RCHC Community Project Abstracts

Back to subject search page or search by preceptor site “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. Dual Relationships in a Rural Community Project Date: 4/25/2005 Dual relationships are a complex and sensitive issue, as they commingle two of the most cardinal aspects of life: Health, and loved ones. The literature describes dual relationships as personal relations, familiar or social, with a patient outside of the office. Historically, medical associations' ethical guidelines recommend against this. Yet there is a paucity of research considering whether this is practical, or even opportune, in small communities. Moreover, short and long-term data on the effects of dual relationships is likewise lacking. This study utilized key informant interviews with 10 physicians and 10 patients in Tillamook OR, in order to assess the prevalence and perception of dual relationships in a rural environment. The hope is to gauge whether these relationships are interpreted as beneficial or detrimental, and to assess the need for future education or intervention. Alcohol Misuse in Benton County Project Date: 4/25/2005 Alcohol misuse is strongly associated with health problems, disability, death, accident, injury, social disruption, and violence. In the United States, alcohol abuse generates nearly $185 billion in economic costs. In general, alcohol misuse is under diagnosed by the primary care physician. The purpose of this community project is to assess the magnitude of the problem of alcohol misuse in Benton County, methods of detecting alcohol problems in our patients, examine the most successful treatment programs for achieving and maintaining sobriety, and the availability of alcohol treatment programs in Philomath, OR and Benton County. A Survey of Alcohol Use Amongst Seniors at Grant Union High School In John Day, Oregon Project Date: 10/18/2004 Underage drinking continues to be a problem among adolescents and has serious social, health, and economic consequences. The purpose of this study was to identify the prevalence of alcohol use among 12th grade students at Grant Union High School (John Day, OR) compared to that of high school students throughout the United States. It is hoped that the information gathered will be used by school district authorities to assess the success of currently instituted alcohol prevention programs, stimulate thought into further methods of prevention, and help promote student understanding and insight into the pitfalls of alcohol abuse. The study was conducted in a survey format, which was completed by individual students on a confidential and anonymous basis. The final results of this project show that alcohol use is common among students at Grant Union High School, with many of them being initially exposed to alcohol at an alarmingly young age. Prevalence of Eating Disorders in a Klamath Falls Pediatric Clinic Project Date: 8/9/2004 Eating disorders represent a significant cause of morbidity and mortality and typically present in adolescents and college-aged young women. Pediatricians have a unique opportunity to detect and treat these disorders.6 At the Klamath Pediatric Clinic it was noted that a large proportion of the visits were for mental health, however none of these were for the treatment of eating disorders. The purpose of this study was to specifically screen for eating disorders to determine if the prevalence was low or if the disorders were not being identified. A screening questionnaire was developed and given to patients at the clinic aged 10 and over, over a two week period. None of these patients screened positive for anorexia or bulimia, however the prevalence of obesity appeared to be fairly high. In addition, a brochure was developed to use as an informational and screening handout for concerned patients and an initial assessment form was made to use for a patient presenting with an eating disorder. I also visited the mental health treatment center for the area, which had the ability to provide outpatient treatment for eating disorders. Off Highway Vehicle Injuries at Lower Umpqua Hospital in 2002 and 2003. Project Date: 5/10/2004 Introduction: In May 2003, the US Forest Service implemented a policy banning the possession of alcohol outside of designated areas in the Oregon Dunes National Recreation Area. The goal of that policy was to reduce the risks of using Off Highway Vehicles (OHV) to both the people using them and the natural environment. Organizers of a OHV centered event called Dunefest also attempted to increase regulation of riders in an attempt to increase safety. Methods: A retrospective chart review was conducted of all patient charts presenting to the Lower Umpqua Hospital emergency room between July 1 and August 31 of 2002 and 2003. 165 charts were abstracted for the following variables: date, time, patient age, Dunefest weekend, insurance status, EMS usage, alcohol use prior to the incident, protective equipment used at time of incident, type of injury, and disposition. Chi-square and Fisher’s exact test were used to analyze the data. Results: The average age of injured riders was 27.9 with 34 patients being 16 years old or younger. No significant change in the number of OHV related injuries was found other than a decrease in the number of patients without helmets. Alcohol use was associated with higher rates of admission or transfer to higher levels of care, lack of documented insurance, presentation to the ER between 2100 and 0700, and lack of helmet usage. Thirty-one (19%) patients had no documented insurance representing a significant potential financial burden for the hospital. Conclusions: While the new US Forest Service policy did not appear to reduce the number or severity of injuries presenting to LUH ER, the number of unhelmeted patients declined. Riding OHV’s while under the influence of alcohol was associated with greater risk of injury and higher morbidity. Efforts to decrease the operation of OHV’s under the influence of alcohol should continue. Physicians may utilize the ER encounter to screen for alcohol use among injured patients and apply brief interventions to educate patients and their friends and families about risks of combining alcohol with OHV recreation. Future studies will be needed to better determine the effects of the policy. The effects of Chronic psychological stress Project Date: 5/10/2004 The relationship between psychological stress and overall general health has been well documented in many studies. Chronic psychological stress can elicit negative health effects on numerous organ systems including the immune, gastroenteral, and nervous systems. The hope for this study, via questionnaire, was to examine the prevalence of stress in a small community primary care clinic, the perception of stress and its affect on general health, how often measures are taken by patients in order to decrease chronic stress, and to identify examples of major stressors that affect the community. Furthermore, it was hoped that this study would shed insight to what degree a primary care physician can identify stress and its symptoms as well provide information in stress lowering activity. I found that 31% of the respondents indicated mild to moderate stress and 17% of patients had significant stress. 23% of respondents had severe stress levels. 28% of patients felt that stress had little or no effect on general health. Furthermore, 29% of patients indicated they never take steps to reduce stress. Examples of stressors that were listed in the survey varied in sources. These data suggest stress is substantially present in this rural community. A need to address the health concerns that may be associated with increased levels of stress and careful inquiry by primary care physicians into potential stress would likely benefit the management of patient health issues in a rural community. Identifying and addressing stress related symptoms would likely yield many benefits, i.e. productivity at the work place, increased coping strategies, etc. Alcohol Abuse/Dependency Treatment in Harney County: An informal Survey of Available Services Project Date: 9/23/2002 Alcohol/ substance abuse is a significant problem in rural communities, particularly in times of economic downturn. This project is an informal survey of services available in Harney County for alcohol abuse and how the different branches of the health care community communicate and respond to this issue. Personal interviews with the clinical directors at Harney Behavioral Health and Harney District Hospital as well as an administrator at the Sheriff’s Department and a counselor at the Indian Health Service were conducted at various times throughout the clerkship. From these interviews, a barrier to accessing mental health services was identified. Patients seen in the ER after hours for Substance abuse related health problems were not being referred to mental health services for substance abuse disorders. As a result of this observation and subsequent interview with the clinical director at Harney Behavioral Health, renewed efforts at improving communication between the hospital and HBH are being made. This will take the form of HBH sending a representative to monthly staffing meetings in order to network and increase access to mental health services. A Survey Of Teacher Satisfaction With The Woodburn Pediatric Clinic's Monitoring Practices Of Students Diagnosed With Attention Deficit-Hyperactivity Disorder. Project Date: 11/5/2001 Attention-deficit/hyperactivity disorder is the most common school-aged behavioral problem with a prevalence of 3-5%. The Woodburn Pediatric Clinic has a large subset of these patients on its census. Management and monitoring included a questionnaire sent to the teachers and counselors of these patients concerning AD/HD-specific behaviors. This study investigated the efficacy of this questionnaire by employing a teacher survey. Generally, feedback concerning the questionnaire was positive. Suggestions for improvement centered on changing the format from fax to e-mail and giving respondents more lead time in completing the questionnaire. Back to subject search page or search by preceptor site