RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Evidence-Based Medicine in Coquille, Oregon Project Date: 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. "Every 15 Minutes” Program Immediate and Short Term Outcomes Project Date: 4/28/2008 Underage drinking and driving remains a problem throughout the US, including Harney County. About 8.6% of eleventh graders in Harney County had drove under the influence in 2005-2006. Harney County high schools participated in the “Every 15 Minutes” program which focuses on making responsible decisions around driving and alcohol. High school students, sophomores, juniors and seniors, were surveyed approximately thirty days after involvement in the program. After the program students were more likely to be designated drivers and less likely to ride with someone who had been drinking. In general, the “Every 15 Minutes” program has had positive immediate and short-term outcomes. This data was compared with similar data from the 8th grade Oregon Healthy Teen Survey from 2005-2006 which these students participated in. Ongoing surveys would determine long-term effects of the program. A Summary of Continued Medical Education in Rural Health Care Project Date: 8/6/2007 Stayton, Oregon is a unique rural community due to its close proximity to the more urbanized population of Salem. Despite it's location, Stayton has established itself as a self-sustaining center of health care. The local 40 bed Santiam Memorial Hospital serves over 30,000 people with services including an emergency room, two operating rooms, a labor and delivery ward, laboratory services, and imaging services that include ultrasound, MRI, CT, and X-ray. There are no subspecialty units located within the hospital, however many specialists from Salem will travel to Stayton to manage a clinic one or two days per week. Because of these services, few local residents have to travel outside city limits to meet their health care needs. Despite the medical diversity of this small town, Stayton has few opportunities of continued medical education (CME) for its local physicians. Chronic Kidney Disease in Coos Bay- Recognition and Referral Project Date: 5/10/2004 Chronic Kidney Disease (CKD) is a rapidly growing problem in the United States that is not readily recognized by primary care physicians, resulting in excessive healthcare costs, failure to ameliorate disease progression, and increased morbidity and mortality in these patients. One possible reason may be that PCPs are only relying on the serum creatinine as a marker for kidney function, rather than the calculated GFR, which is a truer indicator of renal capacity. Coos Bay, Oregon is a community that receives its nephrology care from a group practicing in Eugene, Oregon. This group of nephrologists is markedly concerned about the underrecognition of CKD and the consequences that come along with it. To express their concern, they recently mailed out a letter to all PCPs regarding this issue. This study was designed to demonstrate to the internal medicine physicians at the Bay Clinic in Coos Bay that many patients with CKD are not being recognized and referred, possibly because the physicians are not using the GFR, but rather are relying only on the serum creatinine. To help overcome this obstacle it was coordinated with the laboratory staff at the Bay Clinic to include a calculated GFR with every serum creatinine on lab reports. Finally, a handout containing recommended CKD guidelines was created and distributed to the internists at the Bay Clinic. ADHD vs. Bipolar Affective Disorder: a Comparison of the Two Mental Health Problems in the Pediatric Population of Klamath Falls. Project Date: 5/10/2004 Mental illness is an important medical problem in the pediatric population that affects communities ranging from large metropolitan areas like Portland to small towns such as Klamath Falls. Although the prevalence of attention deficit hyperactivity disorder (ADHD) and bipolar affective disorder (BAD) are significantly different in the pediatric population, they are often confused with one another due to the overlap of common symptoms. Therefore it is important to identify children with these disorders and make an accurate diagnosis to ensure that they receive the proper medical and psychological treatment. Analysis of ICD9 codes from 2003 demonstrated almost 1,000 visits for ADHD and BAD at The Klamath Pediatric Clinic. These numbers were confirmed by my own record keeping during a three week period which showed 16% of all visits were for mental health issues. Given the number of patients with ADHD and BAD, a screening tool was utilized to try to find differences in the presentation of these two illnesses at the time of diagnosis. Results from questionnaires handed out in the clinic showed higher scores by patients with BAD (24 versus 15; p 0.011). In addition, three specific categories including irritability, thought content, and disruptive behavior were significantly higher in children with BAD. The results of this project suggest that mental illnesses, specifically ADHD and BAD are an important healthcare issue at The Klamath Pediatric Clinic and that there may be ways to better screen for and treat these patients. Continuing Education of Emergency Physicians at a Level IV Trauma Center - A Solution to Boost Medical Morale Project Date: 2/10/2003 Many rural communities are struggling financially. The medical community experiences these same fiscal challenges. Such is the case in Baker City, Oregon where the community hospital is $18 million in debt and local healthcare providers struggle to maintain positive revenue position. Morale is down throughout the medical community. This situation has brought about many changes. One of these changes is primary care physicians leaving their practices to become ER physicians. These emergency medicine providers are in a unique position. By updating and strengthening their emergency skills, they can improve patient clinical outcomes and boost the morale of the medical and patient communities with concomitant financial success of the local medical institutions. The Emergency Procedures Training Program for Rural Oregon can provide customized instruction to these ER providers, enabling them to assist in this improvement of their community. Hormone Replacement Therapy in Baker City, Oregon Project Date: 9/23/2002 The Women's Health Initiative Study about Hormone Replacement Therapy (HRT) has had an important effect on the prescribing practices of physicians. To assess the effect on the practices of Baker City physicians, a short survey was sent to the medical providers in Baker City who were most likely to prescribe HRT. The survey asked questions about how they learned of the study and if the data reported had caused them to change their prescribing habits. The most common modes of learning of the study were through the lay press and self-study. The study caused the majority of the providers to reduce the number of HRT prescriptions they write, especially for women with risk factors for coronary heart disease, stroke, breast cancer, and pulmonary embolism. Documenting a disparity between the musculoskeletal knowledge and skill requirements of primary care physicians in Tillamook County. Project Date: 3/25/2002 Musculoskeletal problems are a major source of pain and disability in our society. The purpose of this study was to determine if there is a disparity between musculoskeletal knowledge and the skill requirements of primary care physicians within Tillamook County. The number of musculoskeletal complaints evaluated and treated in a primary care physician's office was recorded over a one-month period between 1 April and 30 April 2002. Additionally, self-administered questionnaires comparing physician confidence with common musculoskeletal disorders and common medical issues were distributed to all primary care physicians in Tillamook County. The prevalence of musculoskeletal disorders was 17.9% (n=49) among 274 office visits. Survey results suggested that physicians felt more confident managing common medical issues than common musculoskeletal disorders (avg. confidence score=9.0 and 4.2). Specifically, physicians felt most confident with the principles of cardiac rehabilitation, performing comprehensive cardiovascular examinations, and indicating/interpreting flexible sigmoidoscopy (avg. confidence score=9.0, 9.6 and 9.6 respectively). They felt least confident with the principles of bracing and casting, performing comprehensive musculoskeletal examinations, and indicating joint injections (avg. confidence scores=3.6, 7.0, and 3.0). The results suggest that a disparity between skill requirements and musculoskeletal knowledge exists among primary care physicians in Tillamook County. Competence in managing musculoskeletal disorders is a necessity for any primary care physician. To appropriately address this disparity, a new curriculum addressing common musculoskeletal problems should be developed which could be implemented at any, or all, levels of medical training. Methamphetamine: Educating the Health Professionals of Rural Oregon Project Date: 3/25/2002 Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpenseive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse. Methamphetamine abuse, long reported as the dominant drug problem in California, has now become a substantial drug problem in other sections of the Southwest and West, particularly Oregon. Portland consistently ranks 3rd-4th in major US metropolitan cities for positive urine drug screens at the time of arrest. However, recent data suggests that methamphetamine is rapidly becoming a larger problem in rural regions than urban centers. Methamphetamine use was traditionally associated with white, male, blue-collar workers, but is now being used by younger and more diverse population groups usually differing by geographic area. According to the 2000 National Household Survey on Drug Abuse, an estimated 8.8 million people (4.0% of the population) have tried methamphetamine at some time in their lives, and based on similar surveys it is thought that many of these people use on a regular basis. Another shocking result from the NHSDA survey found that an estimated 6.9% of US high school students have used methamphetamine at least once suggesting methamphetamine use is occurring more commonly in younger age groups. The purpose of this project was to put together recent national and statewide data in order to lead a discussion targeted to the health care professionals of Burns, Oregon about methamphetamine. Hopefully this information will increase their overall understanding of the drug, the increasing problem in rural America, the signs and symptoms of methamphetamine use, and some of the medical problems they are likely to see associated with it. Medical Triage Guidelines for an Assisted Living Facility in John Day Oregon Project Date: 2/11/2002 Inappropriate use of the ambulance and emergency room by the staff and residents of Valley View assisted living residence was identified as source of frustration among the physicians of John Day. The cause of this problem is the very limited medical training of the med aid staff at Valley View. An algorithm consisting of a series of simple yes/no questions was proposed as a triage system that would match the medical training of the staff at Valley View to the expectations of the local physicians. The triage algorithm was presented to the staff at Valley View and is being implemented on a trial basis. Once the Valley View staff have become comfortable with the tool and it has been in use for several months the local physicians will be polled to evaluate the triage system's effectiveness. Herbal Remedies and Supplements: Education for Physicians and Parents at Klamath Pediatric Clinic Project Date: 2/11/2002 This project was designed to provide education to the patients and parents of the Klamath Pediatric Clinic regarding herbal remedy use and safety in children. To better understand the needs of the community an informal survey was performed to determine baseline alternative and complimentary medicine use and knowledge among the patients at the clinic. Of those surveyed, 32.9% of parents believed they were adequately informed about available over-the-counter herbs and supplements, while 67.1% felt they were not well informed. 54.8% believe the products are safe, while 24.7% think they are unsafe and 20.4% are unsure. 83.7% of parents could not remember their physician ever inquiring about herbal remedies. 3.8% of parents responded that their children had used either Chamomile or Echinacea. A literature search reviewing recent and historical information about herbal and supplemental remedies was also completed. Using this information and the data from the survey as a guide, patient information handouts about safety and efficacy and were designed and implemented as part of patient education at the clinic. Osteoporosis Prevention: Educating Patient Educators Project Date: 5/6/2002 There is ample data available as to the epidemiology of osteoporosis, its relationship with patient morbidity and mortality. There is also evidence that as a Caucasian retirement community with a long, dark winter, the Florence community represents a population at particular risk of suffering from osteoporosis. Given the short period of time available to promote change in the community health practices, the most effective method is education of the health care providers. This community-based project sought to educate health care providers as to the practical aspects of osteoporosis risks, consequences and prevention. An educational talk about osteoporosis prevention was held for the Medical Assistant staff at Peace Harbor Health Clinic. The responsibilities of the MA staff include scheduling appointments, giving patient advice both in the clinic and over the telephone, eliciting a basic patient history, taking vital signs and promoting basic health with appropriate educational health interventions. Clearly, this is a population of health care providers with a great deal of patient contact who may benefit from further education in preventative health. To evaluate the effectiveness of the presentation in providing helpful information to the MA staff an educational survey and quiz was given before and again after the presentation. In addition, a short questionnaire as the educational value and effectiveness in encourage preventative measures was also given. Final evaluation revealed one hundred percent of the 18 persons who filled out their surveys showed improvement after the presentation. (Appendix C). The average survey improved by 2.4 correct answers out of 7 possible correct answers. The initial average of the survey was 55% with a final average after the presentation of 90%. This represents an improvement rate of 35%. The results of this community project indicate that the content of the talk was appropriate for this audience. The initial scores before the talk indicate that much of this material was new or unfamiliar to the staff. In addition, the scores consistently improved indicating the talk was appropriate and beneficial. Further, only one participant failed to indicate that this talk was helpful to further her understanding and increased the likelihood she would encourage patient preventative health in regards to osteoporosis. Audience participation was also high and, although not reflected in the numbers, is also a potential indicator of interest and the potential to instigate change. Back to subject search page or search by preceptor site