RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Meeting the Need: Is the Pediatric population in Coos County adequately covered by the medical community? Project Date: 8/3/2009 There are eight pediatricians in Coos County serving the Coos Bay and North Bend communities. They meet regularly to address current and emerging concerns to their patient population. At a recent meeting, it became apparent that the current coverage for the pediatric community was unknown. This analysis seeks to reveal more information about the pediatric population in Coos County, including the population of the pediatric community, the number who receive at least annual care, and the principle means of payment for healthcare received. The data was collected using US Census information, collaboration with the two pediatric clinics, and with data from the catchment clinic in the county. This data indicates that no more than 55% of the pediatric population sees a pediatrician, and less than 60% receive care either from a school based clinic, a catchment clinic, or the pediatricians. Assessment of the Gay Friendly Literature and Postings in the Waiting Areas of Local Eugene, Oregon Clinics Catering to Adolescent Populations Project Date: 8/6/2007 Adolescence is a time of great discovery, when important facets of our personalities are experimented with and solidified. It is also a time of great confusion and vulnerability. This vulnerability puts adolescents at increased physical and mental health risks. Gay youth, an often overlooked subpopulation of adolescents, are often at increased risk compared to their heterosexual peers for certain health problems. As medical providers, there are many things we can do to assist our young gay patients during this tumultuous time. Unfortunately, despite our best efforts to provide adequate care to this population of patients, studies show that gay youth are hesitant to disclose their identity to health care providers. Gay youth need to feel safe before disclosing their identity as this leaves them in an extremely vulnerable position. We can help increase their trust in us as providers, simply by encouraging gay friendly literature in our waiting rooms. A cursory assessment was made of local Eugene clinics. Ninety seven percent of clinics available for response did not display gay friendly literature in their waiting areas. The same percentage did not have any brochures on local gay resources to offer their patients. It was evident that if a gay adolescent was presenting at any of these clinics, they would have no obvious signs letting them know that they were in a safe place. It was also evident that a resource guide for gay youth was lacking in local Eugene clinics. 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.” Bringing Community Connections Network To Your Practice and Patients Project Date: 7/2/2007 Continuity of care, identification and access to community resources, and care by specialists are just some of the problems children with specials needs in rural areas may face. How can these children and their families obtain what they need if their primary care provider is unaware of the help that is out there? This study attempts to identify what primary care providers in Coos County and surrounding areas know about Community Connections Network (CCN). Forty-four care providers were identified and given a survey to asses their understanding and use of CCN, and to identify ways to help them bring CCN to their patients. They were also given up to date information on what CCN offers, who they serve, and how to refer in hopes that they might someday refer a child in need. While the resources and referral process used to identify children with special needs is generally understood, there is a lack of knowledge in the community about what is available for follow up care. Upon conclusion of this study, it was discovered that a little more than half of the primary care providers had heard of CCN, and only half of those had actually made a referral. Additionally, new methods of getting up to date information out to the community were identified. 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. Traumatic Brain Injury in Harney County Etiologies and Incidence of Emergency Department Visits, Hospitalizations and Deaths Project Date: 7/2/2007 With a population of 7,660 people spread over 26,486km2, Harney County is the most sparsely populated county in the contiguous US and has a low enough population density to qualify it as a “frontier territory”. Given the abundance of uninhabited land, ranching, hunting, off-roading and other outdoor activities are an integral part of the Harney County culture. These pursuits however provide additional potential risk factors for head injuries and thus might predispose the population of Harney County to increased rates of traumatic brain injuries. The purpose of this study is to assess the impact of Harney County’s frontier-county lifestyles on the rates, etiologies, and outcomes of traumatic brain injuries in Harney County. An examination of national, state, and county data on TBI incidence, etiology, and outcome was performed for comparison. National and state data were obtained from online databases while Harney County information was obtained from Harney District Hospital records department. Analysis of primary data found that there is an increase in the incidence and overall proportion of traumatic brain injury from direct livestock-induced injury, secondary injury from MVA-livestock collisions, and off-road related ATV rollovers compared to other etiologies except falls. The overall incidence of TBI’s in Harney County was found to be slightly higher than that of the national or state incidence rate By identifying common causes of head trauma in Harney County, local providers can identify higher risk communities and at-risk individuals and can thus emphasize patient-specific strategies for prevention of future head trauma. Physician Shortage: Who Will Bear the Burden? Project Date: 4/30/2007 A primary care physician shortage currently affects or is predicted to affect America. While much-deserved, growing attention is being directed at populations who are unable to access medical care because they lack medical insurance, this study attempted to support an observation that certain subsets of the medically insured population would bear a growingly disproportionate burden of the predicted physician shortage, despite medical insurance. The subset of the medically insured population studied was Medicare patients. The study design consisted of primary and secondary data collection in the form of physician surveys and population demographics. Data collected touched on both the deficiency of health care coverage in rural counties, and perhaps more importantly, the flux of disparity in access to this precious and increasingly limited commodity. Data collected clearly revealed a present access inequality in Douglas County and Roseburg, Oregon. Data also revealed that access to primary health care was reduced even among the medically insured population, specifically Medicare patients. Analysis of this data further demonstrated that three explanations were readily available for the growing disparity in access to care between the general insured population and Medicare patients: diminished rates of reimbursement; increased medical complexity; and demographic shift. Interpretation of this data would suggest that the predicted primary physician shortage would only aggravate this disproportionate burden already borne by the underserved and now by Medicare patients. 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. Interfacility transfers from Harney District Hospital, Burns, OR Project Date: 4/30/2007 Harney District Hospital (HDH) is the lone health care center for the 7,600 people living in Harney County, the largest county in all of Oregon. They are able to handle most every medical and surgical problem; however, as a small hospital with limited resources, certain patients come through that require transfer to a tertiary care facility for additional care. The hospital’s ambulance service conducts these interfacility transports; however, they are never quite sure what type of patient to expect when they back their ambulance in. This uncertainty makes it difficult to train and educate ambulance crews, arrange crew configurations, and equip and supply the ambulances. Similar ambiguity exists for the hospital as well. This study aims to elucidate what patient problems require transfer to other facilities, from which setting they are transferred, and by which mode of transportation. Data on every patient which required interfacility transport between December 2005 and April 2007 were collected from hospital databases, and analyzed categorically. During the study period, HDH transferred 3.5% of their patients. The majority of these 171 patients were transferred by ambulance; however, a full 1/3 of patients were transported by air. 50% of all patient transfers were for patients with cardiac, orthopedic, or surgical problems: a large fraction of acute issues. Some problems, like psychiatric, infectious, and oncologic were rarely transferred out. Proportionally, more patients from the inpatient ward required transport than from the ED; however, any given transfer was equally likely to have originated from either setting. These data will hopefully help county EMS to focus education on the high yield and rare maladies, appreciate how to efficiently equip and supply ambulances, and balance the skill level of crewmembers with the anticipated acuity of patients. The hospital may also find valuable information in this project, elucidating where additional specialist care, equipment, and education may decrease the necessity of some transfers, allowing more patients to receive definitive care within their community. Parent education initiative in Florence, OR: Development of a school newsletter that accurately addresses important child health education issues; Project Date: 4/30/2007 Lack of basic child health education is a problem in many small towns. This study attempts to determine what areas of knowledge are most lacking, as well as which topics are the most important for parents in Florence Oregon to learn about in order to improve the health of their children. Parents, children, local physicians and medical office staff were interviewed and internet research was done to answer these questions. The end goal is to create a newsletter that will be sent home to all parents of school-aged children for the purpose of improving their base level of knowledge so that they have the tools necessary to make healthy parenting decisions. Physical Activity in Harney County, Oregon: Attitudes toward, Self-Assessment of, and Barriers to a Physically Active Lifestyle Project Date: 3/19/2007 Obesity and physical inactivity are quickly becoming major causes of morbidity and mortality in the United States. Rates of obesity and physical inactivity are increasing in the US every year. Citizens of rural communities have higher rates of obesity and physical inactivity than the overall population of the US. In order for small rural communities to take action against this slip into a culture of inactivity and obesity, they must identify trends, needs, and strengths within their communities. My project 1) assesses perceptions of and behaviors that affect health and physical activity, 2) identifies barriers to increased physical activity, and 3) solicits possible governmental/community solutions that can help citizens become more physically active. In order to elicit this information, I conducted interviews with a number of Harney County citizens, including health care staff, patients attending a health care facility, and local citizens in community spaces. I also surveyed patients attending High Desert Medical Center on the topics mentioned above. Surveys and Interviews indicated a number of trends. Citizens had a high personal value for health and physical activity, and had overall high average self-assessed levels of health and physical activity (especially high in the young). There was a slight fall off in self-assessed health and physical activity with increasing age, as well as a large decrease in at-home (as opposed to work/school-related) physical activity levels with increasing age. Walking, gardening, ranch work, bicycling, running, and swimming were the most commonly mentioned physical activities that citizens currently engage in. Swimming, walking, yoga/taichi, gardening, and bicycling were the most commonly mentioned activities that citizens would like to participate in. The most commonly mentioned barriers to physical activity were not having enough time, not having enough money, lack of year round facilities, lack of facilities appropriate to their activity of choice, medical conditions that prohibited their participation in an activity of choice. Most ideas submitted by patients were related to increasing availability of indoor facilities, increasing child-care availability at exercise facilities, and increasing hours of operation of facilities. Death with Dignity - a rural community's perspective Project Date: 2/12/2007 Context: End of life care is a subject that has become more important over the last decade. “Death with dignity” is often a phrase that is used when discussing quality end of life care. However, this phrase is still not well defined. Furthermore, end of life care has been recognized as an ethical obligation of health care providers and caregivers, but this concept has not been examined from the perspectives of residents of rural communities. Objective: The objective of this project is to identify and describe elements of quality end of life care from the perspectives of residents living in the rural town of Scappoose, Oregon, as well as determining the level of awareness of advanced directives and POLST forms amongst those residents. Methods: This study is a qualitative study conducted using face-to-face interviews with open-ended questions. A total of 45 participants from 2 patient groups: clinic patients (n=28) and residents of a long-term care facility (n=17). Results: The participants identified eight domains of quality end of life care: avoiding inappropriate prolongation of dying, receiving adequate pain and symptom management, achieving a sense of control, having a peaceful and comfortable death, relieving burden, knowing that they are going to heaven, and not being alone. Overall, less than 50% of the participants in this project were aware of POLST forms. Conclusion: The conclusions drawn from this project are that the domains identified, which characterize a rural community’s perspective on end of life care, can serve as points for improving quality end of life care. Some of the values held by residents of Scappoose may also give insight as to how those residents have defined “death with dignity.” This project has also revealed the lack of awareness of POLST forms amongst the rural community of Scappoose, expressing a need for increased education regarding POLST forms and end of life care. Breast Cancer Patient Resources in Grant County, Oregon. Project Date: 2/12/2007 Breast cancer is a major medical concern for women in the United States. Women currently are thought to have about a 1 in 7 lifetime risk of developing breast cancer. This means that even a small community such as John Day, Oregon in rural Grant County likely has many women who have dealt or are dealing with a diagnosis of breast cancer. The goal of this study was to attempt to determine if there is a need for breast cancer patient resources in Grant County and if so what resources are currently available to meet this need. Although there is not an oncologist in Grant County or a site for chemotherapy infusion or radiation, there are still likely many breast cancer patients/survivors living in the area who may need support and resources outside of those provided when going out of town for treatment. The design of this study was observation of materials available at health care provider clinics as well as interviews of local health care providers and breast cancer patients and survivors. The final outcome of this project was to develop a database of contacts for local resources as well as to obtain a handout of national resources for the local health care provider offices. Breast Cancer Screening in Grant County, OR Project Date: 2/12/2007 Breast Cancer is one of the most common malignancies in the United States today. In fact, it is the most common non-skin cancer. It is also the second most deadly type of cancer behind lung cancer. While the disease is not preventable, it is highly treatable as long as it is caught at an early enough stage. Screening for breast cancer has been standardized and there are screening guidelines and goals defining the percent of the population that need to be screened to meet these criteria. In my clinical experience in John Day, OR, I noted that many patients were not up to date with their breast cancer screening. The goal of this project was to define the current screening rate in Grant County and identify areas for improvement. I found the overall rate to be lower than both the state and national average. There were several identified barriers contributing to this low level of screening, the most obvious being lack of information at the point of service. At the conclusion of this project I supplied updated and more visible information for patients regarding breast cancer screening. When to transfer? Physician decision making while managing ST elevation MI patients in Coos Bay, OR; what to do when there is no interventional catheterization lab. Project Date: 1/1/2007 Current recommendations suggest that either a patient receiving thrombolytics should have a door to needle time in the hospital of 30 minutes or a primary percutaneous coronary intervention (PCI), door to balloon time, of 90 minutes. This project attempted to examine how local physicians in Coos Bay, OR made decisions regarding the management of patients with ST elevation MI, given the lack of a local catheterization lab and the necessity of transferring patients if they are to receive PCI. Debate about the best strategies to improve speed of reperfusion and has spawned discussions within the community about whether there is a necessity for a local interventional cath lab in Coos County, OR. Currently, Physicians in Coos County must decide how to treat these patients appropriately and when to transfer them to Eugene, OR for PCI. Interviews of 10 local physicians were performed to generate ideas and issues associated with management of STEMI patients. All of the physicians were from the same practice and managed patients at Bay Area Hospital in Coos County, OR and responses were compiled and compared to current literature. All physicians interviewed endorsed a combination of thrombolytics for patients when not contraindicated, followed by PCI, and primary PCI for patients not eligible for thrombolytics, due to the inability of transfer to reliably occur within 90 minutes. There was also a wide variety of timing for subsequent transfer reported. None of the interviewed physicians felt that an interventional cath lab was appropriate for the community at this time, citing a lack of economic viability, lack of patient volume, and the need for surgical back up as necessary to the process. Physician strategies in the management of STEMI, while guided by current literature, revealed necessary alterations and individualizations when working with limited resources. The final outcome yielded the result that when making complex decisions about transferring patients for cardiac cath, physicians in rural areas must make an assessment both of the various risks and benefits to their patient while also considering the resource limitations they face. When are Thrombolytics Indicated? Project Date: 1/1/2007 The issue of when and when not to use thrombolytics in rural community hospitals continues to exist. This issue is propagated by an increase in the use of percutaneous intervention in urban areas as well as the increasing frequency of immediate inter-hospital transfer to PCI capable institutions in the case of ST-Elevation Myocardial Infarction. This change in the standard of care in urban settings has caused a perceived lack of need for extensive education in the use of thrombolytics and a resulting deficiency in training at urban care centers. This alteration then disturbs health care administration at rural community sites due to consults from care centers where thrombolytics are rarely used. The use of protocols in community hospitals addressing the proper use of thrombolytic medications when indicated may prevent the under use of this live saving treatment. Assessment of Resources Available for Persons with Dementia in Florence Project Date: 1/1/2007 The population of persons over 65 is rapidly growing in the United States and this is especially true in rural communities, such as Florence, where this population makes up close to 40% of the total population4. One family practice clinic in Florence had close to 45% of its patients over the age of 655. Naturally, this would increase the number of age-related diseases, such as dementia, seen in this clinic compared to an average practice. Therefore, it is important for physicians to have easily accessible resources for themselves as well as for their patients. A resource guide was produced to help health care providers in the clinic better serve their patients with dementia. Mental Health Resources in Linn County, OR for the Uninsured Project Date: 7/3/2006 Prevalence of uninsured patients in Oregon is on the rise. Among these patients are those with mental health needs. This project aims to assess the need for mental health care in Linn County and to research the available mental health resources for the indigent uninsured that are unable to pay for their care. Research was conducted through interviews with possible mental health providers. The organizations offering mental health care to the indigent were identified to include: Linn County Mental Health Clinics, Community Outreach Clinics together with Samaritan Health Care providers, Pastoral Counseling Center, and The Counseling Center of Albany. The ultimate goal was to develop a brochure to be made available for patients with mental disorders coming in to the Community Outreach Clinics in Albany and Lebanon, Oregon. Surveying the diabetic patients at OHSU Scappoose Family Health Clinic: general characterization of the diabetic cohort and their interest in diabetes educational sessions. Project Date: 3/20/2006 Lying within the St. Helens service area, Scappoose is a town with a population of 5,480 where diabetes is the 6th leading cause of death by disease5. With its impending expansion of both location and medical personnel, the OHSU Scappoose Family Health clinic is poised “to expand the scope of services we provide [and] to dedicate more resources to patient education programs,” states Dr. B. Rugge, the Scappoose Medical Director. Among the patient education programs under development are diabetes education sessions in small groups. This project assists in targeting diabetes education sessions for adult patients of the Scappoose clinic. By creating and disseminating a survey to incoming diabetic patients at Scappoose during a 2.5 week period, the intention of this project was to better characterize the diabetic population and their concerns about their disease and its complications. 28 completed surveys yielded a 14% representation of the estimated total diabetic cohort. Generally, the results of the survey portrayed a population with the average age of 59 and average duration of diagnosis at 11 years. While 86% whom monitor blood glucose levels, the majority of them (32%) had cbg between 126-150. 64% of those surveyed were interested in attending education sessions. Finally, the top three most interesting diabetes related topics were nutrition, blindness and weight loss. Further specifics are found in the report below. Future considerations would include continuing the survey such that the majority of cohort will have an opportunity to complete the survey, and discovering deterrents to attendance in order to maximize participation. A Chart Review of Domestic Violence and Specific Co-morbidities on the Warm Springs Reservation Project Date: 3/20/2006 There is a higher rate of domestic violence (DV) in Native American communities, and in turn certain medical problems (DMII, cholelithiasis and cholecystitis, ect) also occur disproportionately in native populations. While it is known that there are a number of co-morbid conditions and problems that victims of DV experience, this has not been examined at length in Native Americans. The clinic staff on the Warm Springs Reservation have been concerned with the problem of DV for some time, and have led in the initiative to make screening for DV a GRPA requirement. As an extension of their efforts to identify victims of DV and increase outreach to this segment of the patient population, they had earlier examined the medical records of a random selection of 100 female patients and found that 58% of these women were identified as victims of some sort of DV. This information has proved useful in discussing the severity of DV on the Warm Springs Reservation, and has been employed as part of educational and grant writing activities. The attempt herein is to look at a select number of medical problems in the same patient sample, in order to gauge what variations in medical problems exist between those with a history of DV and those who have not been victims of DV. The hope is that this information can also be used in expanding educational efforts regarding DV and its comorbidities. Promoting Women Physicians in Tillamook County Project Date: 2/13/2006 Tillamook County not only has a shortage of primary care physicians, but it also has a shortage of women primary care physicians. There are a disproportional number of female physicians in Tillamook County compared to urban areas. 83% of primary care physicians are male in Tillamook county despite a strong demand for female primary care physicians. Dr. Parsons has repeatedly tried to recruit a female internist with no success. There are many barriers to recruiting female primary care physicians to rural areas, specifically partner job unavailability, role of primary caregiver in the family, overfeminization/overloading of their practice, and gender stereotypes/community receptivity. This paper examines these problems in depth and offers some further solutions to these barriers. It also summarizes how a program was set up to encourage young women in Tillamook to pursue scientific professions, such as physicians, in hopes that they would someday return to practice in their own community. Obesity and the metabolic syndrome in Madras, OR Project Date: 1/2/2006 Although attempts at weight reduction are common in the United States, the prevalence of obesity has increased at an alarming rate since the 1980s. In this study an attempt was made to calculate the prevalence of obesity as well as comorbid conditions contributing to the metabolic syndrome in a Madras, Oregon family practice clinic. All patients over the age of 35 who entered during the course of a week were weighed and measured and had BMIs calculated. Their charts were reviewed for comorbid conditions including known cardiovascular disease, diabetes, hypertension, and dyslipidemia.. Patients were categorized as healthy weight (BMI = 18.5-24.9), overweight (BMI = 25-29.9), or obese (BMI > 30). Of 62 patients, 17.7% were of healthy weight, 33.9% were overweight, and 48.4% were obese. Additionally, 21% of patients evaluated met criteria for the metabolic syndrome, a cluster of clinical and biochemical abnormalities associated with the onset and progression of atherosclerotic cardiovascular disease. Asthma in Northeast Portland: Examining the increased prevalence in the underserved Project Date: 10/17/2005 Asthma is a chronic inflammatory disorder of the airways that can be controlled with proper medications. Seventeen million people, 5% of the population, are asthmatics in the United States. The prevalence of asthma amongst children and adults is higher in Oregon than the rest of the nation. Morbidity and mortality is highest in patients who live in the inner-city or who come from low income homes. There are many social, economic, environmental, and pharmacological factors that lead to increased asthma rates among this population. The purpose of this project is to assess the factors that lead to increased asthma rates in Northeast Portland, assess the most effective asthma prevention and treatment programs, and to assess the availability of interventions that are currently in place in the Portland area. Bariatric Surgery in Reedsport, OR Project Date: 10/17/2005 Obesity is a growing problem in the United States and the popularity of bariatric surgery continues to increase. This research project was designed to address many of the issues that are specific to offering bariatric surgery in a rural hospital. A literature review was conducted to determine how morbidity and mortality rates are affected by bariatric surgery performed in a rural setting. Possible reasons for these differences were discussed. Patient demographic factors associated with perioperative complications were identified in order to be able to screen for relatively low-risk patients. The most common complications were discussed, as well as projected rates for these complications. Finally, the plans for the new bariatric program at Lower Umpqua Hospital in Reedsport, Oregon were outlined and potential benefits and drawbacks of the program were discussed. Reach Out and Read: the first steps toward establishing a local program. Project Date: 10/17/2005 Discussions with Kindergarten teachers and reading coaches at several schools in Jefferson County, supported by the DIBELS* standardized literacy test scores for this year, revealed a high percentage of children who are at risk for not meeting benchmark goals in literacy without significant intervention. A growing body of evidence suggests that physicians can play a role in promoting literacy by adopting the strategies presented through a Reach Out and Read program (ROR). Providers give a brand new book to children between the ages of 6 months – 5 years at their well child exam, accompanied by age-appropriate advice to parents on how to effectively read aloud to their children. Retrospective and prospective studies report increased attitudes and frequency of reading to children, as well as higher scores on standardized literacy assessment tests when compared with children not exposed to ROR. The initial steps of establishing an ROR program in Madras were undertaken during this project: gathering local and demographic information to evaluate the need for this program, estimating an annual budget, and presenting the idea to Madras Medical Group, with the goal of attaining a group consensus to continue the steps toward completion of this project. Future steps include identifying and applying for long term funding, generating community support, outlining a plan for creating a “literacy-rich” environment in the office, and finally, submitting the online application to the national ROR center. *DIBELS: Dynamic Indicators of Basic Early Literacy Skills Patient Education Materials at the East Linn Community Clinic: Providing a Much Needed Resource. Project Date: 9/12/2005 The East Linn Community Clinic provides free medical care to uninsured citizens of Albany and Lebanon, Oregon and their surrounding communities. The clinic has struggled to obtain and provide educational handouts for the patients who utilize their services and they desired to improve this aspect of their care. Interviews with two individuals closely connected to the clinic were conducted to better understand their need and educational materials were loaded onto a laptop computer donated to the clinic. Materials were downloaded from well-known medical sites on the internet and a letter of request for a donation was sent to a prominent patient education software company. In addition, readability levels of patient handouts were compared. Emergency Contraception availability in Grant County: Assessing the attitudes and prescribing/dispensing practices of physicians and pharmacists Project Date: 9/12/2005 The 2005 Healthy Teens survey of 11th grade students in Grant County shows that 51% have had sexual intercourse. Of these sexually active teens, 57% rely on condoms as their main birth control, 12% use oral contraceptive pills, and 26% use no birth control method or withdrawal. Based on the results of this survey, emergency contraception (EC) could be very useful in preventing unintended pregnancies for this remote community. The purpose of this project was to survey family practice physicians as well as the pharmacists in Grant County about their attitudes towards EC and their current prescribing and dispensing practices. Recruitment of rural physicians: the challenges of a hospital and a private clinic in Klamath Falls, Oregon Project Date: 9/12/2005 A present and future healthcare concern facing the United States is the shortage of physicians practicing in rural areas. Doctors disproportionately prefer urban-suburban practices, and this makes the recruitment of rural physicians a challenging task. This report documents the hospital and clinic recruitment process of the rural town of Klamath Falls, Oregon. Data were gathered from interviews with the physicians involved in the recruitment process at the Klamath Falls hospital and private clinic, and from published journal articles. The strategies for recruiting included hiring a recruiting service and establishing a local residency program and expanding medical student clerkship programs. The recruitment incentives the hospital and clinic offer to candidates include higher salaries, assistance in setting up a practice, establishing a clientele and assistance with spousal employment. Besides attracting physician candidates with the beautiful environment, physicians are drawn to Klamath Falls because of the low cost of living, the broader scope of the medical practice, the casual lifestyle and the lack of traffic congestion. Nonetheless, the recruitment is low due to the complaints of increased on-call hours, low reimbursement and no educational loan support. I recommend two broad strategies for increasing physician recruitment. First, Klamath Falls should emphasize its stunning natural surroundings. More importantly, Klamath Falls should increase its efforts to reach out to rural training programs nationwide. Stickers Don't Make You Smarter: Bringing Reach Out and Read to Coos Bay Project Date: 8/8/2005 A growing body of evidence supports early childhood exposure to reading as an effective catalyst for linguistic and cognitive development. The Reach Out and Read program, established in 1989 by a group of Boston University pediatricians, promotes early literacy and language development by bringing reading into the pediatric exam room. Participating pediatricians give each patient between the ages of 6 months and 5 years a brand new book at each well-child exam. Additionally, they are trained to appropriately counsel caregivers about the importance of reading aloud with their children. Several pediatricians in the Coos Bay/North Bend area expressed a specific interest in establishing a Reach Out and Read program in their medical offices. For this community project, several critical components of this process were addressed: application submission, generation of community support for the program, and solicitation of financial assistance. A number of service organizations, businesses, and existing grants were identified as promising resources for the program. A grant proposal was drafted and submitted on behalf of the program to the Coquille Indian Tribe Community Fund. Finally, the Reach Out and Read model was presented to representatives from several organizations, each of whom expressed enthusiastic support for the program. The Metabolic Syndrome in Coos Bay Project Date: 7/4/2005 The Metabolic Syndrome (MetS) is a constellation of risk factors identified as a primary focus of concern by the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). Patients with this syndrome have a significantly increased risk for developing diabetes mellitus and various manifestations of atherosclerotic disease. This study assesses the prevalence and impact of the Metabolic Syndrome among the Internal Medicine patients of the Bay Area Clinic in Coos Bay, Oregon. Eighty-eight consecutive patients seen in this clinic over a period of five weeks were evaluated according to the five criteria established by ATPIII. Thirty-five of these patients (39.7%) met the conditions for MetS by having three or more of the five risk factors. Using the population characteristics and specific risk factor profile revealed in this study, an intervention was designed to address the needs of MetS patients at the Bay Area Clinic. Screening for Osteoporosis: Is there consensus? Project Date: 4/25/2005 Osteoporosis is a significant factor in the health care needs of the aging population. Since one-half of all postmenopausal will suffer an osteoporosis-related fracture in their life time, it seems reasonable to screen women before they experience a fracture and begin treatment for those at the highest risk. This strategy seems very reasonable considering the effective treatments available to combat the bone loss. There are several modalities for screening women that are universally accepted, but they are not without cost to the health system. There are some published criteria for screening women age 65 or greater, and those less than 65 years with a history of fracture. However, women began to lose bone density at about 35 years old, so when is it acceptable to begin testing bone mineral density? There are several risk factor assessment tools for selective screening: the SCORE, ORAI, ABONE, NOF recommendations. A screening test needs to be highly sensitive to pick up those at highest risk, with the greatest specificity. The ORAI seems to meet these criteria. Some suggest the NOF recommendations as their preferred assessment tool, which seems very reasonable, but I feel the simplicity of the ORAI and the better operating characteristics make it preferable. Suicide in Harney County: Is it higher than metropolitan Portland? Project Date: 3/21/2005 Suicide is a significant medical issue in the rural United States. This study compared the suicide rate in rural Oregon with more urban areas of Oregon from 1998-2004. It also attempted to answer the question of why the rural suicide rate is higher than urban areas. The design was retrospective review of Oregon vital statistics grouped by counties. Counties were separated into groups according to population. Mean yearly suicide rates for each group were calculated as well as overall suicide rate per group during the time period from 1998-2004. Statistics for variables thought to be associated with suicide rate were also obtained and compared to the group suicide rate in an attempt to determine if any relationship exists. Calculated suicide rates were generally higher in Oregon's rural counties than in urban counties. There was also a difference between the most rural and most urban counties in each variable obtained, however there did not appear to be a trend when looking at all groups by increasing urbanization. Therefore, there does appear to be an increased suicide rate in rural Oregon counties which is consistent with other rural areas worldwide, however no definite risk factors were identified. Emergency Medical Services in Malheur County Project Date: 1/3/2005 During my rural health rotation in Ontario, Oregon, I completed a community project about the local EMS system. I gathered information by speaking with members of the EMS service including the Fire Chief of the Ontario Fire Dept., Paramedics working for Treasure Valley Paramedics, and the Medical Director of the EMS service. I also observed first hand how the system operates while riding along with the Treasure Valley Paramedics. I focused my study on how the EMS service is structured and what challenges it faces providing for the medical needs of citizens in a rural area. The main challenges that I identified are the need to cover a large, sparsely populated area, scarce resources including money, equipment, and trained personnel, and the fact that the system has a low capacity that can easily become overwhelmed. The Forty Assets: A Needs Assessment for Adolescent Well-Being in Burns Project Date: 8/9/2004 In response to a series of adolescent suicides in a single year, Burns developed the Positive Parenting Group to promote healthier adolescent development. They have modeled community interventions based on the Forty Assets program, as developed by the Search Institute. In this project, 124 students from Burns High School were surveyed to ascertain the extent to which adolescents in this community have developed positive assets. The strengths of adolescent development in Burns include family support, clear boundaries established by adults, high expectations by adults, and positive personal values. The community has fewer assets in the areas of adolescent empowerment, the constructive use of time by youth, and a sense of neighborhood support. This data can help community groups and future medical students develop interventions targeting teen involvement in service, community activities (social or religious), or school activities (including sports, arts, or other clubs). Service-related activities are encouraged to promote community interaction in a setting where resources are limited for the creation of new programs. Teaching A Coastal Community To Fish: Participating In A Community Health Improvement Partnership In Reedsport, Oregon Project Date: 2/10/2003 The rural Reedsport, Oregon healthcare community has recently begun participating in a Community Health Improvement Partnership (CHIP) through the OHSU office of Rural Health. This community project seeks to describe the organization of the CHIP program in rural Oregon, and follows the citizens of Reedsport through the process of analyzing a community survey process, and conducting a town meeting/brainstorming session to address local healthcare problems. The survey identified a healthcare system that lacks surgical and obstetrics providers, adequate drug and alcohol rehabilitation, and services for the elderly. The community meeting revealed that community wellness, hospital staffing (surgeon), affordable healthcare, inexpensive medications, and youth and senior services deserve more attention in the Reedsport health service area. Improvements in these areas will require continued work by the CHIP Council people and other community members to develop specific plans and ideas for using community funds to improve the health status of this rural town. Back to subject search page or search by preceptor site