RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Chronic Pain Management Protocol: for utilization by primary care providers in Lebanon, OR Project Date: 10/12/2009 Chronic pain is a growing problem in healthcare today. It is unlike many other medical problems that primary care physicians are presented with throughout their clinic day. Chronic pain has many different components and is sometimes referred to as a “biopsychosocial” problem potentially including aspects like trauma, anatomical abnormalities, psychosocial influences and many others. Interdisciplinary approaches to managing pain have been proven to be effective at reducing pain and at decreasing narcotic dependence. Involving multiple modes of support addresses the complexity of people’s pain, and gives many different ways to make lifestyle modifications to help patients better understand how to manage their pain. In order to address the issue of a family medicine provider as a manager of chronic pain, I decided to help the Lebanon, OR family practice with implementing a protocol for evaluation of chronic pain. My goals included increasing access of protocol forms by facilitating incorporation of them into the electronic medical record. I also put together a patient handout that included simple ideas for an interdisciplinary approach to chronic pain management as well as more specific local resources. 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. Exploring the Potential of Art Therapy as Complementary Medicine in the Treatment of Chronic Pain Project Date: 6/30/2008 Chronic pain is a complex health problem and a source of frustration for both doctors and patients. In treating only the physical component of chronic pain, allopathic medicine fails to adequately address the psychosocial, emotional and spiritual components. The purpose of this project was to explore the potential of one modality, art therapy, as complementary medicine in the treatment of chronic pain. While art therapy has been applied in the psychiatric and oncology settings for many years, little research has been conducted on the potential benefits of art therapy as complementary medicine in the treatment of chronic pain. My project included extensive on-line research of websites devoted to art therapy, search of journal articles in Medline, search and identification of art therapy resources in the Lebanon area, sharing my own experiences using art as therapy, and reading The Art Therapy Sourcebook. I proposed further avenues for research on the efficacy of art therapy in treating chronic pain and explained why this could be a valuable form of complementary medicine in a rural setting. Finally, I sought to leave a tangible source of inspiration for patients at the clinic by designing and completing a large painting. Chronic pain is a complex health problem and a source of frustration for both doctors and patients. In treating only the physical component of chronic pain, allopathic medicine fails to adequately address the psychosocial, emotional and spiritual components. The purpose of this project was to explore the potential of one modality, art therapy, as complementary medicine in the treatment of chronic pain. While art therapy has been applied in the psychiatric and oncology settings for many years, little research has been conducted on the potential benefits of art therapy as complementary medicine in the treatment of chronic pain. My project included extensive on-line research of websites devoted to art therapy, search of journal articles in Medline, search and identification of art therapy resources in the Lebanon area, sharing my own experiences using art as therapy, and reading The Art Therapy Sourcebook. I proposed further avenues for research on the efficacy of art therapy in treating chronic pain and explained why this could be a valuable form of complementary medicine in a rural setting. Finally, I sought to leave a tangible source of inspiration for patients at the clinic by designing and completing a large painting. 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. Herbs and Natural Remedies in John Day, Oregon: A Historical Perspective Project Date: 4/28/2008 The Oregon Department of Parks and Recreation have discovered over 400 herbal and natural medicines at the Kam Wah Chung & Co. museum in John Day, Oregon. It has not previously been identified which of these herbs, if any, are used in modern medical practice, a question frequently asked by museum visitors. Therefore this study aims to answer the following two questions in the form of an educational brochure: 1) Of the remedies that Ing “Doc” Hay and his assistant Lung On used, which are some of the ones still in common use by alternative and western medical providers today? 2) What evidence exists for such use? The design involved interviewing persons directly involved in the museum’s herbal discovery work, researching the historical timeline of traditional Chinese medicine and checking out a scientific catalog of herbs identified at Kam Wah Chung & Co., researching modern-day usage of herbal supplements, and performing an evidence-based review of those in common use. Furthermore, this information was compiled into a visitor-friendly guidebook brochure to be used by the museum staff and handed out to visitors of the museum and interpretive center. In the nearby future, the museum plans to create a hands-on herbal exhibit for which they would offer this brochure to visitors. Finally, Dr. Holland’s clinic office will house copies for patients interested in learning more about the historical and present uses of herbs and the evidence base for such use. As an additional point, the brochure educates the public about the side effects and potential drug-herb interactions of a few traditional remedies. Patient and Provider views on vitamin and mineral supplement use in Roseburg, Oregon Project Date: 2/11/2008 Background: Dietary supplements in the form of multivitamins, single nutrients, and other supplements are consumed by half of Americans and continue to increase in use. However, they are also poorly regulated, which creates a challenge among providers and researchers to establish clinical guidelines for use. Safety and effectiveness are among the greatest challenges given the variable doses available and potential interaction with other supplements and medications. This study aims to characterize use (type, amount, rationale, barriers to use) of dietary supplements, with focus on vitamins and minerals, from both patients and physicians. Methods: This is a descriptive, cross-sectional qualitative and quantitative analysis of patient and provider use and views on dietary supplements. Questionnaires were distributed and analyzed for patients and providers at Evergreen Family Medicine in Roseburg, Oregon and family medicine providers at OHSU. Results: 54% of participants reported regular use of dietary supplements. Of participants reporting use, 73% used multivitamins/minerals, 73% used single nutrients, and 44% used other supplements. Participants who consumed supplements were older, more educated, less physically active, and more likely to have a chronic disease compared to those who did not consume supplements. Provider recommendation was the top reason participants began using supplements. Regardless of current supplement use, 67% of all participants wished to have regular discussions about supplements with their providers. There was a limited response among providers (n=20), but among those 80% regularly recommend supplements (80% single nutrients, 50% multivitamins/minerals), and 71% of doses were within the Recommended Dietary Allowance. Conclusions: Dietary supplements are a relatively simple and inexpensive intervention with potential to replete nutrient deficient diets, treat, or even prevent diseases. These must be tempered with effective and safe use. Physicians have a great influence on patients both in their decision to begin taking supplements or not to use supplements. "Music Therapy: what it is, what it does, and how it is used in Lebanon, OR" Project Date: 9/11/2006 “Music Therapy” is a term that has been used to define many different forms of alternative medicine practices, the most popular and studied of these being the use of live music by a Certified Music Practitioner (CMP) to ease pain, stress, depression, and anxiety. By the very nature of their health status, many patients who are chronically ill or near-to-death undergo significant stress and anxiety. This reduces their quality of life at a time when quality of life is essentially the only area left to make improvements in. While traditional medications are frequently used to make patients more comfortable, many patients and families desire a more “natural” or “spiritual” option. Music therapy can satisfy that desire. While the statistical evidence for music therapy’s efficacy is limited (like most alternative medical disciplines), the anecdotal and subjective responses to the sessions are very positive. In surveying the use of music therapy in the Lebanon/Albany/ Sweet Home area, I found that while all hospice patients in the area are offered music therapy sessions, less than 25% take advantage of the option. Of those that do, the therapy is met with an overwhelmingly positive response, with noticeable (though subjective) improvement in over half of the patients. Use of Herbal Remedies in Florence, Oregon: Helpful or Harmful? A Patient Handout to aid in discussion of natural supplements. Project Date: 5/1/2006 Over the past twenty years there has been a resurgence in public interest and use of complementary and alternative medicine. Although natural, herbal supplements are pharmacologically active and have the potential to both help and harm the patient. While in Florence I attempted to identify those who are using natural supplements and determine if they had discussed their use with their physician as well their reasons for using the supplement. The design was a chart review of all patients seen by one physician during the month of May to determine who had natural supplements on their medication list and to determine what herbal remedies are used most commonly. Informally, patients that were taking herbal medications were then asked if they were aware of any potential interactions or side effects of the medications and if they felt the medication was effective in treating the condition they expected. Many voiced concerns over not knowing the purity and potency of the herbal supplements they were taking or what recent research shows about the efficacy of the supplement. The purpose of the study was to gather information and design a patient handout that would be targeted appropriately to the patient population at the outpatient clinic to encourage open discussion of natural supplements between a physician and patient, as well as provide a brief synopsis of the most commonly used herbs and recommendations on further reading. Complementary and Alternative Medicine in Astoria, Oregon: Examination of community needs and practices, with creation of a patient handout to aid in discussion and decision-making. Project Date: 8/8/2005 This project examined the frequent use of complementary and alternative medicine among patients at the Pacific Family Medicine clinic in Astoria, Oregon. The availability and knowledge of information for physicians and patients on alternative medicine was assessed and found to be in need of improvement. A set of pamphlets was created that provided advice on decision making regarding alternative medicine, listed useful resources, and provided some specific information on selected alternative therapies, medicines, and supplements. These handouts were distributed to the providers at the clinic for use as patient handouts, references, and discussion aids. Use of Alternative/Herbal Medicines Among Family Practice Patients in Rural Eastern Oregon Project Date: 3/21/2005 The popularity of complementary and alternative medicine (CAM) among the general public is irrefutable.1 It is also increasing.2 Importantly, the greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine.3 In parallel with this rise there is increasing evidence citing reactions and side effects of alternative/herbal medicine use as well as possible interactions with conventional medicine.4,5 A study in 2002 looked at CAM use among primary care patients in a rural setting in northern Pennsylvania.6 However, there is no previous study that has looked at its use, and specifically alternative/herbal medicine use, in rural eastern Oregon. This study has two (2) aims: 1) to determine the frequency and types of alternative/herbal medicines being used by patients in Grant County, Oregon; and 2) to determine the rate of physician notification of alternative/herbal medicine use and reasons for not disclosing its use. Methods: A questionnaire was distributed to 235 adult patients in two family practice clinics in John Day, Oregon. Results: Response rate was 99.6% (235/236). Fifty-five percent (55%) of patients reported using at least one form of alternative/herbal medicines in the past 12 months. The most common alternative/herbal medicines used were green tea (16%), megavitamin (13.9%), glucosamine (11.5%), Echinacea (11.5%), fish oil (6.9%), soy products (6.6%), and ginseng (3.9%). The number one reason to use alternative/herbal medicine was for health maintenance (22.6%). The majority (52%) of patients self-prescribe alternative/herbal medicines. Only 46.5% of patients told their physician about their use of alternative/herbal medicine. Conclusion: A significant number of rural family practice patients are using alternative/herbal medicines. A public educational campaign, with inclusion of the need to report such usage to the family physician, should be implemented, and questions on the use of alternative/herbal medicines should (continue to) be incorporated as an integral part of the history taking by primary care physicians. Nonpharmacological resources for the treatment of fibromyalgia in Florence, Oregon Project Date: 10/18/2004 It is estimated that 3-5% of the population has fibromyalgia. The chronic pain of this condition has been a burden for patients and clinicians as pharmacological therapies are frequently insufficient. This project seeks to identify nonpharmacological treatments supported by the literature and present in Florence, OR. Furthermore, patients’ current use of these methods was investigated. Finally, a list of resources was supplied to clinicians for use in their practice in order to improve symptoms for the fibromyalgia community of Florence, OR. Japanese Healing Gardens Project Date: 8/9/2004 The negative effects of stress and anxiety have been well documented in past research and effect psychological, physiological, and behavioral health. Many find hospitals to be complex, confusing, and anxiety-inducing environments, imparting a sterile, institutional vibe to patients and staff. This observation has led architects, psychiatrists, neuroscientists, and health care workers to collaborate on a movement behind “evidence based design.” They promote their research findings that show that environment does effect health, and changes in hospital design can be followed by improved patient outcomes and increased staff satisfaction. As stress and anxiety levels fall, patients and staff feel and do better. A leading investigator in the field, Roger Ulrich, found that positive distractions, such as nature, are especially helpful. He found that patients recovering from surgery with a window view of nature have shorter recovery times, request decreased dose and strength of pain medication, and have fewer post-op complications. Incorporating nature into hospital design has also been shown to improve staff satisfaction and staff turnover, attract more patients, and increase charitable donations. Lebanon Community Hospital is currently in the midst of construction of a Japanese Healing Garden. Many patients and staff are uncertain as to the purpose and usefulness of such an undertaking at a time when resources are in short supply. Thus, I decided to focus my community –oriented primary care project on investigating the topic of healing gardens, including the evidence behind constructing healing gardens in healthcare settings and measurable patient outcomes. Japanese gardens are specifically addressed, and the symbolism involved, in order to more fully explain the components of the LCH garden. Lastly, a few suggestions are made to avoid problems encountered by other facilities, as well as an effort to generate ideas for a research project to monitor the effect of the healing garden on patient and staff. Warm Springs Use of Native Healers Project Date: 8/9/2004 Even though the Indian Health Service at Warm Springs provides extensive care for the Native population through its Clinic, no information is known as to the extent of Native Healer presence on the Reservation. Native Healers are otherwise known as Medicine Men, or Women. Thus this study was conducted with the goals of assessing the presence of native medical practices within the population at the IHS clinic. There have been one study done on this topic, but there a couple of case reports and focused articles in the literature available. The one published study is by C. Kim and Y.S. Kwok looking at the Navajo population in the early 90s. They have concluded that 62% of Navajo Native Americans have used native healers in their lifetime, and that 39% have used one the past year. They found that the concerns that were brought to native healers were mostly arthritis, pain, depression and anxiety and chest pain. Majority of the study focused on epidemiology of native healer use in the realm of socioeconomic status within the reservation. Very few differences were found between the users and non-users. Investigate the Use of Unconventional Therapy in Scappoose and Portland Project Date: 7/5/2004 Unconventional therapy has become popular in the United States. However, the role of cultural beliefs and population size in unconventional medicine use is not known. This study examines the prevalence of and the reasons that underlie unconventional medicine use in two culturally distinct populations in Oregon: the predominately Caucasian population of Scappoose and the Chinese American community of Portland. A survey was designed and was conducted at the Scappoose and Portland health service centers. Among the 14 Caucasian subjects interviewed in Scappoose, 57% reported using unconventional medicine at least once in their life. All of the 16 Chinese American subjects interviewed in Portland have used unconventional medicine. Whether in Scappoose or Portland, the respondents who had tried unconventional medicine used it for chronic medical conditions such as pain and allergies and consulted medical doctors for serious medical conditions including hypertension and renal failure. Furthermore, only 25% of the Portland respondents who used unconventional therapy informed their medical doctors compared to 75% in Scappoose. These results show that over half of the subjects in Scappoose and Portland have used unconventional medicine. However, the subjects in Scappoose are more likely to communicate their use to their medical doctors than do the subjects in Portland. This pattern of use elucidates the phenomenal prevalence of unconventional therapy and suggests that medical doctors should specifically inquire about the use of unconventional therapy when treating patients with different cultural beliefs. Dispelling the Myth about Acupuncture in Florence Oregon: A Patient Education Project Project Date: 11/4/2002 In primary care, there are many medical conditions and nonspecific complaints for which patients present, but don’t find appropriate relief. For example, musculoskeletal pain is a complaint seen daily at the primary care clinic in Florence, Oregon. Many of these patients present multiple times, finding no respite with many different treatment modalities. Either the treatment options simply don’t work for them or the side effects are debilitating (i.e. drowsiness with muscle relaxants and narcotics). Further, many patients are looking for a non-invasive alternative to elective surgery (i.e. carpal tunnel). This project aims to increase knowledge about a lesser known treatment option—acupuncture—that could bring considerable benefit to these patients. The need for this was recognized after seeing dozens of patients who were not finding relief with traditional methods. Further, physicians who did mention acupuncture as a treatment option, were often met with unfamiliarity from their patients and time constraints prevented further education. Aside from these clinic observations, consult with local acupuncturists and clinical acupuncture observation was also done to help with the project. The result of the project is the creation of a patient education pamphlet about acupuncture. This pamphlet will increase awareness about acupuncture in general, its effectiveness for certain medical problems, and its availability in the community. The ultimate goal is to find relief for patients whose needs aren’t being met with traditional approaches. Alternative Healthcare in Florence, Oregon Project Date: 9/23/2002 Florence is a retirement community of about 7300 people, with many low income residents. There are a surprising number of alternative healthcare options in such a small and not wealthy town. This study sought to uncover the reasons behind the use of alternative healthcare in this population. Primary care providers at the only hospital in town were questioned about their practices surrounding alternative healthcare and their patients. Four commonly recommended herbs were glucosamine sulfate for joint pain/arthritis, red yeast rice for hyperlipidemia, saw palmetto for BPH and St. John's wort for depression. Their motive behind recommending these aligned with patients reasons for using them. The majority use supplements because they are significantly cheaper than prescription medications without precription coverage from insurance. Some use the supplements because their primary care provider suggested them, others to match their philosophy of life and healthcare. Several patients with chronic pain issues use alternative healthcare providers such as the acupuncturist, acupressurist or naturopath for treatment of a condition for which there are not good answers. These alternatives are important to the people of Florence as another option, be it to compensate for lack of insurance coverage or to match with their belief system. More research and information is needed, desired and on its way due to funding from NIH of several well designed trials. Herbal and Complementary Medicine Use in a Native American Community Project Date: 9/23/2002 BACKGROUND: Although the use of complementary medicine is known to be extensive in the general American population, the role of alternative treatment in this Native American community has not been described. OBJECTIVE: To determine the prevalence of use of complementary medicine, reason for use, how the patient first learned of the complementary treatments, sources of reliable information on alternative therapies used by the patient, and whether or not they had previously been asked about unconventional treatment by clinic personnel. METHOD: Cross-sectional interview of 21 patients seen in an Indian Health Service ambulatory care clinic. Herbal and alternative treatments were compared to prescription medications obtained by chart review to identify any interactions. RESULTS: Fifty-seven percent of individuals interviewed had used herbal medications or alternative treatment modalities at least once in their lifetime. Patients were likely to continue using herbal and alternative treatments if their initial treatment was felt to be effective, even if later treatments proved to be ineffectual. Herbal and complementary medicine ws used most often for health promotion, family and tribal tradition, and religious practice, as well as chronic conditions such as low back pain, migraine headaches, diabetes mellitus, and depression. Family and tribal traditions was found to be the most common source for first-time patient exposure to herbal and alternative therapies, followed by internet, friends, media advertising, and employers. Nearly half (48%) of all patients would look first to their family physician for reliable information on herbal and complementary treatments. While over half of clinic patients interviewed reported using herbal or alternative treatments sometime in their lifetime, only 5% had ever previously been asked about herbal and complementary medicine use by personnel in the clinic. CONCLUSION: Use of unconventional treatments is common among patients in this Native American community. Patients demonstrate a willingness to discuss use of herbal and complementary therapy and have an expectation that their medical providers will be knowledgeable about these treatment options. Unconventional treatment use is not related to patient dissatisfaction with conventional medicine and patients perceive no conflict between these different health system beliefs. A Glimpse into Curanderismo in Nyssa, Oregon Project Date: 3/25/2002 Few studies have been done to explore the extent to which these factors actually play in determining the trends of Hispanic patients toward utilizing health care. This project attempts to obtain a glimpse of what role folk medicine plays in the health access of the Hispanic population in Nyssa, Oregon. Specifically, the project attempts to determine the services provided by the town curandera, obtain a sense of utilization and perception within the community, and initiate a bridging of the gap between allopathic providers and traditional Mexican healers. In light of the above mentioned statistics regarding Hispanics in the United States and the increased Hispanic population in Nyssa, knowledge of the community's cultural beliefs and traditions can serve to improve patient care by attempting to understand the community members' perceptions of illness and health care. Herbal Remedies and Supplements: Education for Physicians and Parents at Klamath Pediatric Clinic Project Date: 2/11/2002 This project was designed to provide education to the patients and parents of the Klamath Pediatric Clinic regarding herbal remedy use and safety in children. To better understand the needs of the community an informal survey was performed to determine baseline alternative and complimentary medicine use and knowledge among the patients at the clinic. Of those surveyed, 32.9% of parents believed they were adequately informed about available over-the-counter herbs and supplements, while 67.1% felt they were not well informed. 54.8% believe the products are safe, while 24.7% think they are unsafe and 20.4% are unsure. 83.7% of parents could not remember their physician ever inquiring about herbal remedies. 3.8% of parents responded that their children had used either Chamomile or Echinacea. A literature search reviewing recent and historical information about herbal and supplemental remedies was also completed. Using this information and the data from the survey as a guide, patient information handouts about safety and efficacy and were designed and implemented as part of patient education at the clinic. 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