RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Health Provider Emergency Preparedness to Swine Flu in Lebanon Project Date: 4/27/2009 This project is a report on how health providers in Lebanon prepared and responded to the H1N1 influenza outbreak. The resources available to the health providers were the recommendation and guidelines from the CDC, the Oregon Department of Health, the Linn County Health Department and the Samaritan Health Services. Health providers encouraged patients to follow the CDC recommendations on practicing good hygiene habits. They stayed informed by following the daily updates of the Oregon Department of Health and Linn County Health department websites. Health providers implemented the triage guidelines from the Samaritan Health Service officials to prevent over utilization of the clinic. As a result of these strategies health providers in Lebanon were able to efficiently respond to the small surge in medical demand and at the same time continue providing their usual medical care. Preparing a Rural Community for Emergency and Outbreak Project Date: 4/27/2009 When faced with a large scale Emergency or an Infectious disease outbreak a small community is still held to the same standards of preparedness as compared to a more urban medical community but must do so with some unique challenges. The recent global outbreak of H1N1 influenza has proved a catalyst to ensure hospitals are up to par with regards to Emergency and Outbreak response plans and Madras Mountain View Hospital is no exception. This community project has three primary endpoints including: 1) To Conduct interviews with hospital personnel to educate myself with regards to rural hospital preparedness for emergencies and infection disease 2) To identify strengths and weaknesses inherent to the response plans 3) To develop information fliers for medical staff education, outlining levels of the response plans including medical staff responsibilities. An Assessment of the Teen Birth Rate in Florence, OR Project Date: 2/11/2008 Florence, OR is largely regarded as an elderly community where people go to age gracefully. In a population where nearly twenty percent of its citizens are over the age of sixty-five years old, a public heath problem continues to brew quietly among a younger generation. The teen birth rate in Florence and surrounding areas is 1.7 times higher than the State’s rate, a statistic that appears even more exaggerated within this elderly community. Yet even among health professionals there is disagreement as to whether or not there is a problem with teen pregnancy in Florence. This project is an assessment of those perceptions and an evaluation of the availability of specific resources for sexually active teens such as contraceptive methods, emergency contraception, abortion, and adoption services. While access to all of these resources was found to be limited, the most underutilized was emergency contraception. Suggestions are offered as to how a subsequent project may be able to provide help in improving access to key resources and/or improve cooperation between Siuslaw High School and the Center for Women’s Health in generating a school-based clinic or outreach program. Barriers to such changes and a look at the historical aspect of this dilemma are also offered. Your Changing Body: A Look at Sexual Education in Coos County Project Date: 2/11/2008 My goal was to design a pamphlet that would provoke a conversation between the youth and adult, which can then be used as a foundation from which they could share their own morality and perspective regarding sexual health. I also wanted this pamphlet to be used as a starting point for a conversation regarding puberty and sexual health between parents and their children, as well as between pediatricians and their patients entering puberty. My goal was to also include resources, both within the Coos County area and on the internet, that parents, teachers, and youth could access to help educate them as to the options available from within their community when facing issues such as pregnancy, terminations, adoptions, and sexually transmitted infection (STIs) prevention and treatment. Zostavax and Hood River, OR: Raising Awareness of the Efficacy, Availability, and Cost of the Herpes Zoster Vaccine Project Date: 10/15/2007 Herpes Zoster and its all too common complication of postherpetic neuralgia is widely recognized by the medical community as having a significant impact on the well being of the general population. Within the first week alone of the Hood River Rural and Community Health Rotation, four separate patients inquired about the nature of herpes zoster and the available vaccine. As the vaccine has only just recently received FDA approval, the public’s knowledge of its efficacy and availability is quite poor. A small community project was formulated to determine the prevalence of herpes zoster and the efficacy, availability, and cost of the herpes zoster vaccine as it relates to the patient population seen by the Providence Hood River Internal Medicine Clinic. Literature searches, brief health practitioner interviews, and development of a simple but informative fact sheet to be given to inquiring patients were the focus of this community project. Pertussis Outbreak in Union County Project Date: 9/10/2007 Whooping cough is a highly contagious respiratory illness caused by the bacteria Bordetella Pertussis. Classic symptoms include bursts of coughing followed by a large inspiratory effort, cyanosis, apnea, and post-tussive vomiting. complications of the disease are most common in children less than one year old and include pneumonia, encephalopathy, pneumothorax, and seizures. Due to waning immunity from childhood vaccines, adolescents and adults, who experience milder symptoms, often transmit the disease to younger and more susceptible people. While I was completing my rural rotation in LaGrange, OR, Union County was battling its first pertussis outbreak in recent history. I used the pertussis outbreak in Union county learn about the community-wide management of communicable diseases. In addition to doing an extensive literature review, I interviewed personnel from the Union County Center for Human Development (CHD) who were intimately involved in management of the outbreak. I then summarized the results and offered suggestions for improvement. I also developed a condensed handout to which physicians can easily refer when they encounter potential pertussis cases in their offices. Proposal to the Paiute Indians of Burns, Oregon Project Date: 8/6/2007 While doing my clerkship in Burns, Oregon we encountered several cases of MRSA in patients, some of which required hospitalization to receive IV vancomycin. I did a chart review of all patients at HDMC that had been diagnosed with IC9 codes reflecting MRSA, cellulitis, and skin abscesses to determine the incidence of MRSA. We noted a 4.7% incidence from July 2007 to August 2007 of CA-MRSA in Paiute Tribal Members living on the reservation north of Burns. During the same period of time there was a 0.1% incidence of CA-MRSA among non Native American patients seen at the High Desert Medical Center (HDMC) in Burns. Previous annual incidences were between 0.23% and 0.33%. A literature search was then performed, and a proposal was written and submitted to the Paiute Indian Tribe to do nasal swabbing to determine the incidence of MRSA. An educational brochure was also created to be distributed to Tribal Members to help them decrease their chances of becoming infected and potentially hospitalized from MRSA. The human papillomavirus vaccine: Provider attitudes and barriers to utilization in Roseburg, OR Project Date: 7/2/2007 The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. In the U.S., 6.2 million new infections occur annually, most in people 15-24 years old. HPV is necessary but not sufficient to cause all cervical cancer, all anogenital warts, and 90% of anal squamous cancers. During 2002, 126 women developed invasive cervical cancer and 45 died of the disease in Oregon. A quadrivalent HPV vaccine (against 6, 11, 16, 18) was FDA approved June 2006 for use in all 11-12 year old females, with a vaccination range of 9-26 years old. The vaccine is 100% effective against cervical cancer and genital warts. Provider attitudes and barriers to vaccination with the HPV vaccine have not been studied recently, so a survey was sent out to 37 health care providers in Roseburg, OR (included MD/DO, PA-C, NP in Family Medicine, OB/Gyn and Pediatrics). 57% of surveys were completed and returned. 71% of providers provide the HPV vaccine. Barriers to vaccinating include cost to both the patient and the provider, as well as difficulty in getting adolescents to come to well visits, and parental tendency to pay less attention to vaccines after age 5. 67% of providers do not agree with mandating the HPV vaccine in Oregon, citing reasons such as cost, insufficient evidence, and questioning government involvement. Although the HPV vaccine is a breakthrough in cancer prevention, more time must be spent investigating barriers to vaccination before mandating the vaccine will be possible. Influenza and other respiratory illnesses Project Date: 2/12/2007 Influenza, also known as “the flu,” is a viral infection of the nose, throat and lungs that affects roughly 10-20% of Americans each year. Occasionally, a certain subset of people stricken with influenza will attain a high level of sickness that requires acute care. Every year, approximately 200,000 people are hospitalized and 36,000 die because of influenza and its complications. Up to March 1, 2007, 84 cases of influenza have been diagnosed in the state of Oregon. This study attempts to identify the incidence of laboratory-diagnosed influenza in a Stayton, Oregon family practice clinic and compare it with the statewide incidence as well as the incidence of other respiratory illnesses seen in the clinic. The design was a prospective study of patients diagnosed with influenza during a five-week rotation. From this study, it was determined that Stayton alone contributed to 5% of the influenza cases diagnosed in Oregon, which is notable because according to the 2005 population census, Stayton represents 0.2% of the Oregon population (7,700 out of 3,641,056). Also, greater than 50% of the Stayton family practice clinic patient population (25% pediatrics and >35% 65 years old and over) are considered at risk for influenza. This study demonstrates the high incidence of influenza in Stayton, OR and the subsequent need for heightened awareness by both patients and physicians to ensure rapid detection of the disease for effective primary and secondary prophylactic treatment as well as to highlight the importance of promoting influenza vaccine not only to at-risk groups, but also to the general population. The final product of this study was the development of a patient handout, because none previously existed at the family practice clinic, to increase patient awareness and education on the matter. Risk reduction strategies for prevention of STDs and teen pregnancy in Madras, Oregon Project Date: 2/12/2007 Sexually transmitted diseases (STDs) and teen pregnancy remain major public health challenges for young people in the United States and rural Oregon is no exception. STDs in rural Oregon follow national trends: The top two STDs are HPC and Chlamydia, and about half of new infections diagnosed each year are young people 15 to 24 years of age. The service area of Madras Medical Group also has staggering teen birth rates (women age 15 to 19). 2004 estimates of teen births in the service area are 158 per 1,000 live births, almost four times the national average (CPU site information, CDC). The objective of this project was to find clinical evidence of effective risk-reduction interventions in preventing STDs and/or teen pregnancy. Literature search revealed risk-reduction counseling interventions that were effective in reducing STDs and increasing safe sex behavior, notably most effective in younger patients. Studied interventions were based on interactive counseling and the AIDS Risk Reduction Model which focuses on three stages of behavior change: labeling high risk behavior as problematic, making a commitment to change high risk behavior, and seeking and implementing solutions directed at reducing high risk activity. Similar counseling techniques were found to be effective in programs aimed at reducing teen pregnancy. From this data, a proposal for a brief, one-on-one, low cost intervention to reduce the risk of STDs and teen pregnancy was developed for Madras Medical Group. Though not yet fully implemented, the intervention has received positive feedback in informal interviews from both the target population and the clinicians. MRSA infections in rural areas Project Date: 2/13/2006 Community acquired MRSA is a growing problem in Grants Pass. I set out to get an idea what kind of problem this represented in the area. After looking at the disease from a variety of perspectives, I began to realize that the prevalence of the disease may outgrow the medical community’s ability to respond. I began this project in the hospital. I attended the quarterly infectious disease board meeting. Here I was introduced to a current assessment of the problem of both nosocomial MRSA and community-acquired MRSA in Josephine County. Dr. Daniel Selinger, the infectious disease specialist at the hospital, and Marjorie Underwood, the infection control nurse, were both helpful in answering my questions about hospital infection control policy. As it turned out, beginning in February, Three Rivers Hospital was changing some of their hospital protocol with regards to control of MRSA. This new policy was a divergence from the sister hospital, Rogue Valley Medical Center, in Medford and highlighted an ongoing national debate over proper infection control policy. I also spoke with Dr. Ruth Rabinovitch who is Dr. Selinger’s counterpart at Rogue Valley and is an adherent to the other policy approach. In the outpatient setting, I performed a chart review of any patient who during the last three years had a skin or soft tissue infection associated with MRSA. I examined twenty two charts, eleven of which contained a history of MRSA infection. Specifically I was looking for any of the risk factors associated with either a nosocomial MRSA infection or a community acquired MRSA infection. For the third component of my project, I visited both the county jails. At the Josephine County, I had a chance to interview the staff nurses who take care of the inmates. I wanted to get an idea of how they perceived the problem and what was their approach to treating infections that may be MRSA positive. I also had a chance to participate in a clinic for the inmates at the Jackson County jail. Here I had a chance to see some cases of skin and soft tissue infections and observe the Public Health Officer, Dr. Jim Shames, assess and treat these patients Although I did not come away from this experience with any solid answers about MRSA in a small community, it was heartening to see so many providers, in the hospital, in the clinic and in the community, that were working diligently to slow the growth of this inevitable phenomena. Tracking Childhood Immunization Records: the Utilization of Oregon Immunization ALERT in Baker City. Project Date: 9/12/2005 In Baker City the public health department is the only entity that immunizes pediatric patients. There is no system in place for the transfer of patient information between the health department and the rest of the medical community in Baker City. Oregon Immunization ALERT is a statewide database of immunization information for Oregon’s pediatric population whose aim is to track the immunization status of every child 0-18 years of age with the ultimate goal of insuring complete and timely immunizations for all. Baker County Health Department enters each child’s records on ALERT, but the community doctors and hospital personal do not access the program. Increasing the usage of ALERT at Eastern Oregon Medical Associates (EOMA) medical office and by introducing ALERT to the St Elizabeth Hospital Emergency Department could serve to bridge this gap between the health department and the community health care providers. Practitioners at EOMA were retrained on how to access ALERT and the importance of following the immunization status of their patients was readdressed. This resulted in plans put forward to incorporate ALERT records for each patient age 0-12 into their electronic records system with the ability to update the records at each office visit. The nurses and doctors in the emergency department were introduced to ALERT, given access codes, and trained on its use with an emphasis placed on using it to determine DTaP status. The results in St. Elizabeth’s emergency department are less certain. There was resistance to the use of a computer based program and uncertainty of ALERT’s value in the emergency setting. A follow up letter with reminders of passwords and how to access ALERT will be sent to the emergency department in two months time. By accessing ALERT, physicians will be better informed on the immunization status of their patient and better able to encourage prompt vaccination or catch up immunizations as needed. By increasing the knowledge of a patient’s DTaP status in the emergency department, the risk of adverse immunization reactions will decrease. Meningococcal Disease in Klamath Falls, OR Project Date: 7/4/2005 Meningococcal disease is an important cause of morbidity and mortality in the United States. This project attempted to identify barriers to the utilization of vaccination against Meningococcal disease in Klamath County. These barriers surfaced following a small outbreak of meningococcal disease in Klamath Falls. The two major barriers identified had the same underlying issue - a lack of education. The first barrier, lack of knowledge of the citizens of Klamath Falls, was identified through informal surveys. The response to this barrier was to create a pamphlet aimed at increasing patient awareness of meningococcal disease and the vaccines that exist to prevent it. The second barrier, lack of knowledge of health care providers, was gauged through informal interviews. Though multifactorial, it was due, in large part, to the fact that a new meningococcal vaccine was very recently released and most providers did not possess the most current knowledge surrounding this vaccine. This was addressed by creating a concise, clinically relevant summary of meningococcal vaccinations in the form of a memo. These two measures were designed to target the root of the problem, the need for education of both patients and providers. Lessons Learned from a Pertussis Outbreak in Reedsport Project Date: 2/7/2005 Reedsport was hit by a pertussis outbreak in fall 2004. People were inexperienced and unprepared about management of outbreak. I interviewed the participants who were involved in the outbreak, including representatives from Douglas County Health Department (DCHD), Dunes Family Health Care clinic, Oregon State Health Department, schools, parents and local pharmacies. From their different perspectives I summarized the lessons learned from the outbreak and formulated some suggestions for them so that the community will be more prepared for future outbreaks. Philomath Pertussis Outbreak Project Date: 2/7/2005 The number of cases of pertussis has been steadily increasing during the last several years nationally and also in Oregon. Benton County has lead the state during the last year with the help of two outbreaks including a focus in Corvallis during spring and a recent outbreak centralized in Philomath during fall/winter of 2004. The incidence rate has reached 1250/100,000 in Philomath and has overwhelmed the County Health Department along with the rest of the health care system. To deal with the recent epidemic the health department has decided to change its policy concerning chemo prophylactic usage and to recommend antibiotics use only to asymptomatic contact in high risk-groups. This policy change will allow a more careful use of antibiotics and a stronger focus on groups that are more susceptible to complications such as infants, pregnant women and elderly. Through time spent collecting data at the health department, multiple interviews with various people who are involved at different level of the epidemic and my own experience assisting with taking care of patients with pertussis, I have developed a better understanding for how outbreaks are handled by a health system. During my investigation into the outbreak I realized that high school students had a high incidence rate and tended not to understand much about the disease. I made a video with several high school students that was played during school that gave basic information about pertussis, gave them reasons why the disease could be important to them and taught them some ways of decreasing its spread. I also made signs that are posted throughout the school which gave similar information. In addition, I made a handout for the family medicine clinic that I was rotating in that covered the most frequent questions that patients ask about pertussis in order to assist the staff and provide information to the patients in a quick, informative manner. Hepatitis C infection Baker County - educating local healthcare professionals and at-risk populations Project Date: 5/10/2004 At larger than expected segment of Baker Countys population is at-risk for hepatitis C infection. Concurrently, Baker lacks sufficient resources for referrals for therapy with many of these people lacking insurance, making a consult from a gastroenterologist out of the question. Baker City's referral hospital is 130 miles across state miles in Boise, also home to the closest gastroenterologists. Although one local family practitioner has started administering antiviral treament, access for treament is still quite limited but has room for expansion. However, few local health care workers, including the county health department, have undergone training regarding the newest therapies and outpatient management techniques of the disease. Therefore, the goal of this project was to provide training and information for local health care workers involved in the care of hepatits C-infected patients, as well as educating Baker's intravenous drug use population regarding the risks and options for hepatitis C infection. To affect this end, a patient information pamphlet was crated, in addition to in-person presentations to both healthcare providers, as well as at-risk populations. The pamphlet explains basic infection about hepatits C, including outlining methods of transmission, stressing the importance of abstinence from alcohol, discouraging needlesharing, and receiving vaccinations against hepatitis A and B. These preventive interventions may aid in reducing the number of new infections, as well as educating those already infected who may be eligible to advocate for treatment. It may also remind providers to screen and consider treatment for hepatitis C and ensure improved hepatitis A and B vaccination rates. "Keeping Coughing Kids Home": A Description and Analysis of the 2004 Pertussis Epidemic in Benton County. Project Date: 5/10/2004 The national incidence of pertussis has gradually increased over the past several years. Since 2003, Oreogn has gained national attention as the incidence of pertussis appeared to increase at an alarming rate to a 40-year high for the state. Adults and adolescents are believed to be the primary reservoir for the bacterium whereas the disease causes the most morbidity and mortaility in infants less than 1-year-old. Benton County currently has one of the highest numbers of reported cases of pertussis in 2004 in the state. This study sought to provide a descriptive analysis of the current trends of this vaccine-preventable illness in Benton County using the most current data provided by the Benton County Health Department (BCHD) as well as an interview with departmental personnel to discuss the public heatlh measures undertaken to reign in the epidemic. The data from BCHD revealed that the majority of cases were school-associated 92% and occurred in the Corvallis school district with 34.2% of the cases occurring in Corvallis High School primarily between 3/14-4/11/04. Community physicians were responsible for treating both confirmed and presumptive cases (total 110) in addition to lowering the antiobiotic prescribing threshold for upper respiratory tract infections with a protracted cough. The BCHD has responded to the epidemic by regularly communicating with schools and parents. The department has many interventions planned during the anticipated peak months of the epidemic this summer. It is unclear whether the increased number of reported cases is simply due to increased surveillance or more disease, but is likely a combination of both. Hepatitis C in Madras, OR: Development of a Patient Information Handout Project Date: 3/29/2004 The hepatitis C virus (HCV) is an enormous public health problem in the United States. In 1997, the cost associated with HCV was approximately $5.46 billion. Though they were not aware of the exact number of patients in their practice with HCV, the physicians at the Madras Medical Group in Madras, OR all felt that HCV was a big problem in Jefferson County. Despite this, it was noted that they had no written information on Hepatitis C to give to patients. Because they are the primary care providers for a number of patients with chronic HCV, and because there are important lifestyle modifications patients can make to optimize their health and the health of their liver as well as prevent transmitting the virus to others, the physicians and I agreed that a comprehensive patient handout would be very useful in their practice. I conducted an extensive internet search for information on HCV designed for patients and created a one page, double sided handout to be distributed to appropriate patients at the clinic as well as the county health office. The Fight Against STDs in Madras, OR Project Date: 9/29/2003 It is estimated the 15 million sexually transmitted diseases are contracted in America every year. Chlamydia and gonorrhea are the 1st and 2nd most reported infectious diseases in the United States. My project examines the incidence of reportable STDs in Jefferson County, Oregon, namely, chlamydia, gonorrhea, HIV/AIDS, and syphilis. This data is compared to more urban counties in the state. Prevention strategies among the adolescent population of Madras, Oregon were also examined, and providers at Madras Medical Group were surveyed to assess how they practice STD prevention and screening. While no new cases of HIV/AIDS or syphilis have been reported in Jefferson County for several years, the incidence of Chlamydia infection is higher than the state average and also higher than several more populous counties (Lane, Benton, Marion). Incidence of gonorrhea is lower than that of chlamydia reflecting a statewide pattern, but incidence is still higher in Jefferson County than in Lane or Benton Counties. Prevention strategies for adolescents consist of an abstinence-based program for 8th graders and an abstinence-plus program for high school students including information about birth control and condom use. While the public health officer for STD prevention would like to have more comprehensive programming at younger ages, she worries that providing students with material that some parents find inappropriate may result in the schools canceling the public health programs. She is also limited by funding constraints, thus does not present as much programming as she feels is needed by the teens. The providers at Madras Medical Group are united in most of their practices and beliefs, including willingness to provide patients of any age with condoms and instructions on use as well as the belief that educational programming on STDs in schools is inadequate. Finally, updated treatment guidelines were developed from the 2002 CDC recommendations and placed at the nurses’ station for quick reference. Incidence of E. coli 0157 in Benton County and Oregon Project Date: 8/18/2003 The CDC emerging Infections Program employs an active surveillance network (FoodNet) to monitor state trends in major foodborne illnesses. E. coli O157 is one of the pathogens monitored, which has not had a consistent decline from 1996-2002. This project is an assessment of the annual incidence of E. coli O157 infections in Benton County and Oregon during the past decade. 2002 incidences for Benton County and Oregon are compared with national values. Data searches were conducted in electronic data collections of CDC's MMWR, FoodNet Annual Reports, and Oregon Department of Human Services Annual Reports. It was found that in the past ten years, Benton County has had a sustained decline in E. coli O157 and has had similar rates as the national rate. Oregon overall has had fluctuations in E. coli O157 incidence and has been consistently above national rates for the past ten years. Meningitis in Madras: Epidemiology, Prevention and Public Education in the Setting of a Local Fatality Project Date: 11/4/2002 Meningitis is an uncommon disease with serious morbidity and mortality. Cases often occur in outbreaks. This study was prompted by a fatal case of meningococcal meningitis occurring during my rural rotation in Madras, Oregon. The tragedy led to grief, confusion, fear and a great demand for information in the local community. Objective: The goals of this study were to 1) research the pathophysiology and epidemiology of meningitis specific to Jefferson County, 2) aid in public education and prevention of meningitis and meningococcal disease through the development of an educational handout. Methods: The study design included discussion with local doctors, interviews with the public health nursing staff, and literature review focused on epidemiology and pathophysiology of meningitis with a focus on trends on Oregon and Jefferson County. Conclusions: Meningitis can be caused by viruses, bacteria or fungi. Bacterial causes tend to be more severe. N. Meningitidis and S. pneumoniae are the most common causes of bacterial meningitis. They are contagious. Symptoms are similar to those causing many common illnesses. Disease rates in Oregon are higher than the rest of the country. Immediate chemoprophylaxis is essential in controlling outbreaks. Only close contacts should take antibiotics to prevent infection. Vaccines are available, however, most cases of meningococcal disease in Oregon are caused by serogroup B, a group that is not covered by the vaccine. Results: The final result of this project was a patient handout written in both English and Spanish focusing on education, epidemiology, prevention and available resources for community residents. The handout addresses questions such as: What is meningitis? Is it contagious? How is it spread? Who needs prophylactic treatment? Are there vaccines available? It is my hope that this information will help dispel disease myths and aid in public education and prevention. Meningococcal Disease: The Health Department Response and Community Awareness/Education Project Date: 2/11/2002 This project was an educational experience in community public health and it was intended to gather data for improving methods for dissemination of information and awareness, following an isolated case of meningococcal meningitis. On the February 22nd, 2002, a case of Meningococcal meningitis was reported to the Josephine County Health Department, involving a 16 year old boy from the Illinois Valley High School. I observed first hand the steps taken by the health department to identify exposed contacts, notify each contact, and arrange for prophylaxis treatment. In the weeks following this case, I arranged a community forum to educate the community regarding the pathophysiology of meningococcal disease, the importance of early identification of symptoms, and the public health departments role in responding to this disease and arranging treatment to the community. It was also my goal to administer a survey at this meeting to gather data regarding the community's perspective on information dissemination and public health awareness. However, a less than expected turnout at this meeting made the survey unfeasible. "Assessing the Understanding of Respiratory Syncytial Virus in a Rural Community" Project Date: 2/11/2002 The major cause of lower respiratory infections in children worldwide is a virus, respiratory syncytial virus (RSV). Usually self limited, RSV can be treated at home, but up to 3% of infants infected require hospitalization. The purpose of this community project was to gain an understanding of the Reedsport, Oregon, area residents' comprehension of a viral respiratory illness symptoms and treatments. From this information, an educational handout specifically about RSV bronchiolitis was created. 124 patients at the Dunes Family Health Care Clinic ranked various "cold and flu" symptoms by frequency of office visits and answered different true/false questions. Results showed the symptoms of difficulty breathing, a cough with phlegm, and fever greater than 101F accounted for the greatest number of clinic visits. Results from the "true/false" section of the questionnaire revealed over one half of the responders (51%) erroneously answered "true" to the following question: "A viral respiratory infections needs antibiotics to be treated properly." Based upon the results, it was concluded that many patients probably don't understand the difference between viral and bacterial respiratory infection and the subsequent treatments. From this conclusion, a handout was created to educate patients about infant bronchiolitis and RSV. Hepatitis C in Lebanon, Oregon: Development of a patient handout to connect patients with Hepatitis C with available community and national resources. Project Date: 5/6/2002 Hepatitis C accounts for 20% of acute viral hepatitis, 60-70% of chronic viral hepatitis, and 30% of cirrhosis, end-stae liver disease and liver cancer. Although 1.8 million Americans are infected with Hepatitis C, many do not know much about the route of transmission of the disease, long-term consequences of the disease, and available resources. The purpose of this study was to investigate the usefulness of a short, concise handout to patients in a clinical setting. The methods of the study included searching the internet and community for existing resources available to patients in Linn county. A handout was then formulated containing this information and dispersed to the Mid-Valley Clinic as well as the Free Clinic in Lebannon, Or. Although the physicians were well educated in Hepatitis C and had a lot of information available about Hepatitis C, there was no single handout available for patients containing both key information abour Hepatitis C and community resources available to them. Therefore, a handout was formulated and dispersed. Treatment For Hepatitis C In Klamath County Under The Oregon Health Plan: A Novel Local Approach To Care Management Project Date: 9/24/2001 This project seeks to describe an innovative, local clinician-designed, formal managed care protocol and treatment program for hepatitis C patients in Klamath County enrolled in the Oregon Health Plan. Results of the first 6 months of this program are presented , discussed, and compared with a recent study of hepatitis C monotherapy treatment compliance at a VA center. Hepatitis C is a highly prevalent disease whose treatment cost is high. It is estimated that 1.8% of the US population is infected with hepatitis C. According to the results of the 2000 census, approximately 1,148 citizens in Klamath County have been infected by hepatitis C. Since 75% of patients who contract hepatitis C develop chronic hepatitis C with ongoing viremia, approximately 861 patients in Klamath County may have chronic hepatitis C. Interestingly, when one consults the Oregon Health Division website, Klamath County only has one reported cases of hepatitis C from 1995-2000. Prevalence of Pneumococcal Vaccination; Among Diabetic Adults Served By The Health Associates Of Peace Harbor In Florence, Oregon. Project Date: 8/13/2001 Streptococcus pneumoniae (pneumococcus) is a bacterial pathogen that colonizes the upper respiratory tract and causes serious morbidity and mortality worldwide. Diabetics, although not more susceptible to the development of pneumococcal infection, are more likely to become bacteremic and require hospitalization than are non-diabetic persons. Furthermore, diabetics hospitalized with community-acquired pneumonia are more likely to die from the infection than are non-diabetic patients. Fortunately pneumococcal vaccination can reduce the occurrence of invasive pneumococcal disease and the associated morbidity and mortality. This community-based project was designed to assess the prevalence of pneumococcal vaccination among diabetic adults served by the Health Associates of Peace Harbor primary care clinic in Florence, Oregon as well as to determine the prevalence of pneumococcal vaccination among diabetic adults discharged from Peace Harbor Hospital, during a one-year period, with a diagnosis of bacterial pneumonia. Approximately 37% of sample diabetic patients at the Health Associates of Peace Harbor primary care clinic had received the pneumococcal vaccine. Diabetics 65 years of age or older were more likely (46%) to be vaccinated than those younger than 65 (26%). Fifty percent of diabetic patients discharged from Peace Harbor Hospital with a diagnosis of bacterial pneumonia had received the pneumococcal vaccine prior to admission. Those not vaccinated prior to admission had an average of 19 clinic and 2 emergency department (ED) visits in the 36 months prior to admission. The results of this community project indicate that the Health Associates of Peace Harbor primary care clinic would benefit from adopting the Healthy People 2010 objectives for pneumococcal vaccination of diabetics. Several strategies can be implemented to increase pneumococcal vaccination among diabetic adults including advocating more precise documentation standards, educating diabetic patients about the risk of pneumococcal disease, minimizing missed clinic vaccination opportunities and taking advantage of a wide variety of vaccination opportunities outside of the clinic. Hepatitis A and B Vaccines in People Infected with Hepatitis C Virus Project Date: 7/2/2001 This project looks at the treatment of patients infected with HCV by doctors in primary care as compared with national guidelines and specifically evaluates the number of patients vaccinated for HAV and HBV. This was done by review billing records for primary diagnosis of Hepatitis C seen by Mid-Valley Medical Plaza in Lebanon, Oregon over a 2.5 year period and reviewing the injection procedures for each patient. Secondly, a questionnaire was used to interview physicians at MVMP regarding their approach to the management of patients with Hepatitis C. Records showed that only 14% of patients studied had received vaccines for Hepatitis A and 8% had received vaccines for Hepatitis B. The questionnaire demonstrates a uniform approach to the treatment of Hepatitis C using the national guidelines with the exception of vaccinations although, all physicians said they vaccinated their patients. The report reviews the frequency of adult vaccines and the importance of reminders in assuring better vaccination coverage. Recommendations are then made to use reminder sheets and suggest the plausibility of a Hepatitis C clinic to improve delivery of vaccines. The Common Cold In Coos County: Patient & Physician Perspectives On Etiology And Therapy Project Date: 7/2/2001 This project is designed to establish how the understanding of patients seen at Bay Clinic in Coos Bay correlates with current medical opinion with regard to the common cold and the use of antibiotics. Secondly, it aims to determine if the level of patient understanding influences the delivery of patient care in the rural setting. Patient knowledge of the causes, course, and treatment of the common cold are explored by the use of a questionnaire. Physician opinions and practices are evaluated by a written survey. Back to subject search page or search by preceptor site