RCHC Community Project Abstracts

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Physical activity group visit at the McClaine Street Clinic in Silverton, Oregon
Date of project: 10/12/2009

Currently, in the United States, obesity is a growing problem with many related health concerns, the small town of Silverton, OR is not exempt from this problem and many of those who reside there are overweight. One of the health concerns related to obesity is Type II DM, this project attempted to identify some of those who are at risk of developing or who already have Type II DM, and get them involved in some type of physical activity. This was done through a group patient visit with a didactic session on exercise, followed by a 1 mile walk for physical activity, and ending with individual meetings to discuss their personal action plan for physical activity. Participants were selected based not only on their Type II DM risk factors but also if they were sedentary.

Prevalence of Antibiotic Resistant Bacteria
Date of project: 4/27/2009

I studied the prevalence of antibiotic resistant bacteria among the population serviced by the laboratories at Silverton Hospital. Antibiotic resistance data for 2009 was obtained for the following species: C. feundii, E aerogenes, E cloacae, E faecalis, E coli, K. oxytoca, K pneumonia, M morganii, P. mirabilis, P. aeruginosa, S marcescens, S aureus, S epidermidis, S. saprophyticus, S. agalactiae. Sensitivity data for the following drugs was available: Amikacin, Ampicillin, Aztreonam, Cefazolin, Ceftazidime, Ceftraxone, Cefuroxime, Ciprofloxacin, Clindamycin, Ertapenem, Erythromycin, Gentamicin, Imipenem/Cilast, Levofloxacin, Nitrofurantoin, Oxacillin, Piperacillin/Tazobactam, Sulfa/Trimethoprim, Tetracycline, Vancomycin. Relevant literature was reviewed including data from national levels and from the greater Portland area. There is data in the literature to suggest that regional antibiograms provide accurate, cost effective information for local providers concerning trends in community-specific resistance trends. Providing sensitivity that is regional and accurate will help to guide empiric therapy of common infections, and can ultimately help to decrease the rate of increase in resistant bacteria.

Helping Chronic Pain Patients Improve their Pain and Functioning
Date of project: 3/16/2009

Chronic pain is frustrating for patients and physicians alike. It is costly to society in terms of lost productivity and high use of health care resources. Medications are one component of managing pain, but they are most effective when combined with exercise, relaxation, nutrition, and counseling. Like patients with other chronic diseases, those with chronic pain must move from being passive recipients of care to informed, active participants if they are to improve their functioning and quality of life. This project consisted of designing a group visit with an educational didactic session followed by brief individual visits using measurement tools and a standardized progress note to set and evaluate goals, progress, and effectiveness of treatment plans for OHP patients in Silverton, OR. While this project is an attempt to implement a chronic care model with limited resources of a small practice, patients could certainly benefit from a counselor specializing in cognitive behavioral therapy.

Tobacco Cessation Group Visit Project
Date of project: 10/13/2008

Tobacco abuse in the United States remains a leading cause of preventable death and disproportionately affects Medicaid recipients. At my rural site, a clinic serving exclusively Medicaid and OHP patients, an approximate 45 percent of our adult patients smoke. A significant percentage of those smokers are afflicted by smoking related illnesses such as heart disease and COPD. Having identified this at-risk population, we set forth to plan and implement a tobacco cessation group visit that is consistent with principles set forth in The Chronic Care Model and the Future of Family Medicine Project (FFMP). Adult smokers with smoking related illnesses were invited to participate based on their desire to quit. Of the 7/15 patients invited participated in the group. At the visit, our care team documented vitals and spirometry values, facilitated a group discussion about quitting, provided a brief informational presentation, and counseled patients individually regarding their plans for tobacco cessation. The visit resulted in 5/7 patients setting a quit date and creating an action plan for quitting! Several barriers to participation were identified including scheduling and transportation. A follow-up group visit is planned for January 2009, and current plans are to continue with new cohorts in the future.

Old Believers of Silverton, Woodburn and Mt. Angel Area
Date of project: 8/4/2008

10,000 Russian old believers community presents a significant percent of Marion county and especially Woodburn and Silverton area. Even though a great majority of them speak English well, their cultural specifics sometimes makes providing a health care for them difficult. Some of greatest concerns of health care providers were identified and included: culture and lifestyle of Russian old beliers; their general attitude toward medical care; family role distribution and medical decision making; women health issues, including early marriage and pregnancies as well as birth control; children health and immunizations; and end of life issues. These issues were then investigated and presented. Due to limit of time available for the project, information was collected from limited sources.

Implementation of a literacy assessment tool: “The Newest Vital Sign”
Date of project: 6/30/2008

In recent years there has been increasing emphasis on improving communication between patients and clinicians. There is more awareness now that the old methods of physician teaching are often not working to adequately inform patients. This is for a variety of reasons but this paper focuses on the issue of health literacy as one of the primary factors. Low literacy rates have now been linked to less knowledge of health problems, more hospitalizations, higher health care costs, and poorer health status so obviously it creates a barrier to effective communication. By finding and implementing a quick and easy literacy assessment tool the McClaine Street Clinic and the Community Outreach Clinic in Silverton hope to identify and help those patients with limited literacy. In my study I obtained assessment tool materials, discussed implementation with both offices, and did a small field study to determine the feasibility of administration.

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