RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Prevention of Osteoporosis Across the Lifespan Project Date: 10/13/2008 Osteoporosis is a major public health concern, affecting an estimated 10 million Americans and costing the American healthcare system close to $19 billion1. Though the diagnosis of osteoporosis typically does not come until after age 50, research has shown that prevention of the disease must begin far earlier than this. In an effort to promote prevention earlier in life, and thus hopefully decrease the prevalence of osteoporosis in generations to come, I preformed a review of the literature on evidence for preventive measures throughout the lifespan. These prevention guidelines were then incorporated into “smart phrases” in the electronic medical record, which could be entered into the patient instructions area with the ease of a couple key strokes. No longer would there be a need to have clinicians memorize the recommended calcium intake for a 3 year old or what type of activities are recommended to help build strong bones. Now the clinicians could simply enter the pre-written smart phrases into the patient instructions area and have the information easily at hand for both themselves and the patient. Not only will this help educate the patient on what they can do to prevent osteoporosis but it facilitates a discussion between the clinician and the patient about risk factors and what the patient can do now to prevent the disease. Thus far, the clinicians in the Scappoose medical clinic like the idea of these smart phrases. Many of them agreed that it was difficult to know what guidelines or evidence was out there concerning osteoporosis prevention early in life. They appreciate these smart phrases for putting that information at their fingertips. Future research that could stem from this project includes assessing how useful these smart phrases actually are, how often they are actually utilized by clinicians and if in fact they helped to decrease the incidence and prevalence of osteoporosis in future generations. Early Identification of Post-operative Needs of Hip Fracture Patients in Grants Pass, Oregon Project Date: 7/3/2006 Hip fractures are common and debilitating injuries that predominantly affect older people. They results in significant morbidity for those who suffer from them and place a considerable burden on the health care system. Three Rivers Community Hospital in Grants Pass, Oregon has initiated a comprehensive program directed at senior citizens in its service area that includes fall prevention, osteoporosis care and hip fracture treatment. An important part of treatment is meeting the post-operative needs of patients through timely and appropriate discharge planning. This student examined records of 91 patients treated at Three Rivers Hospital for hip fractures in 2005 to determine what factors at presentation predict length of hospital stay and whether patients are transferred to their homes or to skilled nursing facilities. Available charts were reviewed of the 93 hip fracture reductions performed at Three Rivers Hospital in 2005. Analyses demonstrated no relationship between the number of comorbidities listed for a patient and her length of stay in the hospital. 85% of patients required post-operative transfer to skilled nursing facilities. The mean age of those patients was 8 years older than the mean age of patients who were discharged to their homes. Also, patients bound for nursing facilities had an average of 2.2 greater comorbidities on admission than patiens who were sent home. Patients living at home with a spouse before injury were the most likely to be able to return home after surgery. Further investigation is needed to assess potential relationships between the types of fractures, types of procedures, and discharge plans. The ability to prepare for post-operative placement early in the course of treatment would facilitate the recovery process and provide for the optimally efficient utilization of hospital resources in Grants Pass. Osteoporosis: Fractures in an Aging Population Project Date: 2/13/2006 Osteoporosis is a skeletal disease characterized by loss of bone mass and strength, leading to the increased likelihood of fragility fractures. Osteoporosis primarily affects the elderly and fractures due to osteoporosis are a principle cause of morbidity and mortality. The goal of this project is to increase awareness of patients and providers on prevention, screening, and treatment of osteoporosis. This was accomplished by examining the current practices of screening for osteoporosis by area providers and identifying the incidence of fragility fractures at Reedsport. A literature review was done to educate providers about the latest in bisphosphonate therapy, and finally a brochure was made to empower patients with knowledge about osteoporosis. From September 2004 to January 2006, there were a total of 53 total fractures in patients 60 years and older treated at Lower Umpqua Hospital. Forty six of the fractures were from low-intensity traumas and only 15% of these patients were previously diagnosed with osteoporosis or osteopenia. It appears osteoporosis is currently under-diagnosed in Reedsport. This is mainly due to provider’s views of the high cost of treatment for their patient’s and ineffective treatment options. 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. Don't let Osteoporosis get you down: Fall prevention in Reedsport, Oregon Project Date: 4/25/2005 Osteoporosis is a disease that affects ten million Americans. Each year, one and a half million of them will sustain a fracture. The purpose of this project was to gather research about fall prevention in order to prevent fractures in people with osteoporosis. The Cochrane Database of Systematic Reviews was accessed to find the latest research concerning fall prevention. Of trials identified that were likely to be beneficial, six specific interventions were suggested. Of these interventions, those most applicable to the inhabitants of Reedsport were chosen for a patient education handout. Final recommendations included specific modifications of the home environment and behavior at home, evaluation and treatment by a physical therapist, and withdrawal of psychotropic medication. Awareness of Osteoporosis in an Elderly Population in Tillamook, Oregon Project Date: 12/30/2002 Osteoporosis represents an important public health problem. The prevalence of this disease and its complications are particularly high in the elderly population. This study attempted to evaluate the level of knowledge and awareness of osteoporosis in a rural community that has a large proportion of senior residents. The second objective was to compare differences in the knowledge level between men and women and identify their source of information. Participants, 18 men and 27 women with an average age of 75 years, were invited to complete a questionnaire. Ninety-three percent of subjects were aware of osteoporosis and 75% gave the correct definition. In contrary to the general thinking that men are not as well aware of osteoporosis as women are, there was no difference in the levels of knowledge between the two sexes. The sources of information used by the two groups were different. Men relied most on television whereas women obtain information from their doctors. The main risk factors for osteoporosis reported were low vitamin D and calcium intake and lack of exercise. These data showed a high level of awareness of osteoporosis in this elderly population in Tillamook. The adolescent years: A window of opportunity to influence lifelong bone health influence lifelong bone health Project Date: 12/30/2002 An estimated 25 million Americans suffer from osteoporosis and about 1.25 million skeletal fractures occur annually in the U.S. as a result of osteoporosis. Weight-bearing activity, avoidance of excessive use of alcohol and decreasing exposure to cigarette smoke are also important factors promoting bone health. Individuals living in northerly latitudes, who are dark-skinned, or who do not drink milk must be vigilant about getting adequate Vitamin D. The study’s results yield a somewhat mixed picture regarding bone health. Students’ calcium intake based on Calcium Score Survey indicates that the vast majority (>90%) are meeting at least the minimally recommended calcium requirements of 1300 mg and that only 12 % are meeting the National Institute’s of Health recommendation of 1500mg daily. However, the Bone Health Survey revealed that forty-five percent of students report not always getting their “4 a day” (approximately 1300 mg) requirement. The BHS also showed that half of students reported inadequate vitamin D levels. Students were two times more likely to report inadequacies in calcium and Vitamin D than in exercise and calorie consumption as factors adversely affecting bone health. Excessive use of alcohol use, on an intermittent or regular basis, and smoking were reported less frequently (10-20 percent of students). Moreover, according to the total scores on the BHS, 91 percent of students are no living adequately bone-healthy lifestyles to prevent future risk to their health. Quantification of risk is not possible because of the multi-factorial nature of osteoporosis and because the greater role of genetics in determining actual risk. Primary prevention of osteoporosis in adolescence is one of the very most potent ways to prevent this debilitating disease. Limiting intake of calcium in schools and milk-flavored vending machines have been successful endeavors in promoting calcium intake in several schools, including Sisters and Bend, and is also recommended for Madras High School. Furthermore, because of its northerly latitude and high number of dark-skinned, and presumably lactose-intolerant, students, a basic multivitamin is recommended to prevent osteoporosis secondary to a Vitamin-D deficiency. Osteoporosis Prevention: Educating Patient Educators Project Date: 5/6/2002 There is ample data available as to the epidemiology of osteoporosis, its relationship with patient morbidity and mortality. There is also evidence that as a Caucasian retirement community with a long, dark winter, the Florence community represents a population at particular risk of suffering from osteoporosis. Given the short period of time available to promote change in the community health practices, the most effective method is education of the health care providers. This community-based project sought to educate health care providers as to the practical aspects of osteoporosis risks, consequences and prevention. An educational talk about osteoporosis prevention was held for the Medical Assistant staff at Peace Harbor Health Clinic. The responsibilities of the MA staff include scheduling appointments, giving patient advice both in the clinic and over the telephone, eliciting a basic patient history, taking vital signs and promoting basic health with appropriate educational health interventions. Clearly, this is a population of health care providers with a great deal of patient contact who may benefit from further education in preventative health. To evaluate the effectiveness of the presentation in providing helpful information to the MA staff an educational survey and quiz was given before and again after the presentation. In addition, a short questionnaire as the educational value and effectiveness in encourage preventative measures was also given. Final evaluation revealed one hundred percent of the 18 persons who filled out their surveys showed improvement after the presentation. (Appendix C). The average survey improved by 2.4 correct answers out of 7 possible correct answers. The initial average of the survey was 55% with a final average after the presentation of 90%. This represents an improvement rate of 35%. The results of this community project indicate that the content of the talk was appropriate for this audience. The initial scores before the talk indicate that much of this material was new or unfamiliar to the staff. In addition, the scores consistently improved indicating the talk was appropriate and beneficial. Further, only one participant failed to indicate that this talk was helpful to further her understanding and increased the likelihood she would encourage patient preventative health in regards to osteoporosis. Audience participation was also high and, although not reflected in the numbers, is also a potential indicator of interest and the potential to instigate change. Back to subject search page or search by preceptor site