RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Health Literacy and Readability of Patient Education Materials at the Klamath Falls Pediatric Clinic Project Date: 6/29/2009 Health Literacy is defined by the Institute of Medicine as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” Limited health literacy may affect some 90 million American adults, and has been postulated as a link between socioeconomic inequality and health disparities. In the pediatric realm, limited health literacy skills among parents or caregivers have been associated with poor health outcomes. This study assessed a measure of health literacy among the primary caregivers (usually parents) of patients at the Klamath Pediatric Clinic in Klamath Falls, OR. One concern regarding health literacy is that patient education materials may be written at levels that are inappropriate for the average patient or caregiver. To determine whether this is the case at the KPC, a number of the handouts distributed at this clinic were assessed for their readability. The average grade level at which caregivers read was compared with the average grade level at which patient handouts were written. Caretaker health literacy was approximated using the Rapid Estimate of Adult Literacy in Medicine-Short Form, administered to parents and caregivers by the medical student prior to appointments in the clinic. Common handouts given to parents, including those about well-child care, normal development and some common childhood illnesses were assessed for their readability using the Flesch-Kincaid Grade Level Formula. According to the REALM-SF, 15 out of 40 caregivers (37.5%) read at a 7th or 8th grade level and therefore are at risk of low health literacy. The average grade level of all the handouts assessed was 6.3, with a range from a 1st grade level to a 10th grade level. Thus, some of the patient education materials used in the clinic may be written at a level that is too advanced for some of the parents of children in the clinic to understand. Dispensing Health Literacy in Coquille: Starting a Medical Lecture Series in a Vacated Pharmacy Project Date: 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. Implementation of a literacy assessment tool: “The Newest Vital Sign” Project Date: 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. Bringing Community Connections Network To Your Practice and Patients Project Date: 7/2/2007 Continuity of care, identification and access to community resources, and care by specialists are just some of the problems children with specials needs in rural areas may face. How can these children and their families obtain what they need if their primary care provider is unaware of the help that is out there? This study attempts to identify what primary care providers in Coos County and surrounding areas know about Community Connections Network (CCN). Forty-four care providers were identified and given a survey to asses their understanding and use of CCN, and to identify ways to help them bring CCN to their patients. They were also given up to date information on what CCN offers, who they serve, and how to refer in hopes that they might someday refer a child in need. While the resources and referral process used to identify children with special needs is generally understood, there is a lack of knowledge in the community about what is available for follow up care. Upon conclusion of this study, it was discovered that a little more than half of the primary care providers had heard of CCN, and only half of those had actually made a referral. Additionally, new methods of getting up to date information out to the community were identified. Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. Attempts to Document Healthcare Perceptions and Expectations of Scappoose Oregon Residents Project Date: 7/3/2006 This study intends to document the perceptions and expectations of healthcare in the rural community of Scappoose, Oregon for use in future healthcare reform. Despite multi-faceted aggressive public invitational postings no community members attended “town hall” style meetings. Further verbal invitations to local churches resulted in five parishioners who perceived most to least significant healthcare issues as being; 1)unavailable/inadequate health insurance, 2)inadequate access to providers, 3)lack of transportation options to an urban center and 4)treatment plans unrealistic in a rural setting. Their expectations included reform to be driven at the federal rather than state level and that such reform include adequate funding. Overall, the failure to generate adequate community participation in this study must be considered in all future efforts to understand healthcare in rural Oregon. Medical Information Researched via the Internet by Patients in Astoria, Oregon: To surf or not to surf...that is the question Project Date: 2/13/2006 The Internet has become a vast resource of medical knowledge for patients all across the United States. This study sought to characterize the level of Internet use with respect to acquiring medical information in an Astoria, Oregon family practice clinic. The study design was based on three individual components: First observational data obtained from patient interactions, second qualitative and quantitative data obtained from patient surveys and finally anecdotal evidence from interviews with physicians. The results indicated a high percentage of patients acquiring information from the Internet. Review of current literature validated our conclusion further quantifying the types of information obtained and the results of acquiring such information. Given the possibility of negative outcomes as a result of false information, a patient brochure was designed to help physicians educate patients on how to obtain credible information on the Internet with the inclusion of disease specific sites. Where did you get that idea? Developing an Integrated Strategy for Patient Information Handouts Project Date: 1/2/2006 The brief time allotted to office visits limits patient education on acute primary care issues. Many practitioners rely upon written information they can give to their patients to follow at home. This study attempted to define a strategy for creating and refining patient education handouts in a Florence, Oregon family medicine clinic. While there were plenty of patient handout materials already existing in the clinic, these were often out-dated or otherwise inappropriate for use. The design was to work with physicians to identify areas where handouts were needed, articulate core concepts that physicians wished addressed, elicit patient feedback on handout materials and create handouts to satisfy these specific goals. Finally, further thoughts on extending the project were considered. Diabetes Mellitus Community Awareness Project Date: 8/8/2005 There are over 18.2 million people in the United States with Diabetes Mellitus. Only 13 million or so of which have been diagnosed. This leaves about 1/3rd with untreated Diabetes. Diabetes itself is the fifth leading cause of death, and a vast contributor to increased morbidity in the form of “heart disease, blindness, kidney failure, extremity amputations, and other chronic diseases. ” The cost of DM to the health care economy is enormous, with over 92 billion per year in direct costs, and an additional 40 billion in indirect costs. Per capita, more than twice the amount of health care dollars are spent on someone with DM than someone without. Various methods are proposed to help eliminate or reduce these problems through better access to preventative care, more widespread diagnosis, more intensive disease management, and through the advent of new medical technologies. The possible results of this project seem pretty intangible. The articles will be going in the paper starting this week and going for the next four weeks. Best case scenario: some people that were previously untreated, like the patient I saw in clinic, will decide to talk to their doctor about their symptoms. Further expansion of this project could include additional articles on Diabetes, to measuring the effect of these articles by comparing rates of DM diagnosis before and after the articles, or by supplying newly diagnosed diabetics with questionnaires about why they came to the doctor. In addition, further outreach could be undertaken, such as ads on the local radio station, or a booth at the County Fair (the first week of Sep). Also, many other health topics are not popularly known, so additional education could be undertaken through the weekly column in the local paper. Substance Dependence In Josephine County Project Date: 7/4/2005 Background: The abuse of substances including tobacco, alcohol, and elicit drugs impact the wellbeing of the individual and drains the financial and social strength of the community. I-5 is a major corridor for drug traffic and smugglings. In Oregon, the nest of this problem appears to be small rural communities along this mega-highway such as those found within Josephine County, including but not restricted to Grants Pass, the site of my rural rotation. In Josephine County, 33% of adults were smokers in 2001; Alcohol was the eighth top cause of death in 2002; In 2004, the Josephine County Sheriffs office seized 25 methamphetamine labs, 7,891 marijuana plants, and 198,718 grams of drugs with a street value of $19,479,868. This study examines the availability, accessibility, and effectiveness of medical treatment and rehabilitation services for individuals with substance dependence within Josephine County. Method: Research was conducted through the internet and yellow pages, followed by questionnaires and interviews with local Josephine county healthcare providers, a hospital social worker, an addiction counselor, and representatives of local rehabilitation programs involved in the care of individuals with substance dependence disorders. Results: Findings indicate a lack of funding, dwindling services and resources, and defective communication and referral protocols are among the sources of problems with access and quality of care for substance dependent individuals. Conclusion: I propose that protocol for referral and communication between the primary care community and the mental health/substance abuse treatment community be reevaluated by a committee of representatives from all involved parties and that new protocol be established and made clear to all members of these parties for the improvement of access and quality of care to patients. Meanwhile, a chart that lists local resources and summarizes some referral protocol was developed and distributed locally to several local primary care providers. Educating The Population Through The Media Project Date: 4/25/2005 The project was suggested by my preceptor, Dr. Tom Fitzpatrick. It involves getting basic medical information out to the population of Burns by publishing a weekly column in the local newspaper. Contact was made with Toni Siegner, a local reporter, to coordinate the publication. An initial article was written, but this proved to be too long; the newspaper wanted the publication to be limited to between 150 and 300 words. Several articles were then written, which met the expectations of the newspaper. As of the end of the rotation, one article had appeared in the paper (an introductory article) and another was to appear in the paper on Sunday, May 29 (two days after the end of the rotation). Three more articles are in reserve, and Dr. Fitzpatrick will submit them for the following weeks. Follow up of this project can be undertaken by any student who goes to Burns; it would involve writing comprehensive, concise, interesting articles on healthcare subjects not yet covered. Dual Relationships in a Rural Community Project Date: 4/25/2005 Dual relationships are a complex and sensitive issue, as they commingle two of the most cardinal aspects of life: Health, and loved ones. The literature describes dual relationships as personal relations, familiar or social, with a patient outside of the office. Historically, medical associations' ethical guidelines recommend against this. Yet there is a paucity of research considering whether this is practical, or even opportune, in small communities. Moreover, short and long-term data on the effects of dual relationships is likewise lacking. This study utilized key informant interviews with 10 physicians and 10 patients in Tillamook OR, in order to assess the prevalence and perception of dual relationships in a rural environment. The hope is to gauge whether these relationships are interpreted as beneficial or detrimental, and to assess the need for future education or intervention. Single Parent Support Group Project Date: 3/21/2005 The United States is home to approximately fifteen and a half million single parents.1 Studies have demonstrated the risk of onset of depression among single parents is double that of their married counterparts with social and financial support being significant variables influencing depression2,3 The large number of mental health problems seen in primary care clinics makes this issue a commonly addressed complaint. This study attempted to identify single parent patients suffering from depression and evaluate the effectiveness of a social support group in helping to reverse their depressive state. The design was recognition of depression in single parent patients and then introduction of these patients into a group of other single parents within their community allowing social interactions and self-determined topics of discussion. While identifying single parents suffering from depression or those who simply had interest in participating in the support group was easily done, there was no existing support group in the community for single parents. Therefore the final product of this project was development of bimonthly support group for single parents with the goal to eventually incorporate family activities, a baby sitting cooperation and educational activities. Parents were encouraged to bring their children with the secondary goal of providing a safe environment for the children to interact with others in similar family structures. The group met for two hours twice during the five week rotation. In addition to self-directed discussion the group was provided with literature addressing various topics regarding parenting techniques, community resources, and self-help motivational information. The effectiveness of the social support group was evaluated by an anonymous survey provided after the second meeting. Mental Health: Coordination of Care in Josephine County Project Date: 5/10/2004 Access to and delivery of mental healthcare in rural America is a significant problem. According to the primary care providers (PCP) in Josephine County, OR, this is one of the most frustrating aspects of their practices. The family practice physicians felt that Josephine County Mental Health Department (JCMHD) was not adequately taking care of the mental health needs of their patients. JCMHD felt that they were doing a reasonable job of this and that their policies and procedures were well thought out and implemented with the blessing of the directors of the local independent physician associations (IPA). This project attempted to improve communication and understanding between the JCMHD and local PCPs in the area in order to help bridge the impasse that had festered. Multiple interviews were held with administrators at JCMHD and local PCPs as well as the director of one of the two local independent physician associations. Through these discussions, a proposal was made to the local IPA and JCMHD. The proposal includes four parts: 1. Same-day call back to the local PCPs from the psychiatrist. 2. Prompt feedback from the therapists after the patient’s initial visit either through a phone call or a fax. 3. Urgent slots with the psychiatrist will be made available for acute patient care. 4. A meeting to be held every four months with representatives from JCMHD as well as the directors of the two local IPAs. The local IPA is on board with the proposal and JCMHD is still reviewing the proposal, but seems willing to agree to it as well. Hepatitis C in Madras, OR: Development of a Patient Information Handout Project Date: 3/29/2004 The hepatitis C virus (HCV) is an enormous public health problem in the United States. In 1997, the cost associated with HCV was approximately $5.46 billion. Though they were not aware of the exact number of patients in their practice with HCV, the physicians at the Madras Medical Group in Madras, OR all felt that HCV was a big problem in Jefferson County. Despite this, it was noted that they had no written information on Hepatitis C to give to patients. Because they are the primary care providers for a number of patients with chronic HCV, and because there are important lifestyle modifications patients can make to optimize their health and the health of their liver as well as prevent transmitting the virus to others, the physicians and I agreed that a comprehensive patient handout would be very useful in their practice. I conducted an extensive internet search for information on HCV designed for patients and created a one page, double sided handout to be distributed to appropriate patients at the clinic as well as the county health office. Physical Activity and Youth in Jefferson County: The role of the healthcare provider Project Date: 1/5/2004 Physical inactivity among all ages is a growing health problem in the United States. Combined with poor nutrition, physical inactivity is second to tobacco-use as a preventable cause of death in Oregon and US. Physical inactivity is a relative risk for coronary heart disease, hypertension, diabetes, strokes, obesity, osteoporosis, depression and anxiety. The prevalence of physical inactivity among youth is high. The “2002-2003 Oregon Healthy Teens Survey” showed that about 66% of eighth graders and 70% of eleventh graders participated in moderate activity less than 5 days per week. This is less than the minimum physical activity recommendations. From the same survey, in Jefferson County about 19% of eighth and eleventh graders exercised moderately 5 or more days in the past 7 days, thus meeting the minimum physical activity recommendations. Addressing physical inactivity in youth is multi-factorial including plan implications at the individual, family, healthcare, school, and community level. The objectives of the 2003 Healthy Active Oregon: The Statewide Physical Activity Plan targets each these various levels. To combine the objectives of the state initiative and needs of the medical clinic in which I worked in Jefferson County, I addressed the following question, “How can a Jefferson County healthcare provider help promote physical activity among youth?” The methods used included literature searches for recommendations for clinical counseling on physical activity, a questionnaire to assess the clinic’s current protocols, and current patients thoughts and questions regarding physical activity, and finally an assessment of what is offered in the community. The final products included an interactive-information questionnaire for patients intended to help healthcare providers assess patients’ physical activity levels, assess barriers and provide patients and their parents the health benefits of physical activity. Also, a list of community resources and additional clinical practice suggestions were made. Suggestions included regular BMI measurements and regular assessment of patients’ physical activity. Increasing Information Accessibility Using Physician Webpages: The Development of the Klamath Pediatric Clinic Webpage Project Date: 7/2/2001 This project sought to address the need for increased access to community and health resources by creating a physician webpage. A webpage was developed for the Klamath Pediatric Clinic after researching available site options and content material. Patients and patients' parents were given an informal questionnaire that asked about Internet use and health topics they would like more information on. Results: 73% of respondents stated that either they or someone in their family used the Internet on a regular basis (defined as usage >1x/month). 70% stated they had at some point used the Internet to look up medical/health information, and 92% said they would use the Internet to look up medical information if they thought it were easily accessible. When asked what community resources they would like more information on, the following results were seen: 20% said mental health; 19% said social services, 17% said family planning; 9% said a specific medical condition; 6% said substance abuse. These results were used to tailor the site's resources and links. Goals the website hopes to accomplish include increasing overall resource accessibility and health information, and more efficient communication between Clinic personnel and patients. The website address is: http://doctor.medscape.com/klamathpediatrics Back to subject search page or search by preceptor site