RCHC Community Project Abstracts

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Transfer of patients by ground ambulance vs. fixed wing aircraft from Coquille to Eugene: Evaluation of the Decision Process and Resolution of Policy among Team Members
Date of project: 10/12/2009

Patients who present in, or who progress to, a state of critical condition outside the ability of the rural facility need to be transported to a larger facility with greater access to technology and personnel. For patients in Coos County, the most frequent transfer destination is Eugene. The options for transport are ground ambulance, rotor wing aircraft, or fixed wing aircraft. Each has their advantages and disadvantages, and each has a place in patient transfer depending on the circumstance. There is a disagreement among healthcare personnel over when to transport patients by air, and when to use ground ambulance. In short, the first question to be answered is this: Is fixed wing aircraft ever a reasonable option between these two locations? The second question is how can we bring about reconciling the two dissenting factions?

Dispensing Health Literacy in Coquille: Starting a Medical Lecture Series in a Vacated Pharmacy
Date of project: 6/29/2009

The town of Coquille is one of the poorest and least educated areas in Oregon and consequently has low health literacy as well. The nature of the town shows that to improve the health of the population, one must improve the basic communal knowledge about common diseases. One way to get that knowledge out is to use a spot frequented by the community, outside of the hospital, to stage a series of medical lectures. The old Barrow Pharmacy downtown had been converted to a make-shift community center where many classes were being held, including cake-decorating. I organized a series of 4 lectures, kicking off the first one as a co-speaker on diabetes, followed by talks about smoking cessation, COPD, and first-aid to take place after completion of my rotation. Seeking recommendations for speakers, I contacted professionals in the respective subjects and signed them up for consecutive Friday afternoons, helping to advertise through flyers and the local paper, and then handing off the information and structure to others who could keep the project going after I left. Despite suboptimal attendance for the first lecture, the stage is set for four lectures that will promote the health of a community that has given me great hospitality as a student.

Evidence-Based Medicine in Coquille, Oregon
Date of project: 10/13/2008

Coquille physicians have no subscriptions to evidence-based medicine resources, and report no use of such resources in their daily practice. They routinely see 30-40 patients per day in clinic, and often must simultaneously cover ER call at the local hospital. Thus it is very difficult for Coquille physicians to remain abreast of new medical developments and current evidence-based guidelines. The goal of this project was to teach Coquille physicians how to use and incorporate into their practice a continuously updated evidence-based medicine resource: ACP PIER, via the Stat!Ref online library. As part of this project, I used a questionnaire to identify the types of resources physicians utilize to keep up with new medical information, registered all seven Coquille physicians for OHSU library barcodes in order to access off-campus OHSU resources for Oregon licensed physicians (which includes Stat!Ref), created a handout detailing how to use these resources, and taught each physician how to use these resources and how they could be incorporated into their daily practice of medicine.

Reviewing the Changeways Program as a treatment for depression in a rural setting
Date of project: 6/30/2008

Mental health care treatment options are limited in the Coquille area. The Changeways Depression Program is a psychoeducational group therapy protocol designed to introduce clients to basic psychological self-care concepts. A group of patients with depression went through the 10-week program earlier this year. In this rural project, interviews were used to review the effectiveness of the program from the group members' perspectives. Overall, the group support setting was appreciated by the participants, and the lesson material was well liked, even though all of the group members still suffer from depression and all continue to take antidepressants. It is the conclusion of this project that the Changeways program should continue to be used, with increased recruitment effort and better data collection.

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