RCHC Community Project Abstracts

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Group Medical Appointments in Rural Oregon
Date of project: 10/12/2009

Group Medical Appointments (GMA) provide one to one medical care in the presence of chronic disease peers. Group visits have shown to increase patient and physician satisfaction, deliver integrated care that enhances quality, improves access, and leverages physician time and productivity. The bulk of research on GMAs has focused on urban, chronic illness populations. Therefore, I was interested in developing a model for GMAs in the rural setting. My population of interest was defined as Walla Walla Clinic Milton-Freewater (WWCMF) chronic illness patients. The project served succeeded in not only educating the project leader in regards to alternatives to the traditional medical appointment, but also inspiring an urbanite to consider rural medicine as a career.

Teen Pregnancy in Milton-Freewater, Oregon
Date of project: 4/27/2009

I sought to investigate why the teen birth rate in Milton-Freewater, Oregon is so high by looking at sex education in the schools, learning about the reproductive health resources for teens in the area, and getting the perspective of the teens that live in the area. I have subsequently identified what I believe to be large factors in this problem and have made recommendations on how to improve the education and resources for teens so as to hopefully decrease the teen birth rate over time. I have also made a handout listing reproductive health resources in the area for the teens.

Hearing Loss in Rural Oregon
Date of project: 2/9/2009

As with many conditions, the prevalence of hearing impairment in rural areas is greater than that of urban areas. While a number of causes for this discrepancy have been identified, one prevailing and preventable reason is the increased noise exposure inherent in rural occupations such as agriculture and manufacturing as well as activities such as hunting. With prevention in mind, two populations were identified and surveyed, and a unique intervention was formulated for each group. The first group included elementary students, for whom an educational program focusing on the science of hearing and the prevention of hearing loss was introduced. The second group consisted of individuals at increased risk of hearing loss as a result of noise exposure. For this group, a patient handout was created that focused on education, prevention, and intervention, as it included a hearing impairment questionnaire and a list of local resources for those requiring further evaluation or treatment

Assessment of the Mental Health Resources in Milton-Freewater, OR
Date of project: 10/13/2008

There is a universal need for mental health services in all areas of rural Oregon, including communities like Milton-Freewater. Additionally, there is an appreciable discrepancy between the services that are available for those who have private insurance, those who use state or federal plans such as OHP and Medicare/ Medicaid and those who have no health coverage. While this may be true for both urban and rural communities alike, there are other additional obstacles more unique to a rural area. Also, some of the mental health care can be provided by local primary care practitioners, however, they often lack the time and the specialized knowledge necessary for anything but maintaining patients that are already stable and in good control of their disease. Additionally, in a rural setting where social workers are not readily accessible, making it more difficult for physicians to know the local resources available in order to effectively help their patients. It was a general consensus from those interviewed for this project that the mental health resources of Milton-Freewater are lacking in many ways; however, there are still some very important services to be used. The goal of this project is to show both what resources are and are not available with the hope that those resources that still exist will be more effectively used.

Most Wanted: Clandestine Patients
Date of project: 6/30/2008

There reside a substantial number of illegal immigrants in Milton-Freewater who are part of the larger Hispanic field worker community. The Hispanics in this rural area are not receiving access to medical care, and the barriers between the physician and this immigrant population in this community are complex, involving economical, social, political and legal factors. Low utilization of primary care services impedes in the prevention and early detection of disease; this negativity impacts the immigrant population as well as the community at large by potentially increasing the incidence of communicable diseases and by driving up healthcare costs due to an increased usage of emergency facilities. In order to investigate the extent to which these healthcare limitations are real and affecting the immigrant population, interviews were conducted and barriers to accessing medical care were discussed. A free blood pressure screening clinic was held three Wednesdays in the evenings at the only clinic in the town. The small turnout at these screenings despite aggressive local promotional efforts proved that the obstacles between provider and the immigrants are even greater than implicated. Traveling to the labor camp in person generated more interest in my project and greater numbers of volunteers were willing to participate in my interview and procedures. The main barriers to healthcare in this population were lack of insurance, fear of deportation, lack of time during the harvesting season, lack of transportation to the low-income clinic in Walla Walla, communication barriers, insufficient education regarding preventive medicine, and a feeling that any treatment will be unaffordable. Increasing awareness was accomplished by having a story printed in the newspaper highlighting that an entire community of field workers receive no primary care. This project has sparked new interest in starting a community-mobile outreach program targeted toward Mexican immigrants in rural areas.

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