RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Harney County Influenza Strategies 2009 Project Date: 10/12/2009 This project is a general outline of the organization of local resources and planning used during the 2009 Influenza Pandemic to provide adequate and appropriate care to citizens in Harney County in relation to influenza prevention, triage, and treatment. There was a large surge of influenza-like-illness (ILI) in the community in mid-October, during which time resources including vaccines, Tamiflu, and hospital space were of limited quantity and maintaining a high level of coordination between the hospital, clinic, pharmacies, and health department were all critical. Access to Specialty Care Services in Curry County Project Date: 10/12/2009 The limited availability of local specialty care services in Gold Beach, Port Orford, and Brookings, Oregon is a significant barrier to accessing adequate health care for patients in Curry County. Patients frequently have to travel to other cities in order to obtain necessary care, incurring additional costs related to transportation/travel, lost work hours, childcare, and direct health care costs. This project aims to illustrate potential barriers to accessing care, delineate where providers are currently referring patients for specialist services, and quantify the costs (time and monetary) of travel for the purpose of accessing such services. Demonstrating the challenges associated with utilizing specialty care services as they currently exist provides insights into potential solutions for addressing these issues in Curry County. Group Medical Appointments in Rural Oregon Project Date: 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. The Strawberry Wilderness Community Clinic: A Patient Centered Medical Home for the people of Grant County? Project Date: 10/12/2009 The Patient Centered Medical Home (PCMH) is a model of care gaining support in the primary care community as a delivery system focused on coordinated, comprehensive health care and the patient experience. As health care reform in this country pushes to make improvements in quality and safety, the PCMH may become an ever-more-relevant piece of the healthcare puzzle. However, transitioning to this model from the current fee-for-service model requires time, money, and a coordinated effort by all levels of staff to change some of the fundamental pieces of the health care delivery system. Is this transition feasible in a small, rural practice like the Strawberry Wilderness Community Clinic (SWCC) in John Day, Oregon? How well does SWCC already provide a PCMH for its patients? What are some of the barriers that SWCC (and presumably other small rural health clinics) face in providing this type of health care and what are some ways in which SWCC can move toward providing a PCMH in the future? This study attempted to address these questions via interviews with clinic staff along with a survey developed to assess patient satisfaction. Results of the interviews were qualitative in nature and produced information regarding quality measures, information technology and practice organization at the SWCC. The patient survey generated 25 responses, producing quantitative information on the patient experience and access to healthcare. It was determined that SWCC provides some aspects of a PCMH, mostly with regards to the patient experience, but struggled to meet most of the quality measures associated with providing a PCMH. The biggest barrier appeared to be a lack of trained staff to do data collection or analysis on the quality of health care and health outcomes at SWCC. There were many suggestions for future improvement. Interpreter use in Klamath Falls, Oregon Project Date: 10/12/2009 United States Federal law requires that limited English proficient (LEP) patients be guaranteed effective communication in the course of a hospital or clinic visit. In order to assess the effectiveness of communication between providers and LEP patients in Klamath Falls, Oregon, Family Medicine and Pediatric clinics in this town were given a short survey on LEP patient population and interpreter use. All responding clinics have patients who are Limited English Proficient (LEP) and all utilize health care interpreters who are not certified (either bilingual staff or people to serve as interpreters brought in by the patient) as their primary method of interpretation. While these interpreters may have the skills required to be certified health care interpreters, this cannot be determined without undergoing the testing that leads to interpreter certification. This means that it is currently uncertain whether LEP patients are encountering accurate and effective communication in Family Medicine and Pediatric clinics in Klamath Falls, Oregon. Analysis of mental health disorders at Dunes Family Health Care, in Reedsport, OR. Project Date: 10/12/2009 Background: Studies show that primary care physicians in rural communities have to play a larger role in mental health care when compared to urban physicians. This is due to the fact that in many rural communities primary care clinics are the only accessible mental health resource for much of the population. There are many that believe that primary care physicians lack the training, skills, and time necessary to shoulder this larger burden. Introduction: The goal of this project was to determine at what frequencies mental illnesses are seen in clinic at Dunes Family Health Care in Reedsport, OR; what the demographics of these patients are; and what treatments are commonly implemented. It was hoped that this data would be valuable to Dunes Family Health Care clinicians as it could be used to better help allocate the clinics’ mental health resources in the future. Methods: Using the clinic’s electronic database, lists of patients with the most common mental illnesses were attained using the corresponding ICD9 codes. Records were pulled from the 2008 calendar year. Random charts were selected from the lists and reviewed on the basis of age at the time of visit in 2008, gender, number of visits for this problem in 2008, new problem in 2008 or follow up, and common treatments. Results: A total of 191 individual patients were identified using the diagnostic codes which accounted for an estimated 15.5% of the total patients seen in 2008. Depression was the most common diagnostic category with 38.8% of the diagnoses. Close behind was Anxiety with 31%. Next was ADHD with 16%, followed by Bipolar disorder and Dementia both with about 6%. PTSD had 2.5%. Schizophrenic disorders yielded 0%. Discussion: Much of the data correlates well with prior studies, specifically with regard to depression and anxiety data, including type and frequencies of medication regimens. Unfortunately, this study had significant limitations. The sample size was not very large for many of the categories which significantly reduces our ability to trust that the data is representative of the population in question. This was likely due, in part, to the fact that ICD9 codes were many times not recorded for a variety of reasons. Also, ICD9 codes may not be the best tool for this type of analysis because patients are often given the wrong code. 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 Project Date: 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? Providing Successful Comprehensive Outpatient Health Care Project Date: 10/12/2009 With increasing information about the evidence-based benefits of preventive measures, and as the number of recommended vaccines, screening labs and exams, and behavioral and lifestyle screening expands, the daily workload for a family physician also increases. Heightened demands on the crucial face time we have with patients mean we need to find a way to complete all the tasks and meet all the goals of a clinic visit while maximizing our time, energy, and resources. One of the most significant things I witnessed during my rotation was the efforts of the office staff to keep up with expectations and workload. I chose to help the Scappoose clinic develop a more efficient way to implement screening tools without having patients fall through the cracks. In my research, I came across an approach for quality improvement that involves multiple steps. The steps involve understanding the current workflow, identifying the goals, coming up with ways to make changes that will help meet the goals, and developing ways to measure improvements. As Cool as ICE: A Community Health Initiative Supporting the Use of "In Case of Emergency" Contact Numbers in Cell Phones Project Date: 10/12/2009 Programming an ICE number, or In Case of Emergency contact number, into a cell phone can help emergency workers gain important medical information or contact a family member in the event that a patient is found unconscious or unable to communicate such vital information. Many community members have heard of the worldwide ICE number initiative, yet relatively few have one programmed into their cell phones. Based on previous research investigating methods for increasing the use of ICE numbers among patients already in Emergency Department waiting rooms, this project uses a preventative approach based on the paradigm of inoculation in the primary care setting using the training of “ICE Ambassadors” in the clinic and community. ICE numbers were directly entered into the cell phones of more than 30 community members. Additionally, medical clinic staff and over 80 volunteers with the local fire department were trained how to increase ICE prevalence by explaining WHY the program is important, by knowing HOW to program an ICE number, and by directly HELPing someone else enter one. The student produced and distributed to community members a “business card” with directions for programming an ICE number on one side and the principles of being an ICE Ambassador on the other. Factors Associated with No-Shows and Methods for Intervention in a Stayton Family Medicine Clinic Project Date: 9/7/2009 Patients who schedule clinic appointments and fail to keep them contribute to decreased opportunities for patient health prevention and disease monitoring and management, and also contribute to wasted clinic resources and decreased productivity. This project was conducted to identify and describe factors associated with why patients do not keep scheduled appointments, and discuss potential strategies to increase attendance at appointments. Methods: 110 electronic medical record (EMR) patient charts at a Stayton Family Medicine clinic were randomly selected from 442 no-shows identified from 2004-2009. Results: 442(<5%) no-shows were identified from 2004-2009, or about 1 no-show per provider per week. 110 patient charts were reviewed, 45(40.9%) male and 65(59.1%) female. Mean age was 37.4 years old (YO), with 17(15.5%) less than 12 YO, 8(7.3%) 12-17 YO, 40(36.4%) 18-40 YO, 31(28.2%) 40-64 YO; 14(12.7%) over 64 YO. Tobacco use was reported in 61(55.5%) patients, with 6(9.8%) previous tobacco users, 49(80.3%) current tobacco users, and 6(9.8%) recipients of secondhand smoke. The 6 cases of secondhand smoke were children 2-15 YO. Alcohol use was reported in 40(36.4%) patients. Mean number of medications reported was 3.7 and 4.5 for non-tobacco and tobacco users, respectively. Mean number of past medical history diagnoses reported was 4.3 and 6.0 for non-tobacco and tobacco users, respectively. Conclusion: The rate of no-shows at the Stayton clinic is much lower than the average rate found in many studies. Over half the no-show patients reviewed in the study were reported to be smokers. Most patients are relatively young with 59% who were less than 40 YO. Several factors must be considered in deciding which methods to implement to reduce no-show rates among patients. Warm Springs Fire and Safety - EMS Funding and Training Challenges Project Date: 9/7/2009 Rural EMS agencies are under similar strains as every other aspect of health care. They struggle to recruit, train, and retain providers. The funding for these agencies, especially in a struggling economy, is at a bare minimum. Many of these agencies in the past have been able to provide continuing education and equipment upgrades with the help of grant funds. The Warm Springs Fire and Safety service is no exception. I tried to identify additional funding or resources that were not being utilized. After a local and regional search I was not able to find any financial sources that had not been evaluated, but I was able to offer some strategies to try to maximize the resources that are available. I also provided 5 hours of training to 2/3 of the staff at this department. Exploring Insider Perspectives on the Future of Rural Medicine Project Date: 9/7/2009 The growing deficit of rural healthcare providers has been studied and approached from several different angles. This project seeks to understand the barriers to fostering more healthcare providers from within rural communities by investigating available resources and obtaining perspectives of different members from the community of Reedsport, OR. This was done by surveying and interviewing healthcare providers at the Dunes Family Health Care clinic (DFHC), faculty and staff at Reedsport High School (RHS), and the senior class at RHS. A particular look was taken into potential barriers of inadequate educational and financial resources, lack of student awareness of the range of healthcare careers, and lack of interest in health and science. A presentation was also given to the senior class of RHS to address these areas and a follow-up survey was given to assess changes in awareness and interest. Addressing rural physician shortages through retention: an assessment of physician retention in Ontario, Oregon Project Date: 9/7/2009 Rural areas continue to suffer from a shortage of primary care physicians. Recruitment of new physicians to these areas as a means to address the shortages has long been studied, but the impact of physician retention is now being examined as an important factor in care access. The role of physician retention in rural town of Ontario has yet to be studied. A descriptive analysis of practice length, specialty and reason for resignation or date of anticipated resignation, if applicable, was completed for 102 physicians on-staff for Holy Rosary Medical Center (HRMC) for at least one month between January 1996 and October 2009. The results demonstrate a significant difference in the average practice years of retained and resigned physicians. They also indicate that the four most commonly cited reasons for resignation are: poor fit, desire for bigger city, completed obligations, and family concerns. Results also revealed high turnover among family physicians following completion of service obligations for visas or loan repayment programs. Finally, the analysis predicted a significant shortage of primary care physicians looming in the near future of this community. Though limited in scope, this study identifies an immediate need for increased recruitment of primary care physicians to Ontario, as well as several starting points for addressing shortages through improved physician retention. Practice Innovation at Dunes Family Health Clinic: Are DFHC patients receptive to the idea of phone and email visits as alternatives to office visits? Project Date: 6/29/2009 Much of the excitement surrounding "Medical Home" style practice transformation involves streamlining patient-doctor interactions to make more appropriate use of time for all parties. One assumption called into question is whether doctor and patient need to physically see each other for a legitimate interaction to take place. If this is no longer the case, then the door is opened for new paradigms of patient visits, namely email and telephone visits. These services are currently scarce, primarily due to lack of reimbursement. But would providers and patients utilize these services even if they were reimbursed? This student sought to gauge patient sentiment at Dunes Family Health Clinic toward the idea of alternative doctor-patient encounters. A sample population of DFHC patients (n=189) completed a survey to answer these questions. Reimbursement without insurance: The cost of free medical care at the Cottage Grove Emergency Department. Project Date: 6/29/2009 The burden of loss of healthcare insurance has been a politically hot topic recently as our country’s leaders are struggling to find a solution to our failing healthcare system. I investigated the problem of uninsured patients seeking healthcare in the Emergency Department at the Community Hospital in Cottage Grove, Oregon, by analyzing financial records and determining total charges and reimbursement characteristics over several years. Comparison of data from 2005, 2008 and estimates for 2009 indicated a steadily increasing proportion of charges were made charged to uninsured patients. Furthermore, there was a coinciding steady decrease in the amount of charges made to patients with commercial insurance. These results indicate a shift in charges, which coincide with national trends indicating increased loss of insurance as unemployment levels continue to rise and other factors are contributing to patients’ loss of insurance. Through programs such as PeaceHealth’s “Bridge Assistance,” our regional healthcare systems are struggling to stay afloat as Congress continues to debate healthcare reform and the Federal Government continues to bail out major healthcare systems across the nation. Chronic Pain Management Treatment Options Project Date: 4/27/2009 Chronic pain management accounts for a significant number of visits to primary care providers. Effective management of these patients is challenging because of the complexity of chronic pain, the variable efficacy of available treatments, the limited resources of patients, as well as the abuse and diversion liabilities of controlled substances. Chronic pain often incorporates physical, psychological, social and cultural elements. Moreover, these patients can present with multiple co-morbidities and are high frequency health care consumers, both of which contribute to provider fatigue. The present study describes a small sample of chronic pain patients, illustrates current and past pain management strategies and reports current opinions from multiple staff members on the current state of pain management at the Legacy Clinic in St. Helens, Oregon. It concludes by proposing one management option that may improve treatment efficacy and address economic concerns inherent in this common medical problem. Prevalence of Antibiotic Resistant Bacteria Project Date: 4/27/2009 I studied the prevalence of antibiotic resistant bacteria among the population serviced by the laboratories at Silverton Hospital. Antibiotic resistance data for 2009 was obtained for the following species: C. feundii, E aerogenes, E cloacae, E faecalis, E coli, K. oxytoca, K pneumonia, M morganii, P. mirabilis, P. aeruginosa, S marcescens, S aureus, S epidermidis, S. saprophyticus, S. agalactiae. Sensitivity data for the following drugs was available: Amikacin, Ampicillin, Aztreonam, Cefazolin, Ceftazidime, Ceftraxone, Cefuroxime, Ciprofloxacin, Clindamycin, Ertapenem, Erythromycin, Gentamicin, Imipenem/Cilast, Levofloxacin, Nitrofurantoin, Oxacillin, Piperacillin/Tazobactam, Sulfa/Trimethoprim, Tetracycline, Vancomycin. Relevant literature was reviewed including data from national levels and from the greater Portland area. There is data in the literature to suggest that regional antibiograms provide accurate, cost effective information for local providers concerning trends in community-specific resistance trends. Providing sensitivity that is regional and accurate will help to guide empiric therapy of common infections, and can ultimately help to decrease the rate of increase in resistant bacteria. Health of the Klamath Tribes Project Date: 3/16/2009 The purpose of this project was to educate myself and my peers about Indian Health Service and unique health and healthcare delivery issues faced by AI/NA patients, within the context of the Klamath Tribes as sole provider of IHS services in Klamath County. The Indian Health Service (IHS) is a unique healthcare delivery system that provides health services to nearly 2 million American Indians and Alaska natives (AI/NA) residing on or near reservations and 600,000 patients in urban areas. The Portland Area Office of IHS is one of 12 area offices around the country, serving 42 federally-recognized Tribes in Idaho, Oregon and Washington State. The project population was patients at the medical clinic of the Klamath Tribes Health & Family Services Wellness Center. Investigation methods included a meeting and extended tour with the Health General Manager, observation of patients at the Wellness Center, discussion of health and healthcare delivery issues with the clinic’s primary providers and use of Internet resources. Results: common health issues included opioid dependency, diabetes, hypertension and obesity, infant mortality, substance abuse and mental illness. Healthcare delivery issues included limited funding, need for providers, limited resources for a growing patient population, and lack of an electronic health record (EHR). Current use and capacity for colorectal screening by colonoscopy in Grant County, Oregon Project Date: 3/16/2009 Colorectal cancer incidence and death is largely preventable by screening. Colonoscopy is a particularly compelling screening modality for frontier communities, but capacity may not exist in all these communities to increase screening via colonoscopy given limited access to resources and physicians. A study was conducted in the frontier communities of Grant County, Oregon to determine existing colonoscopy uptake rakes and screening capacity. Two Year Analysis of Total Joint Replacements at the Lower Umpqua Hospital Project Date: 3/16/2009 Hospital procedure volume has been shown to be inversely proportional to postoperative complications. The objective of this study was to determine if total knee and hip arthroplasties can be effectively and safely performed in a low procedure volume hospital such as the Lower Umpqua Hospital in Reedsport, Oregon. The medical records of patients undergoing elective, primary total knee and hip arthroplasties between January 2007 and December 2008 were reviewed for outcomes occurring three months after the procedure. Results were compared to a large Medicare cohort treated with similar procedures. At this hospital, the rates of complications were minimal to none. There was an acceptable rate of manipulation under anesthesia and no dislocations. One superficial infection was noted, but no deep infections. No deaths, DVT’s, PE’s, MI’s or pneumonias were experienced in this cohort. In conclusion, total knee and hip arthroplasties can be effectively and safely performed at the Lower Umpqua Hospital, a low procedure volume hospital. Educating the Future Project Date: 2/9/2009 From a health care perspective, one of the most difficult tasks in a rural setting is recruiting new physicians to the area. Grants Pass has a population around 30,000 with a wide variety of specialists to serve the population. The problem: physicians are aging and there isn't anyone willing to replace them. It has gotten so bad that the general surgeons are threatening to cut weekend call all together. The greatest hope lies in the community's youth who are likely to return to their hometown upon completion of their training. I was invited to Grants Pass High School to teach the students in the advanced medical skills class how I became interested in medicine, what I did to get into medical school and what life in school is like. It was my goal to demonstrate how much fun medicine is, and how they can go about getting into medical school. To show how much fun it is, I used hypothetical trauma scenarios and asked them what to do. The next day, I brought in 12 pigs feet along with suture material and taught them how to suture using sterile techniques. Through this process, I learned how a physician is not solely a healer, but an educator as well. It is a physician's duty to educate the community. I used the classroom to educate students about medicine, and it was clear that more than a couple of interests were sparked. Pediatric Telephone Medical Care Project Date: 12/29/2008 Since its invention in 1876, the telephone has been used as a tool for delivering health care. The first recorded use of the telephone in pediatric practice was reported in The Lancet in 1879, describing the evaluation of an infant with croup using the newly developed telephone (Melzer et al. 2006). As the future of patient care continues to improve, the addition of telephonic medical care to the health clinic is now on the forefront of interest and debate. The opportunity for parents to call into the clinic with their child’s symptoms, speak with a physician, and receive counsel and treatment over the phone, may not only save time, but may extend care to a greater number of families. For many reasons, the pediatricians at the North Bend Medical Center are interested in establishing a telephone medical service to further extend pediatric care to their community. To better assess their current patients’ interest in such a service, we provided a survey to the parents of visiting patients that assesses the number of children, the number of visits, the number of phone calls, the length of travel time, their interest in speaking with a medical assistant or physician, and their willingness to pay out of pocket for telephone services. When asked to assess, on a scale of 1 to 5, their interest in speaking with a physician over the phone about their child’s medical needs, 88.2% marked interest levels between 3 and 5. . Of all those who took the survey, 63.5% of parents would be willing to pay for telephone medical care if their insurance does not cover it. Telephone medical care is about extending health care to a greater rural pediatric population. Its about saving families the anxiety and time that accompany last minute appointments, and helping those who cannot afford an office visit receive care from their pediatrician. Though the implementation of this service may be months in the making, forward strides are being made to increase pediatric services. Implementation of Personal Health Records in a Rural Community Project Date: 12/29/2008 The term "patient-centered care" is an often-used catch phrase in family medicine. This approach includes core values such as information sharing, participation and collaboration. Stemming from these ideas, interest in the development of personal health records (PHR's) has been a recent hot topic in the world of Health Information Technology. PHR's are a patient-directed tool that may help to deliver integrated, portable, interoperable, patient-centered care. They have many projected benefits especially in rural communities. These benefits include reaching out to areas of unmet need, helping to protect isolated communities, empowering patients and enlarging the "virtual" healthcare network. However, significant risks and barriers to implementation exist and these must be further defined, analyzed and accounted for before PHR's can become a reality. As such, with this project I sought to develop a thorough understanding of OHR's and analyze the risks, benefits and barriers to implementation in a rural community. Overall, PHR's have many potential benefits but implementation will require overcoming many barriers (financial, logistical, and technical) and carry significant security risks to all parties involved. Health Screening Awareness in Grants Pass Project Date: 12/29/2008 Preventative health services are central to individual health while maintaining low overall health care costs. While on my rural clerkship in Grants Pass I found that patients of the Grants Pass Clinic were largely unaware of health maintenance screening guidelines. Further, while performing colonoscopies, I noted the age of most patients was higher than I expected. I then accessed the local OHP plan, OHMS, for claims data for colonoscopies amongst 50 year-olds and mammograms amongst 40 year-olds. This demonstrated the poor compliance of the Grants Pass community with recommended health screening, ranging between 7-15% of patients for these services. I addressed this problem by creating an informative pamphlet to be distributed to OHMS members and to be displayed within the Grants Pass clinic. I hope to increase local compliance with health screening by 10% in the next year. Patient Perceptions of Rural Surgery: Can John Day's Blue Mountain Hospital compete with larger outside hospitals? Project Date: 12/29/2008 CONTEXT: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size and distance from more populated centers. Since rural hospitals are located in varying types of rural communities, they likely differ with regard to the provision of surgical care. PURPOSE: To describe the differences between hospitals located in smaller versus larger rural areas regarding the provision of surgical care. METHODS: A 12-item survey instrument based on one previously used in a pilot study was mailed to a national random sample of rural hospital administrators (n = 233). Rural location was determined using rural-urban commuting area codes. FINDINGS: One hundred and eleven surveys were received, yielding a 48% response rate. Hospitals in larger rural areas had an average of 9 surgeons compared to 1 at hospitals in smaller rural areas. More administrators at hospitals located in larger rural areas viewed the ability to provide surgical care as very important to the financial viability of their hospital. CONCLUSIONS: Among rural hospitals located in communities of varying sizes there are significant differences in how surgical services are delivered and the financial importance of providing surgical care. Administrators at hospitals located in larger rural areas, more than in smaller ones, report financial reliance on their ability to offer surgical care and have significantly more resources available to do so. Recruitment and Retention of Physicians in Klamath Falls, Oregon Project Date: 12/29/2008 Recruitment and retention of physicians in rural communities continues to be a problem throughout the United States. This study aimed to characterize the unique challenges and solutions to the problem of physician recruitment and retention faced by the larger rural community of Klamath Falls, Oregon. Due to its status as a large rural community, Klamath Falls is not eligible for many of the state and federal government programs that have helped smaller rural communities recruit physicians, such as loan repayment programs. This study identified three areas of concern when it came to recruiting new physicians: frequent on-call duties, poor reimbursement rates due to large Medicare population, and lack of loan repayment programs. Through interviews with physicians, citizens, and business members possible solutions to these barriers were discussed. Future direction for this project would entail identifying strategies and resources to aid in overcoming the barriers of retention and recruitment of physicians. Depression in Warm Springs Project Date: 10/13/2008 Depression is a serious condition that affects the mind and body, associated with a host of co-morbidities and potentially resulting in suicide. Factors associated with increased prevalence of depression that are certainly found in Native American communities include poverty, displacement, and relative lack of jobs. However, there are some barriers that prevent the people of the Warm Springs reservation from getting counseling help for depression, such as cultural factors, lack of knowledge about the local Counseling Center and its services, and misconceptions of poor patient confidentiality and costly services. To address the issue of depression in the Warm Springs community, I designed a pamphlet for the Counseling Center that would help in getting the word out to the community about the Counseling Center and the services they offer, appeal cross-culturally, aid in screening for depression, provide resources to help intervene, and dispel misconceptions. Will Baker City Lose Its Only Nursing Facility? An analysis of the St. Elizabeth Care Center Project Date: 10/13/2008 The St. Elizabeth Care Center is the only Nursing Facility in Baker City, OR. The Care Center serves a population of approximately 16,000 residents in Baker County, a disproportionately large percentage of which are senior citizens. When it was discovered that the Care Center faced a fiscal crisis that threatened its closure, an investigation was made into the impact this closure would have on the community’s seniors. Consensus input from those involved in long-term care in Baker suggested that closure would constitute the loss of a critical resource. A further investigation was made into the causes of the Care Center’s financial instability and changes were suggested to prevent closure. Identifying the Disparity: A Comparison of HIV Resources between Curry and Josephine Counties and Multnomah County Project Date: 9/8/2008 As with most health care resources, the HIV resources in rural communities are remarkably less available than more urban areas. This project attempts to qualify and quantify these differences and also attempts to provide an explanation for the differences in funding to these areas. Methods: The study uses interviews with patients, physicians and authorities from Josephine, Curry and Multnomah County Health Departments to identify key differences in these areas. It also uses analysis of the State of Oregon HIV Data and Analysis database. Conclusions: Although there are key differences in resources between rural and urban areas, the study concludes that the disparities are a product of supply-and-demand and a product of the algorithm used by the federal government for allocating dollars to these areas. It also concludes that there is incongruence in the incidence, prevalence and death rates of HIV in these areas, supporting the additional funding to urban areas. A Welcome Home: Needs Assessment and Projected Cost Analysis of the Addition of a Behaviorist to the Primary Care Home in Florence, Oregon Project Date: 9/8/2008 According to a 2002 study published in JAMA, “Most people in the United States want a medical home.” As the PeaceHealth Siuslaw Region Family Medicine practice makes plans to move forward with its version of a Primary Care Home, a needs assessment and a projected cost analysis were performed to determine the probable clinical and financial outcomes of adding a behaviorist to the care team. The design of this study was direct observation of the practice of one of the ten family physicians currently working at the PeaceHealth Family Medicine Center. At the conclusion of each working day, the patient census was analyzed; based on presenting complaints, chronic health problems and length of individual visits, we sought to determine which patients would have benefited from a consultation with a behaviorist. Based on average Medicare and Medicaid reimbursements for both physician office visits as well as Health and Behavior codes, we were then able to estimate the projected financial impact of these determinations. Our findings demonstrate that a behaviorist is a necessary and, in the worst-case scenario, a cost neutral addition to the Primary Care Home in Florence, Oregon Access to Orthopedic Services in Cottage Grove, Oregon Project Date: 8/4/2008 Access to health care services meets many barriers in rural communities and the experiences of community members in South Lane and North Douglas Counties are no exception. While Cottage Grove Community Hospital is generally successful in meeting its community’s primary care needs, the availability of specialty services continues to be lacking. Through observation, interviews of patients and the medical community, and data compilation, the need for orthopedic services in Cottage Grove, Oregon, was assessed. Based on the data and observations, it can be concluded that Cottage Grove Community Hospital patients face significant obstacles to receiving orthopedic care. Furthermore, it can be suggested that there is sufficient patient demand for orthopedic services for CGCH to consider bringing orthopedic services to the facility. It is hoped that this assessment will raise the awareness of specific barriers to health care and provide a direction in which to work to minimize the obstacles Cottage Grove Community Hospital staff and patients face in providing and receiving specialty care, specifically orthopedics. Complementary Health Services in the Mid-Columbia Gorge Project Date: 8/4/2008 This project is a ‘survey of the scene’ of the various alternative and complementary health services offered in Hood River Oregon, and the Mid-Columbia Gorge (MCG) area. Utilizing internet searches, telephone directories, physician and physical therapy interviews; this project first lists all currently existing complementary services in the MCG area then the initial survey is followed by site visits, and interviews of 3 different area complementary health clinics. The clinics are questioned about the unique services they offer, the basic demographics of their clients, and how they contribute to the health of the population of the MCG area. The report concludes with recommendations for future patients seeking alternative or complementary health services. A Look at the Availability of the HPV and Meningococcal Vaccines in the North Santiam Canyon Project Date: 8/4/2008 Vaccination has become a huge part of preventative health in the U.S. and around the world. We've seen illnesses such as small-pox virtually eliminated from the population by successful vaccination programs. The first day I was in clinic, a girl came in requesting the HPV and Meningococcal vaccines and I was surprised to learn that neither of these were offered at the clinic I was at. This study looked at the availability of these two optional and expensive vaccines in the greater Santiam Canyon area. A phone survey of the local physicians was used to assess the availability of the vaccines and to ask about resources outside of these communities that they might utilize to provide this vaccine for their patients. Finally an informational handout was made that outlined basic information about each vaccine, resources available to help pay for them, and a phone number for a resource that provided the vaccine should their own clinic not provide them. Most Wanted: Clandestine Patients Project Date: 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. n=1 or n=1 x 10? An Individual Perspective on Population-based Healthcare: A Case Study Project Date: 6/30/2008 In the United States, cardiovascular disease (CVD) affects 80.7 million (37.l%) individuals, is responsible for 869 thousand deaths per year, and generates an estimated $448.5 billion in annual economic costs. There are an ever increasing number of large epidemiologic studies, trials, and meta-analyses dealing with primary and secondary prevention of cardiovascular disease and its complications. New management and treatment guidelines are constantly generated and old ones discarded, updated, or revised, but the burden of CVD continues to increase. Oregon Health Division vital statistics show that Malheur County, location of my Rural and Community Health Clerkship, has a significantly higher than average death rate due to cardiovascular disease. The goals of this inquiry are twofold: one, to develop an understanding of Community Oriented Primary Care (COPC) within the context of a disease that is as relevant to populations in Malheur County as it is those in places like Orange County or Miami-Dade County and two, to evaluate some of the strengths and weaknesses of population-based perspectives like COPC on clinical outcomes for individual patients or the economics of healthcare. Can Astoria Support a Physiatrist? Project Date: 6/30/2008 Rural communities are disproportionately affected by disabling conditions and chronic diseases. Labor-intensive occupations, older demographics and shortages of medical services contribute to faster progression of disease in rural settings. To address these issues, Columbia Memorial Hospital became interested in the viability of a physical medicine and rehabilitation specialist in Astoria. One of the most significant factors to the success of physiatrist is whether this specialist can obtain referrals from primary care clinicians. The purpose of this study was to assess the attitudes, potential competition, past referral patterns, and predicted referral patterns of clinicians in Astoria and Seaside with respect to physiatry. The majority of surveyed clinicians self-report a high degree of familiarity with physiatry. They are comfortable referring patients to this field and they believe physiatry would provide unique services to the area. While some are concerned about competition with a physiatrist, the overall attitude from local clinicians is supportive of this addition to Columbia Memorial Hospital. While an adequate referral base may exist locally, the catchment area for this specialty can extend beyond Astoria and Seaside to ensure a sustainable number of patient encounters. Educating primary care clinicians about physiatry and cultivating relationships with colleagues in the service area should provide adequate referrals to support this addition to Columbia Memorial Hospital. Enhancing Diabetes Care Project Date: 6/30/2008 Diabetes mellitus type II is nearing epidemic numbers in the United States, straining our healthcare delivery system. A complicated disease to manage, diabetes poses a particular problem for rural hospitals and providers who may lack the resources or continuity available to urban patients. Blue Mountain Hospital in John Day, Oregon has addressed the problem of complicated inpatient management, in part, by creating standardized admission and discharge orders for complicated problems. This project aimed to enhance diabetes care at BMH by adding admission and discharge order sets that any provider may use to streamline admission and improve the hospital course. In addition, patient education materials were found and provided. Due to low patient volume, the orders have not yet been used, but received positive feedback from practitioners, hospital staff, and the director of nursing services. The Underutilization of Available Social and Healthcare Services by Seniors in Junction City, OR Project Date: 6/30/2008 As the population in the United States continues to age, well-developed and funded social and healthcare services aimed at improving quality of care and delivery of services for seniors are more important than ever. This study attempted to identify available social and healthcare resources in the Junction City service area as well as identify reasons for their underutilization. The design was to interview clinic practitioners, patients, senior center staff and patrons, and social workers in the community over a 5-week rotation in a primary care setting, as well as include conclusions from appropriate journal articles. Adequate social services resources and health care clinic practices were identified. They included a Lane County funded social worker/case manager assigned to Junction City as a liaison for seniors, a well-developed website directory dedicated to resources for Seniors and Disabled persons of Lane County, an active senior center with low cost daily activities. Healthcare related practices included a satellite community clinic, nursing home visits, and a generic drug sample machine. Many barriers to utilization of these serviced were elucidated. They included incomplete access to available resource information, which was primarily internet based, a lack of knowledge of available services by clinic physicians, difficulty with transportation, reluctance for help based on current seniors’ fierce independent nature, lack of anonymity in a small town, and stigma regarding mental illness. In conclusion, it was determined that a better flow of dialog and information was necessary between physicians, social workers, and community support centers (senior centers/churches) to enable seniors to find appropriate resources. However, it was also determined that full utilization will be difficult until attitudes towards community aid are altered and seniors, and their families, are more accepting of social services support. Reviewing the Changeways Program as a treatment for depression in a rural setting Project Date: 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. Colon Cancer Screening in Rural Oregon A Small Case-Series for Reedsport, OR. Project Date: 4/28/2008 Purpose: To establish demographic data for those undergoing colonoscopies in rural Oregon. To determine whether current screening with colonoscopy is cost-effective for Reedsport, and Dunes Family Practice. Methods: I performed a chart review of 145 cases dated between 01/03/07 and 03/26/08. Records were evaluated for general demographic data. pertinent past medical/surgical/family/smoking history, presenting symptoms, prior and current colonoscopic & pathologic findings. Results: All 145 cases were included in series (83 females, 62 males). Mean age was determined to be 64.83 years. Approx. 25% had prior history of polyps, 3 % with colon cancer previously. 79% had a positive colonoscopy, with 23% having any type of polyp. Of those with polyps, approximately 47% (15 cases) had adenomatous and 6% (2 cases) with malignant findings. Incidence of colon polyps and cancer was calculated to be 22 per 100 individuals per year and 1.4 per 100 individuals per year, respectively. Total life-years gained for cases was calculated to be 20 yrs. Conclusions: Incidence of colon polyps and cancer found to be significantly higher than national and Oregon average. This is likely due to demographic factors including age and prior health status. Current screening with colonoscopy was found to be cost-effective based on general acceptance of screening procedures with cost per life-year gained <$25,000. Emergency Contraception in Baker County: Compliance with Laws Governing Access and Dispensing Project Date: 4/28/2008 In August of 2006, the FDA approved the emergency contraceptive Plan B to e available over-the-counter in pharmacies nationwide. In 2007, during the Oregon Legislative Assembly passed House Bill 2700, which requires health insurance plans in Oregon to cover prescription contraceptives. It also requires emergency rooms to provide information about emergency contraceptives to all female victims of sexual assault, and to administer emergency contraceptives to these patients while they are in the emergency room if they so desire. Interviews with the county's five pharmacists revealed that four of the five pharmacies in Baker County carry Plan B and dispense it over-the-counter to those 18 and older, and with a prescription to those 17 and under. Conversations with Emergency Department staff at St. Elizabeth Health Services revealed compliance with the spirit of the law, as it applies to victims of sexual assault. Access to emergency contraception in Baker County is further improved by the efforts of the health department, where it is available for free. The final area investigated in this project was the state of the high school health curriculum, which competently addresses contraceptives, including Plan B, and teaches students how to access birth control. A letter detailing these findings was distributed to health department workers as well as 7 physicians and 4 nurse practitioners in Baker City. Feasibility Study of Vitamin K Supplementation to Treat Patients with Unstable Anticoagulation on Warfarin at the Scappose Family Practice Clinic Project Date: 4/28/2008 The management of warfarin therapy affects a large segment of the aging population and is expensive and time consuming for the patients and clinicians. For many of the patients at the Scappoose Family Practice Clinic, it was a financial hardship to take time off work, find transportation and pay a $20 co-pay each time they needed their Warfarin dose adjusted. This is in addition to the financial and medical devastation such as stroke or hemorrhage that could result from a patient being under or over anticoagulated. The purpose of this community project was to design a study to test the hypothesis that 150mcg of daily Vitamin K could stabilize patients on warfarin in an INR range of 2-3 and reduce the frequency of warfarin dosage adjustments. Phase I consisted of a literature search and then based on previous studies developing inclusion and exclusion criteria which would be used to identify a subset of patients at the Scappose Family Practice Clinic who would be eligible for this study. Once these patients were identified, a retrospective chart review was done collecting data on these patients for the period 11/1/07 - 5/1/08. Phase II will involve giving these patients 150mcg of daily vitamin K and collecting data for 6 months. We will then compare the two data sets. If the results indicate that 150mcg daily vitamin K improves anticoagulation control in patients with unstable INRs, this protocol can then be initiated to the benefit of the patients and the clinic. Mental Health Care Practitioners in Philomath, OR: Difficulties with access and availability. Project Date: 4/28/2008 The supply of both prescribing mental health care providers as well as licensed therapists in rural settings in the United States is a major problem. Subsequently, there is a significant shortage of available providers to see patients in a timely manner. Although many primary care physicians, such as family medicine doctors, are capable of supporting and treating many patients with psychiatric problems, most lack both the time necessary to engage in meaningful therapy as well as the skill set required to manage acute mentally ill patients well. For these reasons this project was developed in order to better characterize the local deficiencies in mental health care services and access as well as to offer a potential solution by generating a viable list of providers in the area that are accepting new patients. A general consensus within the Philomath Family Medicine clinic indicated a shortage of rapid access to prescribing mental health care providers was present and that more providers were needed in the area. A provider list was generated four years earlier through a similar project, although many of the physicians, counselors, and therapists on that list were either no longer in the area, or they were no longer accepting new patients. The primary care physicians felt an updated list of social support structures (public and private), psychiatrists, counselors, and therapists in the area would be of value. Through the use of various resources, a thorough list was created and included such information as a description of the practice with areas of interest/specialization unique to the provider, the current waiting time to be seen, eligibility requirements, and payment structure. Resources Available for Patients with Dementia in Columbia County, Oregon Project Date: 3/17/2008 Dementia represents a major health issue for geriatric patients in the United States. This study serves primarily as a community profile and assessment of the resources available to patients with dementia, specifically Alzheimer's disease and their families in Columbia County, Oregon. The study evolved during preliminary conversations with the staff of the primary care internal medicine clinic in St. Helens, Oregon. They identified the availability of resources for dementia as a consistent challenge in offering guidance to their patients. A survey of local resources was conducted which included site visits to nursing homes and senior centers, contacts with social workers, and internet searches for resources. The local resources were compared with those described in the medical literature and the National Alzheimer's Association. Questions to evaluate the effectiveness of the local resources were prepared for patients with dementia and their caregivers. A simple handout was prepared to identify key resources in the community and at large. Establishing a Needle-exchange program in Klamath County Project Date: 3/17/2008 Hepatitis C infection is increasing in incidence throughout the state of Oregon, and particularly in Klamath County. Estimates of hepatitis C rates tend to under-estimate the true incidence: because most hepatitis C infections are asymptomatic, many people do not know they are infected. A majority of acute cases of hepatitis C are associated with injection drug use. Needle exchange programs, where clients can turn in needles and syringes used for drug injection in exchange for new ones, has been demonstrated to reduce the transmission of Hepatitis C and HIV, without increasing IV drug use. The aims of this project are to justify the need for needle exchange in Klamath County, present the data for the effectiveness of needle exchange as a tactic to reduce disease, and identify the steps needed to establish such a program. Access to Mental Health Resources in the Astoria Area, A Narrative Survey. Project Date: 3/17/2008 Mental health complaints are extraordinarily common in the primary care setting with a prevalence of up to 50%. Primary care physicians do the bulk of routine mental health care in all settings but this is particularly true in rural areas. What resources are available to them when they have patients requiring more specialized care? A qualitative survey of mental health care resources in the Astoria was done. Many of the obstacles to care were found to be similar to those of an urban environment: poor access for the uninsured, providers unwilling to accept Medicare patients. Other obstacles were more unique to a rural area, specifically the lack of local inpatient psychiatric beds and certain other specialized psychiatric services such as methadone maintenance clinics or inpatient treatment for eating disorders. Overall PCPs in Astoria have ready access to such referral services as counseling and therapy as well as to psychiatric prescribers. Overall all of the health care providers surveyed seemed to enjoy the benefits of living and working in a small town. Opportunities For and Barriers Against Watchful Waiting as an Initial Management Strategy of Acute Otitis Media in a Rural Pediatric Practice Project Date: 3/17/2008 Over-usage of antibiotics has been identified as a source of antibiotic resistance. To combat the emergence of drug resistance many groups have sought to identify diseases in which antibiotics are frequently used where they are needed to bring out resolutions of disease. Acute otitis media (AOM) is one such disease. In fact, AOM is the most common disease for which a child is given antibiotics. A recent statement by the AAP's Subcommittee on the Management of Acute Otitis Media has stated that observation without antibiotics is appropriate initial treatment of a sub-group of patients. A study published in JAMA in 2006 that was conducted in a metropolitan ED confirmed that watchful waiting in the form of "wait-and-see prescribing" (WASP) was not associated with significant differences with regard to subsequent fever, otalgia, or unscheduled ED visits when compared to day-of-visit prescribing. I wanted to see how often patients in the office-based pediatric practice in Grants Pass, Oregon were prescribed antibiotics for AOM when watchful waiting would have been justified by AAP criteria. I chose to do this because I saw more cases of AOM than any other disease during my rotation and noticed that most children received antibiotics as an initial course of therapy. To assess physician prescribing behavior I reviewed the charts of 55 patients seen between Jan 1, 2008 - March 31, 2008 who were diagnosed with acute otitis media. The patients were selected via ICD-9 code for otitis media. 55 patients with MRIPA insurance were seen between Jan 1, 2008 - March 31, 2008 and diagnosed with AOM. Six patients were excluded. Of the remaining 49 patients (provider breakdown: Ayoli = 18, Crispen = 12, Marshak = 14, Burnett = 5), 31 (63%) were eligible for watchful waiting according to the AAP. The remaining 18 (37%) fit criteria for immediate treatment. 46/49 patients were prescribed antibiotics immediately. 3/49 were offered antibiotics under WASP. All 3 WASP patients were eligible according to the AAP guidelines. Physicians were interview about barriers to WASP. Most common responses were financial burden of additional visits and fear of compromise to customer service element of modern practice. In the end a handout was created to facilitate the WASP discussion. Raising Awareness of HPV and HPV Vaccination Among Eligible Females in Jefferson County Project Date: 3/17/2008 The Human Papilomavirus (HPV) is the most common sexually transmitted infection worldwide and is second only to HIV in the cost burden to the United States health care system. Eighty percent of sexually active men and women will acquire HPV infection at some point in their lifetime . The Quadrivalent HPV vaccine was approved by the FDA in 2006 for use in 9 to 26 year old females. Trials of the HPV vaccine have shown 98 to 100 percent efficacy in preventing type specific HPV infection and 90 to 100 percent efficacy in preventing CIN 2/3. By informal interviews with health care providers and information from two local clinics, it is estimated that the HPV vaccine is being underutilized in Jefferson County. Based on information from two local clinics, approximately 10% of 15 to 24 year old females in Jefferson County were vaccinated for HPV in 2007. The goal of this community project was to increase HPV vaccination rates by raising awareness of HPV and HPV vaccination among eligible females in Jefferson County. To accomplish this goal a lesson plan was created using information from the CDC Department of Health and Human Services that targeted 10th grade students and met Oregon and National Health Standards. The lesson plan was well received by the head of the health department at Madras High School and will be integrated into the 10th grade Health 1 curriculum beginning this year. Hospice and End of Life Care In Tillamook Project Date: 3/17/2008 Hospice care embraces a philosophy of high-quality, comprehensive end of life care. My experience in Tillamook, OR made it clear that hospice is also, in fact, a very natural extension of the strong sense of community that exists in a small town. Through a series of home visits I learned about one Tillamook woman’s experience with hospice care at the end of her life, and via interviews with hospice nurses, the hospice medical director (my preceptor) as well as other users of hospice I found that hospice care in a small town-setting may have advantages over a larger city setting, however issues remain such as reduced use of hospice in rural areas and the financial vulnerability of small hospice facilities. I also discovered that this patient’s case may actually serve as an example for a more efficient use of health care dollars in the final months of life, and as a contrast to more common spending practices in our country’s current health care system. In my five weeks in Tillamook, I was exposed to multiple end of life issues with other patients in the clinic and in the hospital, and I found that more than any previous experience in my third year, the hospice environment and our home visits to a dying patient allowed me to find greater meaning and personal solace in my interactions with these other patients. Assessing the Current Methods for Managing Hyperlipidemia and Their Effectiveness Project Date: 3/17/2008 Chronic disease management is a large part of primary care and it can have a big impact on the heath of a population. Hyperlipidemia is one of the more common chronic diseases seen in primary care and it is a major risk factor for cardiovascular disease and stroke. Coronary heart disease is the leading cause of death in this country. Studies have shown that optimal management of patients with hyperlipidemia is essential to decreasing the risk of cardiovascular disease. The goal of this study was to assess the current methods for managing hyperlipidemia in one rural family practice clinic and their effectiveness. The design was observation of clinical practices, interviews with clinic providers and random chart reviews of twenty-five patients with previously diagnosed hyperlipidemia. The findings indicated that lipid levels were fairly well controlled with the current strategies. Areas for improvement included regular patient follow up and management of coexisting cardiovascular risk factors. A standardized form was created to be both a clinical checklist as well as a tool for documentation. It is expected that this document will help improve overall management and facilitate simple and comprehensive documentation. The Effectiveness of Patient Education in the Total Health Community Clinic: A Media-Based Approach Project Date: 2/11/2008 Patient education is a key component of preventative medicine and is necessary to providing comprehensive patient care. This student attempted to identify the effectiveness of patient education efforts in Monmouth, Oregon family practice clinic. The design included observation of patient education methods currently in use in the clinic and an analysis of the effectiveness of those methods over the course of four weeks. In addition, patient interviews were conducted to both assess the effectiveness of patient education methods currently in use and to discuss methods for improvement. New methods for educating patients were then employed and their effectiveness measured via observation and patient feedback. These included patient educational videos presented in the waiting area as well as patient handouts. In addition, a patient-accessible computer with learning tutorials was proposed to clinic administrators and approved for implementation. The changes achieved in this project enhanced patient education and increased satisfaction with the clinic waiting room experience, as many patients felt that their waiting time was more valuably used. Recruiting and Retaining Physicians in Coos Bay: Assessment of Medical Student Interest in Rural Medicine and Rural Physician Perspectives on Their Practice Project Date: 2/11/2008 Background. Coos Bay is a rural city on the southern Oregon coast that struggles to recruit and retain sufficient physicians. The purpose of this study is to assess medical student rural interest and Coos Bay physician perspectives as they relate to recruiting and retention. Methods. A literature search was conducted to identify common recruiting and retention issues. Physician recruiters and practicing physicians at NBMC were interviewed to identify unique issues and their commitment to this community. Finally, OHSU medical students were surveyed to assess their past and current level of interest in rural medicine. Findings. Key to physician happiness in is their practice. Most of the physicians interviewed are planning on retiring in Coos Bay. Medical student rural interest correlates with increasing student age, male gender, and rural upbringing. Specialties correlated with rural interest are family medicine, emergency medicine, obstetrics and gynecology, and pediatrics. Medical students showed increased rural interest following their rural clerkship. Conclusions. Successful medical practice is key to physician happiness and thus long term retention. OHSU’s third year rural clerkship is a great tool to increase interest in rural medicine. However, it can be further optimized by addressing housing issues, boredom, and misperceptions. Non-urgent Use of Hospital Emergency Services in Grant County, Oregon: The Impact of Primary Care Physicians Fleeing Rural America Project Date: 2/11/2008 Primary care physicians' covering the Emergency Department is almost exclusively seen in rural health settings. While these physicians rarely encounter problems of overcrowding and prolonged patient wait times often seen in larger cities, several issues arise that are somewhat more unique to rural health. One such issue is the direct relationship between the diminishing number of general physicians practicing in rural areas and the resultant overflow of non-urgent patients into the ED. Regardless, it is these same community doctors providing treatment for these patients creating what may be considered a vicious circle. This magnitude of this issue was explored via a questionnaire directed toward patients visiting the rural Blue Mountain Hospital Emergency Department in John Day, Oregon during a three-week period between February 2008 and March 2008. The results of this study showed that nearly 45% of all patients presenting to the ED during this time had initially attempted to address their health care needs in the primary care setting. These patients also encounter 30% higher costs for health care than their counterparts receiving care via their regular physician. Use of email in a rural family practice setting: a strategy to meet increasing demand on limited health care resources in John Day, Oregon. Project Date: 2/11/2008 The challenges created by physician shortages in rural communities require creative solutions that maximize available resources. Previous studies have demonstrated that Internet technology such as email, electronic medication refills, and web consults has the potential to improve efficiency and increase productivity among family practice clinics. It has also been shown that a majority of patients use the Internet and are interested in electronic communication with their physician. This study attempted to determine the number of patients in a family practice clinic in rural John Day, Oregon that have access to the Internet and are receptive to emailing with their doctor. Methods included a survey and informal interview of a convenience sample of patients at the clinic about their use of the Internet and attitude toward using this medium to interact with their doctor. Information about gender, age, and place of residence was also recorded. Fifty-nine percent of patients sampled did not use the Internet and were not interested in any form of Internet technology to communicate with their physician. This attitude was found entirely among elderly patients who cited their inability to navigate the web and lack of understanding of its potential benefits as reasons for not using the Internet. This survey showed that patients in John Day do not have enough interest and fluency in Internet technology to make this form of communication a viable option at this time. Reedsport Elementary: What health complaints occur at school? Project Date: 2/11/2008 Taking care of the health needs of America's children seems to be a shifting priority over the last several decades. Health care concerns for children are not limited to the medical community but also affects school system. Reedsport Elementary has been able to secure a school nurse position which has been financed by a two year federal grant, and the specific health problems suffered by the school's children was quantified and categorized. Incidence logs from 33 consecutive school days were reviewed and data extracted. Data separated into health complaints and outcome of visit. An accurate, though limited, snapshot of health concerns at elementary school given in report. School nurse benefit difficult to quantify based on cases seen due to mass of other work that they do that is unseen. If school nurses contribute to overall safety and education of children at school they will always be an asset to staff and curriculum. Access to Cancer Support Services in Florence, OR Project Date: 12/31/2007 A diagnosis of cancer can be traumatic for a patient, and psychosocial support services have been found to help patients through their battle with cancer. Rural communities present a challenge when trying to provide cancer support services because of limited resources, traveling distances for the patients and the volunteers, and lack of a structure to educate patients about resources. In Florence, OR, a town with an elderly population that is greatly impacted by cancer, psychosocial support services are abundant, but often underutilized. In January, during my rotation, a new Cancer Resource Center (CRC) opened in Florence as a partnership between the American Cancer Society and Peach Health Medical Group. Its mission is to connect cancer patients with the available resources in the community. I decided to investigate the level of awareness of cancer support services among my preceptor’s patients and to work towards connecting patients in the clinic with the CRC. Through interviews with patients in my preceptor’s clinic, and with several individuals involved with the CRC, I concluded that there is a great need for the CRC in Florence and that patients are receptive to the idea of the CRC. The final product of my project was the creation of a referral form that can be used in the exam rooms at the time of cancer diagnosis to direct the patients to the CRC for educational and psychosocial support. The Unintended Model: Bringing Health Care Services to Rural Oregon Project Date: 10/15/2007 Santiam Memorial Hospital (SMH) in Stayton, Oregon is a unique small hospital with a rich history, influential present, and a hopeful future that strives to provide health care services to residents of the mid-Willamette valley in Marion and Linn counties. This qualitative study investigates how SMH administration, employees, and contracted providers have expanded their capacity for health care delivery in a challenging rural setting by cultivating successful staff and community relationships. The utility in exploring this unique situation includes elucidating strategies that may enable rural hospitals and providers to develop a greater capacity to meet the health care needs of other rural populations. The method of investigation primarily consisted of interviews and observation. I discovered that the ability of SMH and contracted providers to successfully deliver health care to their service population is tightly linked to local industry cooperation and successful community relations. Efficacy of Emergency Medical Systems for transport of patients to Portland hospitals and appropriateness of prehospital treatments at the OHSU family medicine clinic in Scappoose Project Date: 10/15/2007 Columbia County has a population of 46,220, 5 family practitioners, 8 general internists, 14 nurse practitioners, 5 physician assistants and no hospitals. OHSU's family medicine clinic in Scappoose and Legacy's urgent care center in St. Helens, provide the lion share of the health care in the area. However both clinics have limited resources and capabilities in providing emergency care. Patients are often transferred either by Emergency Medical Services (EMS) or private cars, 20 miles away, to hospitals in Portland metro area. The transport on average takes about 30 minutes, time that could be crucial in determining the patient outcome. It is thus important to provide all the appropriate tests and treatments to the patients, especially those with suspected myocardial infarctions, prior to the lengthy transport in order to limit the degree of damage and negative outcomes. Barriers to Care in Coos County Project Date: 8/6/2007 Background: 15% of Coos County’s 41,997 inhabitants are on or below the poverty line, with 15% utilizing the Oregon Health Plan (OHP) and 1.5% utilizing cash assistance known as Temporary Assistance for Needy Families (TANF). Forty percent of the North Bend Medical Center pediatric patients have OHP health insurance. Objective: Identify barriers in accessing and maintaining healthcare and public services in Coos County. Methods: Semi-structured telephone interview of parents of pediatrics patients at North Bend Medical Center regarding obstacles to healthcare and public services. Interviews with a county nurse practitioner and case managers of the Department of Human Services (DHS). Literature review for barriers to pediatric health services in rural towns. Results: OHP was praised for its coverage of children, which gave families access to “great doctors.” Parents cited no difficulty getting appointments for their child’s health or for public services. The DHS office was considered well run with “helpful staff.” Cost and transportation are not common obstacles. The forms for TANF/OHP eligibility are considered confusing and are not finished with out the aid of case managers at DHS. Conclusions: Coos County’s public services are providing families below the poverty line with the necessary resources to accessing and maintaining healthcare for pediatric patients. A further investigation is warranted to investigate access to healthcare for children of the “working poor.” General Surgery & Lower Umpqua Hospital: A Case Study and Perspective of Surgery in Rural America Project Date: 8/6/2007 The presence of a general surgeon is essential for health care in rural communities. Across America many rural communities and hospitals are underserved in terms of general surgery coverage. Lower Umpqua Hospital (LUH) in Reedsport, Oregon has experienced this shortage of rural surgeons first hand. Six years ago, LUH lost its first full-time surgeon. Since that time, LUH has had two additional general surgeons come and go, with the last leaving in March 2007. At times when the hospital has found itself without a surgeon it has turned to locums tenens for surgical coverage. Locums tenens surgeons change as frequently as once a month, significantly interrupting continuity of care and communication between the patient, surgeon and primary care provider. LUH is dependent on its surgical productivity for income and for keeping surgical patients within the rural health care system. This project investigated how surgical productivity varies when LUH has a full-time general surgeon versus locums tenens coverage and found that when LUH loses a surgeon, and must turn to locums tenens for surgical coverage, surgical productivity decreases considerably. This loss in surgical productivity has significant and far reaching effects on LUH, the community of Reedsport and the primary care providers of Dunes Family Health Care. Evaluation of the Potential for Expanded Use of the Cascade’s East Family Practice Residency Program Mobile Health Clinic Project Date: 7/2/2007 Southern Oregon includes much vast and scarcely populated territory. This is particularly true in the region served by the medical providers in Klamath Falls. Healthcare resources are intensely focused in Klamath Falls itself, with very minimal services available in the rest of the territory which encompasses almost 10,000 square miles. In addition to the geography, there are social and economic considerations which further pose barriers to effective healthcare access for the most rural residents. The Cascade’s East Family Practice Residency Program has initiated a mobile clinic in an effort to reach out to the vulnerable and underserved populations in the area. Currently the well equipped vehicle is targeting its service delivery to the homeless populations with monthly visits to the area shelters. Given the success of these initial efforts, there is great potential for successfully meeting further needs by expanding the services of the mobile clinic. A needs assessment was conducting to identify and prioritize potential uses of the mobile unit. The demographic and health data for the region was reviewed as well as the current health services. A list of needs and potential mobile clinic activities was then developed. Finally, the available resources and potential funding sources were evaluated and recommendations were developed for next steps. Does Astoria Have A Physician Shortage? Project Date: 4/30/2007 Collaboration with the Community Health Improvement Partnership yielded a method that allowed assessment of a possible physician shortage in Astoria, Oregon. A survey of the local physicians enabled the team to identify the number of physician resources available in the rural town. After the data were collected, the amount of need for provider resources was determined based off of published population studies. In conclusion, the project revealed that there was a shortage in specialty physician resources, including but not limited to: cardiology, oncology, gastroenterology, and dermatology. Interestingly though, the population comparisons demonstrated that there were adequate visits for and number of primary care physicians. Barriers to Accessing Dental Care and Use of Medical System for Oral Health Problems by Low-income Residents in Jefferson County, Oregon. Project Date: 4/30/2007 Despite the preventable nature of most oral disease, Oregonians have high rates of caries and periodontal disease. Low-income populations are disproportionately affected by dental problems and may be influenced by lack of access to dental care. Barriers to accessing dental care and use of emergency department (ED) services for dental needs were studied using interviews and ICD9 code analysis for a local hospital in rural Oregon. Barriers to accessing dental care include transportation and appointment availability for Oregon Health Plan (OHP) patients and cost and appointment availability for underinsured or uninsured low-income patients. Dental appointments and free preventive services are available for Native American patients suggesting other barriers to good oral health. Uninsured patients and Medicaid patients followed by Native American patients represented the largest percentage of patients seen in the ED for dental problems. Preventive resources and education about oral health in the community are limited. These results indicated that lack of access is only one barrier to poor oral health. Increasing preventive services, educational resources and community awareness about oral health may be more beneficial in improving oral health outcomes. Gasps in the Night: Improving CPAP Compliance in the Primary Care Setting of Coos Bay, Oregon Project Date: 3/19/2007 Although continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), it is sometimes intolerable to patients and compliance can be a major obstacle. Primary care providers may not be aware of the resources available to improve compliance and without early intervention the patient may ultimately fail the therapy. In addition, appropriate screening tools need to be integrated into the Electronic Medical Record (EMR) to diagnose sleep apnea, facilitate appropriate referrals for sleep studies, and to follow up after therapy has been initiated. Therefore, it was undertaken to determine what kind of resources can be given to primary health care providers to improve CPAP compliance among their patients with OSA. An estimate of the cost and need of the provision of chemotherapy in Harney County. Project Date: 10/16/2006 Background: Each year approximately 150-250 people from Harney County (population about 7000) seek medical treatment for cancer. The long distance from home exposes patients to added risks during their treatment. Currently, Harney District Hospital (HDH) is researching the possibility of administering chemotherapy on site. This would result in saving cancer patients many hours on the road. Population: This project looked at a subset of Harney County cancer patients who are receiving treatment at Bend Medical Clinic (BMC), St. Charles Hospital. Type of study: Informational. Methods used: A cancer patient list was compiled by BMC, defined by cancer patients with Harney County address zip codes. This list was cross referenced with the EMR at the High Desert Medical Center (HDMC) in Burns to obtain patient's cancer diagnosis. A list of "safe" chemotherapy drugs were provided by BMC oncology staff. The cost of the drugs and administration were calculated. Results: The patient population is described. It appears that the administration of chemotherapy drugs at HDH would be fiscally feasible with chances for a net gain. Barriers to Utilization of the Human Papillomavirus (HPV) Vaccine at the Cottage Grove Hospital & Clinic; Development of Provider Education Materials Project Date: 9/11/2006 The Human Papillomavirus (HPV) is responsible for up to 99.7% of cervical cancer. A new HPV vaccine recently approved by the FDA has demonstrated significant efficacy in preventing persistent, high-risk HPV infections when administered prophylactically. Due to the novelty of this vaccine, however, many providers are unaware of the details of its availability and of their patients’ ability to procure the vaccine at affordable rates. In addition, vaccination is not yet widely accepted by patients or parents, for a variety of reasons. The goal of this project was to investigate the barriers to vaccination at the hospital and clinic in Cottage Grove, Oregon, a facility serving approximately 18,000 patients, 31.5% of whom are aged <25. A literature search was performed for information regarding HPV and the efficacy of the vaccine. Availability of the vaccine was confirmed by the hospital’s pharmacy. Several major insurance carriers were contacted regarding coverage for the vaccine. Availability and insurance coverage of the vaccine was found to be much greater than most providers had previously believed. A secondary goal of the project was to develop provider education materials aimed at minimizing barriers to immunization with this promising new vaccine. This was achieved by the production of a single-page, double-sided, tri-fold informational handout. Provider response was positive, and several providers who had not previously prescribed the vaccine offered it to their patients, some of whom began the 3-shot series immediately. Continuity of Care and Medical Information of Children in Foster Care Project Date: 9/11/2006 In 2005, more than 6000 children entered foster care in Oregon and the population is growing. Foster children are at particular risk for adverse health outcomes and these risks are exacerbated by a common failure to obtain, document, and transmit medical information to case workers, foster parents, and health and social service providers. This jeopardizes the children's health, undermines attempts to provide them with services, and risks unnecessary resource allocation and financial burden for the children's families, foster families, state and healthcare system. The purpose of this project, which was conducted in collaboration with the Josephine County branch of the Department of Human Services (DHS) Child Welfare Office and Siskiyou Pediatric Clinic, LLP of Grants Pass, Oregon, was to address this problem by creating a medical data collection tool and protocol to facilitate the recording and transmission of medical information of children in foster care. The project consists of four phases: information gathering; design and development; implementation; and evaluation, modification, and expansion. At the time of this report, the project is completing its second phase and will soon be implementing the pilot instrument and protocol. To date, the response from the pediatricians and social service providers involved in the project has been very positive. Medical Management of Chest Pain in John Day, Oregon: Development of a Standing Order Form. Project Date: 9/11/2006 I was able to create a standard admission form that is clear in its wording, directs physicians and nurses towards up-to-date diagnostic testing and treatment strategies. Based on my interviews with the physicians, nurses, and ancillary healthcare professionals practicing at the Blue Mountain Hospital, this form will be useful and used by the physicians there. This has the potential to positively impact not only physicians and staff at Blue Mountain Hospital, but also its patients as studies have shown that effective standardized orders lead to more consistent and higher quality care. As chest pain is one of the most common diagnoses in hospitals across the nation, my form has the potential to make a sizable impact in the John Day and Grant County community. The O & C: Unhealthy Drama in Rural Counties Project Date: 9/11/2006 Josephine County is one of many Oregon counties facing the permanent loss of multimillion-dollar "O&C" federal funding, with resulting deterioration of services in public health and safety. Funding is currently set to expire October 1, 2006, midway through my rotation in Josephine County. To examine the impending problem, I attempted to answer whether Josephine County would suffer a severe undermining of its public health because of its largely rural population, and to pursue promising courses of action. Methods: Research involved interviewing the public health departments of Josephine, Douglas, Curry, Jackson, Lane and Clackamas counties on the projected changes, as well as a literature review about the determination of support for health programs and the relevance and precedents of public polls. Findings: While there are unique challenges and few recourses associated with being a rural county, Josephine County appears particularly unprepared. Discussion: The ideal strategy involves a tripartite approach of (1) population education on the role of public health (2) assessment of support for additional tax levies (3) increased alternative funding, taxes, and innovation in organizational structure. The former calls for a controlled, randomized, and validated telephone survey throughout Josephine County to assess what, if any, type of tax levy citizens would support and the demographics involved. Advancing Reach Out and Read in Coos Bay and North Bend Project Date: 1/2/2006 The well-child examination offers a unique opportunity for health care providers to proactively affect the health and development of pediatric patients through efforts targeted at education, health promotion, and prevention. Time limitations of the visit, however, require that physicians tailor interventions with proven efficacy to issues of significant prevalence and impact. Reach Out and Read, a national literacy and language development program that brings reading into the well-child visit, has been effective at improving reading success, parental attitudes toward reading, parental interactions with children, and child language development. This report outlines efforts to advance the Reach Out and Read program in the Coos Bay/North Bend area through strategic planning, information gathering, resource identification, and application completion. Alcohol and Methamphetamine Related Hospitalizations: A Chart Review of 100 Warm Springs Patients Admitted to Mountain View Hospital Project Date: 10/17/2005 After noticing that a large number of Warm Springs patients were being admitted to the hospital as a result of alcohol or methamphetamine abuse, I decided to choose this as my project topic. I completed a chart review of 100 consecutive admissions to Mountain View Hospital in Madras, OR. All patients were older than 10 years of age. Emergency Department visits were not included. I found that 22 patients were admitted with either a positive urine drug screen (UDS) or a blood alcohol level above 0.08. Six patients had a positive UDS: 4 for methamphetamine and 2 for cannabinoids. A total of 30 patients were admitted for alcohol-related reasons, including intoxication, withdrawal or other conditions. This amounts to a 30% alcohol-related hospitalization rate, which jumps to 36% when admissions for obstetrical conditions are excluded. This is a high number of costly hospital stays, some of which could have been avoided if the patient had another place to stay while he or she became sober. The tribe may want to consider establishing such a place and investing the recuperated money into substance-abuse prevention programs. Low Vision in Lebanon: Resources to maximize quality of life with permanent vision loss Project Date: 7/4/2005 Visual impairment and blindness affects 2.94% of Oregonians and in the near future is expected to affect even more of the progressively aging population. A significant number of those affected have vision loss that is not correctable by surgery, medications, or glasses, placing them in the category of low vision. Vision loss and blindness can be psychological and physically devastating and requires unique coping skills and support. It is important to properly educate patients with vision loss about the resources available to them and emphasize that their quality of life can be better maintained by utilizing these resources. This project sought out the resources available to low-vision individuals in Lebanon, OR. Meetings with a low-vision specialist, a patient with low-vision who attends support groups in Lebanon, and representatives from Oregon Commission for the Blind and Vision Northwest made possible the investigation of resources. Low-vision evaluations by a specialist provide evaluation of daily functionality, optimize use of vision aids such as magnifiers and other tools, allow patients to experiment with tools before buying, and provide a specialized refraction for low-vision individuals. Oregon Commission for the Blind provides home evaluations by specialists for safety, independence, and use of low-vision tools. Additionally, they provide vocational rehabilitation and training, counseling for patients and families, scholarships, assistance with mobility tools such as white canes, and donation service for low-income individuals. Vision Northwest is a non-profit provider of low-vision assistive devices and also has a donation service for people with limited income. A monthly support group meets in Lebanon and allows its members to share tips on living with low-vision, emotional coping mechanisms, and has presentations with particular relevance to low-vision by members of the community. An informational handout was developed to summarize low-vision resources in Lebanon for patients and providers. A Quality Improvement Evaluation of Initial and Final ER Radiology Readings at Lower Umpqua Hospital Project Date: 7/4/2005 Reedsport, a town of 4,400 residents, is situated on Highway 101 in the midst of the Oregon Dunes National Recreation Area on the central Oregon coast. The timber and fishing industries traditionally had been the major industries in the area, but in recent years natural resource extraction has declined. Reedsport has more recently become more of a retirement community, as well as a destination for out-of-town visitors who come for the wide range of outdoor activities available. Dune Fest, held in the nearby community of Winchester Bay each summer, draws thousands of people to the area for ATV races and associated events. Because there are so many visitors to the Reedsport area, many of the people presenting in the ER of Lower Umpqua Hospital are not from Reedsport or nearby towns, but are instead people who have come to ride ATVs on the dunes. This project was undertaken because many of the individuals inolved in the process of taking and reading ER radiographs did not have a good understanding of how the sytem worked, especially how discrepancies are handled. Are Group Visits for Patients with Type II Diabetes a Feasible Option in John Day? Project Date: 7/4/2005 The potential morbidity and mortality associated with poorly controlled Type II diabetes mellitus makes patient education a particularly important undertaking in treating this chronic condition. Group visits have been shown to improve HgbAlc and cholesterol levels in patients with diabetes, as well as overall patient and physician satisfaction with care of chronic illnesses. The primary purpose of this study was twofold: to determine whether group visits were a feasible option for the residents of John Day and if so, to put together the necessary information that would facilitate easy implementation of group visits by Dr. Robert Holland. Methods: 1) a focus group was held among select patients with type II diabetes; 2) an interview was conducted with the registered dietitian (RD) to determine whether interdisciplinary support for such visits existed. 3) A review of the literature was conducted for structural and curricular development of a group visit. Results: 30% (4/12) of those invited to the focus group attended. All who attended were eager to participate in group visits. The resulting projected number of Dr. Holland's patients who would be interested in group visits is between 21-32 patients, a sufficient number to make the endeavor worthwhile from a business standpoint. Interdisciplinary support (RD) is available. Conclusions: Group visits are a feasible option in John Day, in terms of interest and from a business perspective. A packet of information for the clinic was compiled that should facilitate this endeavor. A standardized admission order for COPD exacerbations at Blue Mountain Hospital in John Day, OR Project Date: 4/25/2005 COPD is an extremely common chief complaint in the aging population and an exacerbation of COPD is one of the most common presenting complaints at the Blue Mountain Hospital emergency room in John Day, OR. Physician admission orders can be as diverse as the physicians themselves and may also represent a significant point of confusion for nursing and respiratory therapy staff. This project was designed to produce a COPD exacerbation standardized admission order that incorporates individual physician preferences, proven efficacious therapies, local formulary and logistical restrictions, but also an easy-to-read document to which hospital staff can refer for high-quality patient care. Evaluation of Cervical Cytology Screening in Madras, Oregon: clinical considerations in the context of changing standards of care Project Date: 3/21/2005 The incidence of cervical cancer worldwide has declined sharply since the advent of cervical cancer screening. Current focus on decreasing morbidity and mortality related to cervical cancer rests on improvement of screening methods, development of screening guidelines, and establishment of effective follow-up systems. In the context of continually evolving screening methods and guidelines, clinicians are faced with the task of complying with current standards of care. This is made more difficult by subtle lack of consensus between the leading organizations on when and how to screen. The intent of this project was to evaluate Madras Medical Group’s current screening program and to identify areas for future improvement. By examining Pap data from March 2004- March 2005, creating a spread sheet, and reviewing charts, several trends were identified. Madras Medical Group appears to be over-screening women with history of hysterectomy and women who are older than 70. The intervals between Paps may also be more frequent than necessary, especially in patient who are getting ThinPrep exams. By developing a system to identify women who do not need yearly cervical cytology screening, Madras Medical Group may be able to improve their compliance with current standards of care. Identifying Obstacles to On-time Childhood Immunization in Baker County Project Date: 3/21/2005 Background: 77.6% of Baker County’s 24-month-old children were fully immunized with the CDC’s recommended 4:3:1:3:3 series of vaccines (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB) in 2004 (vs. 69.8% of all Oregon children vs. 90% Healthy People 2010 goal). Objective: Identify obstacles to full immunization coverage of children at 24 months of age in Baker County. Methods: Telephone survey of parents of the 130 children ages 12 to 24 months in the Baker County Health Department immunization records regarding obstacles to on-time immunization. Interviews with the county immunization nurse, Baker City family practitioners, and Oregon state immunization program staff. Literature review for vaccination rate improvement methods. Results: One nurse at the Baker County Health Department immunizes 96.3% of that county’s children. Parents cite difficulty getting an appointment within the month and the need for reminders for vaccination schedules and for individual appointments. Cost and transportation are not common obstacles. Children’s immunization records are not checked at their doctor appointments. Conclusions: Baker County’s child immunization coverage may be improved by decreasing the appointment wait time, instituting a recall/reminder system for all children, and checking immunization status at every encounter with the health care system. Barriers to Enrollment in the Oregon Medical Marijuana Program in Madras, Oregon Project Date: 2/7/2005 Since its approval by voters in 1998, the Oregon Medical Marijuana Program has provided legal protection for enrolled patients to grow and use marijuana for symptomatic treatment of cancer, glaucoma, HIV/AIDS, agitation due to Alzheimer’s Disease, and any medical condition that produced cachexia, severe pain, severe nausea, seizures, or persistent muscle spasms. Initial estimates predicted growth of 500 members per year, but by July 1, 2004, OMMP membership cards had been issued to 10,196 people. Despite the popularity and rapid growth of the OMMP, many barriers exist in enrolling patients with qualifying medical problems. Through interviews with physicians, a physician’s assistant, home health & hospice nurses, patients, as well as chart reviews, barriers to enrollment in the OMMP were identified, some of which are unique to the rural community in Madras and others that apply to patients statewide. Information regarding the OMMP, Madras Medical Group’s enrollment in the program, and barriers to enrollment were presented in a lecture to the clinic’s providers with the goal of increasing provider understanding of medical marijuana in Oregon. A Diabetic Management Flowsheet for patients of Primary Care Physicians Based Upon Current Guidelines. Project Date: 1/3/2005 The management of the patient with Diabetes in the primary care environment is both a great challenge as well as a great opportunity for substantial prevention of serious sequella associated with poor control of blood glucose both over the short and long term. Many guidelines are recommended, and the burden of meeting these care guidelines falls squarely upon the primary care physician, and in rural communities the family physician is the first line of management, with more complicated cases being managed by an endocrinologist where geographically possible. The population targeted in this project is limited to those with diabetes being seen by Dr. Dan Gleffe, a family physician in Grants Pass for the past 18 years, but is intended to be usable by any primary care physician desiring to closely and systematically monitor recommended health guidelines of diabetics. Current management guidelines and recommendations were obtained and compiled onto a one-page table format in the attempt to standardize diabetic management and assist the primary care physician in attaining recommended goals. How Oregon Health Plan Cutbacks Have Affected Rural Oregon: Trends in Emergency Department Use at Blue Mountain Hospital, John Day, Oregon Project Date: 1/3/2005 In early 2003, Oregon’s Medicaid program underwent a number of revisions in order to comply with new budgetary limitations that were a result of the state’s fiscal crisis. Among the changes were reduced benefits and increased cost sharing via premiums and co-payments. Rural communities in Oregon face a unique set of healthcare challenges, to which these Oregon Health Plan cutbacks were added. The purpose of this study was to compare emergency department use at Blue Mountain Hospital in John Day, Oregon, in the months preceding and following the cutbacks. Total ED visits and payer type data were gathered using the hospital’s computerized billing system. The results were analyzed at 95% confidence intervals for both percent changes in absolute number of visits per month and proportion of ED visits due to each group; T-values and relative risk were calculated where appropriate. OHP managed care visits decreased 24%, and the proportion of all ED visits for which they were responsible fell from 13% to 9% (RR 0.904), whereas OHP fee-for-service visits increased 95% per month, their proportion rising from 2% to 4% (RR 1.79). Uninsured visits rose a statistically insignificant 6% and their proportion of total ED visits was practically unchanged. Following the cutbacks, the percentage of Grant County citizens eligible for OHP who were enrolled dropped from a monthly average of 86% to 72%. In addition to the sudden drop in OHP enrollment and resultant decreased use of the ED by OHP managed care beneficiaries, new barriers to healthcare may have caused the significant rise in ED visits by OHP fee-for-service patients. Although the number and proportion of visits by the uninsured was unchanged, deteriorating health and continued lack of state support will force this growing group to turn to emergency departments for care. Successful aging in the elderly population of Scappoose, Oregon: A report on the resources and facilities available to encourage successful aging. Project Date: 10/18/2004 The elderly population is the fastest growing group of individuals in the United States. It has been shown that avoiding disease and disability, sustaining high functioning, maintaining and establishing social networks, and actively engaging in life all lead to successful aging in the elderly. Many elderly rely on community services to accomplish successful aging, and it has been shown that rural areas tend to have deceased availability of these services and professionals. This research project identifies and reports the resources available to the elderly population of rural Scappoose, OR in order to age successfully. Visits to the local nursing home, assisted living community, and senior citizens’ center were made. Interviews with staff were conducted and tools to promote successful aging in the elderly population were discussed and recorded. The final report reveals that although Scappoose is a rural community, it contains the resources available to promote successful aging in the elderly population. The Role of a Free Clinic in a Small, Rural Town: A case study in Lebanon, Oregon Project Date: 10/18/2004 Free clinics are located all over the United States, in urban and rural areas alike. These clinics strive to serve the needs of people without health insurance, without access to care, and often, with significant medical illness. These "band-aid" measures to care for the growing access problem in this country serve a vital role in the current health care picture. Communities struggle with increasing numbers of poor and uninsured people with decreasing funds to serve their communities. In Lebanon, Oregon there is a free clinic funded by a hospital foundation that attempts to serve the needs of those without access to health care in East Linn County. While working at the free clinic I discovered a very important lesson: free care is a symbol greater than that of individual health care, it is one of community health. Addressing A Possible Solution for Specialty Outreach Clinics. Project Date: 9/13/2004 OHSU Scappoose Family Practice was recently designated a Rural Health Center. While this designation provides adequate primary care reimbursement for Medicaid and Medicare patients, these patients still experience delays establishing tertiary care. To address a possible solution to this problem we researched the plausibility of specialty outreach clinics. We reviewed 1,000 referrals from the OHSU Scappoose Rural Health Center in 1999 to identify potential specialties with enough patient demand to warrant regular scheduled visits to Scappoose Family Practice Clinic. We also identified which specialties are limited to location by technology, and finally we asked the question if specialties did come to the Scappoose clinic on a regular schedule, would this expedite Medicaid and Medicare patient access to tertiary care. Our findings identified five tertiary specialties that have met these preliminary criteria; Orthopedics, Cardiology, Otolaryngology, Rheumatology, and Dermatology. Health Care Services Available to Undocumented Immigrants in Madras, OR Project Date: 9/13/2004 Policy changes within the past ten years have limited undocumented immigrants access to insurance and health care. Undocumented Hispanic immigrants, many of whom are farm workers, suffer serious health problems because of the conditions in which they live and work. Due to fear of deportation most do not seeking medical care or preventive services for themselves or their U.S. born children. Studies have shown migrant farm workers to be among the most vulnerable populations with poor health outcomes and limited access to care. Madras has a large Hispanic farm worker population many of which are undocumented. These individuals face barriers in accessing health care due to lack of insurance, poverty, and language and cultural barriers. This study attempted to ascertain what health care resources are available to undocumented immigrants in Madras. The project design consisted of gathering information through interviews at area health facilities and observing patient care visits at a prenatal clinic targeting this particular population. Forming an Emergency Operations Plan for Josephine County Project Date: 8/9/2004 The Josephine County Public Health Department, in conjunction with local physicians, emergency services personnel, infectious disease experts, and other interested parties, are currently working on an Emergency Response Plan in the event of natural disaster or acts of bioterrorism. This is in conjuction with Health Resources and Services Administration funding for Josephine and jackson Counties to create a Hospital and Healthcare System Bioterrorism Preparedness Program. This plan seeks to designate how resources in Josephine County will be used in the case of natural disaster such as fire, earthquake, or emerging infectious disease, or intentionally caused disasters such as Smallpox, chemical releases, or intentionally food-bourne illness. The geographical layout of Josephine County brings specific challenges to developing a plan for use of alternative care sites, Stategic National Stockpils resources, medical personnel, and transporation during an emergency that must be planned-out in advance to best coordinate the services necessary. Joesphine County has the unfortunate advantage of having a recent natural disaster, the Biscuit Fire of 2002, which has helped motivate Josephine County to work together on this plan, and has provided insight to its necessity. This project describes Josephine County and the Emergency Response Plan that has been developed by the Josephine County Public Health Department. Lack of Health Care benefits Project Date: 3/29/2004 In the past 6 weeks I have been very fortunate to work with Dr. Lance Loberg, Medical Director for NW Human Services community clinics. Because of the comprehensive care provided through this agency, I had the unique opportunity to see patients at the West Salem Clinic, Total Health in Monmouth and H.O.A.P. Mental Health clinic for the homeless and underserved. The experience of being immersed in the lives of such diverse populations enabled me to learn their different interests and life dreams as well as their common fears and frustrations. In a short time, it became frightingly apparent to me how many members of the Salem communty were living with diabetes and felt like they were fighting against more barriers than they could handle. With the decline in health care benefits and services, most patients had lot their mental health and prescription coverage. This left them using unavailable financial resources to provide for medical care and medications. Combined with the current unemployment rate and the increase in costs of living, many hard working people found it necessary to choose between their health and the basic welfare of their family. Delivery of and Attitudes About Hospice Care in Florence, Oregon Project Date: 3/29/2004 Hospice services are widely underutilized nationwide, despite the desire of the majority of patients to die under hospice care. With this project, I was interested in determining the current utilization of hospice services in Florence, Oregon, as well as the attitudes of the general Florence population about hospice services. The design was a written survey of random patients within a family medicine practice at Health Associates of Peace Harbor in Florence. I also interviewed the intake nurse at Peace Harbor Hospice, which yielded information about the current utilization of and services provided by the hospice program. Although there was already good penetrance of hospice within the community, the average length of stay was shorter than desired. The survey indicated that the majority of patients would prefer to die in their own home under hospice care, but that most patients were not aware of the Medicare Hospice Benefit. Opinions of hospice care by those who had known someone on hospice were overwhelmingly favorable. Concerns about hospice that might be future barriers to seeking hospice care were varied, but the most identifiable concern, especially among younger patients, was the expected cost of hospice services. These results were forwarded to Peace Harbor Hospice to better help them address the concerns of the community and to identify local potential barriers to hospice care. Success of OHP in Coos County, Oregon Project Date: 1/5/2004 In 1989, the state of Oregon embarked on a controversial experiment in the financing of health care. The state planned to add many uninsured people to the Medicaid program and to pay for this expansion by reducing the Medicaid benefit package -- more people would be covered, but for fewer services. To keep the costs of this policy within affordable limits, the legislature determined that the services provided should constitute a basic healthcare package, and it sought to ensure that Medicaid recipients were, whenever possible, enrolled in managed care plans. This program was titled the Oregon Health Plan (OHP). Since implantation of OHP in 1994, there has been a statewide decrease in per capita health care costs, a greater than 50% reduction in uninsured children, and a nearly 50% reduction for adults. It appears that OHP has improved accessibility of health care in Oregon. The emphasis of my research project was on the impact of OHP on Coos county. Specifically I studied whether OHP has accomplished it’s goal of ensuring adequate health coverage to the people in Coos County and whether accepting OHP patients puts Coos county physicians and clinics at a financial disadvantage? In 1995, Doctors of Oregon Coast South (DOCS) was found in Coos County as a managed care program that would serve the county’s Medicaid population. Since that time, profitability for physicians and access to care for citizens have improved. The project investigates the relative success of the managed care program in Coos county, it’s downfalls and it’s possible future. This investigation reveals that even under a fully capitated managed care environment, the clinic can be successful and the community is well served by OHP. Following is a compilation of information I gathered for this project. Most of this information stem from different sources such as physicians, financial officers and other health care workers. Reports published by Oregon Health Policy and Research have also been used in conjunction with financial data provided by the clinic administrator, and legislative reports. Resource Gathering, Early Planning and Evaluation of Group Visits for the West Salem Clinic in the Early Phases of Implementing the chronic Care Model. Project Date: 11/10/2003 The management of chronic illness constitutes a formidable challenge to patients, practitioners, and the health care budget. The Chronic Care Model has been developed to address the increasing strain chronic illness is exerting on the health care system. The six pillars of the chronic care model are: Community resources and policies, Health care organization, Self-management Support, Delivery System Design, Decision support, and Clinical Information Systems. The West Salem Clinic is currently in the midst of a national two year Diabetes Collaborative aimed at implementing the chronic care model in the management of patients with Diabetes. In an effort to further progress to a chronic care model I researched and gathered resources on group visits and queried patients with diabetes on the interest in being involved in the group visit format, diabetes knowledge, self-management and health care utilization. I found that 60% of patients were interested in the group visit format, perceived knowledge of diabetes appears to be greater than actual knowledge, self-management appears to vary widely, and for this population utilization of their PCP for most patients occurs at every three months or less, with few patients requiring hospitalization for their diabetes. House Calls: The secret life of rural physicians? Project Date: 9/29/2003 House calls were once the mainstay of physicians, especially those in rural areas. Over the last century they have decline precipitously while home healthcare has grown. The aim of this study was to ascertain the percentage of physicians making house calls. Further, if house calls are taking place, how common are they and what indications are considered deserving of a physician visit? Lastly the degree of training area physicians have in homecare was queried. Assessment of OHP Changes on OHP Patients at Dunes Family Health Care Last Five Years Project Date: 7/7/2003 The Community Health Improvement Partnership (CHIP) provides a vehicle that allows local health care and public leaders and residents to collaboratively assess health care needs of the community. A result of this collaboration revealed a perceived health resource problem of lacking affordable health care. A project was undertaken to assess this perceived need of the community and evaluate what impact changes in the Oregon Health Plan (OHP) may have had on OHP patients at the Dunes Family Health Care (DFHC) clinic. Results of the analysis reveal the percent of Reedsport Service Area (RSA) population below Federal Poverty Level and require health assistance is well above State and national average. Analysis of DFHC patient data reveals the OHP patient base has remain steady at about 15 percent of total patient population for the past four years, which is higher than the national Medicaid average of 12.7 percent. OHP reimbursement at the DFHC has steadily increased in the past four years with a possible slight projected drop in 2003. The perceived low-income health assistance needs in the RSA is supported by socio-economic and DFHC clinic data. However, changes in the OHP in the past four years have not affected the number OHP patients or their frequency of office visits at DFHC. The DFHC OHP population has averaged 3.5 annual visits per patient compared with 1.5 visits per non-OHP patients in the past four years. This difference in number of visits may justify further evaluation as the debate continues over cost, level of coverage, and eligibility of the OHP. Trends in Hospital Transfer Rates of AMI Patients at PCH in Newport, OR Project Date: 8/18/2003 It had been suspected by the medical staff that over the recent few years, more and more Acute Myocardial Infarction (AMI) patients (at Pacific Health Community Hospital in Newport, OR) are being transferred out to care facilities that offer a catheterization/angioplasty lab and tertiary cardiac care, as such is not available in the rural city of Newport. This study shows that there has indeed been a progressive increase in transfer rates of AMI patients out of PCH (32% in 1995 versus 60% in 2002). However, unlike hypothesized, patients presenting to PCH still cannot be offered angioplasty as primary treatment for AMI; additionally, thrombolytics are still readily administered in patients who meet the criteria for thrombolysis. The increase in patient transfer rate is better attributed to the fact that there now exists a tertiary cardiac care facility (Good Samaritan Hospital, Corvallis) in much closer proximity to Newport than ever before. Results from this study suggest that, for those AMI patients seeking initial treatment at PCH in Newport, these two hospitals have been seeking to improve efficiency of optimizing cardiac care in a more sophisticated facility if needed. Getting It Out There:Developing a Health Care Resource Guide in a rural Community Project Date: 5/5/2003 The Community Health Improvement Partnership (CHIP) has been undertaking a large-scale health needs assessment in Reedsport, OR over the last two years. This has been done by written survey and town hall meetings. These efforts have yielded a set of health issues that the community finds important. The CHIP committee is now at a stage to start implementing solutions to these findings. As my project, I participated in the CHIP committee on health information and referral. The community had indicated that it was difficult to find the appropriate health resources. To that end, the committee has begun compiling a list of healthcare resources and organizing them in a searchable database to be linked to the Lower Umpqua Hospital website and printed for use in establishments that provide resources for a large number of people. The resource directory is expected to be a comprehensive document outlining services, points of contact, hours, etc. It is expected that it will take about 6 months to complete, therefore; an interim guide will be used that simply provides resource names and phone numbers. Implementation of a group-based health care delivery model in Florence, OR: exploring a possible solution to this community’s increasing health care deficit Project Date: 5/5/2003 The six Family Medicine doctors currently practicing in Florence, Oregon conceptually agree that there will not be enough space, money, or physicians within their present medical system to meet the growing healthcare needs of this growing rural community. All six physicians and their ancillary staff at Peace Harbor Health Associates (the only Family Medicine outpatient practice in Florence) recognize this increasing healthcare deficit, as well as the associated problems with regard to access, service, and quality of patient care that it creates. An innovative approach has been initiated by one of the physicians in an attempt to alleviate these specific concerns. This physician has recently implemented a group visit model to address the needs of his large diabetic patient population. This study surveyed the effectiveness and acceptance of the diabetic group based doctors visit model through interviews with the physician, ancillary staff, and patients involved in the first Diabetic Wellness Physician Group Appointment (DWPGA) program. Study results found that the DWPGA program was well received by all of the individuals involved. The physician, his staff and, perhaps, most importantly his patients were found to be very satisfied with their experience, with the vast majority of participants preferring the group-based setting to that of individual diabetes appointments. Increasing Access And Affordability Of Prescription Drugs For Medicare Patients In A Rural Health Setting Project Date: 2/10/2003 Affordable access to prescription medications is a problem for many elderly patients in the United States. For elderly persons living in rural communities the problem seems to be even greater - there seems to be a certain negative synergy between being elderly and living in a rural setting when it comes to drug access. To top it off, rural health clinics lack the typical interdisciplinary teams seen in some urban clinics. By not having a social worker or volunteer who might help patients decipher drug discount programs, health care workers are called to wear many hats, all in a nine-to-five workday. This project aimed to identify what characteristics about elderly rural patients make them vulnerable to decreased access to affordable drugs. The next step attempted to identify what one rural health clinic was doing to increase access. Extensive research was conducted on the available programs for cost savings on prescription drugs. Finally, a revised program was designed to increase access and affordability for patients and hopefully increase efficiency for the health care worker. Nutrition and Fitness: Development of a Program to Supplement Physician Intervention in Management of the Health Risks of Obesity. Project Date: 12/30/2002 Obesity and its many associated health risks is a growing problem in the United States. This study attempted to identify strategies for physicians to increase their effectiveness in promoting dietary modification and weight loss for overweight patients at a family practice clinic in John Day, Oregon. The design was observation of physician interaction with overweight patients motivated to lose weight, and one on one dietary counseling with self selected patients. Community resources available for patients include a dietitian who visits the community monthly, and a new fitness center. Additionally patient handout availability and effectiveness was examined. While the physicians were actively discussing the importance of diet and fitness with their patients, time limitations prevented adequate follow up. Many patients expressed bewilderment at the amount of different diet information available via the popular press. Patients requested basic, simple guidelines to help them start meeting their weight loss goals. Handouts currently available at the clinic are from the American Heart Association, and while quite comprehensive were described as “confusing” and “overwhelming.” The final phase of this project thus involved the creation of a short, simple handout that outlined suggested dietary modifications for weight loss. Methadone Maintenance Therapy: An evaluation of health benefits, cost-effectiveness, social impact. Project Date: 12/30/2002 BACKGROUND: Injection drug use in the United States is a significant cause of morbidity and mortality, increased health care costs, and criminal behavior. While methadone maintenance therapy (MMT) reduces criminality, health care expenditures, and morbidity and mortality among injection drug users and the general population, economic, social and political barriers prevent its universal funding. The purpose of this review was to examine the cost effectiveness, effect on morbidity and mortality, and effect on criminality of MMT in order to help determine whether MMT should be covered by health care plans. METHODS: A literature review was conducted to determine the cost effectiveness of MMT with respect to morbidity and mortality, criminal behavior, and survival as measured by overall survival and quality-adjusted life-years. RESULTS: Among a population of drug users and non-users, methadone maintenance treatment leads to significantly decreased health care costs, decreased morbidity and mortality, and has a cost per quality-adjusted life-years that is well below many other accepted medical interventions. CONCLUSIONS: Methadone maintenance treatment is cost-effective on the basis of commonly accepted criteria for medical interventions. Funding MMT is a cost-effective investment by health care plans that should lead to long term monetary savings and increased quality-adjusted life years among the entire population. Anticipating Longitudinal Growth Project Date: 2/11/2002 This paper encompasses 3 related projects: first, to assess patient satisfaction with the process of establishing care with a PCP at Peace Harbor's Health Associates clinic in Florence, OR; second, to assess local FNP's perceptions of their professional relationships with their Physician colleagues & to describe some current literature on the topic; third, to assess the attitudes of employees of Health Associates about the quality of care delivered by Mid-levels as compared to Physicians. Such data could prove useful in planning for Peace Harbor's expansion. Three distinct surveys facilitated these goals. On average, new patients consider a (5) day wait "reasonable," but a 23-24 day wait "expected." In light of this, 44% of incoming patients had to wait "longer than expected." 83% of new patients feel the most important quality in selecting a specific PCP is his/her special interest in their disease, about 67% were assigned to their first-choice PCP, & 94% of incoming patients feel provider continuity is more important than not. The current FNP's feel their practice is an admixture of "collaborative" & "parallel" models. Finally, staff & nursing cohorts have overwhelming confidence in Physicians to provide superior primary care over Mid-levels (contrary to results of a randomized trial used as the survey's "answer key"), the Mid-level cohort holds false beliefs about their ability to provide better care than Physicians, & Physicians demonstrate uncertainty about the matter. Mental Health Service in Florence, Oregon Project Date: 3/25/2002 Throughout my limited interview sessions with the mental health providers, I was repeatedly reminded of the superior mental health coverage in Lane County. Unfortunately, I have not obtained data to support this claim in quantifiable terms. Instead, this project aims to highlight the two agencies that provide mental health services to Florence: namely, the Siuslaw Pacific Center and Peace Health Counseling Services. More importantly, while I attempt to demonstrate how these two agencies function as an integral part of mental health provision in Florence, I would also highlight the differences between the two such that they work in complementary ways. Are New York Times headlines a reality in Reedsport, Oregon? Project Date: 3/25/2002 According to the American College of Physicians-American Society of Internal Medicine, physicians in general practice stand to lose approximately $8,000 each this year. In Oregon the 2001 Medicare cuts may translate into an overall loss of $14,700,000. For Oregon physicians this problem is made even worse by the fact that the costs of delivering health care in Oregon continue to rise each year. Malpractice premiums alone have increased by double digits for most physicians in Oregon, up to 56% higher for some Oregon physicians. In addition, approximately 50% of Oregon family physicians are age 50 and over. The high cost of providing medical care and poor reimbursement rates may trigger the retirement of many of these older physicians. A national survey has shown that before the Medicare cuts, approximately 80% of physicians were considering leaving or scaling back practice. If the above is true this could potentially create a shortage of access to primary care for Medicare patients both nationally and in Oregon. Mental Health Care in Tillamook County Project Date: 2/11/2002 Despite a popular perception that rural America is a wholesome and healthy place to live, many studies have shown that this is not necessarily the case. Although approximately one forth of all Americans are rural residents, almost one third of the nation's poor and 29% of the nation's elderly reside in rural areas (Human, et al. 1991). Rural residents are also disproportionately affected by chronic illness, are more likely to live in substandard housing, and have more days of disability and missed work (Murray, et al. 1991). All of these problems - advanced age, poverty, and chronic illness - predispose rural residents to a higher risk of mental illness, yet research done over the last decade indicates that this same population is less likely to receive adequate mental health care than urban residents (Badger, et al. 1999). Studies have shown a number of reasons for this. First, rural residents are less able to pay for mental health services. Many rural areas have remained economically depressed since the late 1970's following a decline in the farming, manufacturing, and natural resource based industries such as mining and logging. Rural residents have a higher rate of uninsuredness and, because they are more often among the ranks of the working poor, are less likely to qualify for programs such as Medicaid (Human, et al. 1991). Second, rural areas suffer from a profound lack of mental health care providers. For instance, 77.5% of counties with fewer than 100 persons per square mile lack a single registered psychologist as compared to only 2% of counties with a density of greater than 400 persons per square mile (Murray, et al. 1991). Another study found that only 10% of outpatient psychiatric clinics are located in rural areas (Abraham, et al. 1994). As a result, rural patients with mental illness are forced to seek help from their primary care physicians. Improving The Quality Of Life For An Aging Population: An Analysis of the Accessibility and Availability of Services for Seniors in Benton County, Oregon. Project Date: 9/24/2001 Almost 13% of the population in the United States and 10.3% of the population in Benton County is over the age of 65. Studies predict that the 65+ age group will grow by 135%, while the number of people who are 85+ will grow by 401% by the year 2050. With this incredible rate of growth, the demands on society to develop specialized services that provide assistance for the elderly are profound. The needs of the elderly are extensive and include assistance with the activities of daily living, housing, transportation, nutrition, health care, social interaction, financial assistance, support groups, and end-of-life care. The purpose of this project was to analyze the availability, accessibility, quality, and use of services provided for seniors within Benton County, Oregon. The results of the study show that there are many, high quality services within Corvallis. These services appropriately address many of the needs of seniors and most of the services have an excellent rate of participation. However, several areas of weakness were also found that may prevent many seniors from accessing these services. These included the lack of a central resource agency, extremely high costs for many of the services, lack of an adequate transportation program, lack of adequate resources in rural communities surrounding Corvallis, and a limited number of resources for individuals who do not have a high level of function. If these areas are not addressed, the pressure of the aging population on Benton County may prevent many seniors from receiving a number of services that are required to provide dignity, respect, and a high quality of life. Back to subject search page or search by preceptor site