RCHC Community Project Abstracts

Back to preceptor site search page or search by subject

Addressing rural physician shortages through retention: an assessment of physician retention in Ontario, Oregon
Date of project: 9/7/2009

Rural areas continue to suffer from a shortage of primary care physicians. Recruitment of new physicians to these areas as a means to address the shortages has long been studied, but the impact of physician retention is now being examined as an important factor in care access. The role of physician retention in rural town of Ontario has yet to be studied. A descriptive analysis of practice length, specialty and reason for resignation or date of anticipated resignation, if applicable, was completed for 102 physicians on-staff for Holy Rosary Medical Center (HRMC) for at least one month between January 1996 and October 2009. The results demonstrate a significant difference in the average practice years of retained and resigned physicians. They also indicate that the four most commonly cited reasons for resignation are: poor fit, desire for bigger city, completed obligations, and family concerns. Results also revealed high turnover among family physicians following completion of service obligations for visas or loan repayment programs. Finally, the analysis predicted a significant shortage of primary care physicians looming in the near future of this community. Though limited in scope, this study identifies an immediate need for increased recruitment of primary care physicians to Ontario, as well as several starting points for addressing shortages through improved physician retention.

Ontario Greenhouse Project: Phase 5
Date of project: 6/29/2009

Obesity is a nationwide epidemic, and primary prevention is aimed at combating childhood obesity. Malheur County in Oregon has some of the highest risk children in the state. The Ontario greenhouse project has been in the planning process for the past year with Dr. Sandra Dunbrasky, the community pediatrician, and rotating medical students from Oregon Health Science University. The project’s goals are to implement a greenhouse at a local elementary school in order to get students involved in hands-on learning about raising, harvesting, and consuming the CDC recommended daily amount of fruits and vegetables in the hopes that obesity will be successfully prevented. The current phase of the project centers on securing funds to get the program implemented by fall of 2010. Grant proposals were submitted to various national agencies due to the shortage of local donor support in the rural setting.

Ontario Greenhouse Project: Phase 4. Synthesis, Relocation, Curriculum, Design Ideas
Date of project: 3/16/2009

As medical students and simply as residents of America, we have all been made aware of the nation’s increasing problems with obesity. The prevalence of adult and childhood obesity are now at the point of being called epidemics. Unfortunately, the state of Oregon and especially the children of Malheur County are leading this growing trend. Greater than 25% of the kids in Malheur County are considered obese by their screening BMIs. The Ontario Greenhouse Project is an attempt to combat this rising obesity by teaching kids about healthy food, engaging them in the growing and harvesting experience, and ultimately aiming to change the way children think about and choose the food that they eat. Ontario is the largest town in Malheur County and the hopes are that if this project is successful, more school greenhouses and gardens could be adopted throughout the county and state. The first three phases of the project consisted of 1) research into why this idea is needed, how feasible it is to accomplish, and how we could estimate the success of the project after completion; 2) research into similar programs on the West Coast and an estimate of cost; 3) gathering public support by making teacher and parent-oriented presentations, contacting local media to assess their interest in promoting this cause. By the time phase 4 of the project was initiated, the school that had agreed to be the demo school for this greenhouse announced that their principal would be leaving by the end of this school year. Phase 4 then aimed to approach another school with the idea, thus needing to summarize and condense the work already done into an efficient presentation, and to add some more specifics as far as proposed timeline, materials and recommendations for design, and ideas for curriculum in the greenhouse and in the classroom based on other programs and their successes and challenges. A presentation was made to the principal of Pioneer Elementary in Ontario and now the plan for the near future is to present the project to the superintendant and the school board over the next few months.

Phase III of the Ontario Greenhouse Project: Gathering Public Support
Date of project: 2/9/2009

The problem of obesity within the United States has reached what some have labeled as "epidemic" proportions. Over the last 30 years, the percentage of obese adults within the US had doubled, and the percentage of obese children has nearly tripled. Obesity is the result of ingesting more calories than one expends through physical activity. Hence, reshaping the food choices children make on a daily basis can have a lasting impact on both their weight and their health. The Ontario Greenhouse project strives to do exactly that. The project is a multi-phase endeavor to build a school greenhouse in which the entire student body can participate in growing fruit and vegetables that can be served in the school's cafeteria. This hands-on experience would be supplemented by classroom-based nutrition education and instructional sessions in the greenhouse run by farmers and Master Gardeners from the surrounding area. The goal of the current phase, Phase III, was to gather public support by creating teacher- and parent-oriented power-point presentations to introduce the project to administrators, teachers and parents within the district. In addition several local media outlets were contacted and asked to help garner public support by mentioning the project to consumers. Finally, a wide variety of local community members, as well as leaders in the school garden movement, were contacted and asked to participate on an advisory committee for the project. By involving the community in the nutritional education of children, the project aspires to change the way children and their families approach healthy eating, and thereby improve the overall health and well-being of Ontario's citizens.

Acute Psychiatric Care for the Underserved Population of Ontario, OR
Date of project: 2/9/2009

There is an increasing demand for psychiatric care and a decreasing supply of corresponding resources in rural Oregon, including communities like Ontario and greater Malheur County. Although availability and access to psychiatric care is a problem throughout the United States, significant obstacles exist in rural areas that create unique issues that are not easily overcome. Specifically, while primary care physicians serve to treat common mental health conditions such as anxiety and depression as part of their daily practices, specialty care needed to treat more complicated mental health cases and acute psychiatric crises are becoming increasingly scarce. In the case of the emergency room, hospital staff must overcome a number of hurdles when assessing, evaluating and referring every single psychiatric patient. This is especially evident at the Holy Rosary Medical Center (HRMC) hospital in Ontario, Oregon, where numerous factors combine to make treatment for the acutely mentally ill frustrating at best and impossible at worst. The goal of this project was to: 1) formally investigate these problems and complications; 2) discuss the barriers as they exist in their current state; and 3) suggest some reasonable recommendations that could be implemented to improve present conditions.

Phase 2 of Ontario Greenhouse Project: Learning from other successful programs, estimating initial cost, and initiating community involvement
Date of project: 9/8/2008

The children of Malheur County are greatly affected by obesity with a current rate of obesity that is 13% greater than the rest of Oregon. Obesity among children can be partially explained by the fact that children of Malheur County are eating fruits and vegetables far below the USDA recommendations. The goal of this project is to work towards introducing a greenhouse program at an Ontario school that will involve the student body in growing fruits and vegetables. Hopefully, such a program would curve the students’ food preferences towards more fruits and vegetables and help reduce obesity among the children. This will be a multiphase project, of which this is the second phase. The aims of this phase include: (1) learn from other greenhouse programs (2) estimate the cost of starting the program, and (3) initiate community involvement. These aims will be accomplished through review of available literature, interviews with members of the Ontario community, and contacting people from other greenhouse programs in Oregon. One can get many ideas and resources from other programs. The estimated original cost may range from $5-20K depending on the size and complexity of the greenhouse. Community involvement may be at an individual level, business level, and may include the local hospital and Malheur County Experiment Station.

Phase I of the Ontario Greenhouse Project: Assessing the need for and Feasibility of a School-based Nutrition Education Program in Ontario, Oregon
Date of project: 8/4/2008

The prevalence of childhood obesity in the United States has continued to increase over the last three decades to its current rate of 17%. The problem is particularly felt in Malheur County on Oregon’s eastern border, where greater than 1 in 4 children are obese. The Rural Clerkship preceptor in Ontario (Malheur’s largest town) has proposed a Greenhouse Project to address this problem, starting with a local elementary school. The aims of this phase of the project are three-fold: (1) to assess the need for such a school-based intervention, (2) to assess the feasibility of the Greenhouse Project, and (3) to estimate the successfulness of such an intervention. These aims were accomplished through review of the available literature and interviews with pertinent members of Ontario’s community, including members of an Ontario elementary school identified as a likely pilot site for the greenhouse. It also appears that the project is much needed, due to a lack of nutrition education in the targeted elementary school, as well as the aforementioned severity of the countywide childhood obesity problem. Additionally, the Greenhouse Project has potential to be a successful program; a few major concerns regarding the burden of this project on the school district were brought to light and suggestions are made herein as to how they can be addressed. It is hoped that this project can be carried through to completion with the help of other medical students that will be coming to Ontario for their Rural Clerkships in the future.

n=1 or n=1 x 10? An Individual Perspective on Population-based Healthcare: A Case Study
Date of project: 6/30/2008

In the United States, cardiovascular disease (CVD) affects 80.7 million (37.l%) individuals, is responsible for 869 thousand deaths per year, and generates an estimated $448.5 billion in annual economic costs. There are an ever increasing number of large epidemiologic studies, trials, and meta-analyses dealing with primary and secondary prevention of cardiovascular disease and its complications. New management and treatment guidelines are constantly generated and old ones discarded, updated, or revised, but the burden of CVD continues to increase. Oregon Health Division vital statistics show that Malheur County, location of my Rural and Community Health Clerkship, has a significantly higher than average death rate due to cardiovascular disease. The goals of this inquiry are twofold: one, to develop an understanding of Community Oriented Primary Care (COPC) within the context of a disease that is as relevant to populations in Malheur County as it is those in places like Orange County or Miami-Dade County and two, to evaluate some of the strengths and weaknesses of population-based perspectives like COPC on clinical outcomes for individual patients or the economics of healthcare.

Resources for Children with Autism Spectrum Disorders in Ontario, OR: Development of Resource Planning and Information Brochure
Date of project: 10/15/2007

In Malheur County, the number of children with an autism spectrum disorder is estimated to be the highest in Oregon.1 The purpose of this project was to determine what resources were available to the population in theory and in actuality from interviews with healthcare providers, schools, therapists, and parents. The state provides for therapy as needed for each child to be delivered through the school, but the limited number of therapists in the area demonstrated that only a bare minimum of services were actually delivered, leaving many parents frustrated and hopeless. Furthermore, due to limited education resources, many parents did not fully understand the disorder, itself, or the services that were available to them. This project focused on determining what services existed and what could be further offered. In addition, a brochure was developed to give to parents, educating them on the basics of the disease, techniques to use at home, and resources that were available to them.

Utilization of an electronic medical record to monitor and improve preventive healthcare at Ontario Family Medicine
Date of project: 7/2/2007

Preventive healthcare is an integral part of providing primary care. To guide the use of preventive services, the U.S. Preventive Task Force and Center for Disease control have established based recommendations for health screening and vaccinations. Despite strong evidence supporting the importance of preventive healthcare, the rates of providing these services are often less than ideal in the time pressured setting of primary care. However, the use of electronic medical records with health screening features has been shown to dramatically improve service rates. Ontario Family Medicine is currently using PowerMed electronic medical record, but has not been utilizing the Health Screening section of the program. This project aims to take the first steps to utilize an electronic medical record's health screening capability to improve the provision rates of preventive services in a rural primary care setting. Using current Task Force and CDC guidelines a list of core recommendations that fits the adult patient population of Ontario Family Medicine was established. These recommendations were entered into the program, and then cross-linked to orders so that when an order is entered, it will automatically update the patient's Health Screening section. Next the practitioners and clinic staff were trained on how to view the new Health Screening section, and enter orders. Finally the programs ability to generate reports on overall practice screening rates was evaluated.

Obesity and Delinquency in Ontario Public Schools: A prescription for better schools and healthier kids.
Date of project: 4/30/2007

The pediatric population is unique in that for six-to-seven hours in a given day they spend their time in a controlled environment. The objective of this study was to review the literature and make recommendations that could be instituted by the school district to address two concerns in this population: obesity and delinquency. Many comments were made by health care professionals and community leaders about these problems, particularly the increased disruptive behavior, drug and gang activity in the middle school. Though the school district was restructuring its schools to meet these new challenges, alternative solutions were being sought. A review of the literature revealed a number of strategies that could be implemented by the school district to decrease disruptive behavior and the trend in obesity. First and foremost, returning sixth graders to the elementary schools will decrease disruptive behavior in the middle schools and will decrease the likelihood that these children will continue such behavior into later school years. In addition, scheduling recess before lunch can decrease after-lunch classroom rowdiness and increase instruction time by up to 10 minutes. In addition, children make healthier food choices and waste less food; this can translate into cost-savings for the school district. Lastly, instituting a universal school breakfast program also contributes to children making healthier eating habits during these impressionable years.

Cattle Related Injuries in the Treasure Valley
Date of project: 4/30/2007

The beef cattle industry is a $71 billion per year industry providing 28.0 billion pounds of beef to the U.S. public (USDA background statistics 2006). The beef cattle industry is also an important part of the economy of Ontario, Oregon. However, this industry is also subject to a wide variety of hazards and is considered one of the most dangerous industries in the United States and in the State of Oregon. This study attempts to identify the most common causes of agricultural injury by searching national databases, performing a local study and participating in local ranching activities. According to the national database, the most common fatal accidents were caused by tractor and machinery. The most common non-fatal accidents were related to livestock. These accidents were most commonly crush injuries followed by falls. In the local survey, there was a difference between the most common injury reported health professionals and local ranchers. This is likely due to differences in the rancher’s threshold for seeking medical attention based on the type of injury.

West Nile Virus in Malheur County
Date of project: 1/1/2007

Malheur County, Oregon recorded 52 cases of West Nile virus (WNV) infection during the 2006. This was a dramatic increase from 8 cases the previous year. Cases were investigated by the Malheur County Health Department (MCHD) and forwarded to the state Department of Human Services (DHS). No summary document was generated locally for the epidemic. This left providers without up-to-date information regarding risk for infection and treatment of lasting effects. My project was to generate a provider education pamphlet that included 1) a summary of the 2006 epidemic in Malheur County 2) a review of journal articles regarding the lasting effects of WNV 3) information on clinical trials currently enrolling cases, and 4) predictions for the 2007 season. This pamphlet will be printed and distributed to Malheur County providers by the MCHD

The Development of a Systematic Approach to Mental Health Evaluations at Treasure Valley Pediatric Clinic in Ontario, OR
Date of project: 9/11/2006

Treasure Valley Pediatric Clinic (TVPC) in Ontario, Oregon has a significant number of patients that are seen for mental health care with ADHD accounting for the majority of these cases. The clinic has a total patient population of approximately 5600 patients and 204 (3.6%) patients have a diagnosis of ADHD. Other common mental health issues seen at the clinic include depression (129 patients), anxiety (51 patients), and autism (25 patients). With a staff that includes one pediatrician, two physician’s assistants, two counselors, and a registered nurse that acts as a care coordinator, TVPC is well-equipped to meet the mental health needs of its patients, but it lacks a unified approach to the initial evaluation of these patients. The goal of this project was to learn more about how initial mental health evaluations are performed at the TVPC and to work with the various healthcare providers at the clinic to develop a unified approach to these evaluations. The final product of this project was the development of a protocol for initial evaluation of patients with possible ADHD and other mental health concerns.

Public Health Interventions Regarding Sun Safety in Ontario, Oregon
Date of project: 5/1/2006

Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television.

Public Health Interventions Regarding Sun Safety in Ontario, Oregon
Date of project: 5/1/2006

Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television.

Maximizing Access to Prescription Medications in Ontario, Oregon
Date of project: 3/20/2006

Medicare Part D is an insurance plan for prescription medications that recently became available to everyone enrolled in Medicare. It was designed to provide coverage for prescription medications regardless of income, health status, or costs. With over 450 different plans available in Oregon, and insurance coverage that varies depending upon prescription costs, many patients have questions about choosing a specific plan, and determining if Medicare Part D is right for them. The deadline for joining Medicare Part D without penalty is rapidly approaching, making it even more important for patients to be able to make informed decisions in a timely manner. This study looks at how residents in Ontario, Oregon are making important decisions regarding Medicare coverage, and identifies resources that patients have found useful. In addition, some of the complications with Medicare Part D have been identified, so that they may be avoided in the future. It is hoped that the results of this study will help patients make informed decisions about Medicare Part D, and maximize their access to prescription medications.

School healthcare in Malheur & Multnomah counties: An argument for School Based Health Centers
Date of project: 1/2/2006

Diabetes and asthma are two of the most common diseases afflicting children. As chronic ailments, their acute and long-term management are very important in preventing crises and slowing disease progression. With Oregon law not mandating a nurse in schools, the management of these diseases can become the responsibility of school staff, especially in underserved counties. In this study, quality of school healthcare management of type I diabetes and asthma was assessed in 9 schools in Malheur County. A survey consisting of 12 questions assessing acute critical and chronic management and education competency was conducted by telephone with each school’s primary healthcare provider. The Malheur County mean score was 2.3 out of 12 (SD 1.0). A higher score of 11.375 (SD 0.744) was obtained through survey of 8 schools in Multnomah school district, all of which have at least a part time nurse or a School Based Health Center (SBHC). This study identified that Malheur County had a sufficient database of the protocols for the acute and chronic management of asthma and diabetes, but lacked knowledge in recognizing clinical situations and educating students on disease management. Their staff consists of school secretaries who receive a health source guide and instruction from a registered nurse once annually. While financially expensive, a possibly more efficient and long-term cost-effective solution for Malheur County could be the School Based Health Center. This system has been shown to provide large savings in direct costs of healthcare for school aged children and almost double the service value of each invested tax dollar. It also offers basic healthcare to the uninsured and the intangible benefits such as improved attendance and school performance in the classroom.

Ontario Health Initiative for Children
Date of project: 1/2/2006

The prevalence of childhood obesity has more than tripled in the past 2 decades. As this number continues to rise, it is imperative that children become more educated about how they can live healthier lifestyles. The CDC indicates that the rise in obesity within the US is primarily due to poor nutritional intake and decreased physical activity levels.(5) This project focuses on educating the Ontario community and specifically the 4th grade classes at Alameda Elementary about how to balance good nutrition with daily physical activity. In accord with the CDC recommendations about health education and clinical experience, a poster was created to convey straightforward, attainable goals relevant to all age groups. This medium was chosen to create a publicly displayed message visible throughout the community: at the Treasure Valley Pediatrics clinic, Alameda Elementary, the upcoming Ontario health fair. Hopefully, this will help increase awareness about the importance of nutrition and physical activity in Ontario and lead to a healthier, more active youth.

RESUSCITATION STATUS IN A RURAL HOSPICE Predictors of status & ease of identifying patient preferences in emergent situations
Date of project: 9/12/2005

Hospice is a growing resource in American health care that is being increasingly utilized by greater proportions of the population. In order to receive full hospice benefits, a terminal diagnosis with less than six months of expected life is required. Yet, a DNR status is not mandatory for patients who accept hospice benefits. This study attempted to identify patient characteristics that may make a hospice client more or less likely to choose a specific resuscitation status. Methodology included a chart review of 237 patients of Heart n’ Home Hospice and Palliative Care, in Fruitland, Idaho. This hospice first opened in April, 2004. The files surveyed represent all clients of this business thus far. Specific patient characteristics including resuscitation status, age, sex, hospice diagnosis and religious preference were analyzed. Additionally, impromptu hospice employee interviews provided further data concerning project limitations as well as helped to identify an area of need for which this project could serve a purpose. Though unintended during original inception, this project prompted standardization of resuscitation status within the hospice files. Therefore, the final outcome of this project is a standardized system for which emergency inquiries into a particular patient’s resuscitation status could be quickly answered.

Underutilization of Hospice Services in the Treasure Valley Area: Are we referring patient too late?
Date of project: 8/8/2005

OBJECTIVES: To assess utilization of hospice services in the Treasure Valley area and determine if these services are adequately being used. To determine the views and attitudes of family members and hospice care providers regarding timing of referral. SETTING: Treasure Valley including Ontario, OR, Fruitland ID, Payette ID and neighboring towns. DESIGN: Retrospective analysis of hospice patient charts and Family Evaluation of Hospice Care (FEHC) records from 2004 and 2005. In addition, hospice care providers were surveyed about the timing of referral and usefulness of services offered. PARTICIPANTS: Deceased patients at Heart’N Home Hospice and their surviving family members. Hospice staff including physicians, nurses, counselors, social workers, chaplains, home health aides, and volunteers. MEASUREMENTS: Length of time patients received hospice care, family’s opinion regarding timing of referral (too early, at about the right time, too late) and hospice providers’ perceived average length of stay on hospice and perceived optimum length of stay. RESULTS: Chart review of 126 deceased patients revealed a mean length of stay of approximately 3 weeks. 40 families completed the Family Evaluation of Hospice Care and up to 20% thought that the patient was referred too late and that lack of information was the most common reason. 80% thought that referral was made at the right time. The majority of hospice care providers who responded to the survey believe that the optimum length of stay is 6 month. In addition, most thought that patients stayed on average between 2 and 4 month on hospice. CONCLUSION: The results indicate that in the Treasure Valley area, many family members and hospice care providers feel that terminally ill patients are referred too late and that they could receive greater benefits from longer stays on hospice. The actual length of stay is consistent with that of hospice patients nationally which shows that we are in fact patients are admitted late in the process of end-of-life care. Future effort should focus on patient’s opinion of referral timing and level of awareness of referring physicians regarding prognosis and eligibility characteristics. Hopefully, this could lead to improvements in referral and admission practices.

Investigation of the Pneumococcal Vaccination Policy at Holy Rosary Medical Center in Ontario, Oregon
Date of project: 4/25/2005

Pneumonia, bacteremia, and meningitis are common clinical manifestation of pneumoccoccal disease caused by streptococcus pneumoniae. Pneumococcal disease causes more death than any other vaccine preventable bacterial disease, and antibiotic resistance, especially against penicillin, has emerged. A vaccine to prevent pneumococcal disease has been available for decades, but is currently underutilized. The ACIP recommends implementing a standing order policy to increase vaccination rates. Holy Rosary Medical Center in Ontario, Oregon developed a vaccination policy that includes a standing order and a screening tool, but vaccination rates have not increased. This study investigated possible obstacles preventing the implementation of the vaccination policy. The three largest obstacles appear to be making sure that copies of the screening tool and preprinted order form are readily available and placed on every chart, educating the staff about the policy, and adequately communicating with the patient's primary care provider.

Assessment of Fluoride Concentration in the Drinking Water in Ontario, Oregon and Surrounding Areas and Recommendations for Fluiride Supplementation for the Pediatric Population in this Community.
Date of project: 3/21/2005

Tooth decay is one of the most common problems facing the population. Fluoride has been shown to be an effective means of helping slow or reverse the progression of disease. Excessive fluoride intake can lead to fluorosis, a poor cosmetic result. This risk necessitates optimization of fluoride intake. The average intake of fluoride in the community, based on its concentration in drinking water, was assessed by phoning various water treatment plants in the surrounding communities. Then, using extensive research data complied from multiple sources, a specific set of recommendations for fluoride supplementation in the pediatric population were made based on fluoride intake in the community in which the patient lives.

Increasing Access to Prescription Medications in the Elderly Population of Malheur County
Date of project: 2/7/2005

Many elderly patients take prescription medications on a daily basis; however, the rising costs of these medications make it difficult for patients, especially those with fixed or low incomes, to afford them. For elderly patients in the rural setting, the problem of access to affordable medications is even greater because of the lack of social workers and other staff available to assist patients with applying for prescription assistance programs, Medicare discount cards, and other lower-cost prescription medication programs. Many patients report that their prescription drugs cause them financial hardship. This often leads to patients skipping or cutting down on doses or not filling the prescriptions at all. This is frustrating for both the patient and physician who both are trying to manage what are usually complicated medical conditions. Oftentimes, the physician, nurses, and other office staff take on the responsibility of helping patients access medication assistance programs, which is both time and resource consuming for the staff. This project looked at the elderly population represented in one family practice office in Ontario, Oregon, which is the largest city in Malheur County. A prescription drug questionnaire was utilized to query patients about out-of-pocket prescription medication costs, methods of cost savings (e.g. buying online, skipping doses, etc), and knowledge about cost saving prescription drug programs. A total of 22 patients, age 65 and over, completed the survey, with 45% responding that the cost of prescription medications cause them financial hardship. These patients spent an average of $187.00 a month on prescription medications, and 70% report having no prescription drug coverage. Of the 55% that did not experience financial hardship, 92% had some type of drug coverage and spent an average of $49 a month on medication. Of all the patients surveyed, 45% report using cost-saving methods, including using mail-order companies in Canada, price comparing among different pharmacies, using samples, skipping doses, and not filling prescriptions. Ultimately, the goal of this project was to identify ways to help patients gain access to affordable prescription medications in the most time and resource efficient manner. Development of a simple one page handout with prescription medication resources and consumer buying tips, which could be easily distributed to patients, was found to be the most efficient and helpful to patients.

Emergency Medical Services in Malheur County
Date of project: 1/3/2005

During my rural health rotation in Ontario, Oregon, I completed a community project about the local EMS system. I gathered information by speaking with members of the EMS service including the Fire Chief of the Ontario Fire Dept., Paramedics working for Treasure Valley Paramedics, and the Medical Director of the EMS service. I also observed first hand how the system operates while riding along with the Treasure Valley Paramedics. I focused my study on how the EMS service is structured and what challenges it faces providing for the medical needs of citizens in a rural area. The main challenges that I identified are the need to cover a large, sparsely populated area, scarce resources including money, equipment, and trained personnel, and the fact that the system has a low capacity that can easily become overwhelmed.

Physical Activity in Children and Adolescents in Ontario, OR
Date of project: 1/3/2005

Obesity has become a major health concern in the United States over the past several decades. When attacking this overwhelming problem, two areas are often targeted in order to keep obesity at bay: nutrition and physical activity. Despite their equal importance in a healthy lifestyle, physical activity is often overlooked in favor of nutrition, hence the popularity of fad diets and the current anti-carbohydrate campaign. Unfortunately, these trends are often short-lived and allow for little long-term success. For significant and more permanent change, patient education is an absolute necessity. At the Treasure Valley Pediatric Clinic in Ontario, Oregon, the primary method of patient education came in the form of a handout, whether the health issue was constipation, acne, or nutrition. Glaringly absent from this selection of handouts was any information regarding physical activity and exercise. The aim of this project was to evaluate the level of physical activity in the community, particularly with children and adolescents, and then create a patient handout that would provide education regarding ways to improve current fitness levels. Ultimately, the level of physical activity was found to be inadequate among children and adolescents in Ontario, Oregon; therefore, a kid-friendly brochure was produced and distributed at the pediatric clinic with the hope that early education could lead to a lifetime of healthy habits.

Farming and Ranching Injuries in Ontario Oregon: Survey of injury occurrence and development of a patient handout on farm safety
Date of project: 7/5/2004

In Ontario Oregon, where agriculture is a cornerstone of the economy, farming and ranching injuries contribute to the morbidity and mortality of the community. The main objective of this study is to understand the epidemiology of machinery, livestock and exposure related injuries that affect those patients and their families seen at Dr. David Brauer’s family practice clinic. Approximately forty percent of Dr. Brauer’s patients are part of the agriculture industry. A survey of farming and ranching patients was conducted over a four-week period that evaluated if the patient, a family member, or employee had been injured in a farm or ranch related accident in the last two years. The second part of the study reviewed a random set of hospital charts coded for occupational injuries. The same statistics were recorded for both the patient survey and the chart review, and the data was compiled for the final assessment. Only twenty eight percent of 60 patients surveyed remained free of injury over the last 2 years. The highest rate of injury in the clinic survey occurred with machinery, then livestock, and lastly exposures. In the random chart review of thirty charts, livestock related injuries were the highest, followed by machinery and exposure related. After combining the two data sets, most injuries occurred to the upper extremity, and the 25-50 year old age group was at highest risk for injury. To complete the project, a patient handout was left at the clinic that details the findings specific to Ontario Oregon in the hopes to raise safety awareness. Mechanisms to avoid injuries by age groups are discussed in the handout. In conclusion, there is a need for a more detailed evaluation of ranching and farming injuries over a longer period of time with increased subject numbers in Ontario, Oregon and the outlying areas. It will also be important in the future to understand how effective tools are in increasing safety awareness.

The Ontario Aquatic and Fitness Center
Date of project: 5/10/2004

Intro: The Ontario Aquatic and Fitness Center offers opportunities for people of Malheur County to swim, lift weights, or participate in water aerobics. After arriving in Ontario, it was mentioned that funding for the center was in jeopardy. After talking with my preceptor, individuals at the center, and other local health care professionals, I decided to create a usage survey for the facility to try to help determine who was using the center and for what specific reasons. Materials/Methods: A simple survey was designed asking for age, city of residence, average number of visits to the center in a month, and the main reason for the visit to the center. Five options were listed to select from for the main reason for the trip to the center. Results: 67.4% of the respondents used the center for water aerobics, which was indicated as their main form of exercise. Average age of this group was 67, with an average number of monthly visits of 12.3. The next largest group (18.4%) used the center for its gym, which was the main place they worked out. Average age was 39.6, with average monthly visits being 15.7. The remaining groups were those using the center for water aerobics, which was not their main form of exercise (10.2%), for physical therapy (2.0%), and for recreational swim (2.0%). Conclusions/Discussion: The results of the survey indicated that the center was utilized mainly by the geriatric population for water aerobics, which was their main form of exercise. The gym was used as a main work out facility by another large group, who tended to be of a younger generation. Average number of visits per month by each group was impressive. Given the benefits of exercise in several medical conditions, such as hypertension, diabetes, and osteoporosis, the center is serving a beneficial role in the health and well-being of many of Malheur county’s residents, particularly the elderly.

School Vending Machines and Obesity in Ontario, Oregon
Date of project: 3/29/2004

Obesity is an epidemic among adolescents in America. Overweight children are at risk for many diseases as children and later as adults. There are myriad factors that have contributed to the current epidemic. These factors have been termed a “toxic environment.” I evaluated the food environment at Ontario High School to address what factors at school contribute to a toxic environment. My study found that 40.9% of students at Ontario High School were overweight or at risk to become overweight. This is well above the national rate of 30.4%. A survey assessed reasons for meal termination and the number of snacks purchased from school vending machines. Overweight adolescents were more likely to stop eating because of external cues than healthy weight adolescents. Overweight students drank nearly 2.5 times more soda pop than those of healthy weight. Using this data, a letter was sent to Ontario High School’s principal and school board members strongly encouraging the elimination of soft drink vending machines from school.

Transition Services for Children with Disabilities in Malheur County Oregon
Date of project: 1/5/2004

Children with disabilities often have multiple medical problems and members of their pediatric healthcare teams who are very involved with their lives, but as the transition from childhood to adults, they may be at risk for inadequate healthcare. They are also more likely to be unemployed or earn lower wages as adults than children without disabilities. If those children and parents are provided with adequate resources during the school-age years, they will be more apt to have a smooth transition to adult healthcare providers, hold down a job, play a role in the community, and possibly live independently as adults. Parents visiting the Treasure Valley Pediatric Clinic are often unaware of resources available to their children for these purposes. This project addressed resources available in Malheur County, Oregon to help children transition from childhood to adulthood. Organizers at Ontario High School, The Malheur County Health Department, and Treasure Valley Pediatric Clinic were contacted. Topics addressed included medical care, vocational training, secondary education, and independent living. This project found that though there are many resources available for job training, life skills, secondary education, and community activities while children are in school, more need to be available to address recreation and healthcare transition from pediatrics to adult care.

The Influence of Soft Drinks in the Ontario, Oregon School District
Date of project: 1/5/2004

Childhood obesity is an epidemic in the United States with numerous medical, social, and occupational consequences. Obesity is a complex problem, influenced by genetics, home and school environments, and social pressures. Soft drinks have been one target of obesity opponents: soft drink consumption has been linked to obesity in several studies. One battlefield for soft drink influence has been in public schools across the country. My goal was to explore the consumption of soft drinks and the effects of advertising in the school system of Ontario, a rural community of roughly 10,000 people in Eastern Oregon. To accomplish this end, I spoke with the district food service coordinators, high school principal, and school district superintendent, as well as representatives from PepsiCo. Through these interviews, I sought to uncover each person’s opinions about the causes of childhood obesity, the influences of soft drink advertising, and the role of schools in implementing nutrition programs. Lastly, I hoped to raise awareness of childhood obesity and its health consequences, as well as the negative effects of soft drink consumption in schools through an informational pamphlet.

Treasure Valley Pediatrics in Ontario "Social Stories"
Date of project: 9/29/2003

Treasure Valley Pediatrics in Ontario sees a large number of autistic patients. Autism, a pervasive developmental disorder that has a wide spectrum of clinical manifestations, makes it very difficult for these children to adjust to new situations. Any change in their routine, such as visiting a doctor or dentist, especially if some procedure is to be done, is highly distressing to these children, and in many cases they cry uncontrollably, attempt to run away, and in general make it rather difficult for the clinician to care for them properly. Despite their social adjustment difficulties, autistic children are strong visual learners, and it has been shown that showing them pictures of an upcoming activity helps them adjust better to the new situation. For my community project, I visited the providers in Ontario that see autistic children, 3 dental practices, and ear, nose, and throat clinic, the outpatient surgery unit of the hospital, as well as the pediatric practice of which I was part, and photographed the staff, facility, and equipment. I then put these digital pictures into book files that can be printed for patients or emailed to other providers, at the discretion of the care coordinator for the pediatric practice. We called them “Social Stories.” On the first day the Social Stories were available, 3 families and several schools requested copies.

One community's response to a chronic shortage of psychiatrists: Telepsychiatry
Date of project: 11/10/2003

In Ontario, Oregon, one major issue in the access to psychiatric care and in the continuity of that care is a paucity of mental health providers. This project considers one alternative currently in use in the community-telepsychiatry. Telepsychiatry is effective and convenient in appropriate populations. Interviews of employees of two of three mental health agencies serving the Ontario region were conducted, exploring use of telepsychiatry. The correctional institution in Ontario provides mental health services to inmates by teleconferencing equipment based in Ontario and Portland, Oregon. This is a successful mode of treatment, delivering increased access to care, increased public safety and patient satisfaction. The community psychiatry agency in Ontario, Lifeways, utilized telepsychiatry until costs overcame that effort. They were informed about the Federal Commmunications Commission's support for rural telemedicine efforts.

Evaluation of Occupational Asthma in Ontario, Oregon
Date of project: 7/7/2003

Asthma is a common problem in the general population. Most of us are aware of the more common precipitating factors of asthma, such as allergens, exercise, infections, medications, and emotions. Fewer of us are familiar with those associated with occupational asthma. I became interested in occupational asthma during my rotation in Ontario, Oregon because my preceptor was a pulmonologist and because much of Ontario’s economy depends on industry and agriculture that works with known occupational hazards. In comparing the estimated prevalence of occupational asthma in the literature with the actual prevalence in my preceptors practice, I began to wonder whether or not occupational asthma was being under-diagnosed in Ontario. To evaluate this, my preceptor and I came up with a three part system to crudely estimate undiagnosed cases of occupational asthma relative to general asthma.

Improving preventative services in adolescents: developing a screening questionnaire and health education material.
Date of project: 8/18/2003

Adolescence is a period of life associated with multiple risk-behaviors. Although some might consider these behaviors developmentally appropriate given the limited insight and immature cognition of adolescents, it is critical to realize that risk behaviors account for a significant majority of adolescent morbidity and mortality. Over 75% of adolescent deaths are, for example, attributed to behavioral causes. From drug use to depression, there is much that needs to be done to serve the needs of this unique population. Consequently, several physicians and national organizations have emphasized the need for a greater focus on preventative services in adolescents. Since adolescents visit physicians infrequently, rarely make health maintenance appointments, and often have limited continuity of care with their health care provider, there is definitely a challenge to offering preventative services in this population. Despite these obstacles, this project aimed to enhance adolescent preventative care in a busy pediatric clinic. A trigger questionnaire was developed to serve as a screening tool. The questionnaire was designed to be completed in the waiting room, and thus offers a means to enact preventative services even when the chief complaint is something other than a health maintenance visit. This questionnaire is intended to offer providers guidance as they counsel adolescents. Health education materials offer an effective means to follow up on issues identified by the screening questionnaire. Another component of this study involved conducting a survey of the clinic's health education materials on key adolescent health concerns to determine what materials were still needed in the clinic. In response to the identified needs, an adolescent-oriented informational handout about alcohol use was created.

How ADHD Children are Diagnosed and How they are Cared for in the Community of Ontario, Oregon.
Date of project: 7/7/2003

Attention-Deficit Disorder (ADHD) is now one of most common chronic childhood disorders. My goal for my project was to learn more about ADHD and how it affects a private office. Also, I wanted to know what resources the office brought to bear to handle this disease. The design was mostly observational. I did do a few interviews of office staff and patients. Since, there is not a physical test that can be run, like a CBC or MRI, to diagnose ADHD I also wanted to learn how to make a diagnosis. Then, after getting a diagnosis I wanted to know how kids in this community were being helped. Some comparisons were made between national guidelines and how children in the Ontario area were being cared for. In my project work I found out that this clinic does have a way to diagnose ADHD and a variety of ways that they use to help these patients.

Guidelines for the Assessment of Driving Capacity in the Elderly
Date of project: 8/18/2003

As the elderly population continues to grow in the United States, physicians are acquiring the difficult task of assessing their patients ability to drive. Physicians frequently encounter questions regarding an individual's driving capacity. However, many doctors are not aware of resources available to help them in their assessment. Moreover, state requirements vary significantly. Most states have permissive reporting laws regarding the doctor's role in medical evaluation and managment for fitness to drive. Such laws offer physicians little guidance and may put doctors at risk for lawsuits if they report a patient to the Department of Motor Vehicles (DMV). Seven states, including Oregon, have mandatory reporting laws. In these states, a doctor may risk legal action for not reporting a patient. The purpose of this project was to elucidate helpful guidelines for rural doctors with geriatric patients in assessing fitness to drive. Another goal was to determine how a rural community affects this decision.

Prevalence of Methamphetamine Abuse in Ontario High School, Ontario, Oregon: A demonstration of the spread of methamphetamine abuse to rural communities
Date of project: 11/4/2002

Methamphetamine is a drug of abuse which has been traditionally used in urban areas by mostly white, male, blue collar workers on the west coast. Attributes of this drug, such as its low cost, ease of production, and longer half-life, have led to its spread into more rural areas. This study surveyed 104 high school students in Ontario, Oregon, a town of about 10,500 people, in order to identify attitudes regarding and use of methamphetamine in this rural community. Students were administered a 22 question survey designed to measure exposure, use of, and attitudes towards methamphetamine and other common drugs of abuse. While students generally acknowledged the danger of methamphetamine, comparing it to drugs like cocaine and heroin, 7.7% (8/104) acknowledged use of the drug, a rate nearly twice the national average. Further, 1 in 3 acknowledged having been in the presence of others intoxicated by methamphetamine, 1 in 4 stated they had friends who had used the drug, and a majority (52.9%) knew people who had used the drug. Methamphetamine was also readily available. Half stated that they knew someone who could give or sell them methamphetamine, and more than 1 in 5 (21.2%) had been offered the drug at some point. While exposure is rampant, the attitude that methamphetamine is a dangerous drug is prevalent. This presents a unique window of opportunity for the community of Ontario to address this problem amongst a still receptive audience.

The Prevention of Firearm-Related Injury and Death in Children in Malheur County, Oregon: How One Community Promotes Gun Safety in Children
Date of project: 9/23/2002

Firearms are the second leading cause of death in children in Oregon. Studies have shown that counties in Oregon with a high rate of gun ownership are more likely to have a high gunshot death rate.1 Malheur County, as well as other counties east of the Cascade range, have high gun ownership rates. Children in these counties were 39% more likely to die from gunshot wounds between 1987 and 1996.1 These statistics place children in Malheur County at high risk for gun-related injuries. My project examined measures taken in Malheur County to promote gun safety, and prevent gun-related injury and death in children age 0-19. I researched public policy and community-based interventions, school programs, hunter education and other gun safety classes, and health care provider counseling of parents and children. In general, Malheur County addresses gun safety primarily by educating parents and children on safe behaviors. National studies have shown these efforts to be surprisingly ineffective. Thus, health care providers and local community leaders must find creative, more effective ways to decrease the number of firearm-related deaths in the community.

Providing a home: a place for children with special health care needs
Date of project: 8/12/2002

Pediatric and adolescent patients currently have limited resources for obtaining mental health care and counseling. Three primary reasons exist for this lapse in health care. These include having only one option for Medicaid patients, the social stigma associated with going to a mental health care clinic, and limited physical accessibility. For all these reasons, these children do not obtain treatment or counseling. Another issue that has resulted in fragmented and incomplete care is the lack of communication and coordination between mental health care providers and the primary care physician. Treasure Valley Pediatric Clinic in Ontario, Oregon has become acutely aware of the shortcomings of the mental health care that is offered in our community. Nationally, children with special health care needs constitute 16-18% of all children. A low estimate shows that in the last three months alone, 14.7% of office visits at Treasure Valley Pediatric Clinic comprise seeing CSHCN. In trying to provide complete health care to children, the American Academy of Pediatrics developed the concept of the medical home. In an effort to meet the ideals of the medical home, TVPC presently employs a care coordinator. Unfortunately, this does not address many of the concerns facing mental health care in this community. TVPC wants to expand the medical home by incorporating mental health in a neutral and comfortable environment within the pediatric clinic where routine care is provided. In doing so, TVPC strives to provide accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care to children with special health care needs.

Heel Ultrasonography for Osteoporosis Screening
Date of project: 2/11/2002

Heel ultrasound is a highly acceptable method of identifying patients at risk of osteoporosis. Not only is the heel an appropriate location for measurement, but also ultrasound is an appropriate technique. Both are well supported by the literature. These results are best studied on the Achilles+. If another machine is to be used, the manufacturer should be contacted for further data, as there are likely inadequate published data, based on this review of the literature. If osteopenia or osteoporosis is identified by heel ultrasonography, the patient should be referred for DEXA.

Breast Feeding As A Possible Protective Factor In Children Diagnosed With ADHD.
Date of project: 1/2/2002

This study sought to look at a possible connection between the lack of breastfeeding and the diagnosis of ADHD, in the Treasure Valley Pediatric Clinic in Ontario, Oregon. The design is retrospective case control study involving all patients being seen for ADHD in the clinic. When charts were reviewed in the ADHD population, 39% of that population received a diet containing breast milk within the first six months of life, as compared to 67% in the control population. This report discusses the protective effects of breastfeeding versus non-breastfeeding and how this might affect the diagnosis of ADHD.

Access to Spanish Language Health Information in Ontario, Oregon.
Date of project: 11/5/2001

The Hispanic population of Oregon and the rest of the United States continues to grow rapidly, but unfortunately the number of health care workers who can communicate in Spanish has not. While in Ontario I found that not only is there a need for Spanish-speaking health care workers, but also for Spanish-language and culturally appropriate health information to hand out to the patients. Therefore I decided to translate and make some of my own, including translating patient handouts and making a teaching tool which relied more on pictures than words so anyone who was unable to read could understand them.

The Use Of Handheld Computers In Clinical Practice: A Comparison Between Urban And Rural Settings.
Date of project: 8/13/2001

This study attempted to elucidate the prevalence of handheld computers in primary care practices as well as physician perceptions surrounding the utility of these increasingly common devices. The design is a cross-sectional study conducted with surveys completed by telephone and personal interview. 21 physicians in Ontario, OR and the surrounding area were surveyed, including primary care specialties such as family practice, internal medicine, pediatrics, emergency medicine, and OB/GYN. 29% of physicians used handheld computers in their practice and the average number of years in practice was 9.33. Physicians from both urban and rural settings ranked the importance of handheld computer features very similarly, and the results provide guidelines for furture handheld software and hardware development.

Smoking Prevention Among Elementary-Age Students In Ontario, OR.
Date of project: 11/ 5/2001

In the United States, 2% of 5th graders, 28% of 9th graders, and 43% of high school seniors use tobacco. Therefore, prevention should start at a young age. Ontario, OR is a rural community, which closely follows the national trends of tobacco use. However, there is no smoking prevention program in place in Ontario. This project focused on one smoking prevention curriculum, TarWars, and how it could be useful in Ontario, OR. TarWars is a nation-wide campaign to prevent smoking among 5th graders. It has many benefits, including age-appropriate activities, community involvement, and follow-up. Successful presentations were given to 2 fifth-grade classes at May Roberts Elementary school in Ontario, OR. This school showed great interest in TarWars curriculum and plans to implement it in future school years.

Seizure Recognition And First Aid Training Among Likely Primary Respondents in Ontario, Oregon
Date of project: 7/2/2001

Seizures are a common and possibly life threatening condition effecting 10% of Americans throughout their lifetime. This study is a cross-sectional assessment of the exposure to seizure recognition and first aid training among likely primary responders in the rural community of Ontario, Oregon. Likely responders were defined as public safety officials, child and senior care providers, and educational professionals. The results of this study indicate that while 70% likely primary responders as a group are receiving the exposures of interest, training within the specific sub-population of childcare providers has only a 60% prevalence. Discussed in this report are some of the issues influencing the training of individuals in the rural community and recommendations to the Epilepsy Foundation of Oregon on how to increase the prevalence of seizure recognition and first aid training in rural communities.

Back to preceptor site search page or search by subject