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. Swine Flu Epidemic: What are patient and health care workers attitudes and knowledge of the H1N1 influenza and vaccine in Florence Oregon? Project Date: 10/12/2009 The H1N1 flu is an epidemic that has already reached 48 states, and has killed 672 people, and hospitalized over 17,000 (1). Patients are asking about the H1N1 flu and vaccine on a daily basis and many are very concerned. Health care workers are also frequently discussing these issues. Two surveys were developed to question the opinions and knowledge base of both patients and health care workers regarding the H1N1 flu and vaccines. There appears to be some lack of knowledge about the H1N1 vaccine and flu. People of all ages are concerned about the flu, and age doesn’t determine who thinks they do or do not need a vaccine. The majority of people are receiving information from the television about H1N1, and very little from their doctor’s office. There is a need for greater patient education about the vaccine and the flu. In regards to health care workers that were surveyed, doctors are well vaccinated, and MA’s are not. Many patients (on average 50% or more) are asking about the vaccine and flu. Most workers are providing very minimal information to patients regarding the vaccine and flu. Workers are being approached by family members and the community about the vaccine and flu. Only 13% of workers feel they are confident of their knowledge of the vaccine and flu. In conclusion, patients and health care workers are in need of education about the H1N1 flu and vaccine. Preparation and prevention are key concepts for health care workers and patients to understand (2). Fibromyalgia—More than a Pain in the Neck? Dealing with the Diagnosis at the Klamath Family Practice Clinic Project Date: 10/12/2009 Fibromyalgia is a challenging condition affecting 3-5% of the world’s population, and is characterized by a classic triad of chronic diffuse pain, fatigue, and sleep disturbances. Many providers feel somewhat uncomfortable with fibromyalgia, and primary care physicians, especially those in rural areas, are often those who deal most frequently with the diagnosis. It is important that such providers have increasing familiarity with the condition. This community project, therefore, attempted to determine how comfortable providers at the Klamath Family Practice were with the diagnosis of fibromyalgia and to provide them with educational materials regarding the condition. A survey and educational materials were given to the medical providers to achieve this aim. While most of the providers felt familiar with the etiology and treatment options for the disease, some retained discomfort with the management of the disorder. All had suggestions to improve clinical interactions with fibromyalgia patients, relating primarily to increasing patient education regarding the patient role in treatment. The providers found the supplied educational materials informative and comprehensive, and retained them for additional reference. Public Perceptions Regarding Adult Obesity and Treatment Options in Gold Beach, OR Project Date: 9/7/2009 Obesity is a nationwide problem associated with many well-known effects on physical and emotional health. Gold Beach is a small, coastal community in the southern portion of Curry County, OR. It is not currently known what options exist regarding obesity in this rural area, and what local public perceptions are regarding both the problem of obesity and the treatment options available. This qualitative project was designed to explore regional views on obesity and therapies available both from patients and physicians in the area. These were conducted via personal interviews with many members of the community. In addition, a literature search was performed to explore evidence-based data available on other treatment options that have been explored. Results showed many areas of frustration with diet and exercise, as well as success with mainly surgical therapies. Interestingly, many behavioral and group therapies had not been tried in this smaller community. Based on the perceptions gathered from patients in Gold Beach, failures and successes reported, and the literature search performed, recommendations to help physicians and patients achieve weight loss outside of medical and surgical management were created. Early Formation of Lifelong Health Habits in Baker City, Oregon: a Brief Assessment and Educational Tool Project Date: 9/7/2009 The adult population seen at the Baker Clinic has been noted to have a number of health problems associated with lifelong negative health habits, including tobacco use, alcohol abuse, and poor nutrition/obesity. Even when faced with serious health consequences of these negative habits, many patients find it extremely difficult to make these life changes as adults. The school-based clinic staffed by the Baker Clinic was noted to be an ideal venue to approach high school students at a time when lifelong habits are still being formed, in order to encourage healthy habit formation which might lead to improved lifelong health. A brief 6-question questionnaire was distributed among students at the clinic in order to obtain a rough estimate of knowledge in the areas of nutrition, exercise, tobacco and alcohol abuse. A one page educational tool was subsequently created for distribution to this same population, focusing on areas of weakest knowledge/poorest habit formation, namely poor calcium intake and excessive soda consumption. 2009 H1N1 Influenza – The Response of Klamath Falls, OR to “Swine Flu” Project Date: 9/7/2009 The 2009 H1N1 flu virus spread rapidly throughout the world and created significant concern bordering on panic wherever it went. Klamath Falls, an area with around 50,000 individuals (15,000 of them minors) in southern Oregon, was no exception. The aim of this project was to explore the effect of, and response to, the “swine flu” in the community. To this end I drew off experiences working at the Klamath Pediatric Clinic, developed an educational handout to give to patients and their families, and interviewed public health and school district officials. I was also able to participate in the local hospital’s infection control meetings as they developed their policies regarding 2009 H1N1 and sit in on lectures and webcasts from the AMA/CDC and OHSU Grand Rounds. Medical Marijuana in a Small Town: A Growing Issue Project Date: 9/7/2009 Several states have laws approving the use of marijuana for medical reasons. This requires a special permit and a Doctor’s approval. However, while state government may allow the use of medical marijuana the Federal government still considers it illegal whether for medical use or not. Therefore doctors are wary of discussing or prescribing medical marijuana. Not only do the rules between state and federal government differ, the actual long-term health affects of marijuana is not well understood. For every study that quotes a therapeutic use another shows that long-term use can cause harm. Other studies suggest that marijuana interacts with other medications making it difficult for physicians to know whether the risks of using marijuana outweigh the benefits. Despite these concerns, medical marijuana is being requested by patients more often. This may be more common in certain populations or areas of the state. So not only are the uses of medical marijuana not well understood, the actual number of patients requesting or using medical marijuana is rapidly growing. In my project I will attempt to gain a better understanding of the patients who ask for or use medical marijuana by looking at certain variables such as the reason for requesting medical marijuana, the age, gender and other medications used. An attempt will also be made to estimate the total number of patients with medical marijuana cards in a small southern Oregon rural practice. I also hope to gain more information from clinics that specifically work with patients desiring medical marijuana cards. All this information will be gathered to gain a better, broader understanding of medical marijuana and those who ask for it. Medical Marijuana for Chronic Pain Management at a Mixed Rural/Urban Adult Primary Care Practice: Project Date: 9/7/2009 Following passage of the Oregon Medical Marijuana Act in 1998, medical marijuana has been available to Oregonians with severe pain with the endorsement of their physicians. However, this is a controversial subject involving debates of medical marijuana’s legality and effectiveness for treating chronic pain. While scientific evidence supporting an analgesic benefit of medical marijuana has started to materialize, legal conflict between federal and state statues remains. Complicating this is the unique nature of medical marijuana. It is patient-directed therapy that has standard preparation and consequently, diminished ability to determine dose received. These factors have made it hard for physicians to equate treatment with benefit. While working with Dr. John Allcott at Applegate Medical Associates, a primary care clinic with offices in Veneta and Eugene, OR, a 3 component strategy was derived to monitor the effectiveness of therapy for medical marijuana patients. The components are: 1) determining the level of patient disability through evaluation of patient ability to achieve patient-directed goals addressing social, emotional and physical parameters. 2) Educating patients about possible benefits of medical marijuana, potential adverse reactions, and risks of use. 3) Reviewing patient progress with data obtained from standardized instruments (the PHQ-9 depression screening questionnaire for example) and patient ability to achieve individual goals. The final result was a proposed set of questions to be entered into the EMR and utilized by the clinic staff for medical marijuana patients. Advance Care Planning Project Date: 8/3/2009 Gold Beach has a large percentage of elderly population. The largest age group is 45-64 at 33.5%, above the 27.1% of the Oregon average. The group of 75-84 year-old is at 9.1%, double the Oregon average. Heart disease, cancer and chronic lower respiratory disease are listed as the top three causes of death in Gold Beach from 2001-2005. Advance care planning seems to be more pressing in a small town with a higher elderly population. POLST and Advance Directives are available to facilitate the discussion of advance care planning. After witnessing two patients pass away in the ER with a POLST and DNR during my first week, I want to explore how the hospital and the providers in a small town manage advance care planning. How is Curry General Hospital incorporating POLST and Advance Directives into the care of their patients? The project involves chart review of recently hospitalized patients in 2009 to obtain a baseline of the number of people with and without such forms. Interviews were then conducted with the nursing, medical, and administrative staff to understand how the hospital manages these difficult issues. Recommendations were made based on the chart reviews and discussion with the staff. Exploring the decrease in the percentage of women receiving pap tests at the Warm Springs Health and Wellness Center--reasons why and strategies for improvement Project Date: 8/3/2009 According to the Government Performance Results Act (GPRA) report, the percentage of women age 21-64 receiving pap smears at the Warm Springs clinic has steadily decreased from 74.1% at baseline in 2000 to 58.3% in the past year. The current goal for the clinic is 90%, and the goal of this project is to determine what has contributed to the decrease in pap test rates and what can be done to increase the percentage of women receiving these exams. First a survey was distributed to the health care providers at the clinic to explore reasons for the decrease in pap tests and to gauge community awareness. Based on the responses given, an educational pamphlet was put together for patients including information about pap tests, HPV, and how to prevent cervical cancer. Diabetic foot ulcers Project Date: 8/3/2009 The idea behind this project was to create a informative patient friendly handout with regard to diabetic foot ulcers. Diabetic foot ulcers are a common potential long term complication of diabetes. In the Mid Valley Medical Plaza about 2% of diabetic patients have this particular diagnosis. However currently there isn't a easy to understand, accessible resource to teach patients about diabetic ulcers. The goal of my project was to create a handout that would fulfill these requirements. A handout was created that was composed of 3 sections: what diabetic foot ulcers are and how they form, how to prevent ulcers and how to manage ulcers. Thinking about Health Care in the USA: A Health Care Primer Project Date: 8/3/2009 Health care reform has been one of the big political and social topics of 2009. With a president committed to reform and an equally committed opposition the tenor of the debate has been flooded with misinformation and intentional misunderstanding. The physicians at Dunes Family Health Care felt that their voices needed to be heard on the subject and that it was in part their responsibility to educate their patients. To do this they wanted to develop a tool that they could use to talk to their patients about the basic traits of the US health care system and the key elements of proposed reforms. Patient literacy levels and sophistication are limiting factors in this discussion. A health care primer was developed in a tri-fold color pamphlet form in order to help the physicians with their discussion. A significant effort was made to simplify the presentation of this complex issue. But, ultimately the level of discussion in the finished pamphlet requires an amount of education or literacy that makes it inaccessible still to many of their patients. This seems unavoidable to a certain extent because the health care system is at some point irreducibly complex and can only be simplified so far before the discussion becomes dishonest or meaningless. H1N1 Influenza: Patient Education and Preparation in Jefferson County Project Date: 8/3/2009 With the most current novel influenza virus pandemic sweeping our planet, no locale however small seems immune. Although Jefferson County has yet to confirm a case of H1N1 this year, its residents are still worried and questioning what this coming flu season will bring. After attending the H1N1 Influenza Preparedness Summit in Salem as well as meeting with local representatives from the health department and surrounding clinics, I have learned that patient education with a consistent message will be the key to preventing a widespread outbreak in this community as well as abating much of the fear surrounding this pandemic. My goal in this project was to create materials for the Madras Medical Group (MMG) clinic to use this coming season to educate its specific patient population about H1N1 in order to encourage early preventative measures and limit spread among the community. Through a presentation to the MMG on the current H1N1 status in our state, my goal was also to provide clear and accurate information on treatment and prevention to the medical staff so that they might pass this information along to their patients, families and friends. Vitamin D Explained: Question and Answer Handouts Project Date: 8/3/2009 Vitamin D deficiency or insufficiency is estimated to be a common condition in the U.S. population. Long-term bone health is the most common context for vitamin D deficiency discussions, but there is a growing body of literature associating vitamin D deficiency or insufficiency with other health issues including cardiovascular disease, fall prevention, cancer, multiple sclerosis, depression, diabetes, hypertension, all cause mortality, and health costs. The prevalence of vitamin D inadequacy, and the associated health concerns, in combination with my own experiences, has led me to conclude that public knowledge regarding vitamin D could be improved. In an effort to help patients educate themselves, as well as solidify my own understanding for use in patient encounters, I developed two vitamin D question and answer handouts for use by patients and/or providers; one in brief and one with more detail including references for people wanting additional information. These handouts include a basic overview of vitamin D function, health considerations, deficiency/insufficiency risk factors, deficiency/insufficiency prevalence, dietary sources, and intake recommendations. Health Literacy and Patient Knowledge of their Chronic Illness in a Rural Population with Hypertension Project Date: 8/3/2009 Health literacy refers to the ability of an individual to obtain, process, and understand health information needed to make informed decisions about managing their health. Limited health literacy is common in the United States and is important because it is related to health knowledge, health behaviors, and health outcomes. In this project, the health literacy of a population of primary care patients with hypertension in Grants Pass, OR was assessed and then patients completed a questionnaire asking basic questions about the risks and management of this disease. The goal was to assess the level of patient knowledge regarding their chronic illness and to see if that correlated with health literacy status. Patients were found to have a good overall understanding of blood pressure goals, risks of untreated hypertension, and strategies to reduce blood pressure. Patients were least likely to understand dietary strategies to reduce blood pressure and only about one-third could correctly list all blood pressure medications they were currently using. Patient education materials regarding dietary management of hypertension were obtained for use in the clinic and several strategies for maximizing patient education were presented to the staff of the clinic. Because of homogeneity in health literacy status in the study population, associations between health literacy and patient knowledge was not possible. Ontario Greenhouse Project: Phase 5 Project Date: 6/29/2009 Obesity is a nationwide epidemic, and primary prevention is aimed at combating childhood obesity. Malheur County in Oregon has some of the highest risk children in the state. The Ontario greenhouse project has been in the planning process for the past year with Dr. Sandra Dunbrasky, the community pediatrician, and rotating medical students from Oregon Health Science University. The project’s goals are to implement a greenhouse at a local elementary school in order to get students involved in hands-on learning about raising, harvesting, and consuming the CDC recommended daily amount of fruits and vegetables in the hopes that obesity will be successfully prevented. The current phase of the project centers on securing funds to get the program implemented by fall of 2010. Grant proposals were submitted to various national agencies due to the shortage of local donor support in the rural setting. Utilization of the POLST Form in Long Term Care Facilities in John Day, Oregon Project Date: 6/29/2009 The POLST (Physician Orders for Life-Sustaining Treatment) has helped translate patient wishes into tangible and specific Physician’s orders and helps to ensure that patient wishes during the dying process will be honored across various care settings. The use of the POLST form has increased dramatically since it was first developed at OHSU in 1991. Data from study done in 2004 showed that approximately 96% of Nursing Homes in Oregon used the POLST for around 50% of their residents. Furthermore, another study in Oregon indicated that rural areas are more reluctant to use the POLST forms and usage was less in these areas. My goal was to study the utilization of the POLST form in all of the long term care facilities in and around John Day, Oregon. I reviewed charts at Blue Mountain Nursing Home, Valley View Assisted Living, Country Spice Residential Care Facility and Blue Mountain Hospice. I also interviewed the directors of Elderberry House and Golden Heritage which are both adult foster care homes in John Day. I found that 100% of residents at these facilities have a POLST form in their charts and staff are well aware of the POLST and the patient’s wishes. Directors and staff at these facilities were also educated regarding the POLST Registry which is a way for emergency personnel to access the POLST when the actual form is not available. Further exploration needs to be done to assess the utilization of the POLST form among dying patients at home who are not living in a long term care facility and who are not involved in Hospice. Health Literacy and Readability of Patient Education Materials at the Klamath Falls Pediatric Clinic Project Date: 6/29/2009 Health Literacy is defined by the Institute of Medicine as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” Limited health literacy may affect some 90 million American adults, and has been postulated as a link between socioeconomic inequality and health disparities. In the pediatric realm, limited health literacy skills among parents or caregivers have been associated with poor health outcomes. This study assessed a measure of health literacy among the primary caregivers (usually parents) of patients at the Klamath Pediatric Clinic in Klamath Falls, OR. One concern regarding health literacy is that patient education materials may be written at levels that are inappropriate for the average patient or caregiver. To determine whether this is the case at the KPC, a number of the handouts distributed at this clinic were assessed for their readability. The average grade level at which caregivers read was compared with the average grade level at which patient handouts were written. Caretaker health literacy was approximated using the Rapid Estimate of Adult Literacy in Medicine-Short Form, administered to parents and caregivers by the medical student prior to appointments in the clinic. Common handouts given to parents, including those about well-child care, normal development and some common childhood illnesses were assessed for their readability using the Flesch-Kincaid Grade Level Formula. According to the REALM-SF, 15 out of 40 caregivers (37.5%) read at a 7th or 8th grade level and therefore are at risk of low health literacy. The average grade level of all the handouts assessed was 6.3, with a range from a 1st grade level to a 10th grade level. Thus, some of the patient education materials used in the clinic may be written at a level that is too advanced for some of the parents of children in the clinic to understand. Dispensing Health Literacy in Coquille: Starting a Medical Lecture Series in a Vacated Pharmacy Project Date: 6/29/2009 The town of Coquille is one of the poorest and least educated areas in Oregon and consequently has low health literacy as well. The nature of the town shows that to improve the health of the population, one must improve the basic communal knowledge about common diseases. One way to get that knowledge out is to use a spot frequented by the community, outside of the hospital, to stage a series of medical lectures. The old Barrow Pharmacy downtown had been converted to a make-shift community center where many classes were being held, including cake-decorating. I organized a series of 4 lectures, kicking off the first one as a co-speaker on diabetes, followed by talks about smoking cessation, COPD, and first-aid to take place after completion of my rotation. Seeking recommendations for speakers, I contacted professionals in the respective subjects and signed them up for consecutive Friday afternoons, helping to advertise through flyers and the local paper, and then handing off the information and structure to others who could keep the project going after I left. Despite suboptimal attendance for the first lecture, the stage is set for four lectures that will promote the health of a community that has given me great hospitality as a student. The Usage and Understanding of the POLST Form among Independently Living Senior Citizens in Veneta, Oregon Project Date: 6/29/2009 Oregon has been very successful in implementing portable orders for end-of-life care via the POLST, which is used in nursing homes, hospitals and hospice. For elderly people that aim to stay in their homes until their final days, their introduction to the POLST is usually from a primary care provider. This project was conducted in the Garcia Senior Center lunch program in Veneta, Oregon, where many of the participants live-independently. The aim was identify if the POLST was being used, identify barriers to its use and to create a presentation to break through some of the barriers. In a total of 6 hours spent at the Tony Garcia Center, data was collected that showed the POLST was not commonly used. Barriers included lack of exposure to the topic, confusing medical terminology and the lack of enthusiasm to talk about end-of-life care. Additionally, two presentations on the POLST were given to break through some of the barriers and forms were filled out on a one-on-one basis. The result was an increased awareness and interest in making choices regarding end-of-life care, and an increase in the number of participants that have POLST forms filled out. Teen Pregnancy in Milton-Freewater, Oregon Project Date: 4/27/2009 I sought to investigate why the teen birth rate in Milton-Freewater, Oregon is so high by looking at sex education in the schools, learning about the reproductive health resources for teens in the area, and getting the perspective of the teens that live in the area. I have subsequently identified what I believe to be large factors in this problem and have made recommendations on how to improve the education and resources for teens so as to hopefully decrease the teen birth rate over time. I have also made a handout listing reproductive health resources in the area for the teens. Health Literacy at Dunes Family Health Care Project Date: 4/27/2009 Purpose: To determine the prevalence of patients at risk for poor health literacy at Dunes Family Health Care (DFHC), analyze the readability of the patient education materials (PEMs) provided to the patients, and determine what additional steps can be taken to ensure better physician-patient communication. Methods: Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R). The REALM-R was administered to all English Speaking patients or their caregivers, if the patient was >18 years of age, at DFHC. Those who scored <6 were considered at risk for low literacy. Results: One-third of patients were found to be at risk for poor health literacy. Males were more likely to be at risk for poor health literacy. Fifty percent of high school graduates were found to be at risk for poor health literacy. Nearly 90% of those at risk for poor health literacy had completed at least one year of high school or beyond. PEMs at DFHC were written at a mean grade level of 7.4, well below the national average of 10th grade. Conclusion: A significant percentage of patients at DFHC are at risk for poor health literacy, and therefore poor compliance and worse health outcomes. Fortunately, the PEMs are written at a level lower than that of the national average but are still written at a level too high for patients at DFHC. Ontario Greenhouse Project: Phase 4. Synthesis, Relocation, Curriculum, Design Ideas Project Date: 3/16/2009 As medical students and simply as residents of America, we have all been made aware of the nation’s increasing problems with obesity. The prevalence of adult and childhood obesity are now at the point of being called epidemics. Unfortunately, the state of Oregon and especially the children of Malheur County are leading this growing trend. Greater than 25% of the kids in Malheur County are considered obese by their screening BMIs. The Ontario Greenhouse Project is an attempt to combat this rising obesity by teaching kids about healthy food, engaging them in the growing and harvesting experience, and ultimately aiming to change the way children think about and choose the food that they eat. Ontario is the largest town in Malheur County and the hopes are that if this project is successful, more school greenhouses and gardens could be adopted throughout the county and state. The first three phases of the project consisted of 1) research into why this idea is needed, how feasible it is to accomplish, and how we could estimate the success of the project after completion; 2) research into similar programs on the West Coast and an estimate of cost; 3) gathering public support by making teacher and parent-oriented presentations, contacting local media to assess their interest in promoting this cause. By the time phase 4 of the project was initiated, the school that had agreed to be the demo school for this greenhouse announced that their principal would be leaving by the end of this school year. Phase 4 then aimed to approach another school with the idea, thus needing to summarize and condense the work already done into an efficient presentation, and to add some more specifics as far as proposed timeline, materials and recommendations for design, and ideas for curriculum in the greenhouse and in the classroom based on other programs and their successes and challenges. A presentation was made to the principal of Pioneer Elementary in Ontario and now the plan for the near future is to present the project to the superintendant and the school board over the next few months. Connecting At Risk Infants with Community Resources: Reducing abuse, neglect, and crime Project Date: 3/16/2009 Child abuse is a tragic, costly, and persistent problem; the primacy of infancy implies that these events will follow a child through the rest of his/her life. In the current economy the local population of Jefferson County has been hit hard, particularly with unemployment as major industries have closed their doors. At times like these the risk to children climbs and the need for child abuse prevention is more acute. A local program, the Ellsbury-Read Project, is trying to effect this change through new parent education on brain development in addition to promoting character development through the rest of childhood. The intention of my project is to add materials to the project to allow teaming with medical professionals. I had four main end points: 1) A simple refresher card (Spanish, and English) for new parents based a on brain development DVD the program has to show parents before discharge that will be dispensed at WCC, 2) A review of the most recent literature regarding the complications of abuse/neglect on the developing mind, particularly the hyper-sensitization of the HPA axis, 3) a complete succinct list of community resources for at-risk infants 0-2y.o. explaining services and restrictions, 4) an addendum with risk factors and programs specific info, to either add or attach to current WCC forms, was the final end point. All final products were given to the project and clinic for use as desired. Improving Nutritional Awareness among Pregnant Teens in Columbia County, OR: Design of a Patient Handout on “Eating Right in Pregnancy” Project Date: 3/16/2009 Teen pregnancy continues to be a controversial issue in the United States. A recent increase in the national teen birth rate in 2006 and 2007 may be reflected in the recent “epidemic” of teen pregnancies in Columbia County. Pregnant teens frequently present later for prenatal care and are more likely to suffer from nutritional deficiencies, failure to gain appropriate weight, and higher smoking rates associated with medical complications such as poor maternal weight gain, maternal anemia, low birth weight, prematurity, and developmental disabilities. Recent studies have suggested that many of these medical issues can be resolved when teens receive adequate prenatal care. This study focused on increasing nutritional awareness among pregnant teens in Columbia County as a means of improving pregnancy outcomes. The attitudes of local girls towards body weight and dieting suggest that they may be at risk for nutritional deficiencies and failure to gain appropriate weight during pregnancy. This was an observational study of resources available to teens in the OHSU Family Medicine Clinic in Scappoose, OR, including prenatal visits and one-on-one childbirth education. A review of the literature on teen pregnancy and nutrition during pregnancy was also combined with an examination of statistics on local teen pregnancy and birth rates as well as attitudes of 11th-grade girls towards body weight and dieting. A handout on nutritional issues was created written for a tenth-grade reading level and intended to be provided to pregnant teens during prenatal visits. Hearing Loss in Rural Oregon Project Date: 2/9/2009 As with many conditions, the prevalence of hearing impairment in rural areas is greater than that of urban areas. While a number of causes for this discrepancy have been identified, one prevailing and preventable reason is the increased noise exposure inherent in rural occupations such as agriculture and manufacturing as well as activities such as hunting. With prevention in mind, two populations were identified and surveyed, and a unique intervention was formulated for each group. The first group included elementary students, for whom an educational program focusing on the science of hearing and the prevention of hearing loss was introduced. The second group consisted of individuals at increased risk of hearing loss as a result of noise exposure. For this group, a patient handout was created that focused on education, prevention, and intervention, as it included a hearing impairment questionnaire and a list of local resources for those requiring further evaluation or treatment Phase III of the Ontario Greenhouse Project: Gathering Public Support Project Date: 2/9/2009 The problem of obesity within the United States has reached what some have labeled as "epidemic" proportions. Over the last 30 years, the percentage of obese adults within the US had doubled, and the percentage of obese children has nearly tripled. Obesity is the result of ingesting more calories than one expends through physical activity. Hence, reshaping the food choices children make on a daily basis can have a lasting impact on both their weight and their health. The Ontario Greenhouse project strives to do exactly that. The project is a multi-phase endeavor to build a school greenhouse in which the entire student body can participate in growing fruit and vegetables that can be served in the school's cafeteria. This hands-on experience would be supplemented by classroom-based nutrition education and instructional sessions in the greenhouse run by farmers and Master Gardeners from the surrounding area. The goal of the current phase, Phase III, was to gather public support by creating teacher- and parent-oriented power-point presentations to introduce the project to administrators, teachers and parents within the district. In addition several local media outlets were contacted and asked to help garner public support by mentioning the project to consumers. Finally, a wide variety of local community members, as well as leaders in the school garden movement, were contacted and asked to participate on an advisory committee for the project. By involving the community in the nutritional education of children, the project aspires to change the way children and their families approach healthy eating, and thereby improve the overall health and well-being of Ontario's citizens. Vaccination Hesitancy in Lebanon, OR Project Date: 2/9/2009 Increasingly more Oregonian parents are hesitant to adhere to physician-recommended vaccination schedules for their children. This student attempted to a) accurately describe the rate of vaccine hesitance and b) define reasons behind this hesitancy in Lebanon, OR. Rates of non-vaccination in Lebanon were computed by data from the Linn County Public Health Office. Patient opinions regarding vaccines were collected from 30 patient interviews. The interviews were formatted on a questionnaire created by the investigator. In addition, conversations were conducted with pediatricians and DHS officials regarding this subject. Based on the data from Linn County Public Health, Lebanon has a lower rate of vaccine refusal than the state average. Parental concerns regarding vaccines appear to reflect those expressed in a large-scale statewide study, chiefly among them 1) the belief that children are generally vaccinated at too young an age and 2) concern for a link between vaccines and autism. Play it be Ear: Designing a Program of Pediatric Anticipatory Guidance for the Prevention of ED and After Hours Clinic Visits for Ear Pain Project Date: 2/9/2009 Ear pain and parental concern for acute otitis media (AOM) drive a high proportion of acute care visits for children. For the past 5 years, otitis media has been consistently among the top three most frequent reasons for pediatric ED visits at Bay Area Hospital in Coos Bay, Oregon. The ED and the urgent care pediatric After Hours Clinic are vital components of the regional health infrastructure, though with limited resources that are often strained by misuse and overuse. Recent studies have demonstrated that such reduction in after-hours and emergency resource utilization for concerns of otitis media can be achieve through directed anticipatory guidance. Consequently, it became the goal of the project to develop standardized anticipatory guidance, to be provided to parents during the most appropriate well-child visit. A survey of charts in the After Hours Clinic was performed, as well as interviews with local pediatricians and emergency room physicians. Moreover, literature review was conducted to determine most current guidelines of establishing pediatric anticipatory education, as well as current approaches to diagnosis and treatment of ear infections. The final product of this project was a comprehensive brochure on the diagnosis and treatment of pediatric ear pain and possible ear infections, which parents and legal guardians of all pediatric patients undergoing 15 months well-child visits with one of the pediatricians in the North Bend Medical Center, Coos Bay, OR. Reedsport Nutrition Information Site Project Date: 12/29/2008 Good nutrition is becoming rarer and rarer in Oregon as well as the nation, leading to troubling trends in obesity. The purpose of this project was to provide an easily accessible resource that contained information on good nutrition and had tools for self-evaluation. It was decided the best medium for this project would be a website. Clinicians could then provide the site address to patients interested in nutrition or those struggling with being overweight or obese. Further, patients who benefitted from the site could refer friends as well, increasing the target population to all residents of the county and beyond. The interactive nature of the site was aimed at making it more personal than a handout and thus serving as a personal nutrition consultation. As a consolidated source of information, its utility is hoped to be greater than other sources on the web that may contain each of its individual aspects. Teen Pregnancy in Scappoose, Oregon and the Creation of an Educational Brochure Describing What to Expect and Available Resources for Pregnant Adolescents. Project Date: 12/29/2008 Although teen pregnancy rates have been declining in Columbia County since 1996, nearly 1 in 4 (23.5%) births are still to adolescent mothers aged 15-19 (1,2,3). Young woman in Columbia County face multiple challenges including higher rates of drug and alcohol use, lower economic status, earlier sexual debut, and most importantly lack of sexual education (4,5). During my clerkship in rural family medicine at OHSU’s Scappoose clinic, I saw many pregnant teenagers and was quite surprised by the questions they asked. The young woman that I saw had no idea what to expect, they did not know what resources were available to them, and some didn’t even understand their own anatomy. While researching this topic, I found that there is a great deal of effort being made in Scappoose (and Oregon as a whole) to convince parents that sexual education is important and to create curriculums that teach adolescents about safety and prevention. Prevention is always the best strategy when trying to combat health problems and I therefore understand why so much attention is being paid to prevention in the case of teen pregnancy, there is however less effort being focused on young woman who have already become pregnant. After identifying that education and resources for pregnant teenagers is an area of intense need in Scappoose, I set out to create a simple one to two page brochure that would answer common questions and concerns as well as list resources that would be helpful to young pregnant woman. Information to be included in the brochure was determined by talking with the young woman themselves and also through conversations with the physicians and nurses who take care of these woman at OHSU’s Scappoose family medicine clinic. This brochure will be handed out to pregnant teenagers who come to the Scappoose clinic for prenatal care, or those who attend the clinics prenatal classes. Health Screening Awareness in Grants Pass Project Date: 12/29/2008 Preventative health services are central to individual health while maintaining low overall health care costs. While on my rural clerkship in Grants Pass I found that patients of the Grants Pass Clinic were largely unaware of health maintenance screening guidelines. Further, while performing colonoscopies, I noted the age of most patients was higher than I expected. I then accessed the local OHP plan, OHMS, for claims data for colonoscopies amongst 50 year-olds and mammograms amongst 40 year-olds. This demonstrated the poor compliance of the Grants Pass community with recommended health screening, ranging between 7-15% of patients for these services. I addressed this problem by creating an informative pamphlet to be distributed to OHMS members and to be displayed within the Grants Pass clinic. I hope to increase local compliance with health screening by 10% in the next year. Investigating primary care provider perceptions and practices regarding smoking cessation in Florence, Oregon; and the development of a cost focused informational pamphlet Project Date: 12/29/2008 Rural areas have been shown to have higher rates of tobacco use than urban or suburban areas.(1) These higher rates have led to significant morbidity and mortality in rural populations.(3) Although state and national data has shown declining smoking rates over the past several years, these declines have not occurred as rapidly in rural areas.(2) Previous studies have found that rural smokers tend to want specific smoking cessation counseling from their doctors, including medication costs, efficacies and a specific plan.(2) This study investigated the perceptions and practice patterns of primary care physicians in Florence, in order to assess which smoking cessation tools were being used and whether Florence providers give specific weight to issues like cost and efficacy. Questionnaires were given to Family Medicine and Internal Medicine physicians concerning smoking cessation. These questionnaires showed that providers find smoking cessation to be an important goal, but that they may be underestimating the number of smokers in their practices. All of the providers mentioned patient motivation and willpower as barriers to smoking cessation, while two mentioned the cost of the therapies. Half of the providers preferred Chantix to other pharmacotherapies. With the goal of providing specific information to patients on cost and effectiveness of the different smoking cessation options, a pamphlet was developed for provider and patient use during counseling. Enriching the Cancer Dialogue: The Development of a Patient Handout that addresses underlying roadblocks against parental acceptance of the HPV Vaccine Project Date: 12/29/2008 Cervical cancer remains the second leading cause of cancer-related deaths in women across the globe. In the United States alone, it claims the lives of 3,700 women each year. Infection by the human papillomavirus remains the leading cause of cervical cancer. Since the 2006 release of the first FDA approved HPV vaccine, marked controversy has emerged surrounding the administration of the vaccine to young adolescent girls in an attempt to target women prior to their first sexual encounter. This has led to diminished acceptance of the vaccine by parents as their daughters approach adolescence, a trend clearly observed in a rural Oregon community at a time when rural areas continue to mark the highest yearly incidence of HPV infection. Attempts to identify roadblocks to parental acceptance of the HPV vaccine were made through observation of patient encounters coupled with an examination of online parenting blogs and forums and augmented by a search of the medical literature. The final product of this project stemmed from the information gathered in the creation of a new patient handout that more directly addressed the most important underlying concerns expressed by parents who were reluctant to accept the HPV vaccine’s administration to their daughter. Depression in Warm Springs Project Date: 10/13/2008 Depression is a serious condition that affects the mind and body, associated with a host of co-morbidities and potentially resulting in suicide. Factors associated with increased prevalence of depression that are certainly found in Native American communities include poverty, displacement, and relative lack of jobs. However, there are some barriers that prevent the people of the Warm Springs reservation from getting counseling help for depression, such as cultural factors, lack of knowledge about the local Counseling Center and its services, and misconceptions of poor patient confidentiality and costly services. To address the issue of depression in the Warm Springs community, I designed a pamphlet for the Counseling Center that would help in getting the word out to the community about the Counseling Center and the services they offer, appeal cross-culturally, aid in screening for depression, provide resources to help intervene, and dispel misconceptions. Eating Well on a Budget Project Date: 10/13/2008 Obesity is an epidemic in this country, affecting young people more and more. It is an epidemic that is seen in all social classes, but disproportionately affects people of lower socioeconomic status. The Coos Bay area is generally of lower income than the state as a whole. Several barriers to healthful shopping were identified throughout the project. While overweight and obese children were identified at the clinic, and all children had inquiry into their diets at each well child check, there lacked a comprehensive handout for patients who have trouble creating a menu to keep to their shopping budgets, while providing nutritious meals. This project was designed with the goal of creating an educational handout that would have nutritional information as well as a menu and recipes to demonstrate how a family of four might eat healthy meals for one month while sticking to a $400 budget, (this number based on DHS data showing that, on average, a person receiving food stamps is allotted approximately $100/month). Through working with a local chef, this pamphlet was created with the goal of being handed out in clinic, with the possibility of future distribution at local DHS offices. Tobacco Cessation Group Visit Project Project Date: 10/13/2008 Tobacco abuse in the United States remains a leading cause of preventable death and disproportionately affects Medicaid recipients. At my rural site, a clinic serving exclusively Medicaid and OHP patients, an approximate 45 percent of our adult patients smoke. A significant percentage of those smokers are afflicted by smoking related illnesses such as heart disease and COPD. Having identified this at-risk population, we set forth to plan and implement a tobacco cessation group visit that is consistent with principles set forth in The Chronic Care Model and the Future of Family Medicine Project (FFMP). Adult smokers with smoking related illnesses were invited to participate based on their desire to quit. Of the 7/15 patients invited participated in the group. At the visit, our care team documented vitals and spirometry values, facilitated a group discussion about quitting, provided a brief informational presentation, and counseled patients individually regarding their plans for tobacco cessation. The visit resulted in 5/7 patients setting a quit date and creating an action plan for quitting! Several barriers to participation were identified including scheduling and transportation. A follow-up group visit is planned for January 2009, and current plans are to continue with new cohorts in the future. Insomnia in the Elderly of Stayton, Oregon: Development of a Patient Handout for Improving Sleep Quality Project Date: 10/13/2008 Insomnia, whether it be difficulty falling asleep, staying asleep or simply poor quality sleep, is a common problem, estimated to transiently affect up to one third of adults. During a five week rotation in a family practice clinic of Stayton, Oregon, insomnia was identified as a common complaint. Diagnosis was established on the basis of patient history and treatment with medications was initiated, but non-pharmacologic treatments of insomnia were not discussed. Acquisition of information pertaining to the issue included casual conversation with practitioners and a review of relevant medical literature, as well as easily accessible online resources of patient information. From these sources, a patient handout for improved quality sleep was developed. Further investigation into the relevance of sleep hygiene education and insomnia in the region was accomplished through interaction and discussion with residents of assisted living facilities in the Stayton/Sublimity area, including the Lakeside Assisted Living Community and McKillop Residence. Visiting these local facilities confirmed that insomnia and sleep disturbance is a common problem that affects this community, particularly in the elderly. The positive response to the handout supports its potential as an education tool to be used in the primary care setting in the future. Reducing Obesity in Veneta, Oregon: Is TOPS (Take Off Pounds Sensibly) Part of the Solution? Project Date: 10/13/2008 Obesity is a major health issue for Americans including residents of Veneta, Oregon. A survey of the electronic medical record used at Dr. John Allcott’s Veneta clinic revealed 495 patients with a Body Mass Index (BMI) over 30 (medically obese) out of his 1483 active patients. While observing Dr. Allcott it became apparent that he refers many of his obese patients to a group program for weight management called TOPS (Take Off Pounds Sensibly). In order to learn about TOPS, assess its effectiveness for Dr. Allcott’s obese patients, and determine whether it could be part of a refined obesity initiative patients were interviewed, a local meeting was attended, the TOPS website was explored, and the medical literature was searched. A review of weight loss programs including Weight Watchers and TOPS concluded that TOPS helps some people and is inexpensive, but given the lack of scientific studies demonstrating its effectiveness the decision to join should be left up to the individual. Personal success stories were compelling, but other patients identified barriers that turned them away from TOPS. Survey of the electronic medical record revealed that out of the 110 (22 male, 88 female) patients who were referred to TOPS, 24 had insufficient chart data to analyze, 39 (45%) decreased their BMI overall, 41 (48%) increased their BMI overall, and 6 (7%) had unchanged BMIs. Limitations exist in determining which patients were truly attending TOPS meetings and given that nearly half saw an increase in BMI and half saw a decrease in BMI, the objective evidence is unconvincing. However, given the many compelling success stories heard it was determined that TOPS should be a key component of the menu of options for weight loss. The final product was the development of a system for addressing weight management with obese patients in the Veneta clinic which includes identifying patients with BMIs > 30, a screening question asked by the medical assistant, and recommendations by the physician. This system has been implemented in the Veneta clinic and will hopefully help reduce obesity, its comorbidities, and its unnecessary cost. Childhood Obesity Knowledge in 9th Graders at Klamath Union High School Project Date: 10/13/2008 Since the 1960's, childhood obesity has increased in the United States foru fold from 4% to 16.3% in 2006. In Klamath County, the current rate is even higher at 24.4% in 2007 making childhood obesity a serious epidemic. This is also 5% higher rate than the rest of Oregon. The Klamath Basin United Way 'Trends and Solutions of Klamath County 2006' survey noted obesity as the #8 health concern among children. In addition, a panel of experts surveyed listed obesity/eating disorders as the #1 problem not addressed in the community. Even more surprising, obesity/eating disorder education was listed as the #1 service needing the most improvement. I sought out on my project to prove the United Way study was correct with the assessment that obesity education needs improvement. In order to do so, I taught three classes on obesity to 82 ninth graders at Klamath Union High School. I gave them a survey to fill out before and after the class about their knowledge on obesity. The results showed that less than fifty percent of the students had knowledge in many of the different complications of obesity. Of those, hypercholesterolemia and sleep apnea were two complications that they learned the most about. Alcohol Use vs Dependence in Harney County Project Date: 10/13/2008 Alcohol abuse and dependence is a commonly encountered problem in communities, particularly in Oregon vs. the U.S. This project was designed to investigate potential reasons for higher rates of alcohol consumption per capita in Harney County compared to other Oregon counties but equal rates of alcohol dependence between the two. Identifying potential contributing factors toward increased consumption yet equal rates of dependence between state and county was the primary goal. The design of this investigation included data review from the state epidemiological outcomes workgroup on alcohol statistics, 6 interviews with members in the community that encounter alcohol problems, a survey review of 52 high school students in Harney county, and observations of community advertisement/marketing adds. The data was collected and analyzed. Potential factors discussed in the interviews toward the disconnect between increased alcohol consumption and dependence were identified along with the number and locations of slogans/adds in the community. The final conclusion of the project was that contributions toward increases in alcohol consumption per capita in Harney County but equal rates of alcohol dependence are multi-factorial including community attitudes, attitudes toward rights of passage, marketing/advertising, potential loose law enforcement in the past, economic strains that potentiate alcohol use, and potential under diagnosis amongst clinicians. Recommendations that was used after considering the data was an information brochure to be administered to parents of older children, adolescents, and teenagers in routine doctor office visits promoting awareness about alcohol use amongst these groups in Harney County. Inpatient Hospital Resources in Astoria, OR: Development of a Patient Library Project Date: 10/13/2008 Patient education is a critical part of effective healthcare delivery. Although patient education begins with healthcare workers, it must be reinforced by other modalities including pamphlets, books and the internet. This study aided in the completion of a patient library for inpatients at Columbia Memorial Hospital in Astoria, OR. The design was consisted of observation of patient care and exploration of current resources at CMH, meetings with the Stewards, data collection of population demographics and inpatient diagnosis. To aid in its completion, this project consisted of (1) Instructions of how to access WebMD for a novice computer user; (2) Pamphlets for the most common inpatient admissions at Columbia Memorial Hospital; (3) Development of a handout of patient friendly websites. These resources, including the internet, are cost-effective teaching tools. Increasing patient education will hopefully translate to increased compliance, improved patient-physician relationships, and greater patient autonomy. Preventative Health and Health Maintenance Information for Patients in Monmouth, Oregon: Helping the Patient Help Him(Her)self Project Date: 9/8/2008 Total Health Community Clinic (THCC) primarily serves low income, uninsured or underinsured, individuals. They tend to lack continuity of care and comprehensive care, and often have office visits solely to address acute health issues. Consequently, it is difficult for the health care providers to effectively educate patients on preventative health and health maintenance topics and perform health screening. To facilitate patient knowledge, increase compliance with recommended health screening, and expedite office visits; I created age specific information sheets for patients that outline recommended ways to stay healthy and when specific health screening tests should be performed. Ideally, these will empower the patient to take a more active role in assuring that all of their health care needs are met. Access and quality of Hospice services for patients and physicians in Josephine County; continual strives towards quality assurance Project Date: 9/8/2008 Rural communities in Oregon are facing the aging population of baby boomers. As such the demand for physicians and Hospice services to deal with end of life care is in high demand. Nationally and within Oregon, rural hospices are faced with additional burdens of large square mileage areas of coverage, increased financial burden due to higher overhead costs and less Medicare reimbursement per patient, and late referrals to care with short lengths of stay. Through analysis of a physician survey about hospice experiences and interactions, interviews conducted with Hospice personnel and patients, and local and statewide annual reports for Lovejoy Hospice located in Grants Pass, OR was analyzed for its ability to address the aforementioned issues. It was found that Lovejoy Hospice through several methods such as attention to provider vs. patient locations, extensive annual fundraising, and finally a physician handbook and positive community presence and patient interaction, has addressed these problems and physician concerns with Hospice referrals and transition to care. However, through physician surveys and Hospice personnel interviews, it was identified that the transition to Hospice care could be smoother and that one are of improvement would be initiating earlier hospice planning so a plan was in place before acute patient decline. Therefore, the final product of this project was development of a patient/physician resource handout and pre-enrollment consult form providing physicians with an in-office way to initiate a conversation about end-of-life and hospice care, and brief patient epidemiology and end-of-life desires for Hospice to have on file in order to facilitate a smoother transition to Hospice care. Pediatric Obesity: Documentation and Intervention Project Date: 9/8/2008 Pediatric obesity is a rising epidemic that poses new challenges for clinicians to manage. The goal of this study is to design a clinic documentation tool that can be used to collect data and help focus possible interventions and subsequent progress in a Klamath Falls, Oregon pediatric clinic for patients with a BMI percentile greater than 85%. The design was gathering clinical information on how to manage obese patients, both from the literature and interviews with providers. Observations were made at Klamath Pediatric clinic on how documentation tools were implemented in the clinical outpatient workflow. This data was then synthesized into a document that could be implanted to help manage obese pediatric patients. The document consisted of a single piece of paper in which the front is filled out by the patient's family before the provider has seen the patient, and the back side is filled out by the provider during the office visit. The final product is a tool to manage overweight and obese pediatric patients by assessing obesity risk factors, probe possible interventions, and set goals. Development of Two Innovative Programs in Lebanon, Oregon: Build Lebanon Trails and Planting Seeds of Change Project Date: 9/8/2008 Obesity, and the myriad negative health consequences that accompany it, continues to rise throughout the US, Oregon, and especially eastern Linn County where greater than 66% of the population is overweight or obese. Medical costs for obesity-related health problems in Oregon's adults totaled an estimated $781 million in 2003 - a number that will rise much higher as the current population ages. While some changes have already been implemented to combat unhealthy weight, further work is needed. The Community Health Improvement Partnership (CHIP) program has aided in the development of two innovative programs in Lebanon, OR - Build Lebanon Trails (BLT) and Planting Seeds of Change (PSOC)- that approach this end from different angles. In meeting with the CHIP coordinator and leaders of BLT and PSOC, I found that both programs were recently created and have many obstacles to surmount before they can reach their full potential. During my time in Lebanon I worked with both to help them overcome some of these barriers and aid the programs in progressing to their final goals. Only YOU Can Prevent Colorectal Cancer The Prevalence of Colorectal Cancer Screening at Philomath Family Medicine Project Date: 9/8/2008 Colorectal cancer (CRC) is the third most common type of cancer and the second most common cancer killer in the United States. As a result, an effort is being made to emphasize screening for colorectal cancer to find it before it starts. The methods that are now recommended that can detect pre-cancerous lesions are colonoscopy and flexible sigmoidoscopy with fecal occult blood testing (FOBT), and only FOBT. I was concerned that in a smaller town such as Philomath, OR that these new recommendations may not be in practice. Through my observation of physicians in the practice I was at I saw that indeed these guidelines are in practice. I also did a chart review to get a feel for how many people have been screened for colorectal cancer and if so which methods they used. Eighty patients ages 50 and older were investigated via chart review or direct questioning and it was found that 68 had been screened for CRC and 12 of them had not. The most common method chosen for CRC screening was colonoscopy. Patients who had not been screened were contacted and asked if they would be willing to state the reason they had not been screened for colorectal cancer. Reasons included cost, lack of insurance coverage, lack of doctor visits, lack of discussion with physician, or simply they have not wished to be screened. A brochure explaining the importance of CRC screening and the methods available for screening was sent to patients who had not been screened. Obesity in Scappoose, Oregon: Developing a patient handout about the benefits of a Mediterranean Diet Project Date: 9/8/2008 Obesity and weight-related diseases (hypertension, diabetes mellitus, and hypercholesterolemia) are major medical problems in the United States. This study was initiated to design an educational handout to assist patients in making beneficial nutritional changes to combat these diseases. The study consisted of an observational period to assess patients’ needs, difficulties, and constraints during this process, as well a period of research and development to create a pamphlet to best address these requirements. During the latter phase, strong research was found proving that the Mediterranean Diet was beneficial in addressing these diseases. The final period of the study consisted of a distribution phase to share the new material with the patients and gauge the impact of the handout. More research needs to be done regarding how the pamphlet influenced the patients, and would reveal specific strengths and weaknesses. Addressing Low Rates of Colorectal Cancer Screening in a Rural Community Project Date: 9/8/2008 Colorectal Cancer is one of the leading causes of cancer-related deaths in the United States today; however, timely screening with tests such as the fecal occult blood test and colonoscopies has greatly increased the number of cancers found in early, treatable stages, thereby reducing the incidence of late-stage and metastatic lesions as well as overall mortality from this disease. Despite the focus placed on preventative medicine by care providers at Santiam Memorial Hospital (SMH) in Stayton, Oregon, screening rates for colorectal cancer in Marion County (home of Stayton) remain below the national and state rates. Additionally, colorectal cancer incidence and mortality in Marion County are higher than those of the state and nation. In this project, Barriers to screening at SMH were investigated, as well as factors associated with low patient adherence to screening recommendations. Fecal occult blood tests are not regularly employed by all doctors at SMH, with efforts often focused entirely on colonoscopy referrals instead. Several suggestions for ways in which barriers might be overcome were then developed, including increased information for patients by way of videos, pamphlets, etc. and increased use of fecal occult blood testing as a less-invasive means for screening that patients might perceive as less intimidating and less embarrassing. Finally, several strategies to increase patient adherence were suggested, including re-writing patient information at a more understandable level for patients with low health literacy, and possibly organizing community forums in which trusted members of the community (including doctors and patients) can speak about their experiences with screening and with colorectal cancer itself. By increasing patient awareness of the risks of colorectal cancer, increasing patient awareness of the benefits of timely screening, and increasing follow up for patient referrals, Marion County should be able to bring its screening rates higher than the state and national averages, while bringing colorectal cancer-related mortality rates below the state and national averages. Phase 2 of Ontario Greenhouse Project: Learning from other successful programs, estimating initial cost, and initiating community involvement Project Date: 9/8/2008 The children of Malheur County are greatly affected by obesity with a current rate of obesity that is 13% greater than the rest of Oregon. Obesity among children can be partially explained by the fact that children of Malheur County are eating fruits and vegetables far below the USDA recommendations. The goal of this project is to work towards introducing a greenhouse program at an Ontario school that will involve the student body in growing fruits and vegetables. Hopefully, such a program would curve the students’ food preferences towards more fruits and vegetables and help reduce obesity among the children. This will be a multiphase project, of which this is the second phase. The aims of this phase include: (1) learn from other greenhouse programs (2) estimate the cost of starting the program, and (3) initiate community involvement. These aims will be accomplished through review of available literature, interviews with members of the Ontario community, and contacting people from other greenhouse programs in Oregon. One can get many ideas and resources from other programs. The estimated original cost may range from $5-20K depending on the size and complexity of the greenhouse. Community involvement may be at an individual level, business level, and may include the local hospital and Malheur County Experiment Station. Community Diabetes Education: Development of a patient handout for Madras's Diabetic Workshop Project Date: 9/8/2008 Diabetes has become an epidemic in the United States with over 7.8% of the population affected. Jefferson County is not immune to this phenomenon and Madras Medical Group (MMG) has a large population of diabetic patients. Although no cure to diabetes is currently available, much can be done to prevent complications, improve quality of life and manage the disease through patient education and vigilant care. This project will provide educational information on how diabetes is managed in the primary care setting and what patients can do to minimize complications of diabetes. This information will be presented in the form of an informational pamphlet and a power point presentation to the Madras community at a local diabetes workshop. The content of the pamphlet was a representation of most frequently asked information in the primary care setting based on observations of patient-physician interaction in the office. Information was gathered from clinic staff and online diabetes resources in order to create the educational materials to represent MMG at the workshop. The workshop was set up to introduce diabetic resources to the community and provide information to diabetic and pre-diabetic patients, their families, and those with risk factors for diabetes about the disease. Burns's Biggest Loser: A real world program of education, increased physical activity and healthy food choices to lose weight. Project Date: 9/8/2008 There is an epidemic of obesity across the United States including small communities like Burns, Oregon. One method to counteract obesity includes increasing activity and decreasing food intake. Members of the community of Burns desired a program to lose weight that incorporated health diet advice and physical activity suggestions. They also wanted a program that was fun, motivating and offered social support in their efforts to lose weight. Thus, a program to lose weight was developed that centered around making healthy food choices with portion control, increasing daily physical activity using a team competition approach. Additionally, the participants were offered education on the risks of obesity and methods to recognize and counteract barriers to physical activity as well as education in goal setting. This comprehensive program was implemented and the participants were followed for the first week which resulted in an average weight loss of just less than two pounds per participant. Screening for urinary Incontinence in Women > 50 years of age in Warm Springs, OR: An underdiagnosed issue Project Date: 9/8/2008 Urinary incontinence (UI) is a significant health issue with substantial social impact. However, this issue is often unaddressed by health care providers in one of its major populations, older women. The goal of this study is to illustrated the degree to which urinary incontinence in woman ages 50 and up is underdiagnosed in Warm Springs, OR. Warm Springs Health and Wellness Center is an Indian Health Services clinic and the only clinic on the reservation. A sample population of women ages 50 and up coming to the Warm Springs Health and Wellness Center medical offices between September 23 and October 6, 2008, were screened for UI using the previously validated MESA questionnaire for urinary incontinence. Surveys were scored and UI prevalence according to the MESA questionnaire was compared to prevalence according to IHS ICD-9 codes for UI. According to a VGEN search of EHR (electronic health record), Warm Springs Health and Wellness Center only had a 13.0% prevalence of UI women in aforementioned sample population. However, according to the MESA questionnaire at least 58.7% this sample population had some form of UI. Not only is UI unaddressed in this community, but patient knowledge and educational information is lacking. Therefore, the final product of this project is an educational pamphlet on UI. Social gatherings and community is a very important part of this population, hopefully addressing undiagnosed and untreated UI may be improve the quality of some of these women, allowing them to actively participated in community functions and gatherings without fear or embarrassments associated with UI. Management of Chronic Pain in Reedsport, Oregon Project Date: 8/4/2008 It is estimated that between 15% and 30% of the population of the United States suffers from chronic pain. In Reedsport, Oregon, the number individuals in chronic pain are estimated to be higher than the national average because of a higher percentage of: population over 45 years of age, non-hispanic white adults, and population below poverty level. In addition, unique local factors contribute to the number of people in chronic pain, (e.g. occupations requiring manual labor and high risk recreational activities). After seeing a number of chronic pain patients with abuse and diversion of their medications during a five-week medical student rotation, this medical student wondered if anything could have been done differently for these patients. Thorough observation of office policies and procedures, and interactions between physicians and their chronic pain patients at Dunes Family Health Care (DFHC) were documented. A literature search employing OVID Medline and other professional websites was used to compare what was observed in clinic and the existing standard of treatment recommendations. Emphasis was placed on recommendations from the Institute of Clinic Systems Improvement, the American Academy of Family Physicians, and the Oregon Health Plan. On the final day of the rotation, these observations and recommendations were presented to the DFHC physicians. A pamphlet aimed towards eliciting patient expectations during the course of chronic pain treatment was also produced with the intention of distribution to patients at the start of medical therapy. Juniper Junction Relief Nursery: Child Abuse Prevention in Jefferson County Project Date: 8/4/2008 Juniper Junction Relief nursery is a new organization developing in Madras, Oregon, to address the serious matter of child abuse in Jefferson County. According to the county website, in 2006, Jefferson County’s rate of child abuse was 10.5 per 1000 compared to 6.9 per 1000 in the state, and approximately half of the victims were under six years of age. Further outlined is the epidemic of alcohol and drug abuse in the county, the high rates of poverty and the effect these have on children and their health. Juniper Junction Relief Nursery’s main goal is to assist families with multiple risk factors for child abuse by providing therapeutic classrooms for children 0-5 years old, home visits from teachers, and parent education classes. The organization hopes to follow the Eugene relief nursery’s lead in also offering basic needs support, drug and alcohol support groups, respite care, mental health services and Latino outreach. All of the classes and support revolve around the family and keeping families together in a healthy, safe environment. After learning of Juniper Junction Relief Nursery, I attended a council meeting and interviewed different members to find out what needs they had and what I could do to help address them. After these interviews, a tour of the facility, review of the classes to be offered, and research of the original program out of Eugene, it was decided that pediatric health brochures based off of a class that will be offered, called, “What to do when your child gets sick” was the way I could best help advance the development of the nursery. I created 10 brochures in English and 10 brochures in Spanish that address basic healthcare concerns many parents, especially first time parents, seem to have. I also translated a Tylenol dosing chart into Spanish, that the clinic and the relief nursery both felt was needed. The main goal of the brochures is to help educate parents on the health problems their children may face and provide a source for the relief nursery to reach out to both the English and Spanish speaking population in the county. Ideally, these brochures and the knowledge provided to parents prevents unneeded emergency room visits and clinic visits for children. A Look at the Availability of the HPV and Meningococcal Vaccines in the North Santiam Canyon Project Date: 8/4/2008 Vaccination has become a huge part of preventative health in the U.S. and around the world. We've seen illnesses such as small-pox virtually eliminated from the population by successful vaccination programs. The first day I was in clinic, a girl came in requesting the HPV and Meningococcal vaccines and I was surprised to learn that neither of these were offered at the clinic I was at. This study looked at the availability of these two optional and expensive vaccines in the greater Santiam Canyon area. A phone survey of the local physicians was used to assess the availability of the vaccines and to ask about resources outside of these communities that they might utilize to provide this vaccine for their patients. Finally an informational handout was made that outlined basic information about each vaccine, resources available to help pay for them, and a phone number for a resource that provided the vaccine should their own clinic not provide them. Targeted Sexual Education in Rural Communities Project Date: 8/4/2008 Youth growing up in our countries rural communities face a multifaceted challenge as they become sexually active. Statistically they are a high risk group - often with higher rates of alcohol use, earlier sexual debut, and frequently increased numbers of sexual partners at an earlier age. Compounding and interacting with this is the political climate in which these individuals come of age. Frequently, comprehensive sexual education is discouraged in traditionally conservative communities and school districts - often favoring abstinence-only based education that downplays the importance of contraception and discourages an open dialogue on topics of sexuality and sexual practices. These issues - along with socioeconomic forces at play in our rural counties and districts - lead to disproportionably high rates of teen pregnancy and STI transmission - even in areas where resources, providers, and adequate health care education are available and accessible. My project was designed to find the missing pieces of formal sexual education and directly target a short informational session to give students the skills and knowledge they need to make informed decisions about their health, their decision of how and when to engage sexually, and for those already sexually active - to serve as a reinforcing reminder on the importance of contraception and means of STD protection. Preventing Caregiver Burnout in Grants Pass, OR Project Date: 8/4/2008 At any given point, there are 34 million Americans who provide full or part-time care to aging family members or spouses1. Unfortunately, caregiver stress and burnout continues to be an under-recognized and under-addressed phenomenon, despite its association with increased morbidity and mortality in both caregiver and care-recipient. The goal of this project was to identify resources readily available and easily accessible to caregivers in Grants Pass, Oregon. The design included observation of physician interactions with caregivers and their dependents at WellSpring Family Practice and Three Rivers Community Hospital as well as exploration of local, state, and national support resources for caregivers. Finally, the end-product of this project was a pamphlet outlining essential steps for the caregiver and elucidating the most useful and comprehensive resources available. The pamphlet was made to be distributed in the physician’s office and various other health resource offices (e.g. CareSource, assisted-living homes). Planting Seeds of Change: Improving the Health of the Community - an Edible Endeavor Project Date: 8/4/2008 Childhood obesity is an enormous issue facing the health care system, schools, and the community at large. This study examined a community initiative, Planting Seeds of Change, whose mission is to increase healthy eating habits and reduce childhood obesity through a garden based educational endeavor. The project entails the formation of a school based garden which grows produce used in the school lunches and serves as a classroom without walls for the children of Seven Oaks Middle School. This study hoped to gather the pertinent information about the formation, maintenance, and future aims of the project so as to consolidate this information into a working summary to be shared with others. The study also examined the statistics of childhood obesity and literature which detailed community and/or school based efforts to combat obesity. Research was conducted via interviews, observation, and literature searches. The final result was a detailed PowerPoint presentation discussing Planting Seeds of Change and the literature supporting such a community based initiative, which will be utilized at several state and nationwide meetings and conferences. Management of Patients Abusing Opiate-based Analgesics in Grants Pass: Individual Healthcare Provider Practices, Clinic Guidelines, and Resources and Obstacles in Josephine County Project Date: 6/30/2008 Management of patients abusing prescription opiate-based analgesics is challenging and requires the interplay of many different healthcare providers and community resources. This study identified individual healthcare provider approaches to the management of this population of patients, Grants Pass Clinic policy, and the resources available in and around Josephine County. Information regarding individual healthcare provider practices was obtained via a questionnaire, while resources for and obstacles to the management of this population was gathered through interviews. Healthcare providers generally shared common views and strategies regarding the management of patients abusing prescription narcotics. Discrepancies were found when considering the use of pain contracts and the appropriate time to fire a patient. Grants Pass Clinic had no policy or patient information on the management of patients abusing prescription narcotics aside from the pain contract, so a double-sided handout was created to address the need. Grants Pass has many opportunities for individual drug counseling, less opportunities for group counseling, and nearly no maintenance therapy services (methadone or Suboxone). Possible means to improve access and availability to patients abusing prescription narcotics include increased government funding, reducing healthcare provider prejudice, and increasing the number of healthcare providers trained in Suboxone administration. Optimization of the After-Hours Clinic in Coos Bay, OR Project Date: 6/30/2008 High use of the emergency department (ED) among pediatric patients is a major medical issue in Coos County, Oregon. The Bay Area Pediatric & Adolescent After Hours Clinic (AHC) was implemented in 2006 to decrease the ED flow of pediatric patients for non-emergency health conditions. This study was designed to gain an understanding of how the AHC has impacted ED visits in Coos Bounty and to identify potential improvements to the AHC. To learn about the AHC and its effect on the local ED, interviews were conducted with the AHC sponsors and founders. To identify areas of improvement, physicians and patients participating in the AHC were surveyed. The final product of this project was the development of an AHC brochure depicting the essentials of the AHC more comprehensively than materials currently available. Insights gained through interviews and surveys were incorporated into the construction of an information sheet. The ultimate goal was to increase awareness of the AHC and to provide information about this valuable community resource. Before the Fall: Fall Assessment and Prevention in the Greater Reedsport Area Project Date: 6/30/2008 Injuries related to falls place a large toll on society. This project assessed the burden of falls in the Reedsport Oregon service area and developed interventions to reduce this medical burden, through means of prevention. The medical doctors appear to do an excellent job at discussing fall risk with their patients. Both the local clinic and hospital treat many fall related injuries each year. The local clinic could focus a month of time to further prevent falls in the community through education and community service. A fall prevention handout was created and an educational month was proposed. Portion Size? Serving size; Teaching Healthy Living Choices in Scappoosereatment of Chronic Pain Project Date: 6/30/2008 Obesity is a growing epidemic in the United States of America. This along with low health literacy, especially in rural areas, leads to increased obesity in these areas. Rural areas also suffer from physician shortages making the time spent with patients more and more valuable. The goal of this project was to make the most of time spent at the doctor’s office to educate obese patients about portion control. The design was a PowerPoint presentation about how food portions and therefore caloric content has changed over the past 20 years. This presentation also included information about exercise requirements to burn these extra calories. In order to maximize the time spent at the doctor’s office, the presentation was set up to run on the computer in each exam room while the patient waited for the doctor at OHSU’s Family Medicine Clinic in Scappoose, Oregon and was shown to 15 obese patients. Implementation of a literacy assessment tool: “The Newest Vital Sign” Project Date: 6/30/2008 In recent years there has been increasing emphasis on improving communication between patients and clinicians. There is more awareness now that the old methods of physician teaching are often not working to adequately inform patients. This is for a variety of reasons but this paper focuses on the issue of health literacy as one of the primary factors. Low literacy rates have now been linked to less knowledge of health problems, more hospitalizations, higher health care costs, and poorer health status so obviously it creates a barrier to effective communication. By finding and implementing a quick and easy literacy assessment tool the McClaine Street Clinic and the Community Outreach Clinic in Silverton hope to identify and help those patients with limited literacy. In my study I obtained assessment tool materials, discussed implementation with both offices, and did a small field study to determine the feasibility of administration. Obstetric Guide Project Date: 4/28/2008 West Salem Clinic and Total Health Community Clinic in Monmouth primarily serve low income, homeless individuals. Ten percent of the patients require obstetric care which is currently offered by three providers each having 10 deliveries per month on average. The clinics lack educational material that are practical, user friendly, and accessible to the women desiring pregnancy care at these facilities. For the past year, the clinic director has been interested in creating a brief, up-to-date, and readable manual of obstetric care. The goal of the manual is to offer as a free hand out to their patients as a guide for every step of pregnancy and to help providers become more efficient in managing the prenatal visits. Diabetes Education Among the Local Hispanic Population Project Date: 4/28/2008 The goal of my project was patient education in regards to diabetes. I focused on explanation of the disease, who is at risk for the disease, and what steps can be taken to prevent development of diabetes. My target audience was the Hispanic population that lives in the surrounding areas of Portland, therefore I made a brochure in Spanish explaining the things mentioned above. Educating and Empowering Patients and Physicians to Reduce Diabetes-Associated Morbidity in Eugene, Oregon Project Date: 4/28/2008 Diabetes is an epidemic in the United States. Successful management of A1C, LDL, weight, and blood pressure reduces diabetes associated mortality and morbidity. Patients and physicians have ever-increasing expectations to reach established target goals, many times without complete success. Reaching targets requires a partnership between the patient and physician; patient responsibility, motivation, and investment in their personal health care can have tremendous impact in outcomes. Educational and motivational barriers can be overcome through the use of a patient-specific visual risk assessment profile that demonstrates the direct influence patient actions today have on future risk of complications including heart attack, stroke, kidney failure, foot problems, and eye problems. The American Diabetes Association’s online Personal Health Decisions (ADA’s PHD) risk profile can be used by physicians and patients together in order to successfully move toward established targets, reducing morbidity. Specifically, integration of the PHD into the existing PeaceHealth Diabetes Wellness Assessment Program (DWAP) could increase successful management of physician and patient management of diabetic targets within the PeaceHealth system in Eugene, Oregon. Educational Tools to Promote HealthY Patient Behavior Project Date: 4/28/2008 Diabetes and hyperlipidemia are now well established risk factors for cardiovascular disease that are quite poorly controlled in our country. Each of these medical conditions drain the health and financial reserves of all of our communities. Grants Pass, is an economically challenged community located in Josephine County Oregon. High rates of cardiovascular disease and chronic medical conditions in this city serve to only worsen the already poor socioeconomic state of this city. The Wellspring Family Practice Grants Pass clinic is composed of a high proportion of patients with diabetes and hyperlipidemia. Unfortunately, the patients lack a sophisticated understanding of how these disease processes lead to harm in their lives. Furthermore, many individuals were frustrated with the lack of success of lifestyle intervention and were skeptical that improved diet and exercise would improve outcomes in their community. The results of this study confirmed that increased exercise, improved diet and tight glucose control were all correlated with better health outcomes in this population. The findings appear to support the applicability of well established cardiovascular risk factors in this community and thus provide an additional powerful set of educational tools to promote health patient behavior. 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. Childhood Obesity in John Day: Building on Previous Work and Increasing Community Awareness Project Date: 3/17/2008 Obesity is a growing problem in the United States and its rise has been well documented and publicized as are the long-term health consequences of obesity. During the fall of 2007, during her Rural Community Health Clerkship at the Strawberry Wilderness Community Clinic in John Day, OR, Logan Thomas investigated the prevalence of obesity in elementary schoolchildren in John Day by analyzing height, weight, and sex information and calculating the BMI for all children at Humbolt Elementary School in Canyon City, OR. She found that 32% of children aged 6-11 years in John Day were overweight or at risk of becoming overweight, compared to 19% nationally. She presented this data to school district administrators and helped facilitate discussions of options for future action to address the problem of childhood obesity in their community. In these discussions, the consensus reached by school administrators was that initial efforts should be focused on educating the community. Interest was expressed in developing a handout for parent-teacher conferences to educate parents about the prevalence of childhood obesity in John Day and to give parents some hints and ideas on ways they can help improve their children’s health. I sought to gauge whether there was continued interest in such a handout and coordinate my efforts with those community members already actively working in the issue of childhood obesity. I developed handout for parent-teacher conferences that revisited Logan Thomas’ data and provided tips for parents to help improve their children’s health. It is currently being reviewed by the Grant County School District #3 Superintendent. I also developed a more extensive webpage that included the same information plus additional tips for healthy eating that is posted on the Strawberry Wilderness Community Clinic Website. Infant and Children's cough and cold medications - a handout for parents Project Date: 3/17/2008 The common cold, while a limited minor illness, is a frequent source of distress in new parents of infant children and accounts for millions of doctor visits. Children can average 6-8 colds a year. Over-the-counter children's cough and cold medications have been associated with visits to emergency departments and death in children under the age of 2 years old and as a result are no longer recommended for children <2 years old. Educating parents on the appropriate treatment of cold symptoms in their infant can reduce the use of cold medicines and adverse events from cold medicines. This study reviewed risks and benefits of cold medicines and other non-pharmacologic treatment options and appropriate recommendations were compiled in a patient handout. The Effectiveness of Patient Education in the Total Health Community Clinic: A Media-Based Approach Project Date: 2/11/2008 Patient education is a key component of preventative medicine and is necessary to providing comprehensive patient care. This student attempted to identify the effectiveness of patient education efforts in Monmouth, Oregon family practice clinic. The design included observation of patient education methods currently in use in the clinic and an analysis of the effectiveness of those methods over the course of four weeks. In addition, patient interviews were conducted to both assess the effectiveness of patient education methods currently in use and to discuss methods for improvement. New methods for educating patients were then employed and their effectiveness measured via observation and patient feedback. These included patient educational videos presented in the waiting area as well as patient handouts. In addition, a patient-accessible computer with learning tutorials was proposed to clinic administrators and approved for implementation. The changes achieved in this project enhanced patient education and increased satisfaction with the clinic waiting room experience, as many patients felt that their waiting time was more valuably used. 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. 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. Identification and Analysis of Barriers to Influenza Vaccination and Development of Patient Brochure as a Mode of Intervention in Stayton, OR Project Date: 2/11/2008 Seasonal influenza is a significant contributor to morbidity and mortality of Americans, particularly in at risk populations (adults > 50 years, children < 5 years, and persons with chronic disease, immunosuppression, or compromised respiratory function). The most effective means of influenza prevention remains yearly vaccination. This study attempted to identify barriers to influenza vaccination in a Stayton, OR family practice clinic. The design was five week observation of clinic and hospitalized patients with diagnosed influenza or influenza-like illness and their response to a family physician’s intervention regarding influenza vaccination. From these observations, a survey was developed and distributed over 7 clinic days, which asked patients to indicate if they received this year’s flu vaccine and if not, why? Based on survey data, gaps in patient knowledge, as well as systemic barriers to vaccination were identified. Interviews with local influenza vaccination sites were conducted in person and by phone to gather information about shot availability, cost, and type of vaccine offered. While patients were generally aware of availability of yearly flu vaccine, the majority declined due to misconceptions or lack of information regarding the influenza vaccine. No intervention, outside of physician counseling, was identified to target the local population’s low utilization of the flu vaccine during this brief observation period. Therefore, the end product of this project was the development of a patient brochure tailored to the responses of the “Influenza Vaccine Survey” to be distributed in clinic, and a recommended change in policy for local influenza vaccination sites. Cardiovascular Risk Reduction in Hood River, OR: Availability without Access Project Date: 2/11/2008 Although preventable, heart disease remains the number one cause of death in the United States. This study sought to examine cardiovascular risk reduction in an internal medicine clinic in Hood River, OR. Methods included observation of clinic practices, interviews with health care providers, and analysis of inpatient admissions for 2007. Patient education for cardiovascular disease in the clinic included brief, informal counseling performed during the visit and focused on risks that were identified through the patient’s history, physical examination, and laboratory evaluation. No handouts for patients were in use to augment this education or encourage lifestyle modification. A comprehensive cardiovascular risk reduction program was available but expensive, minimizing its utilization. The ultimate goal of this project was to create an efficient and educational patient handout aimed at increasing awareness of modifiable cardiovascular risk factors, encouraging lifestyle modifications, increasing patient-physician dialogue, and highlighting free or insurance-reimbursed programs available in the area. 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. The War on Chronic Illness: A Questionnaire As A Weapon To Reinforce Healthy Habits and Aid Providers in Identifying Problem Areas. Project Date: 12/31/2007 Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. People who are at risk for, or have chronic disease, often have poor self-management of their health. Tools are needed to help healthcare providers efficiently assess barriers to good health management. Health questionnaires can aid providers in quickly identifying areas that need to be addressed and help provide better outcomes for the patient and community3,4 The goal of this project was to develop a health questionnaire that could be used on a trial basis to gather information, and help patients think about their own healthcare management. A Spanish/English questionnaire was developed and administered to adult patients seeking care at the Virginia Garcia Clinic. The results of the questionnaire were reviewed in the patient context when possible, and anecdotal observations along with overall outcome trends were noted. Menos Pesticidas para los Ninos Felices Project Date: 12/31/2007 La Clínica del Cariño is a community health center dedicated to serving migrant agricultural workers and other community patients who would otherwise be without health care. Children in agricultural households have been shown to have higher levels of pesticide degradation products than both their urban counterparts and their own parents. Long term sequelae of these exposures are not uniformly accepted, however, reports have been made in humans that chronic exposure to pesticides can cause malignancy, neuroendocrine deficiencies, and sterility. Pesticides enter the homes of agricultural workers on clothes, boots, skin, and dust. Levels of household pesticides correlate with children’s urine levels of pesticide degradation products. It is reasonable to expect that reducing these sources of exposure for children could reduce their risk of serious long term sequelae. Currently, few providers at La Clínica assess their patients’ level of pesticide exposure and educate their patients regarding how to avoid exposing their children. This study uses a questionnaire to assess the attitudes of providers regarding pesticide education, identify barriers to pesticide education, and establish solutions to these barriers. Providers are interested in educating their patients, but they do not feel that they have enough time to do so and often forget. These issues will be addressed by changing the well child visit forms to include prompts to address pesticide exposure and educational handouts regarding pesticide avoidance strategies. Additionally, parent questionnaires have been added to screen for pesticide exposure, lead exposure, TB exposure, autism, and failure to meet developmental milestones. Which Bay Patients are on Vytorin and What Do They Know About The ENHANCE Trial? Project Date: 12/31/2007 Heart disease is a major cause of morbidity and mortality in the United States and is becoming more prevalent worldwide. HMG-CoA reductase inhibitors, "statins", have been found to be one of the most efficacious ways to treat hyperlipidemia and prevent myocardial infarction and stroke. Some patients are unable to achieve their LDL-C goals with statins alone. Vytorin (exetimibe/simvastatin) has increased in popularity due to its dual action to reduce LDL-C. There was a recent explosion in media attention toward Vytorin with release of the ENHANCE trial. Patients taking vytorin were coming to their appointments unclear as to whether or not they should continue taking their medication. The media was giving them the impression that Vytorin does not work or is actually doing them harm. A letter was written and mailed to approximately 300 Bay Clinic patients documented as being prescribed Vytorin. It was available to hand out at appointments. It included reputable contacts for information on the subject. This gesture upholds the role of physicians as educators and to ensure patients did not discontinue taking their medications without consulting their health care provider. Prenatal care resources available for low-income women in Grants Pass, OR Project Date: 12/31/2007 Adequate prenatal care is important for both maternal health and pregnancy outcomes. There are various social and behavioral risk factors for inadequate prenatal care, including low-income status. Therefore, it is imperative that resources are available for low-income pregnant women, in terms of access to prenatal care and patient education. According to census data, in 2000, 13.3% of the Grants Pass, OR population was below the federal poverty level ($17,170 for a family of 3 in 2007), and 37.4% were below 200% of the federal poverty level. This is in comparison to 11.6% and 29.6%, respectively, for Oregon as a whole. This study examines various prenatal care and education services available to low-income women in the Grants Pass area. Phone interviews were conducted with a coordinator at the Pregnancy Care Center, a county public health nurse, and a maternity case management nurse. In-person interviews were conducted with a member service manager at Mid-Rogue Independent Physician Association (MRIPA/OHP), and several patients. Printed materials available to patients were also obtained from Mid-Rogue IPA, a local county health office, and the Pregnancy Care Center. The findings suggest that a variety of prenatal care resources are available for low-income women in Grants Pass, but several barriers exist, including limited staff and funding for programs. Further examination of ways to optimize prenatal care and education at low cost, as well as potential initiatives to increase funding, would be beneficial. Access to Cancer Support Services in Florence, OR Project Date: 12/31/2007 A diagnosis of cancer can be traumatic for a patient, and psychosocial support services have been found to help patients through their battle with cancer. Rural communities present a challenge when trying to provide cancer support services because of limited resources, traveling distances for the patients and the volunteers, and lack of a structure to educate patients about resources. In Florence, OR, a town with an elderly population that is greatly impacted by cancer, psychosocial support services are abundant, but often underutilized. In January, during my rotation, a new Cancer Resource Center (CRC) opened in Florence as a partnership between the American Cancer Society and Peach Health Medical Group. Its mission is to connect cancer patients with the available resources in the community. I decided to investigate the level of awareness of cancer support services among my preceptor’s patients and to work towards connecting patients in the clinic with the CRC. Through interviews with patients in my preceptor’s clinic, and with several individuals involved with the CRC, I concluded that there is a great need for the CRC in Florence and that patients are receptive to the idea of the CRC. The final product of my project was the creation of a referral form that can be used in the exam rooms at the time of cancer diagnosis to direct the patients to the CRC for educational and psychosocial support. Pathological and Problem Gambling in Reedsport, Oregon Project Date: 12/31/2007 Our state government and the local economy on the Southern Oregon coast are hooked on the profits from state run lottery and the jobs and tourism brought in by Indian Casinos. Unfortunately, problem and pathological gambling are a significant public health problem. Countless studies have shown an association between problem/pathological gambling and drug use, suicide, crime, bankruptcy, divorce, and job loss. Reedsport, Oregon is uniquely located within approximately 20 miles of a casino in both the North and South directions, putting its population at increased risk for these problems. Using the NODS gambling screen, this study looks at the prevalence of gambling problems in the patient population at Dunes Family Health Care in Reedsport, Oregon. After identifying this problem, a patient handout was prepared listing local resources available for those with gambling problems to get help. This handout was distributed to local casinos, shopping centers, family resource center, the family medicine clinic and the library. A better way to manage Diabetes in Eugene, Oregon: The DWAP Project Date: 10/15/2007 The prevalence of Diabetes Mellitus in the United States has been rapidly increasing in the past seventeen years. The complications of poorly managed diabetic care can be disastrous for patients, their families, and society as a whole. PeaceHealth Medical Group of Eugene, Oregon has instituted a Diabetes Wellness Assessment Program (DWAP) in order to maximize diabetes management and avoid these complications. The DWAP program follows the American Diabetes Association’s guidelines of care, and includes comprehensive visits, modifying behaviors, and data reporting in order to improve care for patients with diabetes. Since its inception three years ago, the DWAP program has shown widespread improvement in the way physicians and clinics manage this chronic and potentially debilitating condition. Primary Prevention of Child Sexual Abuse in Coos County, Oregon Project Date: 10/15/2007 Child abuse is a significant problem in Coos County, OR, where child abuse and neglect rates are persistently higher than average for the state of Oregon. Despite the high prevalence of child abuse, there are no primary prevention programs that educate and empower adults to prevent child abuse. This project focused on creating a primary prevention program to aid adults in preventing child sexual abuse. With the assistance of the Coos County Child Advocacy Center, I created educational materials that met three goals. First, the program helps disseminate information about child sexual abuse and increases awareness. Second, the program teaches parents and organizations that serve youth actions they can take to prevent child sexual abuse. Third, the program teaches adults how to recognize and report child sexual abuse. The ultimate goal of this program is to help adults in the Coos County area decrease the incidence of child sexual abuse. Implementation and Continuation of Sex Education in Harney County Project Date: 10/15/2007 Teen pregnancy and teen STD transmission are both issues that are of great impact on individuals, communities and society as a whole. In Harney County Oregon, where social support networks are scarce and difficult to access, this is also true. Although rates of both teen pregnancy and STD transmission are both less than state and national averages1,2, the individuals involved are still greatly affected by these life changing events. Teen pregnancy is well correlated to individuals living in poverty and that must later be supported by a Welfare program that spends 9 billion dollars a year on family support of these individuals4. Seeing that there are 700,000 new teen pregnancies a year4, there is still a lot to do in the department of prevention. My project was aimed at that exact goal, and sought to better educate the middle school students of Hines Middle School following comprehensive national guidelines. “Healthy Futures: Nurturing Children’s Development.” Project Date: 10/15/2007 A child’s early experiences profoundly influence his brain development and how he will interact with the world throughout his life.1 Increasingly, instruction and support in providing the nurturing and stimulation that children require for proper brain development is imparted to inexperienced parents by community resources. 2 One such resource, the Maternal Case Management program at the Jefferson County Health Department in Oregon, has just been eliminated due to low utilization. The Healthy Start program in Jefferson County is facing the same fate, also due to low utilization. The fact that both the teen pregnancy and child abuse rates in Jefferson County are higher than the Oregon state average suggests that lack of need of these social services is not the reason for their low utilization.3,4 Rather, lack of awareness of these social services is to blame for their low utilization, according to the local Community Health Improvement Partnership (CHIP) in Jefferson County. To increase awareness, and thus increase utilization, of social services available to infants and children in Jefferson County, I created a comprehensive list of these resources and made it available at the nurse’s station at the Labor and Delivery Department of Mountain View Hospital, the major hospital in the county. To encourage new parents to access this list of resources, I also created a video that explains the neurodevelopment that results from adults’ early interactions with infants, and the importance of enlisting social services when necessary to ensure that these interactions are positive and promote a child’s healthy development. This video is available in both English and Spanish, and will be required viewing for patients who deliver at Mountain View Hospital, prior to their discharge. Improving Screening Rates for Colorectal Cancer on the Warm Springs Indian Reservation: Using Radio and Internet Video to get the message across Project Date: 10/15/2007 On the Warm Springs Reservation in Central Oregon, the Indian Health Services (IHS) is responsible for providing health care to the members of the Confederated Tribes of Warm Springs. The IHS has a set amount of resources; therefore, preventative medicine is an important component of the healthcare system. One preventative measure, screening for diseases, can help lower costs and reduce incidence of diseases. The Warm Springs Health & Wellness Center (WSHWC) has a chronic care initiative that is exploring new ways of improving the screening rate and treatment of disease. One of the diseases being studied is colorectal cancer. As a part of the chronic care initiative, this community project created two new ways of encouraging tribal members to get screened for colorectal cancer. One is a radio ad campaign educating people on the need to be screened was implemented. The second is an animated video that demonstrates how to complete the screening test. Fall Prevention Services For Geriatric Patients In St. Helens, OR Project Date: 10/15/2007 Geriatric morbidity and mortality increases after fall injuries.1 Many of these falls may be avoided with fall-prevention strategies that involve improving geriatric strength and mobility. The goal of this study was to identify local fall-prevention resources and services for geriatric patients--specifically, programs that could provide mobility-assistance-device (i.e. canes, walkers) training, home fall-prevention safety consultations and home mobility improvements/installations. Geriatrics patients from the St. Helens, OR community and their medical and social services providers were interviewed. Although rehabilitation services in St. Helens for geriatric patients who have already experienced a fall injury are easy to identify and access, services to prevent healthy, active seniors avoid falls are not. Resources for Children with Autism Spectrum Disorders in Ontario, OR: Development of Resource Planning and Information Brochure Project Date: 10/15/2007 In Malheur County, the number of children with an autism spectrum disorder is estimated to be the highest in Oregon.1 The purpose of this project was to determine what resources were available to the population in theory and in actuality from interviews with healthcare providers, schools, therapists, and parents. The state provides for therapy as needed for each child to be delivered through the school, but the limited number of therapists in the area demonstrated that only a bare minimum of services were actually delivered, leaving many parents frustrated and hopeless. Furthermore, due to limited education resources, many parents did not fully understand the disorder, itself, or the services that were available to them. This project focused on determining what services existed and what could be further offered. In addition, a brochure was developed to give to parents, educating them on the basics of the disease, techniques to use at home, and resources that were available to them. Educating patients in Cottage Grove Oregon about the many consequences of cigarette smoking Project Date: 9/10/2007 Tobacco causes more deaths each year than car accidents, suicides, murders, HIV, and illegal drug use combined, according to the CDC. People that are the most likely to smoke are those with lower level of education, lower socioeconomic status, and/or live in rural communities. Sadly, smoking rates are also higher during pregnancy and postpartum in these groups, leading to increased fetal and infant mortality rates. The goal of this project is to educate the community about the dangers of smoking during pregnancy, and exposing children to secondhand smoke, along with educating patients on the multiple consequences of smoking that effects their own bodies. The need for this project was recognized while interviewing patients and parents of patients at South Lane Medical Group in Cottage Grove. Additional information was gathered from government agency websites and from a literary review of studies on the consequences of tobacco use. Patient handouts were created to educate patients on the harmfulness of smoking, and to aid physicians in smoking cessation counseling. These handouts have been made available in patient rooms, so the patient can read them while waiting to see there health care provider, or so that the physician can hand them out to patients to take home to read. Helping Prineville Physicians Help Patients Quit Smoking: Efficacy and Cost Comparisons of Smoking Cessation Methods Project Date: 9/10/2007 Smoking continues to be a health burden in the United States and in Prineville, Oregon. As many hospital campuses are becoming tobacco-free, including Pioneer Memorial Hospital in Prineville as of October 1, 2007, now is a crucial time to assist patients with smoking cessation. This study is an analysis of the various smoking cessation methods available and their relative costs and efficacies. To study this, the four pharmacies in Prineville were contacted in person and/or by telephone to request pricing information for nicotine replacement products as well as first and second-line smoking cessation medications including Bupropion SR, Chantix, Nortriptyline, and Clonidine. In addition, two pharmacies commonly used by Prineville residents, Wal-Mart and Costco, were contacted by phone for pricing information. To study relative efficacies, evidence-based medicine and internet resources were used to analyze the relevant clinical trials and their outcomes. Research was also done to identify local resources available in Prineville for smoking cessation as well as available patient handouts and other telephone and internet support resources. After collecting this data, the results were presented to the physicians of Prineville at their weekly staff meeting in an effort to provide them with knowledge of smoking cessation methods to better assist their patients with their cessation efforts. Data was presented in the form of a handout to the physicians, which included the efficacy and cost comparisons as well as a short summary of other useful resources. “Revenge of the Turquoise Blob” or "A Toxic Algae Bloom in Siltcoos Lake" Project Date: 9/10/2007 Siltcoos Lake located 6 miles south of Florence, OR is the sole source of drinking water for approximately 300 people who live on or near it. It also serves as a recreational destination for fishing, swimming, camping, and boating. On September 18th, 2007 an advisory was issued for residents to avoid all contact with the waters of Siltcoos Lake due to a toxic algae bloom. This project attempts the following; 1. Identify the potential health risks associated with contacting or ingesting waters contaminated with toxic blue-green algae. 2. Estimate the actual numbers and types of illness that might be attributable to exposure the Siltcoos waters. 3. Identify resources for health care providers that help them to recognize blue-green algae toxicity, and resources that aid in treatment of toxic exposures. Improving information and support services available for parents of autistic children Project Date: 9/10/2007 The prevalence of autism in the United States has increased over the last ten years. Parents of an autistic child face many challenges, as their child often has additional health care needs such as physical, occupational, and speech therapy, and requires specialized educational programs. Parental support and education about autism are important aspects of caring for an autistic child, as a child’s home environment can greatly improve his/her overall functioning. The goal of this study was to evaluate what kind of information and resources parents of autistic children at Siskiyou Pediatrics in Grants Pass, Oregon were given. Interviews with pediatricians and parents revealed the need for a concise patient brochure with information on local and regional autistic services. Through an internet search, different agencies providing parental workshops and support groups in the southern Oregon region were located. As a result, a patient brochure was created which the pediatricians at Siskiyou Pediatrics can give to parents of autistic children. Hopefully, this information will be beneficial to parents as they will be equipped with the tools they need to understand, manage, and improve their child’s condition 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. Pattern of Emergency Department Use at Mountain View Hospital in Madras, Oregon Project Date: 9/10/2007 The emergency department use in the United States has reached an unprecedented level. The overcrowding and runaway costs that have resulted are an impetus to investigate ways to redirect nonemergent patrons from the emergency department to the primary care clinic. Despite the common opinion that patients who do not have a primary care physician or health insurance account for the majority of misuse, this is not well supported by published evidence. In single urban center research studies and a nationwide survey have found instead that lack of a regular primary care physician or insurance do not correlate with decrease emergency department use. Studies of single urban centers in particular may not be representative of rural healthcare entities. The issue of ED misuse has not been addressed in the specific setting of a rural ED. In this community-oriented primary care project, it was hypothesized that discernible groups among a small community may disproportionately use the emergency department for nonemergent care and thus provide a suitable target for interventions to decrease this misuse. To this end, emergency department visitors with various local primary care providers were documented for a one-week period and categorized as emergent or nonemergent. Although the numbers in the study were low, they suggest that patients from certain primary care clinics do have disproportionately high levels of emergency department use for nonemergencies. Reasons for this may include deficient patient education measures at these clinics and low weekly business hours. “The asthma burden in Lebanon, OR: development of a patient handout for education of newly-diagnosed and current patients with asthma” Project Date: 9/10/2007 With a population of 13,940, Lebanon, Oregon comprises 13% of the total population of Linn County and is the second largest incorporated town in the area. Given the vast amount of dedicated land to farming, agriculture is the largest industry in the county. It should be no surprise then, that Linn County has a large frequency of respiratory ailments. Compared to the other 35 counties in Oregon, Linn County has the highest prevalence of asthma (11.9%), more than a one-quarter more than Multnomah County (8.9%). With an increased prevalence of asthma in the county, it is essential that patients have readily accessible resources for education on this respiratory condition. This study attempted to identify those available resources and then develop a concise and comprehensive handout for a Lebanon family practice clinic. The design was observation of family physician’s interactions with newly-diagnosed and active patients throughout the course of a six week rotation in a high prevalence setting. A cursory investigation of available handouts yielded a lack of material on respiratory ailments. Therefore, the final product of this project was the development of a basic educational patient handout for those who have been recently diagnosed with asthma and those who desire more information on asthma. The goal was that this handout would work by improving knowledge about a common disease, foster discussions between patients and physicians, and provide patients with additional resources for further education. An analysis of barriers to regular exercise and implementation of a patient handout in Philomath, OR. Project Date: 9/10/2007 Benefits of exercise and increased physical activity are well documented. Despite this, many patients of Philomath Family Medicine (PFM) do not engage in regular exercise. At PFM the barriers preventing patients from engaging in regular exercise were assessed by interviewing multiple physicians within the practice, a local expert, and by patient survey. During observation of physician-patient discussions, physicians often lacked the time to thoroughly explore patients’ reasons for inactivity. A patient handout was created to stimulate self-reflection and provide education and motivation for how to overcome personal barriers. Med-Help: A booklet designed to guide those who need prescription assistance Project Date: 8/6/2007 For many ailments, prescription drugs are the backbone of current treatment. Many times, medication compliance has a direct impact on ones quality of life as well as longevity. Between 1998-2000, the cost of prescription medications rose more than triple the rate of inflation, putting them out of reach for many.1 In order for these patients to continue taking their medications, they need financial assistance. This study was designed with two objectives: First, to identify the population seen at the Wellness Clinic in Roseburg, Oregon. This was accomplished by running billing reports to establish populations by insurance type, since this has a significant impact on what assistance programs are available. Second, to research prescription assistance programs available for this population and design a simple means of delivering that information. It was decided that a booklet would be the best means of delivering the information. It was found that 47% of the patients were on Medicare, 5% were uninsured, and 2% on OHP. Those figures were used in researching prescription assistance programs for this population. A nine-page booklet was then constructed, using only resources already available to the clinic. This strategy was to minimize the burden to the clinic in continuing to make the booklet available to their patients. Diabetes Education Handout Project Date: 8/6/2007 The number of people with Type 2 Diabetes is increasing in the United States. It is a major contributor to overall morbidity and mortality in the Untied States and in Astoria Oregon. There was an average of 41.8 deaths per year (17.5% of all deaths) caused by diabetes between 2000 and 2004 in the Astoria service area1. Following diabetes management guidelines can help decrease the associated morbidity and mortality of type 2 diabetes2.This study attempted to identify information that would be helpful in educating patients about newly diagnosed diabetes and compiling the information into a one page handout. A family doctor in Astoria was observed counseling newly diagnosed diabetics. Educational material for diabetics was reviewed. A handout for patients with diabetes was the end product. Cardiac Arrest: Changing Resuscitation Guidelines to Increase Participation, Improve Survival Rates and Extend Community Resources Project Date: 8/6/2007 Each year, several hundred thousand Americans die as a result of cardiac arrest despite several decades' worth of training in cardiopulmonary resuscitation. Widespread confusion about when and how to implement resuscitation protocols, distaste for certain aspects of the procedure, and declining confidence in its potential for success contribute to a lack of bystander participation and resultant strain on local emergency resources. A handout has been prepared to reflect current research on the subject and provide an opportunity for further discussion. Small steps such as this may help to reintroduce the topic of cardiac resuscitation to the lay public, particularly if new guidelines are easier to understand and implement. 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. Cycling in Florence, Oregon Project Date: 8/6/2007 Cycling is an excellent form of exercise, with physical, mental and environmental benefits. Many of the most common causes of morbidity and mortality have improved outcomes in patients who exercise on a regular basis. Florence, Oregon is a small, coastal town with an older retirement population. Many people in Florence suffer from chronic diseases that could be improved with exercise. This study attempted to identify the current perceptions of, barriers to, and support for cycling among older adult chronic disease management patients in the family practice clinic in Florence. Additionally, an environmental survey of Florence’s cycling amenities was done, revealing a mostly flat, small town with low traffic streets and well maintained multi-use paths. There is also a full service cycling shop with an owner dedicated to promoting cycling in Florence. Most barriers to and negative perceptions of cycling identified in this project would be combated by cycling education and skills training in either group or one-on-one setting. This process was started with a resource book created for this project including safety information, local and online resources, local maps, a biking activity, and copies of several articles with evidence for the benefits of cycling in older adult populations. Putting the brakes on diabetes in Eugene, Oregon by putting the facts in a patient's hands: Development of a handout incorporating diabetes risk assessment and prevention strategies. Project Date: 7/2/2007 Diabetes Mellitus has grown into one of the nation's largest health concerns for the new millennium. Because of its insidious effects on the arteries of many organs, diabetes has a significant morbidity and mortality. The cost of treating diabetes also has a significant impact on healthcare and the economy. Dr. Larry Hirons, a family physician in downtown Eugene, Oregon, has watched many of his patients develop diabetes. He is always counseling his patients concerning weight loss and exercise, but would like a more specific tool to help patients realize their risk for developing diabetes, why they do not want to become diabetic, and how they can avoid diabetes. The prevalence of obesity in patients presenting to Dr. Hirons was observed, as well as his interaction with patients motivating them to lose weight and avoid becoming diabetic. A literature search was performed to identify a tool for diabetes risk assessment as well as studies showing effective risk reduction strategies. A handout was designed using the information from the literature search and the effectiveness of this handout was assessed by patient and physician interviews. Vitamin D Deficiency: Causes, Patients at Risk, Prevention and Treatment Project Date: 7/2/2007 Vitamin D deficiency is a common but often undiagnosed problem in both children and adults. There are many patient groups at risk for vitamin D deficiency, but currently no guidelines for vitamin D screening have been established. The patient base of my rural preceptor's practice includes many individuals who would fit into one or more of the groups at increased risk. This project began as a literature search to attempt to find suggested screening guidelines, and eventually became a project aimed at creating a useful table adapted from a recent meta-analysis of vitamin D deficiency that outlines causes of vitamin D deficiency, patients at risk, and vitamin D supplementation levels for prevention and treatment. Prevalence and patterns of breastfeeding in Scappoose, Oregon: Development of two handouts Project Date: 7/2/2007 The decision of mothers whether or not to breastfeed their infants has historically been influenced by trends and attitudes within our society rather than by an understanding of the benefits of breastfeeding. Lack of support by the partner or family has been demonstrated to be a major barrier for mothers to continue breastfeeding. This study examines the prevalence and pattern of breastfeeding among infants presenting for well-child exams to the OHSU Family Medicine Clinic in Scappoose, Oregon. The design of this study utilizes both quantitative and qualitative methods and included patient data base research, interviews with providers, childbirth educators and the WIC program nurse as well as observation and direct participation in prenatal and postpartum care clinics and a 4-week childbirth education class. The participation in the clinics and the class allowed for direct patient education opportunities and instruction on breastfeeding techniques. From the findings, two patient handouts were created, one explaining the benefits of and myths about breastfeeding, the other given detailed instruction on breastfeeding techniques and partner support. The handouts were available during the final days of the rotation and will assist the clinicians whenever women request information on breastfeeding during their visits to the clinic and serve as a guide to one-on-one instruction about breastfeeding techniques. In addition, they are to be made available during subsequent childbirth education classes and to provide a framework for future breastfeeding classes. Is your car or truck maintenance more current than your patients? Project Date: 7/2/2007 In Oregon we have yet to reach the Healthy People 2010 goals for Cervical Cancer screening and Colon Cancer mortality (Oregon Partnership for Cancer Control, 2005). These are only two of the multiple goals we have yet to achieve, but it shows that we need to improve the current system of patient education and motivation. Although there are many obstacles to reaching the recommended goals, my project focused on literacy, simplification, and consolidation through 3 population specific handouts. Throughout the project I found it odd that most cars are provided with a maintenance schedule that states at predetermined intervals the vehicle needs to have routine care, yet our personal health screening recommendations are not in a usable format for the general population. They are constantly evolving depending on the latest research, and the vaccine schedules can be extremely difficult to understand. While in Baker City, Oregon I created one handout each for men and women 18 and older that included vaccinations and cancer screenings based on the current recommendations of the U.S. Preventative Service Task Force (USPSTF), CDC, and American Academy of Family Physicians. I also created a schedule in a checklist format for parents that included recommendations for vaccines, well child exams, dental, hearing, and vision for children birth to 18, based on USPSTF, CDC, American Academy of Family Physicians, and American Academy of Pediatric Dentists. The goal was to assist patients in using the available resources in a simple and accurate format in order to improve screenings and vaccinations. They were provided to Eastern Oregon Medical Associates and Baker County Health Department. Increasing Exercise in Reedsport. Project Date: 7/2/2007 Exercise can help prevent and improve many chronic conditions. Reedsport, a small town on the Oregon coast, offers an incredible venue for an active lifestyle – there are lakes, rivers, sand dunes, beaches, pools, gyms and great trails for walking. Family practice physicians at Dunes Family Health Care (DFHC) in Reedsport spend a considerable amount of time counseling patients on the benefits of exercise. Despite the encouragement of the healthcare community and the favorable environment for physical activity, many of the patients at DFHC struggle to incorporate exercise into their daily routine. To help address these issues, I created www.reedsportwalks.com - an interactive, self-sustaining, online forum to help the Reedsport community lead a healthy, active life. The site contains information regarding the importance of exercise, how to start exercising by setting reasonable goals, and how to overcome barriers like chronic pain and time constraints. There is also a comprehensive list of exercise ideas specific to Reedsport including a walking map of the surrounding area and schedules for the pool and local gyms. The site was set up as a google group, making it easy to access, self-sustainable, and interactive. Ideas on how to expand the site include: publishing a page on specific exercise ideas for kids and teens, organizing a community fitness event or weekly walking group, or expanding the site to include healthy options for eating out in Reedsport. Establishing a web home for the Strawberry Wilderness Community Clinic Project Date: 7/2/2007 Internet usage in rural areas is rapidly increasing. As this occurs, more and more rural businesses are establishing online web presences, allowing them to interact with current customers and reach potential new ones. In the health care arena, the ability to attract patients is limited by physical distance, but the Internet can also be used to disseminate important information both about the clinic and about the health care provided. This project is designed to establish a web home for the Strawberry Wilderness Community Clinic, for which patients will be able to find out information about the services provided by the clinic, common health problems and procedures performed, and interact with clinic staff by email or by phone. Elimination of tobacco use at a small community hospital as a means to better promote public health: development and implementation of a tobacco-free hospital plan Project Date: 4/30/2007 The adverse effects of smoking are well-known to health care workers and to virtually all of the general population. Yet in the face of strong data, smoking remains a prevalent activity that places a large burden on the health care system. A November 2006 report from the Public Health division of the Oregon Department of Human Services stated that “Tobacco continues to be the leading preventable cause of death and disability in Oregon.” The Tobacco Prevention and Education Program (TPEP) of Oregon has sought to better public health through a three pronged approach: 1) preventing kids from starting to use tobacco, 2) reducing exposure to secondhand smoke, and 3) helping current tobacco users to quit. As sites specifically intended for bettering and promoting health, hospitals are visible platforms for addressing public health issues. This study addressed smoking on the grounds of the Santiam Memorial Hospital and how the approach of the TPEP could be instituted to further promote a healthy community. As a plan for a tobacco-free hospital was developed, all three aspects of the three pronged approach were included. The local Tar Wars program was used a method for attempting to prevent children in the community from starting to use tobacco. Eight local 4th and 5th grade classes received anti-tobacco presentations during the month of May. A ban on tobacco use on the hospital grounds will be put into effect as a method for reducing exposure to secondhand smoke at the hospital. Thirdly, the plan for the tobacco-free hospital included several community outreach activities designed to promote tobacco cessation in the community as a whole. A brief analysis of current smoking cessation aids was also created to help hospital staff evaluate tools for helping patients, staff, and community members overcome nicotine addiction. A timeline for the tobacco-free hospital plan has been created and is currently in motion at the hospital and in the Stayton community. The state of teen pregnancy in Josephine County Project Date: 4/30/2007 Nationwide Oregon ranked 16th (50th = highest) for teen pregnancy rates in 2004. The trend is an overall decrease in the number of teen pregnancies across the nation, the state, and the counties. Despite favorable statistics, further assessment of resources available in Josephine County are concerning for inadequate sexuality education, lack of contraceptive access, and few services for young parents. Teen pregnancy has considerable social, economic, and personal costs, and resources need to be re-allocated in order to continue a downward trend in teen pregnancy, rather than a stasis or increase. A Closer Look at the Nutritional Habits of Scappoose High School Students Project Date: 4/30/2007 Obesity has become increasingly prevalent among school-aged children and adolescents in the United States. With obesity becoming increasingly more widespread in the U.S., especially amongst the rural population, it is probable that adolescents in their high school years will reflect this same trend. This study examines the attitudes towards nutrition of Scappoose High School students who do and do not participate in an athletic activity in Scappoose, Oregon. A survey was formulated which gathered information on their opinions on the cafeteria foods as well as on the impact of athletic or physical activity on nutritional choices. At the present, nutritional education for the general Scappoose high-school population is limited to a part of the Health class curriculum. At the clinic, nutritional habits are checked when adolescents come in for a sports physical exam. Otherwise, there was no established presentation of the nutritional values of the food offered by the school or the benefits of physical activity on their health. The results of this survey will be given to the athletic director and health class instructor to aid in their understanding of their students views on nutrition. Obesity and Delinquency in Ontario Public Schools: A prescription for better schools and healthier kids. Project Date: 4/30/2007 The pediatric population is unique in that for six-to-seven hours in a given day they spend their time in a controlled environment. The objective of this study was to review the literature and make recommendations that could be instituted by the school district to address two concerns in this population: obesity and delinquency. Many comments were made by health care professionals and community leaders about these problems, particularly the increased disruptive behavior, drug and gang activity in the middle school. Though the school district was restructuring its schools to meet these new challenges, alternative solutions were being sought. A review of the literature revealed a number of strategies that could be implemented by the school district to decrease disruptive behavior and the trend in obesity. First and foremost, returning sixth graders to the elementary schools will decrease disruptive behavior in the middle schools and will decrease the likelihood that these children will continue such behavior into later school years. In addition, scheduling recess before lunch can decrease after-lunch classroom rowdiness and increase instruction time by up to 10 minutes. In addition, children make healthier food choices and waste less food; this can translate into cost-savings for the school district. Lastly, instituting a universal school breakfast program also contributes to children making healthier eating habits during these impressionable years. 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. Treatment of the prediabetic patient in a primary care practice. Study of the current practices of managing prediabetic patients in Philomath, OR Project Date: 4/30/2007 Diabetes is a serious medical condition affecting 20.8 million children and adults in the United States, or 7% of the population. The diagnosis of diabetes has far reaching consequences including adverse effects on a patient’s kidneys, heart, eyes and nerves. There is growing evidence that a pre-diabetic states exists before the development of diabetes and that individuals in this state have the opportunity to prevent the disease through lifestyle changes in their diet and exercise regimens. The purpose of this project is to identify the prevalence of a population at high risk for diabetes, to assess current methods of diabetes prevention through interviews with family practice doctors and to develop effective patient education materials, which will help to teach patients methods to modify their risk for developing the disease. Education will be focused on lifestyle modifications with the goal of preventing the development of type 2 diabetes. Future projects may assess the effectiveness of these materials by long term follow up of the identified patient population and their propensity for developing diabetes. Gasps in the Night: Improving CPAP Compliance in the Primary Care Setting of Coos Bay, Oregon Project Date: 3/19/2007 Although continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), it is sometimes intolerable to patients and compliance can be a major obstacle. Primary care providers may not be aware of the resources available to improve compliance and without early intervention the patient may ultimately fail the therapy. In addition, appropriate screening tools need to be integrated into the Electronic Medical Record (EMR) to diagnose sleep apnea, facilitate appropriate referrals for sleep studies, and to follow up after therapy has been initiated. Therefore, it was undertaken to determine what kind of resources can be given to primary health care providers to improve CPAP compliance among their patients with OSA. The perioperative evaluation of the diabetic patient in Grants Pass, OR: A patient guide for long-term disease management Project Date: 3/19/2007 Diabetic patients remain amongst the more vulnerable and complicated surgical candidates. Experts agree that the most effective measure taken to minimize peri-operative morbidity is maintaining long-term glycemic control. During a family medicine clerkship in Grants Pass, Oregon, it was noted that both patients and providers felt that improving patient awareness regarding diabetes management is key in achieving the optimal glycemic control. Given the complexity and scarcity of local diabetes educational resources, a summarized guideline was designed in the form of a patient hand-out to enhance peri-operative cooperation amongst patients and their various health care providers. Based on the request of local family doctors, a portion of this hand-out was dedicated to dietary instructions and risk factor modifications that can serve as a supplement to in-office discussions between the physician and the patient. Reach Out and Read in Baker City. Project Date: 3/19/2007 The importance of health literacy, as well as the importance of early intervention to reading acquisition, has been increasingly recognized. Baker County has a low percentage of children entering school ready-to-learn, and while there is a well-established Literary Council, more emphasis on early intervention is desired. The Reach Out and Read program has health professionals emphasize the importance of parents reading to children, and donates books to those children during well-child visits. Eastern Oregon Medical Associates (EOMA) is the largest primary care provider for children in Baker County, and recently moved to a new office, in which they were wondering how to entertain children in their waiting room. A Reach Out and Read program was developed, which included the following steps. Community data were collected and an application was submitted. Community support was generated through the local Literary Coalition. 200 book donations were collected, and a grant was drafted for submission to the Juan Young Trust. Books were placed in the waiting room with enthusiastic response from parents and children. Optimizing Well-Child Visits in Coos Bay, OR Project Date: 3/19/2007 Well-child visits make up a large part of a general pediatrician’s daily schedule. Due to time constraints and the plethora of information to be addressed, there is a growing desire among the pediatricians of North Bend Medical Center in Coos Bay, OR to make these visits more efficient and effective from both the physician and parents’ perspective. This project aims to identify the general structure of well-child checks (WCC) and the content covered during the visit that is important from both an educational standpoint and of concern to the parent/patient. The design involved a search through literature examining the content and purpose of WCC, improvement strategies, and barriers presenting in rural settings, as well as informal discussions with pediatricians and parents in North Bend Medical Center. As a means of pinpointing what topics directly concern the parent, a questionnaire listing common developmental, psychosocial, safety, and family issues was created. It is thought that specifying concerns through such a questionnaire will help tailor the visit to an educational discussion regarding issues that both the pediatrician and parent believe are in the best interests of the pediatric patient. Urinary Incontinence: Dribbling into the Golden Years Project Date: 3/19/2007 Reedsport, OR is an old logging town with an aging population. Unfortunately, its community is suffering from illnesses that increase with growing old, including urinary incontinence. Urinary incontinence affects up to half of all women eclipsing hypertension, depression, and diabetes in prevalence (Sutherland, 2004). It is associated with troubling morbidity such as falls, urinary tract infections, skin breakdown, depression, and social isolation (Resnick, 2004). Many women believe that urinary incontinence is a normal part of aging. Although the medicines and conditions that predispose urinary incontinence increase with age, UI is neither inevitable nor untreatable. With treatment, up to 90 percent of those with UI can improve (Khan, 2004). In towns like Reedsport, patients routinely wait up to 4 months for an appointment with an urologist. Fortunately, an urologist is only needed for the most recalcitrant cases, and family practitioners have the tools to diagnosis and treat the majority of patients. With this project I described the Reedsport community and why it carries a large burden from this problem. I also interviewed patients to better understand the problem and its impact. Then, I performed a literature review to learn how to best identify and treat UI. Finally, I created tools for diagnosis and patient education. Lane County’s Struggle to Help Newborns and Mothers: An Emerging Problem with Promising Solutions Project Date: 2/12/2007 The process of nurturing an uncomplicated pregnancy, delivering a viable and healthy baby, and maintaining the normal growth and maturation of the baby and health of the mother has been the focus of the field of obstetrics and one of the most important medical issues in the United States and worldwide. Previous research has shown that Lane County has the highest perinatal and neonatal mortality rates in the state of Oregon and ranks among the highest in the nation. This study attempted to identify and shed light on the challenges that face mothers and babies in Lane County which contribute to the high perinatal and neonatal mortality rates and evaluate the effectiveness and availability of resources and regional public health institutions that can best serve this specific health care population. The population studied was the female patients who came to the Junction City Medical Clinic along with their newborns for well-child examinations. Each of these patients was asked about challenges that they had faced with regard to receiving adequate prenatal care during their pregnancies. Using patient-provided information further outside research, and dataset analysis, a patient questionnaire was designed to help the expecting mother from Lane County to assess her prenatal needs and to help her better identify the prenatal care resources available to her. The ultimate goal is to be able to better unify and collect these resources and organize them into a neat and convenient handout that provides patient the information they need and also educates them on the necessary prenatal topics. This handout will be made available to Lane County Public Health Department and to the Junction City Medical Clinic to distribute to patients who need prenatal care and health care for both mother and baby after delivery. 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. Parental safety education for infant children and implementation of the Baby Safe program in Coos County, OR Project Date: 2/12/2007 There are high rates of child abuse and neglect in Coos County, Oregon. Struggling industry and associated poverty, along with difficulties associated with resource accessibility in rural Coos County have contributed to the problem. Although poverty, drug and alcohol abuse, and low education levels will continue in the community, education of mothers regarding infant safety may help to reduce the burden of child abuse and neglect. Working with the Bay Area Hospital MOMS program and the Bay Clinic pediatricians, I updated and developed an electronic program for the new Baby Safe program, a class for mothers designed to educate them how to safely care for their infant children from birth to one year of age. Along with the Baby Safe presentation, I provided local pediatricians and their staff with an overview of National, County, and hospital-based resources for educating and supporting mothers Borderline Personality Disorder and Dialectical Behavioral Therapy in Coos Bay, OR Project Date: 2/12/2007 Borderline personality disorder (BPD) is a DSM-IV Axis II disorder seen in approximately 2% of the population, with higher prevalence in primary care settings. Primary care providers (PCPs) are often challenged by patients with BPD, and in many cases do not recognize these patients who often have higher levels of health care utilization. A treatment for BPD that has proven effectiveness is dialectical behavioral therapy (DBT), a structured psychotherapeutic intervention, which is available in Coos Bay, Oregon as a college course. This project sought to improve health care for patients with BPD in the Bay Clinic of Coos Bay, who face significant limitations in available mental health providers in the area, and thus rely on PCPs for mental health treatment. Ten PCPs were interviewed regarding their knowledge about BPD and DBT, revealing limited knowledge of both of these subjects. Interviews of patients with BPD revealed a lack of communication about their diagnosis and treatment with their PCPs. Informative material about BPD and DBT was provided to PCPs at the clinic. A guide with yes-or-no questions was established and distributed in order to assist PCPs in evaluating patients for potential referral to DBT, and PCPs were provided with materials for patients about the course. Limitations included the use of handouts and lack of time and resources to evaluate outcomes. Eastern Oregon Medical Associates Weighs In: Assessment of the prevalence of overweight and obese patients in a rural community health clinic and provider education about screening, prevention, and treatment of obesity. Project Date: 2/12/2007 The obesity epidemic in the United States is well known to primary care providers. Obesity is a contributing factor to patients acquiring diabetes, hypertension, coronary artery disease, arthritis, certain cancers, and other diseases. Lowering an overweight or obese patient’s weight by just 10% can decreased their cardiac risk factors and can increase their quality of life.1 Primary care clinics are the cornerstone of prevention, screening, and treatment of obesity but according to providers at Eastern Oregon Medical Associates (EOMA), advice on healthy eating and exercise often falls on deaf ears. Physicians at this rural health clinic feel that they have an overwhelming number of overweight and obese patients but are unaware of the most effective ways of counseling these patients about weight loss. They were also eager to learn of any new treatment options. This project aimed to determine just what the rates of overweight and obese adult patients were in the clinic and to educate the providers on the most recent research and recommendations on screening, prevention, and treatment. EOMA uses an electronic medical record system that automatically calculates BMI with each patient visit. To determine the prevalence of overweight and obesity, data was collected for all patients 15 years and older who had a BMI of greater than 24 by using the EMR system’s search function. Data was categorized by overweight (BMI>24 but <30) and obese (BMI>/=30) and then further categorized into gender and age. It was found that EOMA has a prevalence of 12.6% overweight patients and 13.5% obese patients; much lower than the national prevalence. Research using several different methods (Medline database search, Cochrane database search, and use of NIH and CDC data) was used to find the most current information and recommendations on screening, prevention, and treatment of obesity. This information was compiled into a report that included the clinic data and was presented to all providers at EOMA. Depression in the Elderly - Community Resources in Reedsport, Oregon Project Date: 2/12/2007 Depression is a common problem in the elderly population. Literature shows that exercise and social interaction have a tendency to improve and maintain good mood. The goals of this project are to first explore the resources in the community for the senior population, then to evaluate the utilization of these services by conducting a survey, and lastly to develop a patient handout to increase awareness of local resources and to encourage physicians to incorporate exercise and social interaction into treatment plans for elderly with dysthymic mood. Many activities and programs through the senior centers and the senior & disability services are available locally. However, only 50% of those with dysthymic mood use the senior center, while 78% of those with good mood utilize the services. In addition, those with lower mood score are less likely to have a regular exercise schedule. In a rural setting where social workers are not readily accessible, it is beneficial for physicians to know the local resources in order to effectively help their patients. Implementing the New HPV Vaccine: developing informational resources for patients and clinic tools for its use Project Date: 2/12/2007 A new vaccine is available that protects against the most common types of HPV that cause cervical cancer, but the patients of the High Desert Medical Center have limited information available to them about this vaccine, and the clinic itself has not begun using it. This project had two goals: first I attempted to help create informational resources about this new vaccine, and secondly, to help implement its use in the clinic. To achieve increased patient education, a brochure was developed to be distributed to patients at the clinic. An article about the vaccine and cervical cancer was also written that will run in the local newspaper. To help the clinic put the vaccine into use; I worked with IT staff to add reminders and schedule tracking of the new vaccine. I also acquired the cost information from the most commonly used insurance companies in the area. 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. HPV Vaccination in the Illinois River Valley: A survey of attitudes and availability, with recommendations for increased vaccination Project Date: 2/12/2007 Gardasil, the vaccine against 4 strains of the Human Papilloma Virus, is currently a hot topic among women’s health providers and also the mainstream media. My project attempted to identify the best method for improving vaccination rates amongst young women in the Illinois River Valley. I found that no providers in the Illinois River Valley offered the vaccine, due to lack of demand, prohibitive costs and difficulty in purchasing. Young women who were interested in receiving the vaccine were referred to the County Health Department a 25-35 minute drive, which was prohibitive for some patients. Although, I would have liked to be able to recommend that providers in the IVR offer the vaccine to their patients, my research was not able to support that conclusion. Instead, I recommend provider education and a concerted effort to encourage vaccinations through the School Based Health Programs and continued referral to the County Health Department. 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. Educating Expectant Parents: Creation of a Newborn Care Presentation Project Date: 1/1/2007 Many expectant parents anticipate the arrival of their first child with excitement and anxiety. During the months approaching the due date, in addition to advice and reassurance sought from relatives and friends, parenting and birthing classes in communities offer structured education on newborn care to these parents-to-be. In Coos County, Oregon, free educational classes on newborn care, breastfeeding, and children's home safety are offered through the Bay Area Hospital's MOMS (Management of Maternity Services) program. Local pediatricians from North Bend Medical Center and Bay Clinic give presentations on these topical issues in scheduled monthly night courses. The current newborn care class, which consists of a pediatrician talk and bathing and dressing baby demonstrations, includes a stale and outdated slide-show on common and uncommon newborn characteristics from birth marks to neonatal jaundice. MOMS program coordinators and Coos County pediatricians have sensed that this made-in-the-1970s slide-show is ineffective in educating expectant parents and have voiced a need for an engaging and effective presentation on newborn care. The aim of this community project is to create a fresh, interactive, and updated newborn care educational presentation for expectant first-time parents in Coos County. Heart Disease and Diabetes Handout for Kids Project Date: 1/1/2007 Heart disease and Diabetes are two of the most common diseases now present in the U.S. In the National Health Survey of 2004, the percent of non-institutionalized adults with diagnosed heart disease was 11.5 and the number of annual deaths was 654,092. In 2004, heart disease was responsible for 1/3 of all deaths. Diabetes is also of epidemic proportions. Approximately 7.2 million people have Type II Diabetes in the U.S.(actually diagnosed). According to the National Diabetes Statistics fact sheet, (NIDDK of 2003) approximately 1 in 17 or 5.88% or 16 million people in USA have diagnosed and undiagnosed diabetes. Diabetes is the nation's seventh leading killer and contributed to about 187,800 deaths in 1995 Two known risk factors for these diseases include smoking and obesity. Despite this, the incidence of obesity in adults and children continues to rise, and smoking has increased in young adolescents. For these reasons, we feel it is extremely important to begin educating young children about heart disease and diabetes, and give them basic tools to avoid these diseases. To accomplish this in the rural family practice setting, a children's book was created which outlines the basics of these diseases and encourages healthy eating, exercise and not smoking as three methods to help prevent heart disease and diabetes. The book will be used in the office setting as a tool to open up conversation and learning opportunities around these issues. In addition, a one-page handout summarizing the above will be given to the patients to take home as a reminder of what they learned. This is the beginning of an early education regarding the importance of lifestyle choices in the future health of our nation. Expanding Anticipatory Guidance in Columbia County Project Date: 1/1/2007 Columbia County has seen a significant increase in recent years in the number of single mothers with children younger than 5 living below the poverty level. Many parents in the community lack resources and access to parenting information. Various programs in the county provide services to young mothers and children, including Head Start, Healthy Start, and WIC. In addition, the OHSU Family Medicine Clinic at Scappoose serves patients primarily from Scappoose and St. Helens, the largest towns in the county. Providers in all facilities expressed a need for simple hand-outs to give to parents with anticipatory guidance and advice about parenting for children of different ages. Handouts were created with guidance for all well-child visits from ages 2 weeks to 5 years. Guidelines focused on age-specific information about nutrition, development, and safety. The materials were distributed to providers at the Scappoose Clinic and program directors for Columbia County Head Start, Healthy Start, and Columbia County Department of Public Health, which coordinates the county WIC program. Contraception and Family Planning Education in Madras, Oregon Project Date: 1/1/2007 Jefferson County Oregon has the highest teen pregnancy rates in the state, however, it has doctors that are working to decrease that rate. To help them in the pursuit of this I developed a comprehensive patient handout explaining 17 different contraception options available. The handout is designed to allow patients to make the decisions about which contraceptive methods works best for their lifestyle. I attempted to increase contraception education giving a talk to and getting the handouts to be apart of the materials offered at the county birthing and parenting class. The result was a one page double sided handout that was well received by physicians, nurses, and staff at Madras Medical Group. This handout will help Madras health care professionals guide their patients in making contraception decisions. Perspectives on end of life preparedness and POLST implementation by providers in Reedsport, Oregon. Project Date: 1/1/2007 End of life planning is an emotionally charged topic of discussion for medical personnel, patients, and families. Throughout the country, the use of heroic and expensive treatment for those with terminal conditions is the subject of debate by medical personnel as well as ethicists. End of life practices vary by hospital and certainly by demographics. This project seeks to explore the attitudes and practices of seven medical practitioners in a family health clinic in a coastal community in Oregon. The unique environment that is embodied in this town is similar to other small rural communities across the country. Reedsport has a critical access hospital that contains 22 acute care beds with accommodations for two ICU beds. It also has an extended care facility associated with the hospital. Its ER is staffed primarily by local family doctors. The family practice clinic serving this health district is located immediately adjacent to the hospital. This presents a unique opportunity to evaluate the practice and implementation of end of life measures in different medical settings by the same medical practitioners. Many if not all of the patients who are admitted to the local hospital by the ER physicians are also the patients of these same practitioners of community based medicine. Attitudes toward end of life issues were sampled by personal interview and completion of a small survey. Strategies are discussed for the increased implementation of POLST forms in the practices of these providers and in their community. West Nile Virus in Malheur County Project Date: 1/1/2007 Malheur County, Oregon recorded 52 cases of West Nile virus (WNV) infection during the 2006. This was a dramatic increase from 8 cases the previous year. Cases were investigated by the Malheur County Health Department (MCHD) and forwarded to the state Department of Human Services (DHS). No summary document was generated locally for the epidemic. This left providers without up-to-date information regarding risk for infection and treatment of lasting effects. My project was to generate a provider education pamphlet that included 1) a summary of the 2006 epidemic in Malheur County 2) a review of journal articles regarding the lasting effects of WNV 3) information on clinical trials currently enrolling cases, and 4) predictions for the 2007 season. This pamphlet will be printed and distributed to Malheur County providers by the MCHD Patient awareness of smoke cessation resources in a Stayton family medicine clinic and Physician intervention. Project Date: 10/16/2006 Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality worldwide. Smoking is responsible for approximately one in five deaths in the United States. According to the a survey done by the Centers for Disease Control in 2002, there were 50 million smokers in he United States, of which 70% wanted to quit smoking. 41% of those smokers make at least one attempt each year, but only 7% are successful. The majority of these people (90%) attempt to quit “cold turkey.” Countless studies have shown that although this is the most common way to quit it is by far the least effective. Those who use other resources have up to a 30-45 % success rate compare with a less than 10% overall success rate for quitting cold turkey. This study was done to evaluate patients’ awareness of these resources in a Stayton family medicine clinic as well as to determine if they are being encouraged to quit by us as care givers. Through an electronic chart review it was shown that 80% of the smokers in this clinic have documentation in their chart that quitting was discussed. A survey was done and showed the following percentage of patients that knew about each of the resources available: 100% nicotine gum or nicotine patch; 57% Zyban pill; 0% SMART shot; 100% hypnosis, 71% acupuncture; 14% Chantix pill; 42% free telephone counseling. If we can better educate our patients concerning the use of quitting resources it is more likely that they will attempt to quit using them the next time. This will significantly increase the number of patients who are successful quitters and obviously markedly improve their health and the health of the community Patient Centered Education Materials in Klamath Falls Project Date: 10/16/2006 Klamath Falls, OR has a population of around 42,000 people. For many this would call into question it’s designation as a rural community in the state of Oregon. Due to its larger population, however, Klamath Falls provides medical services to many residents of surrounding communities that are completely devoid of medical care. With such a large portion of the patient population located so far from the clinic, I felt that the creation of some patient education materials would help patients learn more about their healthcare outside of the clinic. To accomplish this I created the brochure “Finding Breast Cancer Early with Breast Self Exam” and the handout “Is the new HPV vaccine right for you or your daughter?” The brochure on breast self exam was created in enough time to get some feedback from patients coming in for their annual well woman exam. Overall, they were appreciative of the brochure, but for the most part they ignored it. This didn’t allow for a lot for feedback, and instead it made me question whether my initial assumption about the necessity of such materials was true. I do feel that both of these handouts will be helpful to some of the future patients in my preceptor’s practice, but I also wonder what other ways there are to provide education outside of the clinic. This project definitely got me thinking about other options. Proper usage of child safety seats and booster seats in Baker County, OR: development of a brochure to educate patients for dispersal at the Baker County Health Department Project Date: 10/16/2006 Motor vehicle accidents are the leading cause of death and disability in children. This is often preventable with the proper use of child safety seats and booster seats. While these devices are often used by parents, in Oregon 85% of child safety seats and 51% of booster seats were installed incorrectly. Baker County has NHTSA certified child passenger safety technicians who can assist parents in inspecting and installing child safety seats and booster seats. The Baker County Health Department immunizes 97% of the children in the County and is an ideal location to reach parents and educate them regarding proper usage of child safety seats and booster seats and to direct them towards local resources for inspection and installation. A brochure was produced for dispersal at the health department which included information on local and internet resources, Oregon Law, and the proper usage of child safety seats and booster seats. Diabetes Mellitus and Obesity in Eugene, OR: An Assessment of the Epidemic and Development of Treatment Recommendations. Project Date: 9/11/2006 Diabetes is a growing epidemic worldwide. In the U.S. diabetes is the sixth leading cause of death and affects 18.2 million Americans currently, with an estimated 5.2 million who have not yet been diagnosed. Importantly, overweight and obesity are the main modifiable risk factors for type 2 diabetes. The goal of this community project was: 1) to assess the nature of the problem of diabetes and its relationship to obesity at Barger Family Medicine Clinic, 2) to develop a guideline based on an extensive literature review in the management of diabetes and obesity and 3) to develop a hand-out and nutritional food guide for patients with diabetes. Understanding Chemical Dependency as a Family Illness: Ways to Help in a Rural Primary Care Facility Project Date: 9/11/2006 Misconceptions about drug and alcohol addiction abound in American society. Addiction is a brain disease as shown by neurobiological studies. However, most Americans, even physicians, view it as primarily a moral or personal weakness. Families need to be educated about the causes of addiction, but they also need to understand their roles in helping their loved ones. Resources for addicts are available, but often the effects of chemical dependency on the family system are overlooked. My project’s concrete goals were to educate the staff about addiction, as well as to develop some handouts they can give to families suffering from a loved one’s addiction. Abstract goals were to help families: 1. Understand chemical dependency 2. Accept chemical dependency as a family illness 3. Embrace self-acceptance 4. Commit to a continuing recovery program 5. Identify local resources Educating Parents in Coos County, Oregon: Development of a Postpartum Class at Bay Area Hospital Project Date: 9/11/2006 Many parents of newborn infants are not receiving the information that they desire from their health care professionals. Well child care visits with the pediatrician usually occur at birth, 2 weeks, 2 months, and so forth. During these visits, anticipatory guidance is often limited by the time and preference of the physician. Mothers were indicating a desire for more information and pediatricians were confirming an increased number of phone calls and office visits regarding these same issues. In order to identify the topics of concern as well as propose an educational solution, investigatory interviews were conducted with 10 mothers, 3 pediatricians, and 4 maternal education staff members. Interview results confirmed that parents expressed to know more on the following topics: increased crying, a variety of baby health issues, mother's health issues, sibling adjustment, returning to work, feeding issues with returning to work, time management, and safety. Using the results of these interviews, as well as the published guidelines on anticipatory guidance, a class was developed entitled Postpartum 101: Practical Tips For Parents of 2-8 Week Old Infants. The hour long class consists of a powerpoint presentation, discussion questions, hands-on activities, and associated handout. The class is scheduled to be taught regularly by a local pediatrician and nurse under the auspices of the maternal education program at Bay Area Hospital. Increasing awareness of opportunities for social interactions and physical activity for senior residents of Philomath, OR Project Date: 9/11/2006 Numerous studies have demonstrated the benefits of maintaining social interactions and engaging in physical activity for elderly people. These include an increased sense of independence, improvements in quality of life and general functioning, an increase in measures of mental health functioning, as well as lower rates of obesity, diabetes, osteoarthritis and cardiovascular disease. I sought to catalog resources in the community for opportunities for social interaction and physical activity and to overcome the barriers of cost and transportation to encourage utilization of these resources. I then designed a large color poster to encourage awareness of local opportunities, printed 30 smaller color handouts for seniors to take home, and compiled an informational binder to be housed in the waiting room at Philomath Family Medicine. Primary Prevention in Eugene Oregon: Recognizing Environmental Injuries during youth sporting events Project Date: 8/7/2006 Heat injuries have the potential to become a medical emergency if not detected and treated in a timely manner. Heat stroke, the most severe form of heat injury, carries a significant mortality rate, especially when therapy is delayed. Some studies cite mortality rates between 10-70% depending on several factors including duration of peak body temperature. Heat stroke is 100% preventable and with such a high morbidity and mortality rate primary prevention is paramount. Youth sports that start in the fall begin practice in August and there is a potential to develop heat injuries in this population. Coaches involved with these sports should be trained to recognize the signs, symptoms, and initial treatment of heat injuries to prevent the progression to heat exhaustion or heat stroke. In addition, it is important for coaches to recognize when the local emergency medical services should be activated in order to institute a higher level of care with regard to the injured individual. This project focused on educating youth coaches about the signs, symptoms, and treatment of heat injuries in the effort to prevent the morbidity and mortality associated with the more severe forms of heat injury, heat exhaustion and particularly heat stroke. Mental Health Issues in Josephine County: Facilitating the Transition from the PCP's Office to Community Mental Health Services Project Date: 8/7/2006 Psychiatric illness is a major medical issue in the community at large and is too often under-treated. The problem of inadequate identification and treatment appears to be even more severe in rural areas. This study explores issues that render provision of mental health services in rural areas problematic and discusses a particular mental health issue, namely depression, in some detail. This issue is considered in the context of Josephine County with special emphasis on the Grants Pass area. A patient pamphlet was designed with the purpose of educating patients regarding the illness, screening patients for the illness, and informing patients of their options in the event that they did in fact feel depressed. Weight loss interventions in Astoria, OR: development of a patient resource guide to connect patients with weight loss resources in the community. Project Date: 8/7/2006 With over 60% of Americans classified as overweight or obese, a significant portion of our population continues to share an elevated risk for obesity related conditions such as diabetes, hypertension, coronary artery disease, arthritis and sleep apnea. Through this project, I hoped to identify ways in which physicians could support their patients who are trying to lose weight. Exploring this question involved observing how my preceptor in Astoria discussed weight loss with her patients. I then created a list of simple, cost effective ways a family physician could support weight loss among a patient population. An interview was conducted with my preceptor and her practice partner to learn how willing they would be to implement various weight loss interventions. I spent one morning at Curves, a chain fitness center that offers circuit training and is attended mostly by women. Willing participants were interviewed regarding weight loss and how doctors could support weight loss efforts. Interviewees were also asked to evaluate how helpful it would be if their doctors implemented various specific weight loss interventions. Of the many interventions suggested, patients and doctors were most excited about the availability of a booklet that presented information on local resources for weight management. Therefore, the project culminated in the creation of "Health Knocks: A Resource Guide to Weight Management in Astoria, OR". This tool will help physicians to connect patients with weight loss resources n the community. Improving Anticipatory Guidance in Rural Family Medicine Project Date: 8/7/2006 Anticipatory guidance is considered an important component of well-child care. Many adverse outcomes to pediatric populations are easily avoided with adequate and effective anticipatory guidance. The purpose of this project was to investigate the current practices of providing anticipatory guidance employed by health care providers at the OHSU Family Medicine at Scappoose clinic, and to seek ways of improving parental education and implementation. This project seeks to improve anticipatory guidance in rural family medicine through the development of handouts providing information for parents that correlates with verbal guidance given during the well-child visits from birth to 2 years of age. Providing good anticipatory guidance is an effective and important way to encourage health and safety in the pediatric population. "Health in Action!" in Baker County: How do we determine its effectiveness? Project Date: 8/7/2006 When you attempt to MOVE an entire county, how do you monitor your successes and failures along the way? In Oregon’s Baker County a MOVING FORCE has begun in the form of a community project titled “Health In Action!”. This paper is aimed at developing a means to which “Health In Action!” can gather and eventually begin to analyze data concerning their efforts to MOVE the county. The design was based largely on discussions amongst facilitators of “Health In Action!”. Specific needs for data collection and analysis were primary topics of conversation. Other sources of information included recent studies conducted throughout the United States that were geared toward public health surveillance and program evaluation. It was concluded that to further improve community needs assessments in Baker County with regards to “Health In Action!”, questionnaires would be developed and utilized at four specific activities sponsored by the program. In conclusion, questionnaires were categorically created to facilitate the required data collection and future analysis. Patients and Providers’ Perceptions of Motivations for Cessation of Methamphetamine Use on the Warm Springs Reservation Project Date: 8/7/2006 Methamphetamine abuse continues to be a scourge on the health and welfare of rural communities throughout Oregon. While treatment programs exist, screening for use and facilitating users’ willingness to enter such programs are significant problems. This project examined the motivations of methamphetamine users to quit while concurrently probing the ways in which providers at the clinic on the Warm Springs Reservation screen for and encourage cessation of methamphetamines. The assessment of both groups was done via standardized interview. The results of this study show that the perceived motivations for cessation of use between users and providers were similar in some respects and dissimilar in others. Specifically, a fear of losing custody of children was a common perceived motivation by both groups although there was little implementation of this motivation in patient care. Also, abusive relationships were found to be a perceived barrier for former users while this went largely unrecognized among providers. Well-water use in Springfield, Oregon: Understanding Patient Knowledge and Practices and Developing a Patient Handout on Well Water Safety. Project Date: 7/3/2006 The safety of well water has important health implications for thousands of mostly rural Oregonians. While there is little data quantifying the amount of illness and disease caused each year by the contamination of well water, it is well known that certain contaminants both are present in well water and have the potential to cause short-and long-term health problems. This study attempted to assess the level of knowledge that patients at Springfield Family Physicians have of the potential health risks of drinking well water, as well as patients' knowledge regarding steps that can be taken to assure the safety of well water. This was accomplished by designing a questionnaire about the sources of patients' drinking water and their attitudes and practices regarding water safety. Finally, a handout was developed to provide patients with information about well-water safety and resources to help test and maintain their wells. Fathers of newborns: Are your new babies health care needs being met? Project Date: 7/3/2006 Many people consider the birth of a child to be a highlight of one's life. Naturally, bringing one's own offspring into the world can be a thrilling experience and much focus is spent on ensuring quality health care for both mother and child. The purpose of this community oriented primary care project is to investigate any potential problems with the health care of newborn babies by interviewing fathers of newborn children. Accessing the opinion of a father should reveal new insight into the success and comptetence of newborn healthcare from a perspective not usually considered. The project design included interviewing fathers of newborns in the medical clinic, night clinic and hospital. Improving Birth Outcomes Among Pregnant Adolescents in Klamath Falls, OR Project Date: 7/3/2006 U.S. adolescent pregnancy rates remain higher than any other industrialized nation. According to the Oregon Office of Rural Health, while Klamath Falls’ adolescent pregnancy rates are no higher than the Oregon average, the actual birth rate among pregnant teens is about 1.4 times higher than the Oregon average. Reasons for this have been investigated in prior community health projects, and include lack of access to or knowledge of abortion clinics, as well as the general attitude toward abortion in the community. The focus of this project was the health of those teenage mothers who do choose to give birth. Adolescent pregnancy is associated with various obstetric and birth problems such as premature labor and low-birth weight infants. Reasons for this are related to unique physical, psychological, and social factors present in adolescence. Several prior studies provide a strong argument for instituting specific programs that target this special population in order to improve pregnancy outcomes. Based on these findings, this project used two approaches to improve pregnancy outcomes – a community-based approach and a healthcare provider approach. A teenage pregnancy and parenting workshop course was developed and implemented in the community. Further, a brochure was developed for healthcare providers which provided important information to address in the care of pregnant adolescents. A talk was also given to the residents of Cascades East Family Practice regarding the issue. 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. Medication Compliance in the Elderly Population of Grants Pass Project Date: 5/1/2006 Medication non-compliance is an important issue facing the elderly population because they have the highest prevalence of chronic disease and the largest consumption of medications. Non-compliance is associated with large increases in morbidity, mortality, hospital admissions, and cost to the community and health care system. This study was designed to evaluate and improve the factors contributing to medication non-compliance in the growing elderly population of an internal medicine clinic in Grants Pass, Oregon. Factors were identified using the following methods: extensive review of the literature on medication compliance, surveys of the patients regarding contributing factors, interview with the physician, and identification of resources currently available in the community. Based on the results, a patient handout with a medication log was constructed in order to address these problems and implemented in the internal medicine clinic. Both patients and physicians had a positive response to the handout, however there was not sufficient time to evaluate the effects of the handout/medication log on compliance. Additionally, further work beyond patient education is necessary in order to have the greatest impact on compliance including education of health care professionals and changes within the health care system. The metabolic syndrome in Coos County, Or: Causative factors, and issues for treatment. Project Date: 5/1/2006 The Metabolic Syndrome, which is defined by a combined set of cardiovascular risk factors, has a rising prevalence in the U.S. in recent years. Certain communities, including Coos County, OR have even higher rates than that of the general population. This study aimed at determining factors which increase the prevalence of the metabolic syndrome in Coos County, and looked at patient education as a means for aiding the problem. The study was carried out by interviewing physicians and patients, as well as consulting the county health department to help determine causative factors. Using this information, an education handout was developed and used during short teaching sessions with a representative sample of patients. Finally, patients were interviewed regarding their thoughts as to whether this was helpful for their overall knowledge of the disease. Conclusions taken from the study were that, although many factors contribute, patient education is one modifiable aspect that should be a focus for improving rates of the metabolic syndrome. While the teaching sessions used in the study may not have been time-efficient, they were met with positive feedback, and a more time efficient strategy may be the most ideal means. Assessment of Housing and In-Home Care Options for Seniors in Astoria Project Date: 5/1/2006 In Clatsop County, the percentage of the population over the age of 65 was 15% in 2005, but this number is projected to increase to 24% by the year 2025. The need for long term-care services is steadily increasing as well. Initiating the conversation about the need for more assistance in the home can be difficult for seniors and their families. Furthermore, once the decision has been made, determining the level of care needed and researching the options is complex. Within Pacific Family Medicine, it has been observed that seniors and their families are uninformed about the housing and in-home care options available in their community and lack adequate resources to make informed decisions about long-term care. The purpose of this project was to provide information about different types of housing and in-home care options for seniors, facilitate discussion between families about the need for more assistance in the home, and provide tools to help people assess their level of need and evaluate their options. The final product of this project is a resource guide to be utilized by seniors and their families. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. Hormone Replace Therapy for Menopause Symptoms: Creation of a Patient Guide to the Risks, Benefits, and Alternatives Project Date: 5/1/2006 Hormone Replacement therapy (HRT) for the relief of menopause symptoms has been available to women for more than a century. For the majority of this time the use of HRT has been steadily gaining popularity despite warning signs of potential risks. Results in 2002 from the Women's Health Initiative (WHI), however, dramatically decreased the use of HRT by demonstrating small but significant increases in cardiovascular and cancer risk with HRT. The latest report of HRT and breast cancer risk, published within the last month, has renewed the barrage of media coverage and concern over HRT. Women today who are tyring to decide how to deal with menopause have the challenging task of interpreting a very complex set of data in an arena where there are potentially misinformed sources. The purpose of this project was to deliver a patient education handout that succinctly and accurately summarizes the risks, benefits, and alternatives to HRT. Skin Cancer Educational Outreach in Harney County Project Date: 5/1/2006 Harney County is a frontier county in Eastern Oregon with a culture predominated by desert cowboy culture and outdoor recreation. At an elevation of 4148 feet, and a climate consisting of 300 days of sunshine a year and 11 inches annual precipitation, the area attracts sun and outdoor lovers who will be exposed to high levels of ultraviolet (UV) radiation. Regular physician visits are rare for much of the population and little is known about skin cancer prevention awareness among residents of the county. In addition, the incidence of skin cancer is rising rapidly worldwide. Melanoma is the 5th most commonly diagnosed cancer and the 6th leading cause of cancer deaths in Oregon. Between 1999 and 2002, Oregon's melanoma mortality rate of 29.4 deaths per 100,000 people as the second highest in the nation. Skin cancer awareness is therefore a pertinent issue for residents of Harney County. A chart review was conducted in an effort to quantify the prevalence of melanoma and non-melanoma skin cancers in the clinic's patient population. As an attempt to reach out both to High Desert Medical Center patients and community members that do not regularly visit the local health clinic, a health fair educational display was developed. The display included focused skin cancer screening information, basic medical terminology describing development of skin lesions and methods of skin protection and cancer prevention. Information for the display was included from textbooks, journal articles and the High Desert Medical Center physician staff. Patient handouts were also developed for distribution at the health fair. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. “The Effects of Pharmaceutical Direct to Consumer Marketing: a Comparison of National Data With a Rural Community in Oregon.” Project Date: 5/1/2006 In 1997, along with the alteration of some existing FDA regulations on pharmaceutical advertising came an entourage of direct to consumer (DTC) advertising by drug companies. Money spent particularly on television broadcasts soared as did the revenue from the medications most commonly marketed. The beneficial outcomes for the sales of pharmaceutical companies demonstrated an obvious cause and effect relationship. However, the effects on patients, the patient-physician relationship, and public health in general remain obscure; they are left largely to the opinions of those involved which are derived from sparse survey data at best. Proponents of DTC advertising assert that it serves as patient education, increases autonomy, and encourages pricing competition. Opponents counter that patients should not be made consumers, risks and benefits of a medication are not accurately portrayed in the advertisements, and overuse of prescription medications is encouraged ultimately increasing costs. National survey data raises many concerning factors, especially in regards to public health. A survey of patients from a rural community in Tillamook, Oregon and an interview with local providers suggests that the effects of DTC advertising and the opinions regarding it are similar to those reported in the national data save a few differences. It is likely that the effect of DTC advertising on patients differs somewhat between demographics. However, this information suggests that the detrimental consequences on patient education, autonomy, prescription drug use, and the cost of health care can be generalized even to differing communities. Therefore, the FDA is urged to place some restrictions on the recent trend towards increasing DTC advertising. 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. Medication Compliance in a Small Subpopulation of Elderly Patients in the Illinois Valley Project Date: 5/1/2006 As patients age, their risk of developing chronic conditions such as hypertension, diabetes, and hyperlipidemia increases. These illnesses are manageable by taking medications, but eventually patients may find themselves taking multiple prescriptions which may actually make it difficult to treat their illnesses if they are unable to comply. One reason for this is that as people age they may have increasing difficulty remembering things and may not be able to keep track of many drugs. In a rural setting other factors such as low incomes and long distances may also play a part in medication noncompliance. The family practice clinic in Cave Junction, Oregon consists of almost 2,400 patients; 26% are over the age of 65 and several of them have multiple chronic conditions. The goal of this project was to determine whether there are barriers to compliance with taking medications in this rural community and to identify solutions to resolve them. Ten home visits and eight phone interviews were conducted to determine which systems patients use in remembering to take multiple drugs. Most patients had lists and/or pillboxes to help them remember and were taking everything as prescribed. It was therefore concluded that medication compliance in this small subpopulation of elderly patients is better than expected and that they are not currently plagued by barriers to compliance. Even though these patients are able to get their prescriptions filled now, however, they are worried about rising costs. Many of them are of low income and therefore struggle to pay for their medicines. Patients with Medicare Part D are particularly unhappy because they pay more now than they paid before it was implemented this year. Rising costs and the new prescription drug coverage plan may represent future barriers to compliance for these patients. ASSET: Acute ST Segment Elevation Taskforce Awareness in Grants Pass, Oregon Project Date: 3/20/2006 Heart disease is the number one cause of mortality in Grants Pass, Oregon. Through recent studies, it is clear that Percutaneous Coronary Intervention is the best treatment option for a patient suffering from a myocardial infarction. The Acute ST Segment Elevation Taskforce, serving Grants Pass, was implemented in order to reduce infarct time between recognition of symptoms and therapy. Unfortunately, many patients are not aware of this program and are transporting themselves to the local hospital, one without treatment capabilities. With community education and awareness through direct patient contact, local newspaper articles, posters, and other media, patients were educated about the program. Such education resulted in an increased willingness to use the program and decrease morbidity and mortality. 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. School Based Health Center in Sweet Home, Oregon: Current self-reported health related issues and current acute-care facility usage. Project Date: 3/20/2006 There is an ongoing project by the Linn County Department of Health Services to start a school based health clinic in Sweet Home, Oregon. In an attempt to aid in the planning for this project, this report summarizes the Oregon Healthy Teens survey results for Sweet Home, and looks at emergency department and urgent care facility usage by high school aged children from this city. Findings include similar prevalence of self-reported alcohol use between Sweet Home and the state average (45.2% vs. 47.4%), as well as similar rates of use of other substances. Sweet Home students are more likely than the state average to report having had sexual intercourse, but are also more likely to report having used a condom and/or birth control. Self-reported asthma has a significantly higher prevalence in Sweet Home than across the state (16% vs. 10.8%), and is more likely to have caused students to miss school. The prevalence of self-reported depression is similar between Sweet Home and the state average (7.3% vs. 6.3%), but Sweet Home students are more likely to have considered suicide within the past year (18.1% vs. 12%). Also, at least 281 (39%) of ED/UC facility visits by this population were likely to have been issues that could have been handled appropriately in a primary care setting. The Tillamook Safe Hunting Initiative: Assessment of the Hunter Education Program and Strategies for the Future Project Date: 3/20/2006 As hunting continues to be a popular recreational activity in Oregon’s Tillamook County, emphasis on safe hunting practices is necessary to ensure the safety of all persons who enter the wilderness each autumn. This study aimed to identify what safety awareness programs are available for Oregon residents in this region and to investigate the efficacy of such programs in preventing hunting-related accidents. In addition, an effort to recognize areas for improvement within hunter education was undertaken. Data on Oregon’s hunter education program was obtained through direct communication with the Oregon Department of Fish and Wildlife, personal interviews with hunters native to Tillamook County, and extensive web research. It was determined that emphasis on hunting safety (via formalized courses or independent learning) has led to a significant decrease in the number of hunting-related accidents over the past few decades in the state of Oregon. While firearm handling continues to be the mainstay of safety awareness, Tillamook County residents expressed an interest in basic life skills training and the importance of wearing hunter orange. Therefore, this project would not only provide an assessment of the Oregon hunter education program, but would also focus on the development of a small brochure providing tips on accident prevention and treatment. Increasing Access to Lactation Services in a Low-Income Population: Developing an Outpatient Program Project Date: 3/20/2006 There are considerable barriers to breastfeeding for low-income, predominantly Latina women in Salem, OR. While lactation services are available to women during their postpartum hospital stay, most outpatient options are inaccessible for these patients. Following a model similar to that of a local pediatric clinic, West Salem Clinic, a federally qualified health center, would like to determine the feasibility of providing outpatient lactation services. Grant money would be needed to offset costs of this program. Additionally, West Salem Clinic should increase the volume of newborns seen to improve the viability of the program. Medical Information Researched via the Internet by Patients in Astoria, Oregon: To surf or not to surf...that is the question Project Date: 2/13/2006 The Internet has become a vast resource of medical knowledge for patients all across the United States. This study sought to characterize the level of Internet use with respect to acquiring medical information in an Astoria, Oregon family practice clinic. The study design was based on three individual components: First observational data obtained from patient interactions, second qualitative and quantitative data obtained from patient surveys and finally anecdotal evidence from interviews with physicians. The results indicated a high percentage of patients acquiring information from the Internet. Review of current literature validated our conclusion further quantifying the types of information obtained and the results of acquiring such information. Given the possibility of negative outcomes as a result of false information, a patient brochure was designed to help physicians educate patients on how to obtain credible information on the Internet with the inclusion of disease specific sites. Baker County Sexual Health Education: The Good, The Bad and The Ugly Project Date: 2/13/2006 Baker County has a several high-risk sexual health populations, including high school students, patients in inpatient alcohol and drug treatment facilities, and prisoners. Sexual health education for these groups has been limited in the past. A focus group of public health RNs identified a problem with poor resources for delivering STD education in these settings. They expressed a desire for an easy-to-give and easy-to-understand presentation that they could use to give educational talks to these high risk groups. They also described the lack of resources in the clinics for sexual education during family-planning or sexual health visits. They described a need for an easily accessible photographic flip-book for use with patients in the clinics. With their guidance, I developed a one hour Power Point presentation and a short color photo flip-book about STD risks, prevention and treatment in Baker County. Together we discussed a plan for putting these new resources to use in the community. Palliative Care and Hospice Services in Coos Bay, OR: A Survey of Patient Knowledge and Opinion Project Date: 1/2/2006 South Coast Hospice (SCH) has provided hospice services to Coos Bay, OR for over 25 years. Recently a pilot program for palliative care services was begun in cooperation with Bay Area Hospital. While SCH receives feedback from patients and their families, with generally positive results, they were interested in general public opinion of hospice as well as community knowledge of palliative care. To assess this a survey of random patients within a general internal medicine practice at North Bend Medical Center in Coos Bay, OR was conducted . I also interviewed a social worker at South Coast Hospice tasked with the development of the palliative care program, which yielded information about the progress and current status of the program at Bay Area Hospital. The survey indicated that few people had heard of palliative care, and those that had thought the term was synonymous with hospice. Further, half of those surveyed have had some exposure to hospice, with the majority having had a good experience. Those without exposure were generally in favor of the program and would consider having themselves or a loved one die at own home under hospice care. Concerns about hospice were varied, but the most identifiable concern was the expected cost of hospice services. These results were forwarded to South Coast Hospice to help them address community education and other potential barriers to hospice and palliative care. Advancing Reach Out and Read in Coos Bay and North Bend Project Date: 1/2/2006 The well-child examination offers a unique opportunity for health care providers to proactively affect the health and development of pediatric patients through efforts targeted at education, health promotion, and prevention. Time limitations of the visit, however, require that physicians tailor interventions with proven efficacy to issues of significant prevalence and impact. Reach Out and Read, a national literacy and language development program that brings reading into the well-child visit, has been effective at improving reading success, parental attitudes toward reading, parental interactions with children, and child language development. This report outlines efforts to advance the Reach Out and Read program in the Coos Bay/North Bend area through strategic planning, information gathering, resource identification, and application completion. 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. Where did you get that idea? Developing an Integrated Strategy for Patient Information Handouts Project Date: 1/2/2006 The brief time allotted to office visits limits patient education on acute primary care issues. Many practitioners rely upon written information they can give to their patients to follow at home. This study attempted to define a strategy for creating and refining patient education handouts in a Florence, Oregon family medicine clinic. While there were plenty of patient handout materials already existing in the clinic, these were often out-dated or otherwise inappropriate for use. The design was to work with physicians to identify areas where handouts were needed, articulate core concepts that physicians wished addressed, elicit patient feedback on handout materials and create handouts to satisfy these specific goals. Finally, further thoughts on extending the project were considered. Increasing Awareness; Decreasing Risk: Hispanic farm workers and pesticide education in Hood River, Oregon Project Date: 10/17/2005 Hood River, Oregon is the largest city in the 4 county Mid-Columbia region which spans the Columbia River Gorge between northern Oregon and southern Washington. The area is famous for fruit production, with raising and harvesting of cherries, apples and pears heavily dependent upon the region's large Hispanic population of seasonal farm workers and migrants. Though all Americans are exposed to pesticides, many studies have supported the fact that farm workers and their families are the most vulnerable to both the acute and chronic deleterious health effects of the more than 16,000 different pesticide products currently in use in the United States. Studies have indicated that potential chronic adverse effects of pesticide exposure include cancer as well as reproductive and developmental, immunological, neurological and behavioral effects. Though an official system exists across the country for notification of acute pesticide poisoning events, little emphasis is currently placed upon the long-term effects associated with chronic, low-level pesticide exposure. La Clinica del Carino, a federally qualified community and migrant health center established in 1986 in Hood River, Oregon, has been an active advocate for farm worker health for 20 years. This study attempted to clarify the reasons behind the current lack of focus on this important area of farm worker health in both the clinic and the community as a whole, as well as to suggest appropriate avenues for educational interventions in the future. The Problem of Obesity in Coos Bay, OR Project Date: 10/17/2005 This Community Project studies the prevalence and impact of obesity among internal medicine patients of the Bay Area Clinic (BAC) in Coos Bay, OR, and provides a convenient source of patient education in the form of a brochure. The first 50 internal medicine patients seen by my preceptor were evaluated and were categorized according to their BMI. Patients were categorized as “healthy weight” (BMI = 19-25), “overweight” (BMI = 25-30), or “obese” (BMI > 30). Of the 50 patients evaluated, 26% were of a healthy weight, 36% were overweight, and 38% were obese. Because of the high prevalence of obesity in this patient population, as well as the lack of convenient patient education materials on the topic, an informative/educational brochure was created with the goals of: 1.) informing patients of the health risks associated with obesity, 2.) providing patients with a list of useful diet and exercise resources, and 3.) providing patients with tips on weight loss. Effectiveness of Type 2 Diabetes management in Astoria, Oregon Project Date: 10/17/2005 The management of type 2 diabetes represents a unique challenge for Oregon’s rural practitioners. Death rates among diabetic patients in Oregon have steadily increased, with much of the disease burden resting in rural communities. In Clatsop County, the death rate from diabetes is staggeringly high, at 40.8 per 100,000 people – a rate almost double the national average. In attempt to address this issue, I investigated the management of type 2 diabetes mellitus at a small, private family medicine clinic in Astoria, Oregon. A chart review was performed of fifty patients with the diagnosis of type 2 diabetes, with a focus on three components of diabetic care: 1) glycemic control, as measured by HbA1C, 2) cardiovascular risk management, and 3) the assessment, prevention, and treatment of diabetic complications, specifically retinopathy and nephropathy. The results of the review revealed several areas of possible improvement in diabetic monitoring, in addition to highlighting the importance of medical therapy with aspirin, ACE inhibitors, and lipid-lowering agents. Several barriers to optimal diabetic management were identified, with the primary impediment being patient non-adherence to diabetic treatment and follow-up regimens. This data should serve as a background for future endeavors in the clinic, with the eventual goal of developing a better tracking system for diabetes management. Hypercholesterolemia and hypertriglyceridemia in Grant County, Oregon Project Date: 10/17/2005 Hyperlipidemia is well-established as an important risk factor in the development of heart disease. Estimates of the prevalence of hyperlipidemia in the US are approximately 1 in 3. Discussions with Grant County physicians and the Grant County Health Department family nurse practitioner indicated that the health care community was unaware of the prevalence of hyperlipidemia in their patient population. Lab data from the annual Health Fair sponsored by the Grant County Health Department, Blue Mountain Hospital and the US Forest Service was reviewed, and individuals with hypercholesterolemia and hypertriglyceridemia were identified. 620 blood draws were recorded, approximately 10% of the population of Grant County. 47% of participants demonstrated elevated cholesterol levels and 27% had elevated triglycerides. These results suggest that hyperlipidemia is a grave health concern in Grant County. A comprehensive educational patient handout addressing screening, prevention and treatment was developed for distribution at the next annual health fair and at the Grant County Health Department. Suggestions for future possible research projects related to this topic are included. Preventive Medicine and Clinical Preventive Services for Patients Project Date: 10/17/2005 Preventive medicine and clinical preventive services today are a cornerstone of care for maintaining the health of any population. The activity of health maintenance is conducted by providing periodic health examinations and screening to identify an unrecognized disease or risk factor through history taking, physical examination, laboratory test, or other procedure that can be applied in short order. Screening tests can rapidly sort out apparently well persons who have a disease or a risk factor for a disease from those who do not and therefore are an important part of preventive medicine. However, many patients are unaware of or misunderstand the purpose of these preventive medicine measures which can ultimately lead to higher rates of morbidity and mortality if not accomplished or may even cause distrust in the current health care system due to the perception that a test or procedure is unnecessary. This project was created to help patients gain a better understanding of preventive medicine services. It provides a patient handout that describes the purpose of preventive medicine and lists medical conditions and screening options according to specific patient groups. This is intended to aid in both patient education as well encourage patients to ask questions and enable them to become more directly involved in the decision-making process that affects their health and health care. The preventive services described are compiled from the current U.S. Preventive Services Task Force guidelines and recommendations for clinical preventive services from the American Academy of Family Physicians. 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. Barriers to Breastfeeding in a Low-Income, Predominantly Hispanic Community. Project Date: 9/12/2005 Despite the clinical evidence that supports the nutritional and developmental advantages to breastfeeding, the initiation, duration and exclusivity of breastfeeding remain low in the United States. The barriers that exist for women wishing to breastfeed are multifactoral, especially for low income mothers. However, by providing support and education, primary care physicians are in a pivotal position to address breastfeeding complications during routine examinations and potentially increase breastfeeding rates. An analysis was conducted to assess what breastfeeding difficulties exist for mothers at the West Salem Clinic. Patients delivering within the last six months were interviewed about their desire to breastfeed, the support they received and complications they experienced. Problems such as perceived decrease in milk supply, sore or cracked nipples or latching difficulties were consistent with other published reports. However, barriers unique to this population included cultural perceptions, financial and educational obstructions as well as language difficulties. By identifying the obstacles that exist for breastfeeding mothers, primary care providers might be better able to offer more continued support, thereby improve breastfeeding outcomes. Lifestyle Modifications to Prevent and Treat Hypertension in Reedsport, Oregon. Project Date: 9/12/2005 Hypertension is epidemic in developed countries today. In United States, 50 million adults, or approximately 25%, have hypertension (defined as blood pressure > 140/90 mm Hg) and/or use anti-hypertensive medications1. More than half of all adults aged 60 years or older have hypertension2. As Reedsport and its surrounding communities contain large proportion of elderly population, many patients at the Dunes Family Health Care (DFHC) have hypertension and its complications. Thus, hypertension is an important and common health problem treated at DFHC. The purpose of this project is to increase public awareness of hypertension by creating an informative pamphlet. The results from a survey indicate that participants place lifestyle changes, mainly diet and exercise, as best methods to prevent and treat hypertension over anti-hypertensive medications, even though almost half of participants are currently taking anti-hypertensive medications. Thus, lifestyle changes in regards to diet and exercise are emphasized in the pamphlet, with main focus on Dietary Approaches to Stop Hypertension (DASH) diet as well as community resources available to Reedsport residents to make exercise and dietary changes to lower and maintain healthy blood pressure. Sex Education in Philomath, Oregon: What is the message and is it getting across? Project Date: 9/12/2005 Teen pregnancy and sexually transmitted infection (STI) rates are important indicators of issues affecting the health and future prospects of our country's youth. This project attempted to look at the sexual education provided to students at Philomath High School to help them make the decisions affecting these rates, and compare this to programs used nationally. It researches the specific components of the high school curricula, then, by means of a questionnaire, evaluates how the Philomath specific education translates into the knowledge and attitudes of the students it serves. Finally, using available data, it looks at how Philomath compares at a national and state level regarding teen pregnancy rates and rates of sexual activity. Data collected on the Philomath School District sexual education was obtained by interviews with the school nurse, high school counselor and the high school health teacher. Pediatric Poisonings- Epidemiology and Prevention. Portland Oregon Project Date: 8/8/2005 There are more than four million incidents of poisonings in the United States each year. The institute of Medicine identified poisoning as the second leading cause of injury-related mortality, with an estimate of economic cost at $12.6 billion annually based on societal lifetime cost of injury. Hospital admissions for poisoning are the second leading cause of injury-related hospitalizations for all ages in Oregon (Poison Press 2004). In this study I have evaluated the impact of poisonings in children under the age of 13 in the Portland community by reviewing hospital records, obtaining Oregon Poison Center data, and surveying and interviewing members of the community. In an effort to increase awareness of poisonings in pediatrics and decrease their prevalence and severity I have created a poster. This poster along with fliers and handouts from the poison center has been placed in local clinics and hospitals. 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. Management of Chronic Back Pain: Evaluation of the Efficacy of Spinal Surgery Project Date: 8/8/2005 Less than 10% of individuals who experience back pain will develop a chronic back pain syndrome. Of these patients, a fraction will fail all conservative therapies and seek relief through one or more spinal surgeries. There is much controversy regarding the effectiveness of surgery compared to an intense rehabilitation program. During a meeting of the Independent Physician's Association (IPA) of Josephine County, this issue was discussed in relationship to disbursement of state and federal funds to provide coverage for a procedure that has not been shown to have steadfast value in the management of patients with chronic back pain. This project was devised with the ultimate goal of examining the pre- and post-operative functionality and use of prescribed medications of patients undergoing back surgery. A small sample of patients who have undergone one or more back surgeries were selected from a family practice clinic in Grants Pass, Oregon. Their charts were reviewed and documented information on functionality, number of office visits relating to pain, and medication usage were extrapolated. The results of this project were inconclusive as insufficient information was present in the patients charts. Future research could evaluate efficacy of surgical treatment by utilizing IPA databases, contacting and surveying patients, and running analyses on changes in medication utilization. Health Literacy in Rural and Underserved Populations Project Date: 8/8/2005 Does offering health information on topics that are in high prevalence in underserved populations and have more negative outcomes in those populations, improve the health of the population, and are those services readily utilized? Health Literacy regarding diagnosis, disease pathology and treatment options are at a low in rural populations. Without an awareness of what disease processes may be occurring in a patient, it becomes more difficult for patients to help themselves, do the things that are within their own capacity to reduce their morbidity, with respect to their disease. Health Literacy is a key component to health care outcomes, and directly relates to compliance of treatment protocols and adherence to prescribed regimens. Without health literacy, it is more difficult for patients to understand the importance of adherence and more likely for adverse effects to result, and decreased efficacy in treatment outcomes. Low health literacy has also been shown to directly impact the overall health of a community and health education has been shown to improve specific outcomes like reduction in unnecessary office visits, poor health resource utilization and medication compliance. A questionnaire was designed to ascertain the general perception of the patient population of health literacy, and was given to patients as they checked in for visits. When a disease process was identified in a patient that was addressed at the conference, the patient was counseled as to the importance of health information and invited to attend BRIDGING THE GAP NORTHWEST 2005, free of charge. Bridging the Gap is a community education forum, bringing information, tools and resources to the community at large, specifically targeting those underserved populations that are at the highest risk for negative health outcomes based on literacy and economic status. Patients were also offered information on their specific condition, and were asked if they understood the information that was provided. Diabetes Mellitus Community Awareness Project Date: 8/8/2005 There are over 18.2 million people in the United States with Diabetes Mellitus. Only 13 million or so of which have been diagnosed. This leaves about 1/3rd with untreated Diabetes. Diabetes itself is the fifth leading cause of death, and a vast contributor to increased morbidity in the form of “heart disease, blindness, kidney failure, extremity amputations, and other chronic diseases. ” The cost of DM to the health care economy is enormous, with over 92 billion per year in direct costs, and an additional 40 billion in indirect costs. Per capita, more than twice the amount of health care dollars are spent on someone with DM than someone without. Various methods are proposed to help eliminate or reduce these problems through better access to preventative care, more widespread diagnosis, more intensive disease management, and through the advent of new medical technologies. The possible results of this project seem pretty intangible. The articles will be going in the paper starting this week and going for the next four weeks. Best case scenario: some people that were previously untreated, like the patient I saw in clinic, will decide to talk to their doctor about their symptoms. Further expansion of this project could include additional articles on Diabetes, to measuring the effect of these articles by comparing rates of DM diagnosis before and after the articles, or by supplying newly diagnosed diabetics with questionnaires about why they came to the doctor. In addition, further outreach could be undertaken, such as ads on the local radio station, or a booth at the County Fair (the first week of Sep). Also, many other health topics are not popularly known, so additional education could be undertaken through the weekly column in the local paper. Educating pregnant teens about their options and the resources available to them in Klamath Falls, Oregon Project Date: 8/8/2005 Though teen pregnancy rates have been on the decline in the United States for many years, they remain higher than in any industrialized country. As a medical student found in 2002, while the teen pregnancy rate in Klamath County is no higher than that of Oregon as a whole, the teen birth rate is higher because more teens choose to raise their children than elsewhere in the state. This is potentially problematic because teen parents and their children are subject to a unique set of public health problems. One of the reasons discovered for why Klamath County teens chose to become parents is lack of access to pregnancy termination, a fact that was confirmed by discussions with Klamath Falls physicians and a health educator. Resources do exist for Klamath Falls teens seeking pregnancy termination, although these resources are limited. Realizing that Klamath Falls teens may not have information available to them about pregnancy termination, and also that termination is not the choice every pregnant teen will make, an informational brochure was created to be distributed to nurses at Klamath Falls high schools. This brochure listed resources for teens that choose to become parents, those who choose to place their baby for adoption, and those who choose to terminate their pregnancy. To address the issues of teen pregnancy prevention, a second informational brochure was created for the nurses, this one describing various birth control options and informing teens of local family planning resources. Health Literacy in John Day, Oregon: A Patient Screen and an Evaluation of Educational Resources Project Date: 8/8/2005 According to the National Assessment of Adult Literacy (NAAL), forty-six to fifty-one percent of adult Americans are illiterate or functionally illiterate. This adds up to 90 million Americans who cannot synthesize information from complex or lengthy texts and cannot consistently perform quantitative tasks requiring two or more steps. The inadequate literacy skills of Americans are impacting health care in a big way. Numerous studies have linked low literacy with important negative outcomes in healthcare, including higher medical expenses and poorer management of chronic illness. This link between literacy and health has lead to the defining of health literacy as a separate component of functional literacy, and the responsibility to recognize and accommodate patients with low health literacy now lies with health care providers. The problem this project aims to address is that of assessing the health literacy among adult patients of the Strawberry Wilderness Clinic in John Day, Oregon and evaluating resources available both in the clinic and the community for patients with low literacy skills. The results of a health literacy screen of 74 patients using the Rapid Estimate of Adult Literacy in Medicine - revised show that 23% of adult patients in John Day read at or below the 6th grade level and are thus expected to have significant difficulty comprehending most written and oral medical information. There was no significant difference in literacy skills between elderly and young adults. An assessment of written materials available for distribution at the clinic revealed that there were no printed patient education materials designed for patients with low literacy. Finally, local adult basic education resources were found to be more than adequate for meeting the needs of adults wishing to improve their literacy at no cost. However, few people seem to be aware of these education resources. Awareness of Diabetic Foot Complications in Baker City, OR Project Date: 8/8/2005 Diabetic foot complications are associated with significant morbidity and mortality. Patient education has been shown to decrease diabetic foot complications. Therefore, the purpose of this study was to assess patient education in a rural community. The level of education in Baker City diabetics was found to be low compared to other studies. Complications reported among diabetics were also low, suggesting that the lower level of education has not adversely affected this population. However, the complication rates could be reduced and education was shown to have a positive effect on reducing complications. Additionally, annual foot exams, podiatry referrals and medication management were lacking, and could be improved with education. Thus, a patient education brochure regarding diabetic foot care would be appropriate. 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. Meth Use During Pregnancy Project Date: 7/4/2005 Methamphetamine use during pregnancy is quickly becoming a major problem in rural Oregon. This study attempted to identify the health effects of meth use during pregnancy on the mother and the baby and the resources available in Klamath Falls for meth cessation. The design was a meeting with Molley Boham RN, instructor of prenatal classes at Cascades East Family Practice, and Merlaine Zwartverwer RN Maternity Care Coordinator for Cascades Comprehensive Care to determine the extent of meth use during pregnancy with their patients. A medline search for methamphetamine and pregnancy articles was then done, as well as an extensive Internet search, focusing on meth use in Oregon. I also consulted with Dr. Sohl, perinatologist for Southern Oregon. There are multiple opportunities to reach pregnant women including office visits at Cascades East, office visits with Dr. Sohl, prenatal classes by Molley and home visits by Merlaine. However, there is currently no handouts or material about meth use being used. Therefore, the final product of this project was development of a patient handout for pregnant women coming to Cascades East or in Merlaine's program. Also, a presentation was given to all physicians at Cascades East to educate them about meth. Low Vision in Lebanon: Resources to maximize quality of life with permanent vision loss Project Date: 7/4/2005 Visual impairment and blindness affects 2.94% of Oregonians and in the near future is expected to affect even more of the progressively aging population. A significant number of those affected have vision loss that is not correctable by surgery, medications, or glasses, placing them in the category of low vision. Vision loss and blindness can be psychological and physically devastating and requires unique coping skills and support. It is important to properly educate patients with vision loss about the resources available to them and emphasize that their quality of life can be better maintained by utilizing these resources. This project sought out the resources available to low-vision individuals in Lebanon, OR. Meetings with a low-vision specialist, a patient with low-vision who attends support groups in Lebanon, and representatives from Oregon Commission for the Blind and Vision Northwest made possible the investigation of resources. Low-vision evaluations by a specialist provide evaluation of daily functionality, optimize use of vision aids such as magnifiers and other tools, allow patients to experiment with tools before buying, and provide a specialized refraction for low-vision individuals. Oregon Commission for the Blind provides home evaluations by specialists for safety, independence, and use of low-vision tools. Additionally, they provide vocational rehabilitation and training, counseling for patients and families, scholarships, assistance with mobility tools such as white canes, and donation service for low-income individuals. Vision Northwest is a non-profit provider of low-vision assistive devices and also has a donation service for people with limited income. A monthly support group meets in Lebanon and allows its members to share tips on living with low-vision, emotional coping mechanisms, and has presentations with particular relevance to low-vision by members of the community. An informational handout was developed to summarize low-vision resources in Lebanon for patients and providers. Are Group Visits for Patients with Type II Diabetes a Feasible Option in John Day? Project Date: 7/4/2005 The potential morbidity and mortality associated with poorly controlled Type II diabetes mellitus makes patient education a particularly important undertaking in treating this chronic condition. Group visits have been shown to improve HgbAlc and cholesterol levels in patients with diabetes, as well as overall patient and physician satisfaction with care of chronic illnesses. The primary purpose of this study was twofold: to determine whether group visits were a feasible option for the residents of John Day and if so, to put together the necessary information that would facilitate easy implementation of group visits by Dr. Robert Holland. Methods: 1) a focus group was held among select patients with type II diabetes; 2) an interview was conducted with the registered dietitian (RD) to determine whether interdisciplinary support for such visits existed. 3) A review of the literature was conducted for structural and curricular development of a group visit. Results: 30% (4/12) of those invited to the focus group attended. All who attended were eager to participate in group visits. The resulting projected number of Dr. Holland's patients who would be interested in group visits is between 21-32 patients, a sufficient number to make the endeavor worthwhile from a business standpoint. Interdisciplinary support (RD) is available. Conclusions: Group visits are a feasible option in John Day, in terms of interest and from a business perspective. A packet of information for the clinic was compiled that should facilitate this endeavor. Improving patient awareness of stroke disease Project Date: 7/4/2005 According to the American Health Assocation (AHA), stroke is the leading cause of long term disability in the United States today. Four million Americans currently live with the chronic effects of strokes, with another 700,000 strokes occurring each year. In addition, studies show that for all strokes, 50-70% of patients are able to recover functional independence, with another 15-30% remaining permanently disabled. Due to the long-term medical care and disability that is so often needed, the annual cost of stroke treatment has soared to $57 billion annually in the United States alone. Thus, the need to recognize stroke risk factors and educate those at risk has become increasingly important to healthcare practitioners. The AHA, American Stroke Association and National Stroke Association all agree that studies have proven the existence of a variety of stroke risk factors, which are all classified as controllable or uncontrollable. Examples of controllable factors include smoking, obesity and alcohol consumption while uncontrollable problems include family history and age. By virtually any outcome measures defined, study questionnaire results show that baseline knowledge of strokes among West Salem Clinic patients is sufficient at best. In addition, comparison of questionnaires with corresponding patient chart info provide evidence that stroke knowledge actually declines linearly with stroke risk, exactly the opposite preferred trend. After completing the study questionnaire, all subjects were furnished with materials containing basic information regarding stroke disease background, risk factors and symptoms. In addition, other methods to improve patient awareness of stroke disease are considered. Bipolar Education in Klamath Falls Project Date: 7/4/2005 Current prevalence estimates of bipolar disorder in the pediatric population are thought to be about the same as those in the adult population, approximately 1%. Existing evidence indicates that bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent- and adult-onset bipolar disorder. Recently, as the understanding of childhood bipolar disorder has grown, provider education about bipolar disorder has increased the rate at which diagnoses occur. With this large rise in the number of bipolar cases, physicians need to utilize all resources available to help them treat their patients including the patients themselves. The purpose of this project was to improve patient education about their disease. To accomplish this a survey was conducted of current patients and their parents to determine their current knowledge of the disorder. Reporting on these questionnaires showed that all parents sought out alternative resources to fill gaps in their knowledge. Information from the questionnaire was used to help in the creation of an educational brochure about bipolar disorder. This document was given to the Klamath Pediatric Clinic for distribution to current and future patients. 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. Lets Talk About Sex: A look into the Attitudes and Behaviors of Jefferson County Project Date: 4/25/2005 Teenage pregnancy is a problem throughout the United States. In Oregon, Jefferson County has the second highest teenage pregnancy rate when compared to other counties. This leads to increased health risks for teens and children, and an increasing amount of financial stress on Madras, OR, the heart of the medical and educational services in the county. This study connected the researcher with Jefferson County High School teens via one-hour focus groups in a effort to generate ideas that will be helpful in decreasing the teenage pregnancy rate in Jefferson County. The focus group design and the sample population were chosen because teenagers may have insight into solutions that adults are less able to provide. The information gathered from students was compared with literature recommendations for effective community strategies for decreasing teen pregnancy. The result is a list of recommendations or suggestions for the community of Madras in addressing the important problem of teenage pregnancy. Hyperlipidemia in Grant County: Is the Public aware of the dangers of elevated cholesterol levels? Project Date: 4/25/2005 The cardiovascular risks associated with hyperlipidemia have been well established through multiple studies. The public’s understanding of this issue, however, has lagged behind scientific discovery, and failure to make appropriate life style changes may unnecessarily lead to an early demise. A recent article published by the Center for Disease Control and Prevention (CDC) showed that too few Americans have their serum cholesterol checked as recommended by the National Cholesterol Education Program (NCEP). My objectives in this project were to first identify the prevalence of hyperlipidemia in Grant County, Oregon and then conduct an informative discussion with the public regarding cholesterol physiology. Using a computer generated list, I was able to identity 282 adults who receive care at the Strawberry Mountain Wilderness Clinic in John Day, Oregon who carry the diagnosis of hyperlipidemia. Based on this number, the calculated prevalence of hyperlipidemia within this cohort was 6.7%, far short of the national average of 24%. Following this discovery, I held a 45-minute PowerPoint discussion in an attempt to enhance the public awareness of the dangers associated with hyperlipidemia and presented potential solutions to this problem. My interactions with the group lead me to the conclusion that the public’s knowledge regarding cholesterol health is insufficient, though a more thorough investigation is needed to substantiate this hypothesis. Furthermore, I believe that with more physician-directed discussions, the public will take a more active role in screening and reduction of hyperlipidemia. Educating The Population Through The Media Project Date: 4/25/2005 The project was suggested by my preceptor, Dr. Tom Fitzpatrick. It involves getting basic medical information out to the population of Burns by publishing a weekly column in the local newspaper. Contact was made with Toni Siegner, a local reporter, to coordinate the publication. An initial article was written, but this proved to be too long; the newspaper wanted the publication to be limited to between 150 and 300 words. Several articles were then written, which met the expectations of the newspaper. As of the end of the rotation, one article had appeared in the paper (an introductory article) and another was to appear in the paper on Sunday, May 29 (two days after the end of the rotation). Three more articles are in reserve, and Dr. Fitzpatrick will submit them for the following weeks. Follow up of this project can be undertaken by any student who goes to Burns; it would involve writing comprehensive, concise, interesting articles on healthcare subjects not yet covered. 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. Diabetes Education in Scappoose, OR: Assessing diabetic education through the development of a patient questionnaire and educational handout Project Date: 3/21/2005 Diabetes is a very common disease in the U.S. and is growing in prevalence by the day. It is a major cause of morbidity and mortality and one of every ten healthcare dollars are spent on diabetes and its related complications.1 Since diabetics themselves are the one’s responsible for the prevention of long-term complications, they must be properly educated on the basic etiology of their disease and it’s management. This study attempts to assess the overall education on pertinent facts about diabetes in both the diabetic and non-diabetic population in Scappoose, OR, and then to educate patients on important concepts and common misperceptions of diabetes management. Overall, this study found that diabetics in general were not more knowledgeable about their disease than the non-diabetic population. In fact, the general population seemed to be more knowledgeable about the etiology, prevention and treatment of diabetes and the diabetic population sampled. Weight Loss Support Group Project Date: 3/21/2005 Obesity has become one of the most problematic medical conditions currently faced in the United States as well as Oregon. Obesity raises the risk of morbidity from several life threatening conditions, however that risk may be reduced with weight loss. The purpose of this study is to improve the effectiveness of treating obesity in the setting of the Rinehart Clinic in Wheeler, Oregon. Observation of a family practitioner and patient interviews were the primary sources of patient information about dieting effectiveness and patient resources. A diet plan which included educational materials was readily available in the clinic, but no further information or support source was identified in this community. Evidence exists that social support dramatically increases the amount of weight loss as well as the ability to keep weight off. Therefore, a weekly weight loss support group was established as a social support network for patients trying to lose weight. 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. Preventative Health Maintenance in Asymptomatic Men of Florence Project Date: 3/21/2005 Men are more likely to die from 13 of the top 15 causes of death. Despite this, men are more likely not to visit a health care professional than women. The reasons are varied, but I believe a significant cause is lack of health knowledge. I believe that the use of mass media can be a useful tool to assist in educating asymptomatic men about health care issues. The focus of my project was to determine what screening and interventions would be most useful to the asymptomatic male. Recommendations are derived mostly from the USPSTF. I then published this information in the local paper so they would have a checklist of preventative health items. To determine the effectiveness of my project, I would propose that the PCPs in the area keep track of new patients and their motivation for visiting. Screening and Intervention for Psychosocial Risks: Analysis of Barriers to Appropriate Utilization of Social Services for Obstetric Patients in Astoria, Oregon Project Date: 2/7/2005 Most communities have social services available to, or directed towards the Obstetric population when they are identified as having specific needs. Unfortunately for the community of Astoria, Oregon, the obstetric patients in need may not be aware of the social services available to them. To further complicate the problem, there are no dedicated obstetric social workers in this community to identify high risk Obstetric patients and help them access and navigate the systems that administer these services. The individuals that are called upon to help obstetric patients connect with available resources are the health professionals caring for these patients such as the nurses, midwives and obstetricians, who are already overworked in their existing roles. This community project includes a survey of social services that are available to obstetric patients in the community of Astoria, Oregon: current methods used to identify patients with needs and facilitate connecting patients to these services; and based on this research, recommended changes to improve this process. A comprehensive list of the available social services was compiled to improve patient and provider awareness of available social services. Utilization of Eye Care Services by Patients of Scappoose, Oregon Project Date: 2/7/2005 Blindness and visual impairment currently affects over 3 million Americans and this number is growing. Visual impairment and blindness are easily prevented in many circumstances through timely eye screening and treatment. Rural populations are traditionally limited in availability of specialized care. The aim of this project is to determine patterns of utilization of eye care services in the rural town of Scappoose. To achieve this goal, patients were surveyed during a 2 week period regarding their risk factors, utilization of eye care services, and vision coverage. Seventy-three patients completed the survey. All of the patients were over 18, with a mean age of 46.57 years. Nineteen patients reported having existing eye disease that included age related macular degeneration, glaucoma, and multiple sclerosis. Seventeen patients reported a history of diabetes, 35 % of these patients had not received a comprehensive eye exam in the past 2 years. The most common reasons given for failing to seek eye care were lack of vision insurance and lack of tangible vision problems. Based on the findings of this survey, an informational brochure was produced for patients. This brochure focused on: 1. Highlighting current screening recommendations, 2. Educating patients regarding common eye disorders, and 3. Providing uninsured patients with resources to obtain vision coverage. This brochure was made available to patients in the clinic waiting room. The four primary care providers at Scappoose were also provided with copies of a recent review article tailored to PCP’s that highlights the recommended role of PCP’s in preventing blindness and visual impairment. Informal discussions were held with each provider to highlight the findings from this project and emphasize their role in vision screening. Reported Stroke Mortality in Harney County: the perceived need for additional stroke education Project Date: 2/7/2005 Cerebrovascular accident "Stroke" is one of the leading causes of Morbidity and mortality in the US. Unfortunately, Oregon stands out as a state with a disproportionate stroke-related burden of morbidity and mortality. As Harney County is one of the most rural counties in the state, the goal of this project was to use rough analysis of mortality data for the county and state to make assessments of relative stroke burden compared to stroke. What was revealed from the analysis was a significantly decreased level of stroke-related deaths reported for the county, than the state. Assuming that Harney County is not significantly healthier than the state at large, the disparity in reporting is hypothesized to be due to a relative lower level of stroke awareness and education, which may lead to lower frequency of presentation to available health system. Therefore, a newspaper article/public service announcement was written and information cards posted in the clinic in an effort to further educate the community to the signs, symptoms and risk factors associated with stroke. Thus, the intended long term outcome from this project developed into further education of the Harney County community regarding recognizing stroke and minimizing risk factors. Gambling in John Day, Oregon: Creation of a Patient Brochure. Project Date: 2/7/2005 Gambling is a prevalent problem both nationally and in Oregon. It can have wide-ranging effects, including those on finances (like bankruptcy), higher rates of receipt of past-year unemployment and welfare benefits, arrest, incarceration, divorce, poor or fair physical health, and mental health treatment. Despite this prevalence, it is not routinely screened for in a family practice clinic in John Day, Oregon, and there is no current patient information brochure here addressing it. The purpose of this project was to develop a patient information brochure to address gambling in one rural Oregon family practice clinic. The patients of this clinic were the target population. Data was gathered by speaking to the clinic’s provider as well as a gambling counselor regarding the negative effects of gambling and things to include in a brochure. An extensive Internet search was also undertaken to gather information. This data gathering yielded the creation of a brochure that included the following information regarding gambling: basic statistics, forms and locations in which it takes place, negative effects, common myths, screening questions, and treatment resources. If there were more time in the clerkship it would have been beneficial to try and observe whether the brochure prompted any discussion between patient and provider, as well as to try and contact other providers in the area to see if they would like to display the brochure in their offices. Working toward a Community based education approach for Diabetes management and prevention of complications in John Day, Oregon Project Date: 2/7/2005 Diabetes is a disease that is approaching epidemic proportions in the US. It is a disease with high morbidity and mortality due in large part to its complications. Intensive therapy has been shown to be important in the prevention and control of diabetes. Community - based education is one modality of treatment that has been shown to work to prevent development of, and reduce complications of diabetes. In this study I surveyed 68 diabetes treatment and management where patients had questions. The results of this survey show a high interest in small group-based education for diabetes. Issues that many diabetics had questions about included nutrition, medications, need for specialist exams, and blood testing. These topics could be covered in group-based education and supplemented with a brochure/handout. The results of this survey and production of this handout may be useful building blocks to establish community-based or small-group education in John Day, Oregon. The Impact of Alcoholism in Tillamook County and the Resources Available for Alcoholics. Project Date: 2/7/2005 Unhealthy alcohol use can be associated with multiple economic, social, and medical problems. This project will assess the impact of alcoholism in Tillamook County and assess the resources available for alcoholics. To assess the impact of alcoholism, community members who were dealing with alcoholism either directly or indirectly were interviewed. Statistical information was gathered by the Oregon DHS, National Institute of Alcoholism and Alcohol Abuse, and Oregon Crime Data websites. According to the Oregon Department of Human Services, the rate of adult alcohol abuse or dependence in Tillamook County is roughly similar to the state average (7.5% vs. 7.8%). The rate of alcohol related arrests in Tillamook County is significantly higher than the state average (182.5 vs. 48.6 per 10,000 in 2002) however, and this might be attributed to the influx of tourism during the summer and the lack of public transportation in the evening and taxicabs. However, in a 2004 survey, the rate of binge drinking among North Coast County (Tillamook, Clatsop, Columbia) eighth graders, the rate of binge drinking was 39% versus 29% statewide. A barrier to treatment in Tillamook County is a lack of a formal detox center. Individuals hoping to detox must drive over one hour away either to Lincoln County or Portland. However, there are also some great resources available as well, including AA, which has 21 meeting times a week and Tillamook Family Counseling Center, the primary mental health and alcohol/drug service. Physicians can take a proactive approach by screening patients with the AUDIT questionnaire, engaging in brief interventions, and providing medications when necessary. 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. Abuse in Pregnancy Project Date: 1/3/2005 Domestic abuse is a very serious and prevalent issue inthe United States (US). The prevalence of domestic violence is approximately 9.7-29.7%. It is estimated that 3.9- 8.3% women will be abused during pregnancy. In Columbia County, the prevalence of domestic abuse presumably follows national trends. Columbia County Women's Resource Center reports taht 25% of the women who use their crisis hotline and safety shelter are pregnant. Scappoose family clinic has a prenatal packet that is given to all new OB patients but does not include a domestic violence educational brochure. The importance of educating women on the consequences of domestic abuse for themselves and their child is essential to their well-being. Addditionally, providing resources for women who are victims of abuse may save their lives. The development of an educational brochure to give in an existing prenatal package will provide a tool for education and contacts for local resources. Skin Cancer Awareness in Harney County Project Date: 1/3/2005 Burns is located in Harney County, which is part of the High Desert near the edge of the Great Basin. There is over 300 days of sun per year at the elevation of approximately 4,200 feet above sea level; obviously putting residents here are risk for increased ultraviolet radiation (UV) exposure. Presently in the United States skin cancer is the most common tumor diagnosis made each year with 1 in 5 Americans developing a skin cancer over his/her lifetime. Additionally, the incidence of skin cancer has been on the rise for the past 30 years with a doubling in the number of people diagnosed with melanoma every year. These facts combined with the unique climate of Harney County made working on skin cancer awareness an important topic. This project included making a patient friendly newspaper article to be published in the local newspaper that will run in conjunction with advertisements about an upcoming skin cancer screening clinic. The goal of the article was to inform the surrounding population about their risks for skin cancer, how to prevent it, and when they should seek medical attention. Research was conducted about the most up to date information about skin cancer then used to create the article to address the entire community, especially to inform those who may be at a higher risk of skin cancer. During this project input was sought from the providers here at the High Desert Medical Center and from the Dermatology Department at OHSU. A new way to save on prescription drugs? Educating the physicians and Medicare patients of Klamath Family Practice on the Medicare-Approved Drug Discount Cards Project Date: 1/3/2005 The cost of prescription drugs continues to be a major health issue in the United States, especially for elderly patients on Medicare. The goal of the project was to educate the physicians and Medicare patients of Klamath Family Practice about Medicare-approved drug discount cards so that patients could take maximum advantage of the offered savings. First, the project was designed to interact with Medicare patients and try to understand how they currently try to save money on prescription drugs and determine how familiar they were with the new Medicare-approved drug discount cards. After determining that the physicians and patients knew very little about this new program from lack of available information, the program was thoroughly researched to determine if Medicare patients would benefit from these new discount drug cards or not. The physicians were educated about the new program, and the final product of this project was the development of a poster for the lobby and a brochure to educate Medicare patients about this new program and help them save money on prescription drugs. Perceived Availability of Physicians To Patients in the Clinical Setting Project Date: 10/18/2004 Access to medical care is often the main barrier to health in a rural community. While access can take on many different meanings for a community, I chose to focus on the perceived availability of physicians to patients in the clinical setting. I observed an independent Internal Medicine practice of 4 physicians and 2 nurse practitioners serving roughly 12,000 patients in a rural area. Over a five-week period, I observed office staff and physician perceptions that patients have many unrealistic expectations for the logistic aspects of their health care. I listened to patients’ questions and expectations regarding their care by the facility. Unnecessary phone calls and incomplete follow-up were two main complaints by office staff, while not being able to talk to a person on the phone and high cost of medications were consistent problems noted by patients. This informal research resulted in the formation of an educational handout to patients to improve their expectations of the logistics of their medical care. By improving patient knowledge of appropriate interactions with the office staff, it is hoped that there will be a decrease in unnecessary phone call volume, to ultimately improve access to the clinic for urgent concerns. Westside Elementary School Asthma Education Project in Madras, Oregon Project Date: 10/18/2004 Asthma accounts for 14.6 million lost school days, 12 million bed rest days, and 24 million restricted activity days per year. It is the leading cause of school absences among children with chronic conditions. In Oregon, there are 74,000 children with asthma. Elementary school asthma education can assist schools in organizing a community to the needs of children, including disadvantaged and minority children whose asthma often goes undetected. A group of six previously identified Westside Elementary School children in Madras, Oregon completed an asthma education program, which consisted of five, 50-minute group lessons held during the school day. It taught the kids how to detect the warning signs of asthma, including triggers that can cause an attack, and how to respond appropriately. The program has been proven to reduce the number of asthma attacks, improve student academic performance, develop student's confidence in managing their own asthma and assist in teaching parents about better asthma management decisions. Hypertension in Baker City, Oregon: Treatment, Awareness, Compliance, and Lifestyle Project Date: 10/18/2004 Hypertension is a major risk factor for many cardiovascular diseases, renal disease, and retinopathy. Hypertension is implicated in 800,000 deaths per year in the United States, and is highly prevalent in the portion of the American population over 60 years of age. A study of patients’ knowledge of hypertension was conducted in Baker City, Oregon in October and November 2004. Patients diagnosed with hypertension were interviewed regarding their awareness, compliance, and lifestyle choices related to hypertension. Interviewed patients are moderately aware of their condition, are compliant with physician recommendations, and have altered their lifestyles to reduce hypertension-related health problems. Summary statistics suggest that interviewed patients had similar levels of compliance compared to those reported in the literature. In most cases, the physician’s response to elevated patient blood pressure was to adjust medication dosages. 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. Newborn Discharge Packet for Siskiyou Pediatric Clinic Patients Project Date: 9/13/2004 This project was designed to provide a brochure of important information for parents of newborns at the Three Rivers Community Hospital in Grants Pass, OR. Multiple resources exist to provide support and advice to parents of newborn infants. However, most of these require the use of internet access or the financial ability to purchase parenting books. Pediatricians supply many free handouts that parents can collect, but many of the parents I talked with indicated a desire for a quick reference source that gave them bulleted points outlining key information and guiding them in when to access their pediatrician. Interviews were conducted with new parents, nurses in the Family Birth Center and the pediatricians at Siskiyou Pediatric Clinic in Grants Pass, OR in an attempt to determine the most important topics to include and what the best format to present this information. A brochure format was believed to provide the best presentation of information for this community. Further data collection determined five main areas for the newborn brochure, including newborn safety, immunizations, well-child checks, local contact numbers and guidance on when a new parent should call the pediatrician. The product of this project is a brochure entitled "Newborn Information That Every Parent Needs to Get Started" that will be given to every parent in the Family Birth Center before discharge from the hospital. High Cholesterol: A simple means of patient education Project Date: 9/13/2004 High cholesterol is known to play a major role in heart disease and is one of the more common health care issues Americans face. This study attempts to identify the effectiveness of cholesterol screening and the accuracy of information given to patients at St. Elizabeth Hospital and Eastern Oregon Medical Associates Family Practice Clinic in Baker City, OR. Physician interaction with patients who either have high cholesterol or risk factors for coronary heart disease were observed during a 5 week rotation in Baker City. The annual Health Fair is the primary resource outside of the physician’s office that patients can get their cholesterol, as well as several other health issues, screened for health maintenance. The director of this program was contacted for information regarding the number of patients that use the health fair and what health information was given to patients regarding the different health conditions they were being screened for. Although there seems to be a mechanism for roughly identifying those with high total cholesterol, there did not seem to be an effective method of identifying and educating patients who would benefit, based on their individual cholesterol values, family history and other health issues, from preventative steps to help them avoid high cholesterol and heart disease in the future. The endpoint of this study was the creation of a patient handout to be used in the clinic to explain the basics of cholesterol and its role in heart disease, as well as helping the patient understand that cholesterol and heart disease goals are developed in regards to the specific patient. In addition, the handout incorporates the latest updates to cholesterol management by the NCEP, is formatted in a brief and simple document, and encourages patients to develop a regular dialogue with their health care provider about how to maintain healthy cholesterol levels. Tobacco Use Cessation in Grant County: An Evaluation of Available Resources and Development of a Patient Handout Project Date: 9/13/2004 Quitting smoking or chewing is a difficult process regardless of whether it is attempted in an urban or rural environment; however, major differences exist in community attitudes and the support resources available that impact success. This project examines how practitioners in John Day, Oregon manage patients, the resources available to offer those who are interested in quitting, and the community values that influence cessation efforts. Interviews were conducted with five family medicine health practitioners in John Day and the Alcohol and Tobacco Prevention Specialist for the Grant County Center for Human Development. In addition, a training session for managing smoking cessation in pregnant women sponsored by the Grant County Public Health Department was attended. These sessions revealed medical practitioners as the primary source for cessation information and support with no local secondary resources available for referral and a community where tobacco use, especially chew, is seen as a norm. In an effort to aid cessation counseling at both the practitioner and public health level, a handout was created to address issues faced by smokers at various stages of the quitting process. The handout can be used to supplement cessation counseling in a clinical setting where time is limited yet is also broad-based enough to help those seeking to quit outside of a practice setting. General Guidelines for Preventing Childhood Obesity, and a Closer Look at Progressive Resistance Training as a Therapy for Diabetic (Type II) Patients with Co-morbid Obesity Project Date: 7/5/2004 Obesity in adolescents and children is a growing trend across the US. It is not an isolated phenomenon but is a co-morbid condition and even a causal factor for many other pathologic processes. Among the Native Americans, there is an extremely high prevalence of obesity and diabetes mellitus II. In Burns, there are efforts to make obesity more visible on the health awareness billboard. This will be a continuation of the project started by Alison Bahr, a former medical student in Burns. This project will provide two handouts. One handout will outline the guidelines for the prevention of childhood obesity, and will be made available for the Logician digital system at the clinic. The other handout will discuss options in physical activity as an adjunctive treatment of obese diabetic patients, and will be submitted to the Burns Times-Herald for public awareness. Patient Participation in the Legislative Process in Klamath Falls, OR: Identifying Patterns and Perceived Obstacles Project Date: 7/5/2004 Patient initiated discussions concerning dissatisfaction with various health and health care policies are common in the rural primary care setting. Anecdotally, however, patients report not sharing these opinions with their legislators, while lawmakers describe a situation in which they feel uninformed about the ideas of the citizens in the communities they represent. A disconnect exists, whereby opportunities for constructive sharing of opinions and factual knowledge are missed. In order to describe the patterns of participation in the legislative process amongst the patients of a primarily adult Family Practice clinic, a patient survey was administered that inquired about both past experience if contacting legislators, perceived barriers to making such contact, and interest in obtaining information designed to facilitate this contact in the future. 33% of survey respondents had contacted their legislators in the past, an average of 2.6 times. 30% of those contacts were in regards to a health or health care issue. For those respondents who wanted to contact legislators but did not do so, common reasons cited included “I don’t know how to contact them”, “I’m not confident about how to present my ideas”, and “I don’t think it will make a difference”. 57% of all respondents said it would be helpful to have information about legislators and how to contact them, while 63% said having this information would make it more likely that they would contact their legislators in the future. In response to the survey answers, a patient information guide was designed in order to provide both accurate contact information for the appropriate Representatives and Senators, as well as suggestions for effective ways to communicate with legislators, and additional resources for more information. Television and Childhood Obesity: Spreading the Message in Harney County Project Date: 5/10/2004 Childhood obesity is a problem across the country with health implications for the present and future. Recent studies have shown that reduced time in front of the television for children and adolescents may help prevent obesity. While community groups and programs exist in Burns to promote youth fitness, no one has specifically outlined the role television viewing has on childhood obesity. The purpose of this project is to educate patients and the community about reducing time in front of the television and its potentially significant impact on childhood obesity prevention. This will be done through an article publication in the Burns Times-Herald and a public service announcement on local radio stations, KQHZ and KZZR, all in association with the physicians at High Desert Medical Center. In addition, a patient handout will be made available in clinic to help parents develop good television viewing habits with their children. Emergency Contraception: Provider Attitudes and Prescribing in Jefferson County, OR Project Date: 5/10/2004 Emergency contraception is a safe, easy to use and relatively inexpensive method for preventing unwanted pregnancy. In spite of this, it continues to be underutilized for reasons that are not fully understood. This study was an attempt to examine the prescribing habits and attitudes of rural primary care practitioners regarding emergency contraception in the Madras, Oregon area. The design was a written survey of local primary care practitioners and emergency physicians. The overall response to the survey implied that primary care practitioners in the Madras area are open to the use of emergency contraception but most do not make it part of routine family planning discussions. The majority desire an informational handout to use as a tool for discussion of EC with patients. 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. Obesity and clinical interventions in John Day, Oregon: Develpment of a patient handout. Project Date: 3/29/2004 Obesity is a growing problem in the US and in Oregon leading to several chronic health problems. This study evaluates clinical interventions and community resources for patients wanting to loose weight in John Day, Oregon. A family physician was observed providing recommendations on diet and physical activity changes intended to result in weight loss. Due to time constraints in a busy practice, several times the conversation had to be limited. The clinic routinely weighed patients but calculation of a patient's body mass index was rarely calculated. The office lacked printed material to raise awareness of how weight affects health or health or diet and exercise suggestions for weight loss to offer patients. A survey of community resources was completed including interviews with a county health nurse and nutritionist. There were limited community resources and no information about them in the clinic. Two patient handouts were developed and made available to patients. The handouts were used as an aide to provide information and tools for patients to refer to at home. Evaluation and Management of overweight children in Cave Junction, OR: development of a patient/student handout to outline behavior modification strategies for patients and students at the local schools. Project Date: 3/29/2004 Obesity is on the rise in the world, in the U.S. and in Oregon. Obesity and its complications and co-morbidities are poised to overtake tobacco as the leading “actual” cause of death in the U.S. And our children are right in the middle of the epidemic with the rate of overweight in Oregon’s teens tripling in the past 20 years. Objective: The aim of this study was to ascertain where the children in Cave Junction, OR fit in the larger picture of obesity. How many of the children in a rural Family Medicine practice are overweight and “at-risk” for overweight? Also, what interventions are available and what will be effective at helping these children maintain appropriate weights? Methods: The charts of the 208 children aged 2-20 years old that are seen at Cave Junction Family Medicine clinic were reviewed for heights, weights, gender and age of the children. Body Mass Indexes (BMIs) were then calculated using the CDC’s BMI-for-age and sex charts. Results: Of the 208 children found in the clinic’s database, only 113 of them had heights recorded. Two children (2%) were “underweight” (<5th percentile BMI for age and sex.) Seven children (7%) were “at risk for underweight” (5-10th percentiles). Fifty-eight children (51%) were “normal weight” (10-85th percentiles). Twenty-two children (19%) were “at risk for overweight” (85-95th percentiles.) And twenty-four children (21%) were “overweight” (<95th percentile.) The only BMIs in the charts were from transferred records. Conclusion: The children in Cave Junction are more overweight than the average child in the U.S. (21% in CJ vs. approx 15% in the U.S.) Also, BMIs are not currently being tracked in that clinic and there is good reason to do so. Physical Activity and Youth in Jefferson County: The role of the healthcare provider Project Date: 1/5/2004 Physical inactivity among all ages is a growing health problem in the United States. Combined with poor nutrition, physical inactivity is second to tobacco-use as a preventable cause of death in Oregon and US. Physical inactivity is a relative risk for coronary heart disease, hypertension, diabetes, strokes, obesity, osteoporosis, depression and anxiety. The prevalence of physical inactivity among youth is high. The “2002-2003 Oregon Healthy Teens Survey” showed that about 66% of eighth graders and 70% of eleventh graders participated in moderate activity less than 5 days per week. This is less than the minimum physical activity recommendations. From the same survey, in Jefferson County about 19% of eighth and eleventh graders exercised moderately 5 or more days in the past 7 days, thus meeting the minimum physical activity recommendations. Addressing physical inactivity in youth is multi-factorial including plan implications at the individual, family, healthcare, school, and community level. The objectives of the 2003 Healthy Active Oregon: The Statewide Physical Activity Plan targets each these various levels. To combine the objectives of the state initiative and needs of the medical clinic in which I worked in Jefferson County, I addressed the following question, “How can a Jefferson County healthcare provider help promote physical activity among youth?” The methods used included literature searches for recommendations for clinical counseling on physical activity, a questionnaire to assess the clinic’s current protocols, and current patients thoughts and questions regarding physical activity, and finally an assessment of what is offered in the community. The final products included an interactive-information questionnaire for patients intended to help healthcare providers assess patients’ physical activity levels, assess barriers and provide patients and their parents the health benefits of physical activity. Also, a list of community resources and additional clinical practice suggestions were made. Suggestions included regular BMI measurements and regular assessment of patients’ physical activity. Patient medication knowledge in Grant County, Oregon Project Date: 1/5/2004 Most older Americans take 3-5 medications daily, but many patients have inadequate knowledge of the medications that they are taking. In a New York study, less than 15% of elderly patients were able to accurately identify the names, doses, dosing schedule and indication for all of their medications. 80 consecutive adult patients at the Strawberry Wilderness Family Clinic in Grant County, Oregon were asked complete a medication list at their medical appointment, indicating name, dose, dosing schedule, prescriber and indication of any medication they took regularly, including prescription, over the counter and herbal remedies. The adults taking regular medications took an average of 5.3 daily medications and knew the names and indications of an average of 69% and 59% of these, respectively. In an effort to educate patients, a one page handout on the importance of taking an active role with their medications and a wallet-sized medication log were distributed with the medication survey. Teenage Pregnancy in Lebanon, OR: physician attitudes and development of an educational handout for new parents Project Date: 1/5/2004 Teenage pregnancy, although on the decline, continues to be a major health issue in the United States. This study attempted to evaluate attitudes toward teenage pregnancy and produce an intercention aimed at helping these young parents once they have made a decision to parent the child. The design was a survcey administered to health practitioners in a family medicine setting, and chart review of pregnant women in the clinic practice. Observational evaluation of local services available to pregnant women was performed. Throufh interaction with teen parents in the clinic wellchild checks, firsthand information was obtained about lack of knowledge of local resources available. After a web search of pre-existing resources, meeting with a prenatal class instructor, and feedback from practitioners, a handout of essential parenting and safety information was compiled, including a list of phone numbers for important resources for parents. The handout was disseminated into the clinic practice to be given out at the two- week well-child check, and also incorporated into the prenatal class curriculum. The Frequency and Pattern of Dermatological Cases in a Rural Primary Care Practice in John Day, Oregon Project Date: 1/5/2004 Studies have demonstrated that up to one third of patient visits to general practice physicians are for skin problems. However, there is not much information on the frequency of dermatological diseases in rural areas in the United States. Objective: To evaluate the frequency and the pattern of dermatological diseases in a primary-care-practice population in John Day, Oregon in order to decipher the epidemiological medical conditions and to better address them. Results and conclusion: 27.7% of the diagnosis in a John Day primary care practice were of dermatological origin. Surprisingly, Actinic Keratosis was the highest dermatological diagnosis, accounting for 20%. This figure is high compared to other studies mainly due to the high outdoor activities and occupations in rural areas such as John Day. This demonstrates the importance of rural physicians having further training in diagnosing and managing pre-malignant skin changes and other conditions of high frequency in their medical population. This also enforces the use of teledermatology to better manage difficult dermatology conditions without having to send many patients out of town for consultations. Intervention: In order to educate the patient population about high rates of pre-malignant skin lesions, a pamphlet regarding skin cancers was designed and distributed to patients with high risk factors. Intimate Partner Violence Resources in Benton County: Needs Assessment and Development of Patient Education and Physician Intervention Tools Project Date: 1/5/2004 With a lifetime prevalence of one in ten, intimate partner violence (IPV) is the number one health threat to women in the United States today. This study explored the resources available to abused women in Benton County and sought to optimize physician IPV intervention at the Philomath and Corvallis Family Medicine clinics by developing a reference tool for recognition, screening, management, and referrals. The design included interviews and observations of physicians, nursing staff, and patient advocates, interviews and tours of community resources, telephone interviews with the district attorney, county sheriff’s office, and Benton County Health Department, and research on visibility of community resources via phone book, patient outreach materials, and online sources. As patients were not universally screened for IPV, a patient education poster with crisis line numbers was designed for use in all exam rooms. Further, physicians indicated a need for a concise reference guide for IPV screening and intervention in Benton County. Thorough review of online and community resources revealed no such tool; thus, this project culminated in the development of a laminated exam-room card listing Benton County IPV impact and statistics, effective screening techniques, management of disclosed abuse, mandatory reporting, legal rights of IPV victims, and further resources for physicians. Finally, a Center Against Rape and Domestic Violence presentation was organized to further physician education regarding effective IPV screening, intervention, and community resources. By implementing IPV patient outreach and physician intervention tools for practical use, I sought to streamline the coordination of care between community resources, physicians, and their patients. PHYSICAL ACTIVITY AND HEALTH IN SCAPPOOSE, OREGON: Identification of Perceived Barriers to Being Physically Active and Development of a Patient Handout on the Benefits of Regular Exercise Project Date: 9/29/2003 The prevalence of obesity is increasing and continues to be a national problem. Although the benefits of weight control and physical activity are well documented in the primary prevention of many chronic diseases, most Americans do not participate in regular amounts of physical activity at recommended levels. This study attempted to identify the perceived barriers to being physically active in an OHSU family practice clinic located in the community of Scappoose, Oregon. Development and administration of a patient survey during a one-week period was the primary source of data used to identify the barriers to physical activity. Additional information was collected by direct observation of preceptors counseling patients on the topic of exercise throughout the six-week rotation. The goal was to create a patient handout that could be used during office visits to supplement counseling on the benefits of exercise and expose the common myths limiting participation. Knowledge and epidemiology of diabetic risk factors among The Baker City high school population Project Date: 11/10/2003 Adult onset diabetes and the devastating sequela that result there from are not only occurring in greater prevalence in this country, but are also occurring younger. After making the disturbing diagnosis of adult onset diabetes in a 28 year old patient and observing her remarkable ignorance of the disease and its consequences, the question was asked, "how much does the younger generation know about diabetes and how many of them are currenly at risk for developing adult onset diabetes"? This study was designed to assess the current knowledge of diabetes among the high school aged students in Baker City Oregon, whether they appreciate the effects of the disease, its preventablitiy and treatments, to educate them as to the seriousness of the disease, and finally, to determine the prevalence of diabetic risk factors among them. The study was conducted with the participation of 4 high school health classes (3sophomore classes and 1 junior) and was seperated into three major parts: a 10 question test consisting of baskic but pertinent diabetic questions, a 30 minute lecture following the test, and the collection of fasting sugar levels, blood pressures and abdominal cirumferences to ascertain the prevalence of certain risk factors. In addition, both high school health teachers were present during the lectures and received the nexessary materials and instruction to present an updated lecture to their classes in the future. The goals of this project closely mirror the three segments to which it was administered namely, to determine if a need exists in Baker City to better educate high school students of the effexts and precalence of adult onset diabetes ( as indicated by either a gross ignorance of the disease, a high prevalence of risk factors, or both), and to equip those students, as well as their health teachers, with the information to help aid themselves and others in the prevention of diabetes. Breastfeeding in John Day and Grant County: Development of a Patient Handout to Encourage Breastfeeding Project Date: 9/29/2003 The advantages of breastfeeding are well documented in scientific literature, and it is apparent that it is in the best interests of public health to encourage breastfeeding. The purpose of this project was to identify the resources available to residents of John Day and Grant County with regard to breastfeeding support, and to encourage breastfeeding through the use of a handout in the clinic. National and local statistics on breastfeeding were noted, as well as possible reasons that women quit breastfeeding. Benefits of breastfeeding were researched and summarized, and online and local resources were included in the flyer as well in an attempt to improve breastfeeding participation. The small numbers of women giving birth in Grant County made it unrealistic to determine the impact of the handout during the rotation, but the handout was well received by clinic physicians and staff. Early intervention to prevent diabetes in Lebanon, Oregon: development of a patient education pamphlet on insulin resistance syndrome for clinical use Project Date: 11/10/2003 Insulin resistance syndrome (IRS) has been established as the predictor for diabetes1. The prevalence of insulin resistance in the U.S. is estimated at 70-80 million. Without intervention or treatment, patients with this disease will progress to impaired glucose tolerance or overt diabetes within 10 years2. Primary care physicians are currently actively identifying patients whom they suspect to have insulin resistance or at risk for pre-diabetes so that aggressive lifestyle modification can be used to prevent the progression from insulin resistance to overt diabetes in these patients. In Lebanon, Oregon, family physicians are diagnosing many patients with insulin resistance syndrome or pre-diabetes. As a result of the complexity of this disease, patients often fail to understand their disease and its implication on their health or the goal of the treatment; therefore, they often become noncompliant with treatment plans (diet, exercise and hypoglycemic agent such as Metformin). Patients diagnosed with this syndrome are asymptomatic and are less motivated to change their lifestyle than patients with other diseases such as myocardial infarction. Newly diagnosed patients are initially educated with slides on the topic of insulin resistance at their doctor's office in the Mid-Valley Medical Group. These educational slides are provided by the Endocrine Society as a patient education aid3, 4. However, patients remain unsure and confused about their diagnoses of IRS and require subsequent reinforcement during follow-up visits, pre-diabetic classes and discussion with registered dietitians. During the first week of my rural rotation, I had to explain to many patients at the Mid-Valley Medical Group practice what insulin resistance is by using diagrams and hand drawings. I quickly realized the need for a patient educational pamphlet on insulin resistance syndrome. This patient pamphlet would also serve as a resource for pre-diabetic patients and introduce them to the pre-diabetes classes offered by Samaritan Lebanon Community Hospital (SLCH). This pamphlet was put into clinical use during the last week of my rotation in Lebanon and was very well accepted by patients and physicians. Determining Efficacy of the Seatbelt Coalition: Finding other areas of outreach Project Date: 11/10/2003 Deaths due to unintentional injuries ranks first among the people aged 1-44 years old living on the Warm Springs Reservation. Compared to U.S. accidental death reates (which ranks as the fifth leading cause of death among the same age group). Before the passage of a tribal seatbelt law, the safety officer at the warm springs health & wellness center began to collect survey data on the use of seat belts in Warm Springs, OR. Dating back as far as 1992, the data has shown a slow and consistent rise in the use rate of 88% (as of 2002) This project was designed to invesigate what the Seatbelt Coalition's goals and activities, provide an assessment of data collected on seatbelt use, and develop a set of educational materials for the Warm Springs Health & Wellness Center and its patient population. Results revealed a average seat belt use of around 56% in drivers and 42% in passengers in 2003. A set of ten slides were created that attempted to reach out to the younger at-risk population to help them gain insight into the reasons for using seat belts. Further efforts by the seatbelt coalition are needed to continue the fight to get more community memebers to use seat belts. This will ultimatley reduce the number of fatalities due to MVA that can be saved by simply using a seat gelt. A Survey of Awareness and Practice Regarding Preventive Measures Against Mosquito-borne Disease in Philomath, Oregon. Project Date: 5/5/2003 The West Nile virus, responsible for West Nile fever and viral encephalitis, is expected to arrive in the Pacific Northwest for the summer of 2003. This anticipated event provides the healthcare community with a rare opportunity to educate the public about a disease prior to its occurrence in the community. Historically, vector control and personal protective measures have been shown to be one of the most effective approaches to minimizing the impact of vector-borne diseases. Understanding the current state of knowledge regarding these practices is a useful step in preparing educational material, for both healthcare recipients and providers. A self-selecting, self-administered anonymous survey was conducted with 109 patients at a Family Medicine clinic in Philomath, Oregon. Awareness of preventive measures, as well as actual performance of those measures, was queried, in addition to the gathering of demographic data. A secondary benefit was the passive education of the study participants, via the survey-taking process. The results demonstrate a high level of awareness of preventive measures (72%), despite a moderate level of implementation of those same procedures (55%). The provision of education material to patients as well as care providers would likely assist in achieving a greater level of compliance with preventive measures against vector-borne disease. Does Diabetes Play Fair in Coos County? An Attempt to Even the Playing Field. Project Date: 5/5/2003 Diabetes is one of the most devastating diseases to the population of the United States. It can be a difficult and frustrating for physicians to manage because the course of the disease is dictated by patient compliance. This project, conducted at Bay Clinic in Coos Bay, Oregon, has two parts. Part one will increase patient compliance through patient education in the form of a patient handout. Part two will show that there can be improvements in the screening exams and pharmacological management of diabetic patients by their primary care providers. Through the coordination of physician and patient, better diabetic management can be obtained in the areas of blood pressure, cholesterol, HbA1C, and renal screening. Providing Comprehensive patient education materials in The West Salem Clinic. Project Date: 3/24/2003 After assessing patient education materials at West Salem Clinic it was found that very little to no patient education materials were available or disseminated to the primarily low income patient population. A written survey was conducted in Spanish and English, and the providers and staff were interviewed regarding the need for patient education materials. These queries indicated a need for the development of a comprehensive, centrally located, set of patient education materials, and a convenient method of distributing this information to patients. The goal of this project was to acquire these materials in Spanish and English and to develop a system to distribute this information in the normal course of office visits. Prostate Cancer in Florence: Listen to the Patients Project Date: 5/5/2003 Prostate cancer is the most common non-skin cancer diagnosed in men and the second leading cause of cancer death. Each year, about 220,900 men will be diagnosed with prostate cancer, and 28,900 will die from it (1). Age is the biggest risk factor. In fact, more than seventy percent of all prostate cancers are diagnosed in men over age sixty-five (1). In 2002, 15% of the population of Florence was composed of men over age sixty-five (2). For this reason, prostate cancer is important to this town and to its physicians. Much information concerning the screening and treatment of prostate cancer is readily available in books and online, however, there is no substitute for patient experience. This project provides this opportunity by looking at prostate cancer from the patient’s perspective. Eighteen men with a history of prostate cancer, from the Health Associates of Peace Harbor Internal Medicine practice, were interviewed concerning their experience with the disease. The patients were asked about their screening, diagnosis, and treatment. They were further questioned concerning satisfaction with their treatment choice, side effects from treatment, and finally, if they had any advice for the newly diagnosed patient or the physician treating him. At the time of diagnosis, the men ranged between the ages of fifty-six and seventy-nine, and they had undergone a variety of different treatment options. Thirteen of the men had experienced significant treatment-associated side effects, and six had their cancer reoccur. From these differing experiences comes a rich opportunity for the physician to learn. Managing the Cost of Pharmaceutical Drugs in Small Town Oregon Project Date: 2/10/2003 Increasing prescription drug costs are becoming a financial stressor for patients and a burden for office staff. Patients have been reporting to doctors and office staff that they cannot afford the prices of their medicine, thus choosing between buying their medicines or other basic necessities. Some patients report that they have been missing doses of their medicine or not purchasing it all together simply due to cost. Besides the obvious negative health outcome this has for the patient, it also frustrates the health care providers hoping to manage a patient's particular health problems. Furthermore, office staff often finds themselves trying to help the patient apply for social assistance programs or get in touch with other resources. Ultimately, this consumes a significant amount of time and resources for both the doctors and office staff. Furthermore, patients often have difficulty understanding ways in which they can cut their drug prescription costs, and consequently rely on office staff for help. To address this issue, a survey of Bay Clinic patients was performed to discover what patients currently spend per month on their medicines, how much money they save using office samples, and what cost saving measures they currently use to help control costs. Ultimately, after analyzing the data, it was determined that a simple piece of literature could be developed which could help the patient learn of ways to reduce their prescription drug bill. Resources for parents in Philomath, Oregon: development of a patient handout for supplementation of office visits Project Date: 2/10/2003 Parenting issues are not uncommon in primary care. This study attempted to investigate how these issues were handled in a Philomath, Oregon family practice clinic. Family physicians in this clinic were observed in these circumstances. Although physicians were adept at dealing with these issues, it was noted that a handout summarizing some helpful resources for parents would be beneficial. This handout was created using local resources as well as resources available on the internet. 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. Creating a health information library in a coastal community: the never-ending project. Project Date: 12/30/2002 Education continues to be a primary goal of population-based health care. This project begins to address the health education needs of a rural community through the establishment of a patient resource library. Informal interviews and observations, coupled with an internet-based search helped to formulate the two goals of this project: 1) laying the groundwork for a patient resource library with respect to location and physical construction, and 2) assembling examples of and guidelines for creating/selecting effective educational materials. Special attention was given to assessing the readability of existing patient information in light of the large segment of the population with low health literacy. Many well-used handouts were assessed as being written at reading levels exceeding those recommended by professional health educators. However, it may not be advisable to provide only low-literacy information, as this has been found to lead to decreased patient satisfaction. 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. Colorectal Cancer Screening in the Bay Area Project Date: 11/4/2002 Colorectal cancer screening, though effective in the prevention and detection of cancer, continues to be underutilized by the majority of the population in the United States. This study attempted to examine the issue of colorectal cancer screening in Coos Bay, Oregon during a six-week rotation. First, a limited chart review was performed on patients aged 50 to 80 who had undergone either fecal occult blood testing in the past year, flexible sigmoidoscopy in the past five years, or colonoscopy in the past ten years. This determined that 50% of patients whose charts were reviewed were current with colorectal cancer screening. Next, the study included observation of physician approaches to screening as well as discussions about the views of local internists and their patients in regards to colorectal cancer screening. Discussions with patients found that the majority of those that were declining screening were doing so out of embarrassment or fear of discomfort during the screening test. And, though all internists at the Bay Clinic agreed that colorectal cancer screening is important, their time spent discussing this with patients was limited, particularly if patients did not immediately express a high level of interest in screening. Thus, a patient handout was developed that could be used as a resource to educate patients about colorectal cancer screening. Discovering Diabetes Education in Klamath County: Diabetes CareLink Project Date: 11/4/2002 Problem: 16 million people in the United States are estimated to have diabetes. Diabetes is a chronic disease and therefore requires time, money, and education. The Task Force on Community Preventive Services (Task Force) found that diabetes self-management education (DSME) provided in the community setting resulted in improved glycemic control and recommended that DSME take place in community gathering places for adults with type 2 diabetes. According to the Oregon Public Health Department, of the 705 deaths in Oregon from diabetes in 1995, 4% occurred in Klamath Falls. People with diabetes in Klamath Falls would greatly benefit from better glycemic control and hence from DSME. Population: The population studied were residents of Klamath County of all ages with type 2 diabetes. Methods: I interviewed the diabetes educator of Diabetes CareLink, a DSME program in Klamath Falls, and several participants. I also attended a community diabetes education seminar, conducted a survey, and attended a local diabetes support group. Findings: Survey results showed increased understanding of diabetes among participants of Diabetes CareLink. Diabetes CareLink meets the Task Force’s criteria of a DSME by providing group or individual classes. Discussion: Diabetes CareLink is a good example of a DSME that is working in a rural community. 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. Asthma Screening, Health Education and Referral - Community Health Education Coalition Health Fair, Coos County, Oregon Project Date: 9/23/2002 The National Asthma Education and Prevention Program (NAEPP) addressed the growing number and rate of asthma-related hospitalization and emergency room utilization in this country. For example, since 1994, the prevalence rate increased 75%, death rate increased 56%, and hospitalization rate increased 3%. To ensure effective control of the disease, NAEPP highly recommends multidisciplinary approach - education, prevention, social and medical interventions. Most of what is currently known about asthma distribution, utilization of ER, subsequent follow-up with a PCP and prevalence of high-risk population is based on surveys at the national level. Unfortunately, not enough data is available in small counties, such as Coos County, Oregon. To investigate the prevalence of asthma in rural Oregon community, we conducted a prospective screening study on adult population, ages 18 years above. The screening test was conducted as part of the Community Health Education Coalition (CHEC) Coos County Elder's health fair on Oct 12, 2002 in Pony Village Mall and Oct 22, 2002 in Mill's Casino in Coos Bay, Oregon. Managing Your Diabetes: A blood glucose diary and educational brochure designed for education, motivation and improved utilization of the 15-minute appointment Project Date: 8/12/2002 Diabetes Mellitus (DM) is a serious and potentially deadly syndrome that affects 6.2% of the United States population. It is also a financial burden. The estimated cost of annual medical care for diabetics (direct costs) is $100 billion. Fortunately, it is also controllable. Through observation of family physicians, nurses, and diabetic patients, at Philomath Family Medical Practice, three issues fundamental to diabetes management were identified: 1) time limitations (15-minutes) of the diabetic appointment 2) education 3) motivation/morale. Both a blood glucose diary and an educational brochure were developed to try and address these three issues. Concerns about Hormone Replacement Therapy in Florence, Oregon: Development of an Educational Handout for Patients Project Date: 8/12/2002 Hormone replacement therapy (HRT) has been prominently featured in recent television news broadcasts and newspaper articles, since one trial of an observational study - the Women’s Health Initiative - was stopped because the number of cases of breast cancer caused by hormone replacement therapy had exceeded acceptable safety limits. Always a difficult choice for women, HRT has become an increasingly complex treatment for both patients and physicians. Of the postmenopausal women in the United States, approximately 40%7 opt to use HRT for some length of time, though many women discontinue therapy within a few years of initiation. Because the Health Associates of Peace Harbor serves a primarily elderly population in Florence, Oregon, menopausal and postmenopausal women comprise a large part of clinic practice. Thus, HRT is a relevant and important topic to many of the female patients, whose concern regarding their possible increased risk of breast cancer and thromboembolic disease with use of HRT appears to have increased recently due to extensive media coverage. This project consists of use of observation and informal surveys to define a population - menopausal and post-menopausal women on HRT – and a need – accessible information on HRT. After consideration of the clinic’s use of informational handouts on other health topics, and the need for a form of education on HRT that is both efficient and easy to use, recent journal articles and online sources were used to create a double-sided, one-page educational patient handout. Assessing the needs of adolescence in a rural community with a high rate of teenage pregnancy. Project Date: 8/12/2002 This project aimed to assess the needs of adolescence in a rural community with a high rate of teenage pregnancy. Although the rate of teenage pregnancy and births has been declining across the U.S. and Oregon over the last decade, there are still many counties in Oregon that are disproportionately affected by this social burden. Linn county (as a rural community) has the highest rate of teenage pregnancy and births. This project tries to unravel the mystery of how we can best target teens with useful information that they want to hear and will further utilize. The project lead to numerous discussion groups with over 100 high school students. The results show that in the area of sex and pregnancy teens are concerned about their comfort level with the person discussing these issues and the relevance of these issues to their lives. Therefore, the most effective form of education for teens on pregnancy prevention would be one that incorporates a peer provider model into a comprehensive education program. Examination of risk factors for the development of osteoporosis in adolescent girls at the Woodburn Pediatric Clinic. Project Date: 7/1/2002 Osteoporosis is a major health issue in America, affecting 30% to 40% of adults older than 60. Although osteoporosis is most prevalent in the older population, it is now understood that its roots lie with the pediatric population. The failure to achieve an adequate peak bone mass is a significant risk factor for future development of osteoporosis, and this process is almost complete by the onset of adulthood. This study attempts to identify the prevalence of risk factors in 9 to 13 year old girls that may predispose them to the development of osteoporosis. Data was collected by surveying girls regarding their dietary habits, exercise routine, medication use, and family history of osteoporosis. A chart review of well child exams for children of the same age was completed to assess how the Woodburn Pediatric Clinic addresses the issue of bone health. The findings of this study estimate that 60% of female patients in this age range were not consuming the recommended 1300 mg of calcium daily, 50% were not participating in regular weight-bearing exercises, and 33% already had a known family history of osteoporosis. The chart review demonstrated that the Woodburn Pediatric healthcare team is addressing nutrition and exercise in a broad sense, but fail to specifically evaluate and educate patients about the risk of developing osteoporosis. It is recommended that clinicians begin screening girls for inadequate calcium intake and exercise and providing counseling regarding preventing osteoporosis beginning at the 5-year-old well child exam. Patient Information Sources in Salem, Oregon: An Evaluation of Patient Resources and Integration of Care Project Date: 7/1/2002 A growing diversity of information sources are available to modern health care consumers in the United States. This study attempted to evaluate the prevalence of patient efforts to educate themselves regarding health care concerns, as well as the type of resources they used, if they shared those resources with their physician, and their perceived education regarding their health concerns. The design of the study was an anonymous 28 question survey distributed to patients during clinic visits at the West Salem Clinic. Surveys were distributed in English or Spanish, or patients were given assistance by the nursing staff if necessary. Surveys specifically addressed what types of information sources patients used, other health practitioners they had seen, if they felt their sources were reliable and accurate, if they shared their information with their physician, and whether they felt well informed about their health concerns. In total 49 usable surveys were received. The majority of patients were found to be interested in learning about the disease and actively seeking out information. Further, nearly half of patients had used complementary or alternative medicine at some time in the past. Overall patients felt well informed about the disease and felt that their physicians repsponded well to their initiating discussions regarding the information they collected. Children and Grief: Resources for Pediatricians in Coos County Project Date: 2/11/2002 Children grieve according to their developmental stage and individual personalities. There is no "right" way to grieve and each child will go through the process in their own way. Pediatricians can be a vital source of support and information for families dealing with the loss of a loved one. In Coos County pediatricians also have the additional resource of the Light House Center, a support program for grieving children, teens, and families. Working with the Family Services Manager, I developed an educational and fund-raising presentation as a service to the Light House Center and the pediatricians of Coos County. 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. 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. An Anti-Smoking Campaign To The Paiute Indian Youth Boxing Team. Project Date: 1/2/2002 The onset of smoking in all ethnic groups typically takes place during the teenage years, with thousands of teenagers each day becoming regular cigarette smokers. Current data shows that racial/ethnic smoking prevalence is highest among American Indian and Alaska Native teens when compared to other racial groups including Caucasians, Hispanics, Asian Americans and Pacific Islanders, and African Americans. Studies have shown that the onset of adolescent tobacco use can be curbed by education of the hazardous nature of smoking and through athletic participation. The goal of my community research project was to provide the educational aspect to a group of young men and women participating in a boxing program at the Burns Paiute Indian Reservation. Access to Spanish Language Health Information in Ontario, Oregon. Project Date: 11/5/2001 The Hispanic population of Oregon and the rest of the United States continues to grow rapidly, but unfortunately the number of health care workers who can communicate in Spanish has not. While in Ontario I found that not only is there a need for Spanish-speaking health care workers, but also for Spanish-language and culturally appropriate health information to hand out to the patients. Therefore I decided to translate and make some of my own, including translating patient handouts and making a teaching tool which relied more on pictures than words so anyone who was unable to read could understand them. The Impact of Patient Education on Routine Screening of Common Treatable Ocular Diseases in the Elderly Population of Florence, Oregon. Project Date: 5/6/2002 This project was designed to achieve two goals: 1. To estimate the adequacy of routine screening of several common treatable eye diseases (cataracts, glaucoma, and macular degeneration) in the elderly population in Florence, Oregon. 2. To educate this subset of the population on the importance of such preventative care in order to increase the percentage of those receiving adequate screening. The project is a study in which the subjects were given a 20-minute interactive lecture on the topics of cataracts, glaucoma, and macular degeneration and then given a questionnaire. Of the people surveyed, 32.26% were not receiving adequate screening for cataracts, glaucoma, and macular degeneration. However, of this group that was receiving inadequate preventative care, 60% reported that they were more likely to seek such care as a direct result of the lecture. In addition, 96.77% of all the subjects reported that they felt the lecture was beneficial to their understanding of the eye disorders discussed, and as a result, 83.87% stated that they were more likely to continue to receive or seek out preventative eye care as a result of the lecture. These results suggest that there is a significant percentage of the elderly population in Florence, Oregon who are not receiving adequate preventive eye care and that this percentage may be decreased through a community education program. Firearms and Parental Perceptions on Gun Safety in Grant County. Project Date: 5/6/2002 This study sought to examine parental perceptions on firearm safety among Grant county residents. A 6-item questionnaire was distributed to all patients visiting the Strawberry Wilderness Family Clinic from May 20 to June 10, and customers at two local supermarkets on the weekends of June 1-2 and 8-9. Outcome measures are prevalence of firearms in households, practice of safe storage, history of firearm safety discussion with children, and parent's opinion on hypothetical situations involving a child and firearms. Among the 148 participants in the survey, 82% reported having at least one piece of firearm in their household. Of these, 60% stored loaded firearms in the house without a secured or locked cabinet. Among parents owning one or more guns, 75% have discussed firearms safety with their children, 38% thought their less than 6 year-old child can distinguish a real gun from a toy gun. Weight Loss Success: A Local Guide to Resources. Project Date: 5/6/2002 Obesity has become a serious health issue in the United States. The population of Philomath and Corvallis, both located in the mid-Willamette Valley in Oregon, is no exception. In response to the lack of awareness of local resources for sufferers of weight loss issues, a local guide was created to increase the general population?s knowledge of this critical issue, as well as assist individuals mentally and medically. A brochure was constructed to warn them of the dangers of obesity, to inform individuals of the benefits of weight loss, and to inspire and spark an interest in the many exercise and nutritional programs available in the area. Surfing Lessons in Klamath Falls? Project Date: 5/6/2002 One third of the US population uses the Internet regularly. One half of these people have used the Internet to look up medical information in the last year. Half of these admit that what they read influenced their decision regarding treatment. There are 26,000 health-related websites as of March 2001. The public needs help in finding quality web pages, evaluating sites for reliability, and discovering the resources that are available. Klamath Falls is a diverse rural population with significant Internet use and poor statistical information regarding individual use and Internet access. In the future, a study to further investigate needs and use would be a great student project, and there are numerous local grants available. For the sake of this project, however, a brochure was created instructing the public where to look for medical information, and how to evaluate what they find. Knowledge Is Power: Rural Women's Access To Contraceptive Information. Project Date: 1/2/2002 Despite advancements in contraceptive technologies over the past two decades, unintended pregnancy, particularly teen pregnancy, rates remain high in the United States compared to other industrialized nations. Almost half of all pregnancies in the U.S. each year are unintended. Numerous factors contribute to this problem, many of which are personal, political, economic, or cultural in nature. Providing information is not the only way to increase women's contraceptive use. There are other barriers to care that have as much or more of an impact on access, particularly in the rural setting. But lack of information is not a very difficult obstacle to overcome if it is acknowledged and addressed. Contraceptive knowledge is one of the few modifiable risk factors for unwanted pregnancy. This project consists of three components: assessing patient access to contraceptive information and services, taking action to improve access, and recommending changes that may benefit some patients. 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. 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. Good Touch, Bad Touch: Addressing the Problem of Child Abuse in Coos Bay. Project Date: 11/5/2001 Child abuse and neglect is a significant problem nationwide with over 1 million reported cases each year. For the past two years, Coos County has had the highest child abuse rates in the state of Oregon. In spite of these significant statistics, little is being done in Coos County in terms of primary and secondary prevention. The purpose of my community project was to bring a program into the schools that would address prevention of child abuse. Through research of resources, in collaboration with school nursing staff, I was able to develop a ready-made program for the school nurses to present to children in both the primary and intermediate grades. The program addresses good touches and bad touches, and instructs children on how to seek help if they are touched in a way that makes them feel sad or uncomfortable. The goal of this project is to reduce incidence of child abuse in Coos County by educating and empowering children. Creating Culturally Appropriate Materials To Encourage Drinking Water On The Warm Springs Reservation. Project Date: 9/24/2001 The potency of providing health care in a manner that is consistent with people's cultural traditions is becoming evident to many. Those in attendance at the Barbados III conference held in Rio de Janeiro in 1993 go beyond deeming such practice powerful; they declare that people have a right to receive such care and to have their own health care practices disseminated: "Indigenous people have an undeniable right to their history and cultural heritage. The medical establishment should... collaborate in a more decisive and committed way in the formulation and application of preventative health policies, including the legitimation of ethno-medicine as a fundamental contribution of ethnic culture for all humanity. I am not yet knowledgeable enough about allopathic medicine to legitimize ethno-medicine with any authority. However, I certainly agree that "(i)ndigenous people have an undeniable right to their history and cultural heritage" and am aware that scientists who have investigated indigenous medical practices have discovered that they often make sense from a scientific cultural perspective. Thus, when the nutritionist at Warm Springs asked me to design posters that would encourage water drinking, I was excited about attempting to do so in a way that honored the cultures of the three nations on the reservation. In this paper I will first give a demographic, historical and philosophical context to my project and then will discuss the project itself. Harney County Health News "Patient Education Newsletter" Project Date: 9/ 24/2001 The rural area of Harney County represents one of Oregon's underserved healthcare populations. Barriers to care in the county include a scarcity of healthcare providers, long travel distances to health care sites, low socioeconomic status, and a low education level. In an effort to overcome these barriers, it is important to provide county residents with an alternative means of communication that provides both general health care education and recommendations, as well as a summary of the healthcare resources that are available but may currently be underutilized. This would allow patients to take greater responsibility for their own healthcare needs and could potentially reduce the demand for acute medical care. Colorectal Cancer Screening Practices at the Dunes Family Health Care Clinic Project Date: 9/ 24/2001 This study sought to examine the colorectal cancer (CRC) screening practices and rates among the family practice providers at Dunes Family Health Care in Reedsport, Oregon, as well as to increase patient awareness about the disease. There were four components of the study: a) written survey of the providers' screening preferences, b) chart review to determine screening rates, c) review of the adjoining hospital's surgery logbook to examine colonoscopy rates, d) creation of an article on screening for CRC to be included in the clinic's newsletter to patients. The providers' screening practices were also compared to national guidelines for screening recommendations. There was found to be an overall high rate of screening at the Dunes clinic, although this was provider-dependent. There was some variation in preference for screening exams among the providers, but all screening plans were within the bounds of most guidelines. Finally, some suggestions were made on how to increase screening rates, and patient groups at increased risk of not receiving screening were identified. Educational Material For The Patient Population At High Desert Medical Clinic In Burns, Oregon. Project Date: 8/13/2001 The objective of the project was to update the pre-existing handouts on the guideline of preventive measures for adult patients. This project focused upon age and gender specific preventive protocols for adult patients aged 18 years and older at the High Desert Medical Center. Back to subject search page or search by preceptor site