RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Optimizing Care of Chronic Pain Patients in a Rural Primary Care Clinic Project Date: 8/3/2009 Treatment of chronic pain can present one of the most challenging scenarios in medicine – both for clinicians and patients alike. Managing constant prescription refill requests and sometimes frustrated patients can be taxing on clinic staff and providers, while communicating the subjective experience of pain can be emotional for patients whose pain may often go untreated or under-treated due to historical sensitivity about prescribing narcotic medications. Further complicating this delicate relationship between patient and clinic is the increasing prevalence of prescription drug diversion and abuse, particularly among American youth. This project investigated current trends in the management of chronic pain at the clinic and community level, gathering information from medical literature, local clinic staff, surveys of chronic pain patients, and interviews with key community role players. A summary of recommendations was developed to assist local providers in optimizing the care they provide to patients with chronic pain. Prevalence of Antibiotic Resistant Bacteria Project Date: 4/27/2009 I studied the prevalence of antibiotic resistant bacteria among the population serviced by the laboratories at Silverton Hospital. Antibiotic resistance data for 2009 was obtained for the following species: C. feundii, E aerogenes, E cloacae, E faecalis, E coli, K. oxytoca, K pneumonia, M morganii, P. mirabilis, P. aeruginosa, S marcescens, S aureus, S epidermidis, S. saprophyticus, S. agalactiae. Sensitivity data for the following drugs was available: Amikacin, Ampicillin, Aztreonam, Cefazolin, Ceftazidime, Ceftraxone, Cefuroxime, Ciprofloxacin, Clindamycin, Ertapenem, Erythromycin, Gentamicin, Imipenem/Cilast, Levofloxacin, Nitrofurantoin, Oxacillin, Piperacillin/Tazobactam, Sulfa/Trimethoprim, Tetracycline, Vancomycin. Relevant literature was reviewed including data from national levels and from the greater Portland area. There is data in the literature to suggest that regional antibiograms provide accurate, cost effective information for local providers concerning trends in community-specific resistance trends. Providing sensitivity that is regional and accurate will help to guide empiric therapy of common infections, and can ultimately help to decrease the rate of increase in resistant bacteria. Coming Out of the (Sample) Closet: Pharmaceutical Samples at Dunes Family Health Care, Reedsport, OR Project Date: 2/9/2009 Introduction: Pharmaceutical samples are commonplace in most medical offices in the United States, including Dunes Family Health Care in Reedsport, Oregon. The goal of this study was to assess the current inventory of drug samples at Dunes Family Health Care, and to survey the providers’ attitudes toward the presence of drug samples and industry detailers in the office. Materials and Methods: A comprehensive inventory of all drug samples was performed. The products were then further stratified by cost and therapeutic purpose. Voluntary surveys regarding pharmaceutical samples were distributed to all clinic providers with a license to prescribe medication. Results: There were a total of 2305 individual sample units in the clinic, which comprised 81 distinct drugs. The average retail cost per dose was $3.75 (range $0.25 - $21.00). The most common categories of medications in the office were those for asthma and hypertension, each accounting for 13% of the total number of distinct drugs. Survey results demonstrated a decrease in use of drug samples over the past five years. Lack of patient insurance was the most common reason for dispensing pharmaceutical samples. Most providers believe that drug samples save their patients money. Conclusion: Physician opinion regarding pharmaceutical samples varies among providers at Dunes Family Heath Care. There are numerous complex interactions at work when providing sample medications. The best way to ensure a positive outcome is a close relationship with one’s patients and a thorough knowledge of their medical history and social situation. A Brief Sojourn in the Land of Chronic Pain Medication, as experienced at Scappoose Family Medicine Project Date: 8/4/2008 A recent article in the New York Times detailed the increasing use of methadone for chronic pain in the primary care setting. Often considered by the public as a drug for drug addicts, it is an opioid similar to the prototypical opioid morphine. However, methadone has substantially different pharmacokinetics, and these properties may make the drug dangerous to certain patients. Still, the increase in methadone use continues, likely due to its lower cost relative to other extended-release opioid formulations. Does this pose problems for primary care patients with chronic pain and public benefits such as CareOregon? Does it pose problems for providers who are unaccustomed to or uncomfortable with methadone's pharmacokinetics? Though this short study cannot answer these questions definitively, by considering the patients of OHSU Family Medicine Scappoose, we can learn about chronic pain medications and their use. We also can glean some providers' opinions regarding the prescription of methadone, and the restrictions that they face due to many patients having public benefits. Finally, we may remind ourselves as clinicians that hidden dangers lurk for patients starting methadone, or for those converting to methadone from another opioid. 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. Avoiding Unintentional Doping Violations Project Date: 4/28/2008 The problem addressed in this project was the possibility of a volunteer physician at the 2008 Olympic Trials causing an unintentional doping violation in an elite athlete/patient, by unknowingly prescribing a medication containing an agent prohibited by anti-doping regulations. The proposed solution was the creation of a concise educational report, detailing the appropriate prescribing practices for elite competitive athletes, and warning them of the often-prescribed medications which may cause positive drug screen results. This was accomplished by researching the anti-doping policies, practices, and requirements of US Track and Field and the International Olympic Committee, and the US Anti-Doping Agency and World Anti-Doping Agency. Research was also done to determine the medications most likely to cause unintentional doping violations. The result was a concise report, intended to be distributed to the physician volunteers for the Olympic Trials. True assessment of the success of the project would require follow up surveys of the physicians after the conclusion of the competition. Recommended Techniques for Safe and Environmentally-conscious Disposal of Un-needed prescriptions in Madras, Oregon Project Date: 4/28/2008 The proper disposal of expired or unused prescription medications continues to be an ongoing problem in the United States with no standardized disposal technique in place at a federal level or, in Oregon, even a state level. This study was designed to examine the current disposal technique Madras residents utilize to dispose of unused or expired outpatient medications as well as to provide a comparison as to what happens in an inpatient setting at the pharmacy and home health/hospice associated with the MountainView Hospital. The design was an informal survey of patients in clinic regarding their disposal habits as well as querying the MountainView pharmacists and hospice nurses as to their current protocol for medication disposal. Further phone calls were made to the Oregon Board of Pharmacy and the DEQ in regards to their recommendations for proper disposal techniques. Previously, there was no information available to patients for proper techniques to purge unneeded medications; therefore the final product of this project was the development of a patient handout to inform Madras residents of the most appropriate and environmentally friendly mechanisms of pharmaceutical disposal. Furthermore, as there is no organized collection system for outdated or unused medications anywhere in Oregon, an additional component of the project was to create a proposal for the Madras Medical Group to use as a long term community solution for the problem of proper medication disposal Difficulties in Narcotic Prescriptions for Chronic Pain Patients in a Rural Clinic Project Date: 3/17/2008 Background : It is difficult and time-consuming for different providers in a small rural healthcare practice to determine when a pain medication is due for a patient under a narcotic contract, because of different levels of patient understanding and variability in the wording within the prescriptions. Furthermore, the dispensation of narcotics causes significant tension in the doctor patient relationship. Question: I set out to determine if there was a way to improve the communication between a patient and a provider and among different providers in a group. Methods: I conducted a number of interviews with staff and patients and used the GE Centricity electronic medical record to better define the population with narcotic prescriptions within the practice, and then attempted to use the electronic medical record to generate uniform narcotic prescriptions. Results: The population receiving narcotics prescriptions in this practice were disproportionately Medicaid and Medicare patients. Although prescribing practices varied significantly among providers, the idea of creating a uniform disclaimer for narcotics prescriptions was met with enthusiasm. Therefore, a quick text generator, or “dot phrase” was created that could be entered into a prescription that read “Do not refill. Do not drink alcohol while taking this prescription. Do not operate a motor vehicle if impaired. Limit to Applegate Medical Providers. Limit to _______ Pharmacy. This medication is to last until ________.” This was then linked into the patient’s medication chart, the current visit note, and the after-visit summary. Although this was not a complete solution, the project was viewed as a success by groups prescribers Antibiotic resistance data for Lower Umpqua Hospital and the surrounding area for 2007. Project Date: 3/17/2008 Emerging antibiotic resistance of bacteria is a major problem in healthcare. It is a frequent cause of morbidity and mortality in hospitalized patients and is a major financial burden. As resistance patterns increase, newer and more expensive antibiotics must be used. Several strategies have been postulated to prevent these resistance patterns. They include: minimizing inappropriate use of broad spectrum antimicrobials, knowledge of local resistance patterns, prompt initiation of empirical therapy, using proper dosing and dosing regimens, prompt narrowing of antimicrobial therapy, and antimicrobial cycling. To date, antibiotic resistance in rural hospitals has not been well studied. At the Lower Umpqua Hospital (LUH) in Reedsport, OR, due to a low volume of cultures, antibiograms are not routinely done. Thus, to aid the physicians in understanding the local resistance pattern of their hospital, antibiotic resistance data was gathered for LUH between 2007-08, and 2008-present. Additionally, resistance patterns were gathered for the two nearest hospitals: Peace Harbor in Florence, OR and Bay Area Hospital in Coos Bay, OR in order to both compare the different communities and provide further information is aid in antimicrobial prescribing, since the these three hospitals often share patients. This information was presented to the physicians of LUH in order to help in the prescribing of the cheapest, narrow spectrum antibiotics possible for their patients. Generally, the resistance patterns at LUH were better than that of the surrounding hospitals. Quality Assurance at PeaceHealth: Medication Reconciliation as a Priority Patient Safety Goal Project Date: 12/31/2007 Despite the best intentions and hard work of healthcare providers, thousands of patients are harmed across the United States everyday. These instances of medical harm include adverse drug events (ADEs), which are many times the result of incomplete or inaccurate patient medication lists. ADEs can be reduced by implementing improved medication safety, so strategies to achieve this goal are a national patient safety priority. This study attempted to identify the process, successful implementation, and outcome of a medication reconciliation program led by the Medication Oversight Safety Team of the Quality Committee (QC) at PeaceHealth ambulatory clinics in Eugene, Oregon. Because medication reconciliation is a PeaceHealth system-wide initiative, the population studied was all patients seen at PeaceHealth ambulatory clinics across several departments, including internal medicine, family medicine, and pediatrics. The methods included observation of and direct participation in the medication reconciliation process with patients. Formal interviews with the QC chairperson, PeaceHealth healthcare improvement coordinator, and internal medicine clinic front- and back-office staff were conducted. Weekly meetings with the QC chairperson and PeaceHealth quality department manager as well as participation in a QC retreat also contributed to the study. At PeaceHealth, the medication reconciliation process involves a defined series of interactions between patients, clinic staff, and physicians and monthly report of these events to the quality department for an audit. Over the last 9 months, PeaceHealth clinics have on average performed medication reconciliation with 88.5% of their patients, which is just under the set target of 90%. At this stage, the outcome, or actual reduction of ADEs correlated with medication reconciliation, is not being measured at PeaceHealth. 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. The Oregon Prescription Drug Plan & the Uninsured and Underinsured Residents of Harney County Project Date: 12/31/2007 Senate Bill 362 is an amendment passed in the legislature in April, 2007 that expanded the Oregon Prescription Drug Plan (Ballot Measure 44). All Oregonians are now eligible for a free discount card for prescription drugs. Unfortunately, the bill did not include adequate funding to promote the program. Given the high costs of prescription drugs and the difficulty many Harney County residents have paying for their medications, this project was designed to increase local familiarization with the program and also to better understand the workings of the program. How well known is the program? How does it work and is there a true benefit? Is it possible for it to be sustainable in the long term? To answer these questions, staff members at the clinic and hospital were interviewed. Community resources to help patients pay for medications were evaluated, and interviews with the pharmacists in Burns, the director and assistant director of the OPDP, the executive director of the Oregon Pharmacies Association and a reporter from the Oregonian were conducted. In the end, two articles were written for the Burns Times Herald, the first informing citizens that the program is available with instructions to register. The second article focused on the details of the program, its funding and its future. Notifications were placed in several church bulletins in town, and the hospital, clinic and senior center were provided with resources to promote enrollment in the program. The benefits and drawbacks of the program were discussed with staff at the hospital and clinic so they could continue to educate patients in the future. 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. Evaluation of chronic pain management patient burden on CEFP clinic, Klamath Falls, OR. Are we simply refilling opioid medications? Project Date: 9/10/2007 Klamath Falls, is a larger than rural community in S. Oregon. However, due to its proximity to other outer lying rural areas, CEFP serves as the hub in the wheel and center of focus for much regional primary care. There is only on Pain Management specialist in Klamath Falls, and this provider does not take OHP. Thus the burden of low income pain management falls mainly on CEFP. Currently many urgent care visits are taken up by medication refills and frustration of residents in trying to deliver appropriate care is evident. Most notably, loss of professional autonomy is cited by residents in their frustrations in dealing with this patient population. This does not allow for continuity of care and addressing of other patient health issues. In fact these patients are seen more often but with less emphasis on other health maintenance issues. A 6 mos interval of chronic pain management visits was queried from CEFP electronic medical record system. 158 unique patients involving a total of 1075 patient visits in the last 6 mos. These patients were chart reviewed to identify continuity of same provider care and top categorical assignment of other co-morbid health conditions in an attempt to identify strategies to better improve delivery of health maintenance. These results will help the faculty and residents determine if: 1) they are meeting their health care mission to their patients 2) if a pain refill medication clinic is specifically needed to relieve burden on the urgent care practice and allow patient visits to focus more on other health issues. 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. Antimicrobial Prophylaxis in the Surgical Patient at the Lower Umpqua Hospital in Reedsport, OR Project Date: 4/30/2007 Postoperative surgical site infection (SSI) is a major source of illness in the surgical patient. According to many experts, the level of bacterial burden is the most significant risk factor in the development of SSI, but modern surgical techniques and the use of prophylactic antimicrobials have reduced this risk. Despite the evidence of effectiveness and the publication of guidelines for antimicrobial prophylaxis to prevent SSIs, substantial inconsistencies exist in the use of prophylactic antimicrobials for patients undergoing surgical procedures. After the literature review, medical records of the patients who had a surgical procedure and were discharged from the Lower Umpqua Hospital from 10/01/2006-03/31/2007 were reviewed. After the data was collected and analyzed, the results from this project were compared to the results obtained by the National Surgical Infection Prevention Project. An estimate of the cost and need of the provision of chemotherapy in Harney County. Project Date: 10/16/2006 Background: Each year approximately 150-250 people from Harney County (population about 7000) seek medical treatment for cancer. The long distance from home exposes patients to added risks during their treatment. Currently, Harney District Hospital (HDH) is researching the possibility of administering chemotherapy on site. This would result in saving cancer patients many hours on the road. Population: This project looked at a subset of Harney County cancer patients who are receiving treatment at Bend Medical Clinic (BMC), St. Charles Hospital. Type of study: Informational. Methods used: A cancer patient list was compiled by BMC, defined by cancer patients with Harney County address zip codes. This list was cross referenced with the EMR at the High Desert Medical Center (HDMC) in Burns to obtain patient's cancer diagnosis. A list of "safe" chemotherapy drugs were provided by BMC oncology staff. The cost of the drugs and administration were calculated. Results: The patient population is described. It appears that the administration of chemotherapy drugs at HDH would be fiscally feasible with chances for a net gain. Maximizing Access to Prescription Medications in Ontario, Oregon Project Date: 3/20/2006 Medicare Part D is an insurance plan for prescription medications that recently became available to everyone enrolled in Medicare. It was designed to provide coverage for prescription medications regardless of income, health status, or costs. With over 450 different plans available in Oregon, and insurance coverage that varies depending upon prescription costs, many patients have questions about choosing a specific plan, and determining if Medicare Part D is right for them. The deadline for joining Medicare Part D without penalty is rapidly approaching, making it even more important for patients to be able to make informed decisions in a timely manner. This study looks at how residents in Ontario, Oregon are making important decisions regarding Medicare coverage, and identifies resources that patients have found useful. In addition, some of the complications with Medicare Part D have been identified, so that they may be avoided in the future. It is hoped that the results of this study will help patients make informed decisions about Medicare Part D, and maximize their access to prescription medications. Medicare Part D in Tillamook, Oregon and Its Implications: Both Financial and Ethical Project Date: 1/2/2006 January 2006 has ushered in a new era in American health care with the institution of the Medicare part D prescription drug benefit. Its promise is to improve prescription drug coverage for seniors. It has been championed as the financial savior for the elderly, but it may pose more problems than it could ever solve. There are actually many cases where the new program hurts the people it is meant to assist. This scenario became evident in a small town, Tillamook, Oregon, during my rural healthcare rotation. In talking with my prceptor, Dr. Parsons, it seemed there were many reasons why Medicare Part D may actually be doing our seniors a disservice. This new drug benefit may also carry with it some ethical issues as well, specifically, is this new program allowing physicians to do the most good for their patients? While Medicare Part D has the potential to ease the financial burden of healthcare for millions, it may pose hidden costs to both seniors and physicians. Medicare Part D Project Date: 1/2/2006 Medicare part D, is a new prescription drug plan being started by the government beginning this year January 1. There is lots of confusion regarding general information, how to sign up, and which plan to choose. This program affects a large amount of the community in Klamath Falls, since all people on Medicare currently are eligible. In addition there are many penalties and nuances of the program. The goal of the project was to find out more information on Medicare D and what it was about, to see the population’s grasp of the new program, and to see what was out there to help those who needed aid. A quick survey was distributed through the practice to see if people knew about Medicare part D. The only community resource in K. Falls was contacted, interviewed, and observed to see what educational opportunities were available to the public. Of the eligible parties only 55.8% were familiar with the new program showing a definite need to further educate those eligible. A Suggested Protocol for the Management of ADHD in School-Aged Children of Coquille, Oregon Project Date: 9/12/2005 Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder of childhood, affecting 3% to 12% of school-aged children. ADHD may cause children and their families significant problems; symptoms may result in academic underachievement and difficult relationships. However, pharmacologic treatment of ADHD is largely effective, and is promoted by the American Academy of Pediatrics and the American Academy of Family Physicians. As no standardized ADHD management algorithm was available to the physicians of Coquille Valley Medical Center, this study sought to merge national treatment recommendations with the community standard of care to develop an ADHD management strategy for the treatment of school-aged children with ADHD in Coquille, Oregon. The effect of the new Medicare Prescription Drug Benefit on the 65 and older population at the OHSU Scappoose Primary Care Center Project Date: 9/12/2005 A significant number of the OHSU Scappoose Primary Care Center's patients who are 65 and older do not have prescription drug coverage. These patients bear the entire cost of their medications, and many carefully weigh treatment decisions based on cost. In the author's time at the Scappoose Clinic, numerous encounters were noted with patients from this population where prescription cost was a larger consideration in therapy selection than for those who have prescription coverage. This project describes how the clinic's patients will potentially be affected by new Medicare legislation, effective January 1, 2006, that will provide prescription drug coverage for millions of retired Americans. Multiple Strategies Designed to limit Medication costs for the underserved at the West Salem Clinic Project Date: 4/25/2005 Medication cots in the United States continue to trouble the patients taking the medications and the physicians prescribing them. This study attempted to identify and explain the many strategies the Northwest Human Services West Salem Clinic is using to combat therapeutic costs. The design was collection of information and data from multiple sources regarding several current methods currently being used at the clinic. All staff involved with patient care as well as staff specifically dedicated toward cost reduction programs were observed, studied, and queried regarding the ins/outs of these programs. This project will allow for a wonderful synopsis for clinics to possibly emulate the medication reduction cost programs currently being implemented at the NHSWSC. Increasing Access to Prescription Medications in the Elderly Population of Malheur County Project Date: 2/7/2005 Many elderly patients take prescription medications on a daily basis; however, the rising costs of these medications make it difficult for patients, especially those with fixed or low incomes, to afford them. For elderly patients in the rural setting, the problem of access to affordable medications is even greater because of the lack of social workers and other staff available to assist patients with applying for prescription assistance programs, Medicare discount cards, and other lower-cost prescription medication programs. Many patients report that their prescription drugs cause them financial hardship. This often leads to patients skipping or cutting down on doses or not filling the prescriptions at all. This is frustrating for both the patient and physician who both are trying to manage what are usually complicated medical conditions. Oftentimes, the physician, nurses, and other office staff take on the responsibility of helping patients access medication assistance programs, which is both time and resource consuming for the staff. This project looked at the elderly population represented in one family practice office in Ontario, Oregon, which is the largest city in Malheur County. A prescription drug questionnaire was utilized to query patients about out-of-pocket prescription medication costs, methods of cost savings (e.g. buying online, skipping doses, etc), and knowledge about cost saving prescription drug programs. A total of 22 patients, age 65 and over, completed the survey, with 45% responding that the cost of prescription medications cause them financial hardship. These patients spent an average of $187.00 a month on prescription medications, and 70% report having no prescription drug coverage. Of the 55% that did not experience financial hardship, 92% had some type of drug coverage and spent an average of $49 a month on medication. Of all the patients surveyed, 45% report using cost-saving methods, including using mail-order companies in Canada, price comparing among different pharmacies, using samples, skipping doses, and not filling prescriptions. Ultimately, the goal of this project was to identify ways to help patients gain access to affordable prescription medications in the most time and resource efficient manner. Development of a simple one page handout with prescription medication resources and consumer buying tips, which could be easily distributed to patients, was found to be the most efficient and helpful to patients. 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. The rising cost of prescription medications continues to impact the lives of many individuals. Project Date: 9/13/2004 The rising cost of prescription medications continues to impact the lives of many individuals. It is one thing to hear that prescription medications are expensive, it is quite another to put a name and a life to the out-of-pocket cost than an individual has to pay in order to maintain health. The majority of prescription medications are utilized by individuals greater than 65 years old. In the retirement community of Florence, individuals 65 years and older represent 35% of the population and also represent the fastest growing group of individuals. In order to better understand the impact of the price of prescription medications on the elderly population of Florence, the aims of this study were to 1) determine the average out-of-pocket price of medication for individuals on Medicare or Private insurance; 2) research the price of commonly prescribed medications; and 3) to conduct a survey in order to better appreciate the impact of the cost of prescription drugs on patients in Florence. This experience not only helped me to become more aware that simply writing a prescription for a medication was not necessarily going to mean that a patient was going to be able to take the medication. Lastly, through observing patients as well as my preceptor, I learned that there are alternative ways to obtain prescription medications in order to ensure that patients are able to receive the medicine that they need to maintain health. Analysis of drug sample use at OHSU Scappoose Family Practice Clinic Project Date: 8/9/2004 Prescription drug costs are a growing concern for many patients seeking medical care in the United States today. One recent study predicts that drug expenditure growth should continue to outpace the growth in overall health care expenditures and the growth in the U.S. economy. Currently many physicians use free drug samples provided by the pharmaceutical companies to provide medication to their patients. This study attempted to analyze the use and opinions of drug sample resources from three practitioners in a rural OHSU primary care clinic in Scappoose, Oregon. The design was to randomly select 101 instances in which drug samples were given out to patients and analyze as to which physician prescribed the sample, total costs saved for the patient versus local pharmacy costs, and compare with the insurance status of the patient. In addition the three practitioners from the clinic were independently interviewed concerning their views of drug samples to be compared with the actual free sample prescribing habits. The overall objective of this project is to determine if there is any pattern to the prescribing of free drug samples from the clinic and to investigate alternatives available for patients who are not able to afford their prescription drug costs. Uncovering Available means to reduce prescription drug costs, and improving patient access to this information Project Date: 5/10/2004 Increasing prescription drug prices place significant financial strains on numerous segments of the population. The reduced medication compliance that results from this reality adversely impacts both the directly involved individuals health and the overall healthcare system. While this is not a problem with an easy solution, numerous programs currently exist that could benefit those less then able to pay. These programs are underutilized, however. Using mainly discussions with providers, obervation patient questions, and internet seraches, the following resource categories were discovered: PAP programs, Medicare drug cards, and miscellaneous state-specific programs. Additionally, a previous student handout on the use of overseas pharmacies was consulted. Though the handout's recommendations were technically illegal, the fact remains that millions of Americans do obtain their medications at discounted rates from overseas pharmacies - without real FDA enforcement. As such, an attempt was made to help make the practice as safe as possible. From all this information a handout was created, inteded to maximize patient self-sufficiency and benefit while minimizing resource costs. 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. Strategies for Coping with Rising Medication Costs. Project Date: 3/24/2003 Rising prescription medication costs pose an acute financial burden on the lives of rural Oregon's senior citizens. This project is designed assess patient difficulty and provider awareness with the issue and provide education materials. Short surveys were given to senior patients with questions concerning income, costs of medications, insurance coverage, compliance, and strategies used to lower costs. Additionally, to assess physician knowledge of cost issues, a quick, "off-the top-of-your-head" quiz concerning prices of three common medications at different doses. Focusing in on pill-splitting, an computerized chart review was used to identify potential savings from implementing pill-splitting techniques for one common medication. Finally, both patient and physician education handouts detailing cost saving strategies were developed and distributed, along with a common medication price list for providers. The Community Health Improvement Partnership (CHIP) and Reedsport, OR: A Prescription Drug Assistance Program for Seniors. Project Date: 3/24/2003 In cooperation with Office of Rural Health at Oregon Health & Science University, the small rural town of Reedsport, OR has initiated a process of evaluating and addressing the community healthcare needs through the Community Health Improvement Partnership (CHIP) (McGinnis, 1999). The goal of the project outlined here is to use some of the information and infrastructure that has been laboriously compiled through the efforts of numerous people within and outside the community to address one of the major healthcare disparities identified through the CHIP process. Several students have worked as part of the CHIP process in Reedsport, following the project through its different phases (Morgan, 2002; Kerr-Valentic, 2003). These past projects have described the coalescence of the CHIP council, its decision-making, and the identification of the community healthcare needs. The next step in the process is the design and implementation of specific programs to address those community needs. This project proposes one such program, the creation of an organized prescription assistance program for seniors. Prescription Costs in Tillamook Oregon Searching for Keys to Education & Compliance. Project Date: 3/24/2003 Background: In the 4 years preceding 2002 medication costs increased at a rate of about 30% yet over that same time frame social security benefits increased only 9.4%. How do the ever-increasing cost of medications affect the lives of those who take them? Do these increase costs have an effect on patient compliance? Do people know about programs that are available to help low income seniors with the increasing costs of medication? These questions were attempted to be answered. Methods: An anonymous questionnaire was obtained in two locations in Tillamook, OR. Total surveys returned were 58. An attempt was made to correlate medication expense with patient medication compliance. An additional attempt was also made to compare the difference in response between the in-clinic and out-of-clinic settings. Results: It was determined that as monthly costs rose patient compliance decreased. The average patient expenditures for medications was $162 while the average for the self-reported non-compliant patient was $276. There was about an equal percentage of patients in the clinic and out who knew about programs from drug companies but in the clinic only 38% wanted more information on these programs while outside the clinic (at the senior center) 88% of patients requested more information. Conclusions: As medication expense rose compliance decreased. This shows a need for decreasing the overall cost of medications. Also patient education goals are not being met. Only 50% of patient were knowledgeable about reduce cost drug programs. This leads us to conclude that our education methods at present are insufficient in office and desperately inadequate in the general community. It is the feeling of the author that informational material should be better displayed in the clinic and a program be established to make at least some basic information available to those in the general community. This information that might be made available was reviewed under the programs portion of this paper. Community Response to Loss of Pharmacy Benefits for Patients with Schizophrenia in Lebanon, Oregon Project Date: 2/10/2003 Recent budget cuts have led to the loss of pharmacy benefits for certain Oregon Health Plan patients. People with schizophrenia were identified as a group particularly vulnerable to deterioration and increased complications without medication. The purpose of this project was to examine the resources available to address this crisis in Linn-Benton counties, and Lebanon specifically. Community response included creation of a generic formulary and a medication assistance program, despite lack of government funding. Resources in Lebanon for this population are substantial. The primary shortcoming was dependence on pharmaceutical company patient assistance programs for patients who require atypical antipsychotic medication. 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. Paying for Prescription Drugs in Newport, Oregon. An analysis of prescription drug expenses and the methods of payment for patients at Pacific Internal Medicine Project Date: 9/23/2002 Prescription drug costs create a financial burden for many patients nationwide. This study attempts to assess this burden for patients at Samaritan Pacific Internal Medicine (SPIM) of Newport, Oregon. A survey of patients was conducted to examine how they pay for pharmacotherapy (i.e. insurance, out-of-pocket payment, government assistance), the monthly expense of prescription drugs, and what percentage of the patient population believes that prescription drug costs are a barrier to treating their medical conditions. This study also evaluated the methods employed by SPIM to assist their patients in obtaining drugs at discounted rates; this analysis was performed through observation and informal interviews of members of the medical staff. The results of the survey indicate that many do consider the cost of prescription drugs a barrier to healthcare, particularly patients with net monthly incomes below $1500, those paying over $50 per month for prescriptions, and the uninsured. Analysis of office practices to assist patients in managing prescription costs demonstrates that SPIM works diligently to educate patients about opportunities to receive discounted drugs and to assist them with the application process required to receive them. Prescription Medication Patient Assistance Programs in Harney County, OR: Development of an Efficient Application System Project Date: 8/12/2002 The access to prescription medications is an essential component of complete health care for our patients. Increasing drug costs, increased utilization, and the lack of bulk medication purchasing for the uninsured populations makes medication acquisition a growing problem, especially in rural areas. The patient population at the High Desert Medical Center in Burns, OR was evaluated for eligibility for existing pharmaceutical manufacturers’ patient assistance programs. Results indicate that 100 patients were receiving benefits, while up to 509 may be eligible. The labor required to complete applications and to distribute medications was cited as a barrier for efficient utilization of these assistance programs. Software was ordered and installed to help the clinic staff in administration of these programs. A patient handout summarizing the various options for obtaining affordable medications was constructed and published (http://www.geocities.com/mmacht/medhelp.pdf) so it could be used by patients and health care providers throughout the state. Further sources of aide, including grants from the Rural Health Foundation, were discussed with clinic staff. The handout was observed during the final three days of the rotation, and found to be extremely successful in educating patients and staff about the various assistance options, involving patients in the administrative process, and encouraging more eligible patients to seek assistance. An Evaluation Of U.S. And Canadian Online Pharmacies For Medicare Patients At Klamath Falls. Project Date: 1/2/2002 Approximately half of the patients seen at Klamath Family Practice Center are on Medicare, which does not cover outpatient prescription drugs, and many of these patients struggle with high costs of their prescription medications. This study evaluates 6 online pharmacies, 2 in U.S. and 4 in Canada in terms of their prices and selections in comparison to Klamath Falls Safeway Pharmacy. Results indicate that U.S. online pharmacies offer little or no savings over local prices. In fact, many of the drugs they carry may actually cost more than at local pharmacies. Out of the four Canadian online pharmacies evaluated, three offer significant savings of 24.10-30.80% over local prices. The fourth Canadian pharmacy offers a much lower 4.60% saving mainly due to its high dispensing and shipping fees. In Conclusion, www.canadameds.com and www.canadiandrugstore.com are found to be highly recommendable online pharmacies for their low prices and good selections on prescription medications. The Use of Medication Lists in a Community Health Center. Project Date: 11/5/2001 OBJECTIVE: To determine the effectiveness and accuracy of medication lists. Specifically, whether they help to reduce medication regimen complexity, enhance patient education. To implement simple strategies to increase the value of an already established medication list system. DESIGN: A questionnaire was designed and given to randomly selected non-pediatric patients during a 3-week period. The questionnaire included various demographic information. It also included a list of the patient's medications taken per the patient and per the patient's chart as well as the reason the medication was prescribed per the patient and per the patient's chart. Finally, the questionnaire included a list of non-prescribed medications and alternative forms of care (i.e naturopathy). SETTING: The West Salem Clinic, a community health center serving low-income individuals in Salem, Oregon. RESULTS: A total of 28 patients were interviewed during the three week period. Patients were taking an average of 8.4 medications. The average age of patients was 61.7; there were 19 females and 9 males. The percentage of errors per the patient recollection of his or her medication was 36.4. The percentage of errors per the patient's chart was 18.2. Nearly 62 percent of patients were unaware of the reason for taking at least one medication. The majority of patients over 65 were insured via Medicare (80%) and the majority of patients under 65 were insured by the Oregon Health plan (75%). Non-prescribed medications were mentioned in 36.4% of responses and 18.2% of patients reported using alternative forms of medicine sometime in their lives (no patients were currently using alternative forms of medicine). CONCLUSIONS: Patients at West Salem Clinic are taking a relatively high number of medications. Errors were seen by both the patient and the patient's chart. Many patients did not understand why they are taking certain prescribed medications. Compared to other studies medication lists used by the clinic seem to have a decreased number of errors suggesting the efficacy of an already existing system. However, steps aimed at increasing patient education and awareness as well other adjustments can help improve an already efficacious system. Overseas Pharmacies Online Cutting Prescription Drug Prices. Project Date: 11/5/2001 Troubled by stories of patients who had chose to go without medications because the cost was too high and after the frustration of having prescribed a medication only to find out that it was not covered by a particular insurance company's formulary, I decided to see if there may be a way to purchase drugs cheaper overseas. Studies have noted that Americans regularly pay up to twice as much as Europeans and Canadians for the same drug, and my preceptor had mentioned that a few of his patients had purchased discounted drugs across the border in Mexico and Canada. I was curious to have an idea of what type of patient would benefit most from lower prescription drug costs and what the patients' perspective was on why drug costs were so high. I offered a questionnaire to patients over the course of a week in the clinic. Thirty-five patients responded to the questionnaire and the results are detailed in Table 1. The questions were not designed to provide hard data, but rather to offer a subjective framework and personalize the project for the community. The average age of the patient was 57, with oldest being 90 and the youngest being 18. There was an even distribution among income categories. However, the common denominator appeared to be in answering the question that asks if they would benefit from lower prescription drug prices. Invariably, the answer was "yes". One frustrated patient wrote, "Please tell me if there is anything that does not cost both arms and both legs." The elderly patient with a mid to low income appeared the most affected by a long list of medications and little or no supplemental insurance to cover the bill. Also interestingly, most did not choose to answer the question that asked why the cost of drugs is so high in our country. The question fell at the end of the survey and may account for why some chose to skip it, but more likely a blank answer indicated that the respondent did not know the answer to the difficult question. In the recent years, the pharmaceutical industry has been by far the most profitable industry in the country (2,3). Drug companies are beginning to offer indigent programs for patients that meet an income level, on average, of less than 15,000 dollars per year. These are praise-worthy programs and my preceptor and his staff have worked hard to identify patients who fit the appropriate profile. For instance, Merck offers up to three drugs completely free of cost for three months when the proper application has been completed. While programs such as these are certainly beneficial, they often do not cover all medications and those patients with incomes above the cut-off are still paying hefty sums. Not to mention, patients without insurance are left to pay directly out of pocket. Before large scale reforms and national price control measures begin to be entertained in public debate, patients and physicians must do all they can to find other ways to help defray some of the cost. With this Back to subject search page or search by preceptor site