RCHC Community Project Abstracts

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Patient and Provider views on vitamin and mineral supplement use in Roseburg, Oregon
Date of project: 2/11/2008

Background: Dietary supplements in the form of multivitamins, single nutrients, and other supplements are consumed by half of Americans and continue to increase in use. However, they are also poorly regulated, which creates a challenge among providers and researchers to establish clinical guidelines for use. Safety and effectiveness are among the greatest challenges given the variable doses available and potential interaction with other supplements and medications. This study aims to characterize use (type, amount, rationale, barriers to use) of dietary supplements, with focus on vitamins and minerals, from both patients and physicians. Methods: This is a descriptive, cross-sectional qualitative and quantitative analysis of patient and provider use and views on dietary supplements. Questionnaires were distributed and analyzed for patients and providers at Evergreen Family Medicine in Roseburg, Oregon and family medicine providers at OHSU. Results: 54% of participants reported regular use of dietary supplements. Of participants reporting use, 73% used multivitamins/minerals, 73% used single nutrients, and 44% used other supplements. Participants who consumed supplements were older, more educated, less physically active, and more likely to have a chronic disease compared to those who did not consume supplements. Provider recommendation was the top reason participants began using supplements. Regardless of current supplement use, 67% of all participants wished to have regular discussions about supplements with their providers. There was a limited response among providers (n=20), but among those 80% regularly recommend supplements (80% single nutrients, 50% multivitamins/minerals), and 71% of doses were within the Recommended Dietary Allowance. Conclusions: Dietary supplements are a relatively simple and inexpensive intervention with potential to replete nutrient deficient diets, treat, or even prevent diseases. These must be tempered with effective and safe use. Physicians have a great influence on patients both in their decision to begin taking supplements or not to use supplements.

Med-Help: A booklet designed to guide those who need prescription assistance
Date of project: 8/6/2007

For many ailments, prescription drugs are the backbone of current treatment. Many times, medication compliance has a direct impact on ones quality of life as well as longevity. Between 1998-2000, the cost of prescription medications rose more than triple the rate of inflation, putting them out of reach for many.1 In order for these patients to continue taking their medications, they need financial assistance. This study was designed with two objectives: First, to identify the population seen at the Wellness Clinic in Roseburg, Oregon. This was accomplished by running billing reports to establish populations by insurance type, since this has a significant impact on what assistance programs are available. Second, to research prescription assistance programs available for this population and design a simple means of delivering that information. It was decided that a booklet would be the best means of delivering the information. It was found that 47% of the patients were on Medicare, 5% were uninsured, and 2% on OHP. Those figures were used in researching prescription assistance programs for this population. A nine-page booklet was then constructed, using only resources already available to the clinic. This strategy was to minimize the burden to the clinic in continuing to make the booklet available to their patients.

The human papillomavirus vaccine: Provider attitudes and barriers to utilization in Roseburg, OR
Date of project: 7/2/2007

The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. In the U.S., 6.2 million new infections occur annually, most in people 15-24 years old. HPV is necessary but not sufficient to cause all cervical cancer, all anogenital warts, and 90% of anal squamous cancers. During 2002, 126 women developed invasive cervical cancer and 45 died of the disease in Oregon. A quadrivalent HPV vaccine (against 6, 11, 16, 18) was FDA approved June 2006 for use in all 11-12 year old females, with a vaccination range of 9-26 years old. The vaccine is 100% effective against cervical cancer and genital warts. Provider attitudes and barriers to vaccination with the HPV vaccine have not been studied recently, so a survey was sent out to 37 health care providers in Roseburg, OR (included MD/DO, PA-C, NP in Family Medicine, OB/Gyn and Pediatrics). 57% of surveys were completed and returned. 71% of providers provide the HPV vaccine. Barriers to vaccinating include cost to both the patient and the provider, as well as difficulty in getting adolescents to come to well visits, and parental tendency to pay less attention to vaccines after age 5. 67% of providers do not agree with mandating the HPV vaccine in Oregon, citing reasons such as cost, insufficient evidence, and questioning government involvement. Although the HPV vaccine is a breakthrough in cancer prevention, more time must be spent investigating barriers to vaccination before mandating the vaccine will be possible.

Physician Shortage: Who Will Bear the Burden?
Date of project: 4/30/2007

A primary care physician shortage currently affects or is predicted to affect America. While much-deserved, growing attention is being directed at populations who are unable to access medical care because they lack medical insurance, this study attempted to support an observation that certain subsets of the medically insured population would bear a growingly disproportionate burden of the predicted physician shortage, despite medical insurance. The subset of the medically insured population studied was Medicare patients. The study design consisted of primary and secondary data collection in the form of physician surveys and population demographics. Data collected touched on both the deficiency of health care coverage in rural counties, and perhaps more importantly, the flux of disparity in access to this precious and increasingly limited commodity. Data collected clearly revealed a present access inequality in Douglas County and Roseburg, Oregon. Data also revealed that access to primary health care was reduced even among the medically insured population, specifically Medicare patients. Analysis of this data further demonstrated that three explanations were readily available for the growing disparity in access to care between the general insured population and Medicare patients: diminished rates of reimbursement; increased medical complexity; and demographic shift. Interpretation of this data would suggest that the predicted primary physician shortage would only aggravate this disproportionate burden already borne by the underserved and now by Medicare patients.

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