.5%).

Discussion/Implication: APRNs have obligations of care to their adult patients with ASD. In primary practice, there is no screening instrument to diagnose adults with ASD; therefore, the APRN must be aware of its prevalence and symptoms. The APRN must protect these patients from harmful beliefs, comments, and treatments that are not backed by evidence. It is necessary to understand the non-linear nature of ASD to extrapolate the value of interventions and therapies for the individual, which requires ongoing research. Strengthening education and awareness among APRNs may lead to the development of guidelines, which are currently lacking in the US. Future interventions such as this have the capacity to improve patient-provider relationships and care competency for adults with ASD.

Keywords: autism spectrum disorder, adults, outpatient, primary care, nurse practitioners

Committee Members:

Dr. Angeline Bushy, Chair

Dr. Deborah Tedesco, Committee Member

The state of science for autism spectrum disorder (ASD) in the United States varies, but federal
support is weak, leaving decisions regarding support to individual states. Adults with ASD are
an often-overlooked population who have multiple comorbidities requiring self-care. Room for
improvement exists in caring for and identifying adults with ASD in primary care. A literature
review was performed, and three studies analyzing screening tools and provider awareness and
skill were selected for synthesis. These studies were critically appraised for content,
methodology, rigor, quantitative metrics, applicability to the clinical inquiry, and overall
strength. The results were synthesized to make recommendations for practice with implications
pertinent to the locality of Brevard County, Florida.

Keywords: autism spectrum disorder, adults, primary healthcare, screening, synthesis

Telemedicine is a field in its early development. The Health First Virtual Clinic started providing services in January 2017 after vetting quality considerations, reviewing national standards and existing systems, and consulting legal and risk counsel. The virtual clinic utilizes a nurse practitioner to see clients for a variety of urgent care ailments. Clinic goals are four-fold, and include gaining telehealth experience, reducing emergency department visits, preventing the spread of infection, and providing patient convenience. Benefit analysis shows that Health First associates reap the greatest rewards in convenience and savings. Cost analysis shows that with current clinic trends, the clinic’s incurred costs per visit exceed revenue and will continue to do so with increased service use. There is a diminishing return on investment, and the clinic incurs significant projected losses if it maintains operations as-is. Recommendations are made to improve efficiency, to increase marketing to non-Health First associates, and to charge a fee to Health First associates based on existing Health First insurance co-pays. This will reduce the loss incurred to less than $1 per visit while continuing to realize organization goals and exemplify its mission of positively affecting the health and well-being of the community through compassionate, excellent health care.

Keywords: primary care, telehealth, urgent care, virtual visit, financial analysis

Tobacco use is a common, preventable cause of mortality in the United States. Smoking is a significant factor for the development of coronary heart disease and causal factor (up to 50%) for acute myocardial infarction in U.S. adults. After an acute myocardial infarction (AMI), patients who quit smoking up to six months post-discharge from the hospital have significantly lower risk for recurrent AMI, stroke, and death compared to those who continue smoking, and quitting smoking can reduce these risks to almost the same as a never-smoker. Without intervention or care, 60% to 70% of patients return to smoking within one year of an AMI. This limited integrated literature review was conducted to determine if specialized long-term follow-up programs initiated in-hospital had a positive effect on smoking cessation rates for people recovering from AMI, coronary artery bypass graft, percutaneous intervention, or coronary heart disease after discharge from the hospital. Five high-quality studies were included in this limited review, which determined that specialized smoking cessation programs with long-term follow-up by telephone after discharge had a significant positive effect on smoking cessation rates at one-year post-discharge and on the reduction of relapse during that year. These programs have been shown to be cost-effective, and recommendations to policy changes were made to make their inclusion in post-AMI hospital care routine and mandatory.

Keywords: smoking cessation, tobacco, coronary heart disease, hospitalized, telephone intervention