RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Physical activity group visit at the McClaine Street Clinic in Silverton, Oregon Project Date: 10/12/2009 Currently, in the United States, obesity is a growing problem with many related health concerns, the small town of Silverton, OR is not exempt from this problem and many of those who reside there are overweight. One of the health concerns related to obesity is Type II DM, this project attempted to identify some of those who are at risk of developing or who already have Type II DM, and get them involved in some type of physical activity. This was done through a group patient visit with a didactic session on exercise, followed by a 1 mile walk for physical activity, and ending with individual meetings to discuss their personal action plan for physical activity. Participants were selected based not only on their Type II DM risk factors but also if they were sedentary. Providing Successful Comprehensive Outpatient Health Care Project Date: 10/12/2009 With increasing information about the evidence-based benefits of preventive measures, and as the number of recommended vaccines, screening labs and exams, and behavioral and lifestyle screening expands, the daily workload for a family physician also increases. Heightened demands on the crucial face time we have with patients mean we need to find a way to complete all the tasks and meet all the goals of a clinic visit while maximizing our time, energy, and resources. One of the most significant things I witnessed during my rotation was the efforts of the office staff to keep up with expectations and workload. I chose to help the Scappoose clinic develop a more efficient way to implement screening tools without having patients fall through the cracks. In my research, I came across an approach for quality improvement that involves multiple steps. The steps involve understanding the current workflow, identifying the goals, coming up with ways to make changes that will help meet the goals, and developing ways to measure improvements. 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. Harney County Tobacco Use, Perceptions, and Education: The Tar Wars Experience Project Date: 9/7/2009 Tobacco use and abuse including cigarettes, cigars, and smokeless tobacco is the number one preventable cause of death in the United States. Smoking has been linked to approximately 1 of 5 deaths annually. Each day in the United States approximately 3,600 young people between the age of 12 and 17 try tobacco for the first time. It is estimated that 1,100 of these young people will become daily users. Currently 1 in 5 Americans use tobacco on a daily basis. Oregon’s average tobacco use is similar to that of the greater United States. However regions in Oregon, like Harney County, have data illustrating much higher use in both adults and school aged children. This project was designed to investigate the perceptions and educate school-aged children in Harney County. This included epidemiological data review from Harney Behavioral Health, state data, and national data. Next, a survey investigating perceptions of 135 students, representing 80 percent 4th and 5th graders from Harney County, was created and administered. The final aspect of the project included educating 4th and 5th graders about tobacco use through the Tar Wars curriculum so young adults can make educated decisions about tobacco use. 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. The Frequency and Types of Dermatological Diagnoses in a Rural Primary Care Practice in Klamath Falls, Oregon Project Date: 6/29/2009 Dermatological disease is frequently encountered in the primary care setting. Some studies show that up to 36.5% of patients who presented to their primary care physician (PCP) had at least one skin problem. The current literature regarding dermatological disease in primary care has mainly been done in urban areas, and little data exists regarding the frequency of dermatological diseases seen by PCPs in rural areas. The goal of this project was to determine the frequency and types of distinct dermatological diagnoses in a family practice in Klamath Falls, Oregon, from July 2006 through July 2009, in order to establish a baseline of data regarding dermatological disease in a rural primary care setting. A total of 437 unique dermatological cases were seen by the PCP during the three year interval, amounting to 2.7% of total patient visits. The diagnosis of actinic keratosis was most common (18.1%) and is attributed to the high amounts of sun exposure in many of the area's occupations and popular outdoor activities. These results will be used to inform rural primary care practices and direct continuing medical education. Due to the high number of sun-related diagnoses, a sun safety poster from the American Academy of Dermatology was chosen and offered to be placed in exam rooms as an educational tool for patients. 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. Stress Induced Illness; diagnosis and treatment in Lebanon, Oregon Project Date: 3/16/2009 The primary goals of this project were to better understand the diagnostic approach to stress-induced illness and effective treatment modalities. These questions arose from patient interactions surrounding stress-induced illnesses which left both the patient and provider feeling frustrated and confused. I recognized my own inability to effectively diagnose and treat stress-induced illnesses and wanted to know more. On further examination, I found 27% of patient visits to the PCP office in Lebanon, OR, over a 5 week period, were related to stress-induced illnesses. These included chronic back, neck, and body pains without clear etiology, depression, anxiety, irritable bowel syndrome, and generalized fatigue. Patients often re-presented with repetitive pain complaints after steroid injections, medications, or “tincture of time” did not adequately treat their illness. Methods: I interviewed specific inpatients and outpatients, selected based on their diagnosis of exclusion, stress-induced illness. I investigated the pathophysiology of stress-induced illnesses, diagnostic algorithms, and treatment modalities through literature review. Finally, I followed up with as many patients as I personally saw in clinic, to better understand the efficacy of different treatments. Results: Stress-induced illnesses are prevalent in the primary care setting, making up 27% of Physician-visits in Lebanon, OR over a five week period. Effective treatment is time consuming up front, but inexpensive. When appropriate treatment is implemented, it has the potential to save over five hundred dollars and ten physician hours per week, not to mention, considerable human suffering. 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 Comparing Trends in Cardiac Disease between Multnomah and Klamath Counties Project Date: 2/9/2009 Background: Coronary heart disease (CHD) is the single leading cause of death in the United States. Mortality from CHD and overall incidence of CHD has been declining since the 1960’s. This trend has not been as significant in African Americans, Hispanic Americans, American Indians, individuals of lower socioeconomic status, and rural populations. Differing trends in heart disease have been observed within different sub-populations in Oregon. The purpose of this study was to compare trends in heart disease in the most urban area of Oregon, Multnomah County, to heart disease trends in a rural region, Klamath County. Methods and Results: Yearly, age adjusted heart disease death rate, coronary heart disease (CHD) death rate, myocardial infarction death rate, and risk factor data, including data on smoking, obesity, physical activity, diabetes, and cholesterol awareness data for Klamath and Multnomah counties was analyzed. Trends in heart disease mortality from 1995 to 2005 were compared. Heart disease death rates were found to be consistently been higher in Klamath County than in Multnomah County. Hispanics and Native Americans residing in Klamath County had significantly higher mortality rates from cardiac disease. There was a decreasing trend in heart disease mortality and myocardial infarction mortality in Multnomah County from 1995-2005 that was not apparent in Klamath County. Prevalence of major risk factors such as smoking and obesity was also found to be significantly higher in Klamath County. Conclusion: Klamath County exhibits several disparities related to recent trends in heart disease. Primary prevention programs with improved outreach that are more specifically targeted towards those living in rural areas need to be established. Better access to health care is necessary in rural Oregon. Physician shortages must be addressed to improve both preventive and specialized care. 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. Childhood obesity in a rural setting Project Date: 10/13/2008 The prevalence of childhood obesity among US children has increased between 2-4 folds in the last 40 years. The state or Oregon has not been an exception from this nationwide epidemic and in fact one in four eighth-graders in Oregon are now overweight or at risk of becoming overweight. Studies have been conducted looking at the causes and origins of this potential disaster. However, few of these studies have been done in a rural setting. An array of environmental and social changes that severely challenge a family’s ability to make healthy choices for their children have contributed to this epidemic, including barriers to safe and accessible physical activity and fresh, nutritious foods, coupled with an increase in sedentary pastimes such as television and computers, known as "screen time", and more frequent use of automotive vehicles rather than walking and biking for transportation. This article is intended as a very preliminary beginning at studying childhood obesity in a rural setting with the ultimate goal of providing additional insight into this problem as well as potential possible solutions. 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. Prevention of Osteoporosis Across the Lifespan Project Date: 10/13/2008 Osteoporosis is a major public health concern, affecting an estimated 10 million Americans and costing the American healthcare system close to $19 billion1. Though the diagnosis of osteoporosis typically does not come until after age 50, research has shown that prevention of the disease must begin far earlier than this. In an effort to promote prevention earlier in life, and thus hopefully decrease the prevalence of osteoporosis in generations to come, I preformed a review of the literature on evidence for preventive measures throughout the lifespan. These prevention guidelines were then incorporated into “smart phrases” in the electronic medical record, which could be entered into the patient instructions area with the ease of a couple key strokes. No longer would there be a need to have clinicians memorize the recommended calcium intake for a 3 year old or what type of activities are recommended to help build strong bones. Now the clinicians could simply enter the pre-written smart phrases into the patient instructions area and have the information easily at hand for both themselves and the patient. Not only will this help educate the patient on what they can do to prevent osteoporosis but it facilitates a discussion between the clinician and the patient about risk factors and what the patient can do now to prevent the disease. Thus far, the clinicians in the Scappoose medical clinic like the idea of these smart phrases. Many of them agreed that it was difficult to know what guidelines or evidence was out there concerning osteoporosis prevention early in life. They appreciate these smart phrases for putting that information at their fingertips. Future research that could stem from this project includes assessing how useful these smart phrases actually are, how often they are actually utilized by clinicians and if in fact they helped to decrease the incidence and prevalence of osteoporosis in future generations. 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. Underage Drinking in Southern Oregon's Illinois Valley Project Date: 9/8/2008 The U.S. Surgeon General recently addressed the country's underage drinking problem in his 2007 Call to Action to Prevent & Reduce Underage Drinking. Underage drinking is especially prevalent in rural communities like the Illinois River Valley in Southern Oregon. This project analyzed the Illinois Valley's underage drinking problem, evaluated the best approach to help ameliorate it, and attempted to improve it. It was concluded that boosting alcohol prevention education and raising awareness in the community would have the most impact. 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. 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. 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. Advancing Pertussis Prevention Project Date: 8/4/2008 According to recent research the incidence of “Whooping cough” is increasing in Oregon. Infants are both at the highest risk of contracting a severe infection that may be fatal and too young to be fully protected by immunization. The most common sources of pertussis in children are caregivers and loved ones, who often carry the disease and don’t realize they are passing it onto children. While most people are vaccinated against whooping cough as infants, new research suggests, that because immunity diminishes in adolescence, adolescents and adults should receive booster vaccines. Implementation of the recent CDC recommendation for adult and adolescent vaccination at NBMC will substantially diminish exposure to B.pertussis and reduce the burden of infant pertussis in Oregon. Supported by free vaccine from the DHS Oregon Tdap Special Project and the collaboration of many of the NBMC departments and providers, a system was organized so that all adolescents and adults can be vaccinated in Pediatrics clinic. The vaccine was ordered and the new Tdap program was presented at the monthly Pediatrics conference. 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. 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. To immunize, or not to immunize: that is the question. Project Date: 4/28/2008 Immunization continues to be a critical component of preventative care and public health. However, in recent years, there has been increasing attention on the possible negative effects of immunizations on children, contributing to decreasing immunization rates and the recurrence of several vaccine-preventable diseases. This study attempted to identify the concerns of parents of pediatric patients at North Bend Medical Center in Oregon regarding immunizing their children. The design consisted of interviews with physicians and parents, as well as a survey of 65 parents of clinic patients which inquired about their concerns about vaccines. The most common worries were related to the perceived link between vaccination and autism, as well as general safety issues such as pain and side effects. The survey results were used to create a handout for use in the clinic which briefly addressed these concerns and listed reliable, easily accessible sources for more detailed information. 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. Opportunities For and Barriers Against Watchful Waiting as an Initial Management Strategy of Acute Otitis Media in a Rural Pediatric Practice Project Date: 3/17/2008 Over-usage of antibiotics has been identified as a source of antibiotic resistance. To combat the emergence of drug resistance many groups have sought to identify diseases in which antibiotics are frequently used where they are needed to bring out resolutions of disease. Acute otitis media (AOM) is one such disease. In fact, AOM is the most common disease for which a child is given antibiotics. A recent statement by the AAP's Subcommittee on the Management of Acute Otitis Media has stated that observation without antibiotics is appropriate initial treatment of a sub-group of patients. A study published in JAMA in 2006 that was conducted in a metropolitan ED confirmed that watchful waiting in the form of "wait-and-see prescribing" (WASP) was not associated with significant differences with regard to subsequent fever, otalgia, or unscheduled ED visits when compared to day-of-visit prescribing. I wanted to see how often patients in the office-based pediatric practice in Grants Pass, Oregon were prescribed antibiotics for AOM when watchful waiting would have been justified by AAP criteria. I chose to do this because I saw more cases of AOM than any other disease during my rotation and noticed that most children received antibiotics as an initial course of therapy. To assess physician prescribing behavior I reviewed the charts of 55 patients seen between Jan 1, 2008 - March 31, 2008 who were diagnosed with acute otitis media. The patients were selected via ICD-9 code for otitis media. 55 patients with MRIPA insurance were seen between Jan 1, 2008 - March 31, 2008 and diagnosed with AOM. Six patients were excluded. Of the remaining 49 patients (provider breakdown: Ayoli = 18, Crispen = 12, Marshak = 14, Burnett = 5), 31 (63%) were eligible for watchful waiting according to the AAP. The remaining 18 (37%) fit criteria for immediate treatment. 46/49 patients were prescribed antibiotics immediately. 3/49 were offered antibiotics under WASP. All 3 WASP patients were eligible according to the AAP guidelines. Physicians were interview about barriers to WASP. Most common responses were financial burden of additional visits and fear of compromise to customer service element of modern practice. In the end a handout was created to facilitate the WASP discussion. 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. Assessing the Current Methods for Managing Hyperlipidemia and Their Effectiveness Project Date: 3/17/2008 Chronic disease management is a large part of primary care and it can have a big impact on the heath of a population. Hyperlipidemia is one of the more common chronic diseases seen in primary care and it is a major risk factor for cardiovascular disease and stroke. Coronary heart disease is the leading cause of death in this country. Studies have shown that optimal management of patients with hyperlipidemia is essential to decreasing the risk of cardiovascular disease. The goal of this study was to assess the current methods for managing hyperlipidemia in one rural family practice clinic and their effectiveness. The design was observation of clinical practices, interviews with clinic providers and random chart reviews of twenty-five patients with previously diagnosed hyperlipidemia. The findings indicated that lipid levels were fairly well controlled with the current strategies. Areas for improvement included regular patient follow up and management of coexisting cardiovascular risk factors. A standardized form was created to be both a clinical checklist as well as a tool for documentation. It is expected that this document will help improve overall management and facilitate simple and comprehensive documentation. Writing Exercise Prescriptions For the Primary Care Physician. Project Date: 12/31/2007 The epidemic of overweight and obesity in America is on the rise. Many public health organizations, including the National Institutes of Health and the U.S. Department of Health and Human Services Office of the Surgeon General, have called upon physicians in the primary care arena to assess and treat this growing problem. Numerous scientific studies have revealed the benefit of physical activity on not only preventing and treating obesity, but also on the prevention of other diseases; indeed exercise has been associated with a decreased risk of overall mortality. The use of a written exercise prescription, as opposed to verbal advice, is a significantly superior method of galvanizing sedentary individuals to start and follow a regular exercise schedule. Here, an exercise algorithm was developed and built-in to the EMR at AppleGate Internal Medicine Clinic to facilitate discussion about exercise between physicians and patients, and to generate a written exercise prescription based upon individual patient needs, limitations, and desires. 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. Utilization of an electronic medical record to monitor and improve preventive healthcare at Ontario Family Medicine Project Date: 7/2/2007 Preventive healthcare is an integral part of providing primary care. To guide the use of preventive services, the U.S. Preventive Task Force and Center for Disease control have established based recommendations for health screening and vaccinations. Despite strong evidence supporting the importance of preventive healthcare, the rates of providing these services are often less than ideal in the time pressured setting of primary care. However, the use of electronic medical records with health screening features has been shown to dramatically improve service rates. Ontario Family Medicine is currently using PowerMed electronic medical record, but has not been utilizing the Health Screening section of the program. This project aims to take the first steps to utilize an electronic medical record's health screening capability to improve the provision rates of preventive services in a rural primary care setting. Using current Task Force and CDC guidelines a list of core recommendations that fits the adult patient population of Ontario Family Medicine was established. These recommendations were entered into the program, and then cross-linked to orders so that when an order is entered, it will automatically update the patient's Health Screening section. Next the practitioners and clinic staff were trained on how to view the new Health Screening section, and enter orders. Finally the programs ability to generate reports on overall practice screening rates was evaluated. 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. 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. Striving for Healthier Children: A Closer Look at the Scappoose School District’s Local Wellness Policy Project Date: 3/19/2007 The prevalence of obesity and its associated diseases in the U.S. has been increasing over the last decades at an alarming rate. The OHSU clinic in Scappoose was noted to have a particularly high prevalence of obesity amongst its adult patient population. Obesity rates in the U.S. of young children have doubled and that of adolescents have tripled over the past twenty years. Prevention is the most effective tool in reversing the obesity epidemic, as well as increasing overall health, and generally the earlier the intervention, the more potentially effective it is. One particularly important site for prevention measures are the public schools, since children often receive most of their nutrition, exercise, and lifelong nutritional and physical education at school. Three years ago, the federal government signed into law an act that requires each local education agency or school district participating in the National School Lunch Program and/or School Breakfast Program to develop a local wellness policy that promotes the health of students and addresses the growing problem of childhood obesity. This project focuses on analyzing and discussing the Scappoose school district Local Wellness Policy along with some of the major obstacles to its implementation. Meet Me In The Woodshed A Tragedy in a Small Town: Recognizing and Preventing Suicide in the Elderly Project Date: 1/1/2007 Elder suicide is major issue in Oregon and the United States. Suicide rates among persons age 65 years and older are the highest compared to any other age groups. In 2003 in Oregon, the suicide rate per 100,000 in people aged 65 years or more was more than twice the rate in people aged 15 to 34 years old (27.14 versus 13.41). This project aimed to quantify the problem of elder suicide, identify risk factors both generally and specific to Oregon and Tillamook County, and propose prevention strategies for the community and physician. Data sources included research studies on elder suicide, census and CDC statistics, and interviews with community professionals involved with suicide prevention and treatment. Risk factors for elder suicide overall include chronic disease, social isolation, and the misconception that elder depression is a normal part of aging. Oregon has the 4th highest elder suicide rate in the county and some factors specific for the elder Oregon population include living in a rural setting, “rugged individualism”, and firearm ownership. Physicians can help prevent elder suicide by encouraging a warm and trusting relationship with patients so that they feel safe sharing depressive thoughts. Physicians have tremendous power of influence with their patients’ health care decisions and can strongly recommend counseling and treatment for patients at risk. In the upcoming year, the Oregon DHS plans several community meetings to develop prevention strategies specific to the local area. Finally, a refrigerator magnet with important contact numbers for outreach and counseling services was designed for elder patients to have at available at home. The hope is that in the future, elder patients considering suicide will contact his friend, doctor, or counselor to begin their path to recovery. 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 Continuity of Care and Medical Information of Children in Foster Care Project Date: 9/11/2006 In 2005, more than 6000 children entered foster care in Oregon and the population is growing. Foster children are at particular risk for adverse health outcomes and these risks are exacerbated by a common failure to obtain, document, and transmit medical information to case workers, foster parents, and health and social service providers. This jeopardizes the children's health, undermines attempts to provide them with services, and risks unnecessary resource allocation and financial burden for the children's families, foster families, state and healthcare system. The purpose of this project, which was conducted in collaboration with the Josephine County branch of the Department of Human Services (DHS) Child Welfare Office and Siskiyou Pediatric Clinic, LLP of Grants Pass, Oregon, was to address this problem by creating a medical data collection tool and protocol to facilitate the recording and transmission of medical information of children in foster care. The project consists of four phases: information gathering; design and development; implementation; and evaluation, modification, and expansion. At the time of this report, the project is completing its second phase and will soon be implementing the pilot instrument and protocol. To date, the response from the pediatricians and social service providers involved in the project has been very positive. 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. Medical Record Documentation Project Date: 3/20/2006 Medical therapy for heart failure including ACE-I/ARB and beta-blockers extend life and improve symptoms in patients with heart failure, as well as decreasing hospitalizations. They are therefore the cornerstone of therapy for heart failure. At the Cascades East Family Practice Residency, quality assurance/ chart reviews are done on inpatients that are discharged from the hospital, but this is typically not done on their outpatient clinic population. The patient population of CEFPC has a high level of medical comorbities, polypharmacy, limited follow-up as well as substance abuse and psychiatric co morbidities. I felt this made this population high risk for not receiving appropriate medical therapy. An audit was performed on pts with the ICD-9 code for heart failure, presenting for appointments over a six month period and from this list 26 patients were selected. Of the sample 34% of patients were on ACEI/ARB and beta- blocker. 27% were on an ACE only, 12% were on a beta blocker only and 27% were on neither. In conclusion, treatment with Angiotensin agents and B-blockers could be improved. There may exist absolute or relative contraindications for some patients, however these could be better documented in the problem/med list. In addition in patients with heart failure it would be useful to briefly summarize the results of the most recent echocardiogram including ejection fraction (EF), hypertrophy, valvular lesions, bundle branch block, and atrial fibrillation. MRSA infections in rural areas Project Date: 2/13/2006 Community acquired MRSA is a growing problem in Grants Pass. I set out to get an idea what kind of problem this represented in the area. After looking at the disease from a variety of perspectives, I began to realize that the prevalence of the disease may outgrow the medical community’s ability to respond. I began this project in the hospital. I attended the quarterly infectious disease board meeting. Here I was introduced to a current assessment of the problem of both nosocomial MRSA and community-acquired MRSA in Josephine County. Dr. Daniel Selinger, the infectious disease specialist at the hospital, and Marjorie Underwood, the infection control nurse, were both helpful in answering my questions about hospital infection control policy. As it turned out, beginning in February, Three Rivers Hospital was changing some of their hospital protocol with regards to control of MRSA. This new policy was a divergence from the sister hospital, Rogue Valley Medical Center, in Medford and highlighted an ongoing national debate over proper infection control policy. I also spoke with Dr. Ruth Rabinovitch who is Dr. Selinger’s counterpart at Rogue Valley and is an adherent to the other policy approach. In the outpatient setting, I performed a chart review of any patient who during the last three years had a skin or soft tissue infection associated with MRSA. I examined twenty two charts, eleven of which contained a history of MRSA infection. Specifically I was looking for any of the risk factors associated with either a nosocomial MRSA infection or a community acquired MRSA infection. For the third component of my project, I visited both the county jails. At the Josephine County, I had a chance to interview the staff nurses who take care of the inmates. I wanted to get an idea of how they perceived the problem and what was their approach to treating infections that may be MRSA positive. I also had a chance to participate in a clinic for the inmates at the Jackson County jail. Here I had a chance to see some cases of skin and soft tissue infections and observe the Public Health Officer, Dr. Jim Shames, assess and treat these patients Although I did not come away from this experience with any solid answers about MRSA in a small community, it was heartening to see so many providers, in the hospital, in the clinic and in the community, that were working diligently to slow the growth of this inevitable phenomena. 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. Parental Concerns Regarding Vaccinations in Grants Pass Project Date: 10/17/2005 Childhood immunizations are an important step in decreasing the amount of disease in communities. This study attempted to ascertain why some parents whose children receive care at Siskiyou Pediatrics in Grants Pass, Oregon choose not to immunize their children and to identify some of the concerns parents have regarding vaccines. A questionnaire and cover letter was developed to gather information from parents. After collecting the responses, it is clear that parents take the decision on whether or not to immunize their children very seriously and that misinformation about vaccines contribute a lot to parent's concerns about immunizations. These false beliefs persist despite all the pamphlets available to parents in the exam room. After speaking with a few parents about their worries, it became clear that the parents felt better about the immunizations after their concerns were heard and addressed. 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. Pediatric Follow-Up for Infants of Uninsured Hispanic Women in Madras, Oregon Project Date: 9/12/2005 Pressure from restraints of the current health care system, as well as recent advancements in methods to prevent and treat disease have put preventative health care in the forefront of the minds of primary care physicians and public health professionals. Unfortunately, in the area of pediatrics, recommendations for preventative services have not always been supported with well studied and documented evidence. This is true of the current standard system for well-child visits to general pediatricians. Although routine immunization has been strongly supported with clinical trials, very few of the current accepted practices of behavioral counseling and routine screening during well child visits are supported by solid evidence. Despite the lack of evidence, the American Academy of Pediatrics' Guidelines for Preventative Pediatric Health Care have become the standard of care and are expected by pediatricians and parents alike. This study looks at a population of children born to uninsured Hispanic mothers in Madras, Oregon and attempts to answer two questions. First, chart review and a database of national health statistics were used to determine whether this particular population of young infants is receiving preventative health care at a rate equivalent to national levels. Second, two subsets of the population were compared in an attempt to assess the efficacy of well-child care in preventing disease and its usefulness in contributing to the full vaccination of this subset of children. Results show that the study population is receiving preventative healthcare services that meet the current community standards. They also suggest that children that receive higher levels of those services are more likely to be healthy, immunized and free of disease. Emergency Contraception: School Counselor and Pharmacist Practices and Attitudes in Coos County, OR Project Date: 4/25/2005 The rate of teenage pregnancy has been declining in Oregon, yet it still remains unacceptably high. Nearly 26 per 1000 teenage girls ages 15-17 years old in Oregon will become pregnant this year, given current trends. Rural communities are plagued with even higher rates of teenage pregnancy, in large part due to the limited access to family planning and abortion care services. Emergency contraception (EC) provides a safe, easy to use, effective and relatively inexpensive method for preventing unintended pregnancy, yet it is extremely underutilized, particularly in rural communities. The reasons for this are not well understood, and are likely multi-facetted, with responsibility resting on physicians, pharmacists, patients, and educators. Physician attitudes and prescribing practices with EC have been fairly well documented, however little is known about pharmacist and school counselor attitudes and practices with respect to EC. The aim of this community project was to examine the attitudes and practices of Coos County middle and high school nurses and counselors regarding emergency contraception. Furthermore, the project also addressed pharmacist attitudes and dispensing practices for EC. The design was a written survey distributed to local school nurses and counselors, and community pharmacists. An informational pamphlet on EC was also developed and distributed to community clinics, schools and pharmacies. The overall response to the surveys suggest that school providers in the Coos Bay/North Bend area are open to the use of EC yet do not counsel students on it unless specifically requested by a student. It was also found that pharmacists dispense EC to all customers with a valid prescription, regardless of age, yet few pharmacies reported EC requests from teenagers. 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. Identifying Obstacles to On-time Childhood Immunization in Baker County Project Date: 3/21/2005 Background: 77.6% of Baker County’s 24-month-old children were fully immunized with the CDC’s recommended 4:3:1:3:3 series of vaccines (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB) in 2004 (vs. 69.8% of all Oregon children vs. 90% Healthy People 2010 goal). Objective: Identify obstacles to full immunization coverage of children at 24 months of age in Baker County. Methods: Telephone survey of parents of the 130 children ages 12 to 24 months in the Baker County Health Department immunization records regarding obstacles to on-time immunization. Interviews with the county immunization nurse, Baker City family practitioners, and Oregon state immunization program staff. Literature review for vaccination rate improvement methods. Results: One nurse at the Baker County Health Department immunizes 96.3% of that county’s children. Parents cite difficulty getting an appointment within the month and the need for reminders for vaccination schedules and for individual appointments. Cost and transportation are not common obstacles. Children’s immunization records are not checked at their doctor appointments. Conclusions: Baker County’s child immunization coverage may be improved by decreasing the appointment wait time, instituting a recall/reminder system for all children, and checking immunization status at every encounter with the health care system. 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. Prevention of Traumatic Pediatric Falls in Grant County Oregon Project Date: 3/21/2005 Trauma is the number one cause of mortality and morbidity in children ages 0- 14 years old. This study compares national and Grant County trends in fatal and nonfatal trauma focusing on unintentional fall injury in a rural community in eastern OR. Although MVA represent the number one cause of mortality among pediatric populations, accidental falls and fall related injury provide the number one source of morbidity and hospitalization among children aged 0-14. We sought to examine the trends of pediatric fall related injury in a rural community in order to focus efforts at prevention of morbidity amongst this vulnerable population. Systematic review of all emergency room visits among patients aged 0-14 between 1/1/1999-12/31/2004 at Blue Mountain Hospital in John Day Oregon were evaluated. Injury trends were determined by examining data included presenting complaint, primary diagnosis (ICD-9), and injury mechanism (E-code). Results: Mechanism of injury leading to ER visits in peds 0-14YO: FALLS 310 (31%), BLUNT TRAUMA 123 (12%), SHARP OBJ 101 (10%), MVA 78 (7.8%), REC VEH (3%), BIKES 62 (6.2%) HORSE REL INJ (1.7%) SPORTS 55 (5.5%) Mechanism of falls: GROUND LEVEL/NOS 102 (35%), PLAYGROUND EQUIP 31 (10%), FURNITURE/BED 30 (9.7%), ON OTHER OBJ/NOS 28 (9.1%) SPORTS 12 (3.9%) STAIRS 12 (3.5%) Types of injuries secondary to falls:OPEN WOUND OF HEAD, NECK, AND TRUNK 76 (22.7%), CONTUSION WITH INTACT SKIN SURFACE 71 (21.2%) FX OF UPPER LIMB 61 (18.2%), SPRAINS/STRAINS OF JOINTS 58 (17.3%) Falls represent a significant source of traumatic injury in the rural pediatric population of John Day, OR and surrounding communities. Prevention measures are a major public health concern and prevention efforts in Grant County should be focused at prevention of accidental falls at home (furniture/bed falls) and school (playground equip). A brochure on child safety and prevention was developed with the concerns of this rural community to be distributed at the emergency room to parents of children aged 0-14 years old. 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. 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. 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. You Are What You Eat! Project Date: 9/13/2004 My community project was aimed at educating teen athletes about eating healthy diets to maximize their success in sports and to maintain their health. I picked this topic because all teens that want to play school sports must get a sports physical before they can participate in the sports. This allows physicians a good opportunity to educate the athletes before they start to train. The second reason that I decided to educate teens about a healthy diet is because it may be confusing for teens. I was also hoping to educate the teens about eating disorders so that they may recognize the signs and seek help if needed. Lastly, I wanted to educate teens about nutrition because for them, this is the time to develop proper eating habits that will serve as a foundation for healthy eating as an adult. I decided that the best way to educate teen athletes was by making an informative flyer that could easily be handed out at their sports physical. In this flyer, I provide information about main things to consider with respect to diet as an athlete, helpful eating habit hints, pre and post game eating tips, and eating disorder signs. I hope that this information will contribute to the success of teen athletes in developing healthy eating habits for the present time and for later on in life. The Pneumococcal Polysaccharide Vaccine in Reedsport, Oregon Project Date: 9/13/2004 Pneumococcal infection causes an estimated 40,000 deaths annually in the United States, accounting for more deaths than any other vaccine-preventable bacterial disease. Approximately half of these deaths could be potentially avoided through the use of the pneumococcal polysaccharide vaccine. The highest mortality from pneumococcal infection occurs among the elderly and patients who have underlying medical conditions (Center for Disease Control and Prevention (CDC) 1997). The purpose of this community health project was to estimate the percentage of high-risk patients at Dunes Family Health Care (DFHC) who are vaccinated, and to develop an educational tool to help raise awareness of the dangers and ways of preventing Pneumococcus. The project consisted of a chart review of one hundred seventy high-risk patients, a questionnaire for DFHC physicians, and an assessment of resources available through the Douglas County Health Department. Based on the data obtained, a patient pamphlet was created for DFHC physicians to review and distribute. 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. Hepatitis C infection Baker County - educating local healthcare professionals and at-risk populations Project Date: 5/10/2004 At larger than expected segment of Baker Countys population is at-risk for hepatitis C infection. Concurrently, Baker lacks sufficient resources for referrals for therapy with many of these people lacking insurance, making a consult from a gastroenterologist out of the question. Baker City's referral hospital is 130 miles across state miles in Boise, also home to the closest gastroenterologists. Although one local family practitioner has started administering antiviral treament, access for treament is still quite limited but has room for expansion. However, few local health care workers, including the county health department, have undergone training regarding the newest therapies and outpatient management techniques of the disease. Therefore, the goal of this project was to provide training and information for local health care workers involved in the care of hepatits C-infected patients, as well as educating Baker's intravenous drug use population regarding the risks and options for hepatitis C infection. To affect this end, a patient information pamphlet was crated, in addition to in-person presentations to both healthcare providers, as well as at-risk populations. The pamphlet explains basic infection about hepatits C, including outlining methods of transmission, stressing the importance of abstinence from alcohol, discouraging needlesharing, and receiving vaccinations against hepatitis A and B. These preventive interventions may aid in reducing the number of new infections, as well as educating those already infected who may be eligible to advocate for treatment. It may also remind providers to screen and consider treatment for hepatitis C and ensure improved hepatitis A and B vaccination rates. Are the Diet and Exercise Habits of Middle & High School Students in Coos County Influenced by the School Environment? Project Date: 5/10/2004 The school environment has been shown to be a powerful determinant of child and adolescent diet and exercise habits. However, facets of school environment’s are believed to be unconducive to, as well as not fostering or promoting, healthy diet and exercise habits among students. In an effort to see whether the diet and exercise habits of students in Coos County School District are influenced by their school environment, 448 middle and high school students were surveyed. Specifically, their intake of fast food, candy and carbonated beverages, as well as their participation in school PE, or other physical activity was queried. They were also asked their responses to hypothetical situations where the school environment was modified, such as if vending machines were removed from campus, if they were not allowed to leave campus for lunch, or if PE were a required class. The results of the survey show that the school environment does indeed influence students’ diet and exercise habits. Furthermore, a majority of students indicated that they would relish changes to their school environment that would help foster healthier diet and exercise habits among them. The St. Elizabeth Health Services Annual Blood Draw: The Evidence For and Against the Use of Routine Blood Testing as a Health Screening Tool Project Date: 3/29/2004 Many of the leading causes of death and disability can be prevented given the appropriate interventions. Thus, providing preventive services is a cornerstone of modern day primary care practice. Routine screening examinations and laboratory tests are major mechanisms by which preventive medicine is carried out in practice and should ideally be based upon recommended guidelines developed from the best currently available evidence. The focus of my community project was to research the evidence in support of and against the use of routine blood testing as a health-screening tool for the St. Elizabeth Health Services Health Fair in Baker City, Oregon. I planned to submit my results as well as my recommendations to the governing authorities of this event for further review. As a result of my investigation I found sufficient evidence to support the practice of routine lipid screening for men >35 and women >45 years of age. Insufficient evidence existed to support routine screening of CBC, CMP, TSH, PSA, LDH and Uric acid. Conflicting recommendations existed regarding the practice of fasting glucose screening mainly due to the fact that no clinical trial has been conducted to establish whether systematic screening of asymptomatic individuals for type 2 diabetes improves health outcomes compared with initiating treatment after clinical diagnosis. Sufficient evidence did exist, however, to recommend routine screening of fasting glucose in individuals with hypertension or hyperlipidemia. Given the high prevalence of these comorbidities in the U.S., especially among the population screened at the annual blood draw, routine fasting blood glucose testing may indeed prove to be an effective health screening practice in Baker County despite the lack of current evidence in support of it. Colorectal Cancer, Screening for Prevention: How well is Rural Oregon Doing? Project Date: 3/29/2004 BACKGROUND: Colorectal cancer is the third leading cause of cancer related death in Oregon, and it ranks fourth in incidence with five new diagnoses of invasive colorectal cancer occurring daily. The US Preventive Services Task Force recommends universal screening of men and women age 50 years or older for colorectal cancer. This study sought to evaluate how well physicians in John Day, Oregon were providing screening for their patient population. METHODS: Chart review to determine screening practices was completed with 100 randomly selected charts of current patient age 50 and older. Interviews with physicians in the community were held to identify barriers to screening, and hospital medical records were reviewed to determine if colonoscopy-screening rates had improved since the time when a surgeon performed the procedure rather than family physicians. RESULTS: Of the 100 charts reviewed, 36% of patients had been screened, 26 by colonoscopy, 5 by flexible sigmoidoscopy, and 5 with fecal occult blood testing. Three percent additionally had screening studies either recommended recently or were scheduled for the near future. The number of colonoscopies completed at Blue Mountain Hospital has increased considerably since family physicians have been trained to perform the procedure. There was an average of 13 colonoscopies performed over 3 years while a surgeon alone was performing the procedure compared to 36 completed in 2003 by three family physicians. CONCLUSION: While the number of people being screened for colorectal cancer each year in John Day is increasing, the majority of patients over the age of 50 years have not been screened for colorectal cancer. Barriers identified include inadequate insurance coverage for preventive procedures, lack of time for physicians to discuss the necessity of screening, and patient disinterest for the topic of colon cancer. 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. The Prevention of Firearm-Related Injury and Death in Children in Malheur County, Oregon: How One Community Promotes Gun Safety in Children Project Date: 9/23/2002 Firearms are the second leading cause of death in children in Oregon. Studies have shown that counties in Oregon with a high rate of gun ownership are more likely to have a high gunshot death rate.1 Malheur County, as well as other counties east of the Cascade range, have high gun ownership rates. Children in these counties were 39% more likely to die from gunshot wounds between 1987 and 1996.1 These statistics place children in Malheur County at high risk for gun-related injuries. My project examined measures taken in Malheur County to promote gun safety, and prevent gun-related injury and death in children age 0-19. I researched public policy and community-based interventions, school programs, hunter education and other gun safety classes, and health care provider counseling of parents and children. In general, Malheur County addresses gun safety primarily by educating parents and children on safe behaviors. National studies have shown these efforts to be surprisingly ineffective. Thus, health care providers and local community leaders must find creative, more effective ways to decrease the number of firearm-related deaths in the community. Mexican American attitudes and perspectives regarding Type II Diabetes and its modifiable risk factors. Project Date: 9/23/2002 CONTEXT: Mexican Americans have a genetic predisposition to Type II Diabetes Mellitus, whcih theoretically evolved from a "thrifty gene". In an increasingly obese and sedentary society, the frequency with which Mexican American youth and young adults are acquiring Type II DM is reaching epidemic proportions. OBJECTIVE: To explore cultural-specific attitudes and beliefs pertaining to Type II DM and its modifiable risk factors with the goal of providing valuable information about prevention strategies in a culturally-sensitive manner. DESIGN: A cross-sectional survey of 15 parents of school-aged patients at the Woodburn Pediatric Clinic appearing for routine clinic visits. Specific information about respondents included age, country of birth, and linguistic capabilities. Children's ages, weights (kg), and heights (meters) were recorded. BMI's were calculated using the equation kg/meters squared. Respondents answered 10 short-answer and 5 multiple-choice questions in their language of choice (Spanish and English), which addressed attitudes and beliefs surrounding four major themes: Diabetes, obesity, eating habits, and physical activity. Brief 5-10 minute follow-up interviews conducted by a skilled bilingual investigator provided clarifications of both questions and answers and explored additional commentaries on behalf of respondents. RESULTS: One-third of patients were considered obese (95th percentile or greater for weight) The majority of parents attributed diabetes and obesity to the excessive consumption of foods high in fat and carbohydrates. Only two believed diabetes was due to a "susto" (fright). Parents of obese children were concerned about their children's weight. Most parents felt that it was important to provide a variety of fruits and vegetables to their children and convince them that fruits and vegetables were necessary for good health. Half of the children engaged in sedentary activities (TV, video games, computer) for 3 or more hours per day. Seven of the children engaged in near daily physical activity, however the majority of these had a BMI at or above the 90th percentile. Parents who were active on a daily basis attributed activity to work-related activity (3) or walking 1/2 to 2 miles per day (3). The remaining nine were minimally active or sedentary. Parents encouraged their kids to engage in sports so they can be healthy, but only three were proactive about exercising for health and involving their kids in habitual exercise regimens. CONCLUSIONS: Mexican American parents are appropriately aware of the role of excessive fats and carbohydrates as a risk factor for diabetes. However, there is little awareness about the role of physical activity in diabetes prevention. In general parents do little to encourage their children to exercise, nor do they model physically active lifestyles to their children. Recommendations for cultural-specific approaches to diabetes prevention were provided based on these findin Increasing Immunization Rates at Klamath Family Practice Project Date: 8/12/2002 Vaccination rates affect everyone, because each unimmunized person risks transmitting the disease to other vulnerable populations. Unvaccinated children risk acquiring serious, even fatal diseases such as tetanus, diptheria, pertussis, measles, meningitis, epiglottitis, mumps, rubella or polio. Nationwide, vaccination rates typically remain above 90% (MMWR Morbidity Mortality Weekly Report, 2001). However, as of June 2002, Klamath Family Practice Center's Immunization Coverage Rate was only 60% by babies' first birthdays (Figure 1; AFIX, 2002), and coverage rates remained below 40% through year 2 (Figure 1). It was observed that Klamath Family Practice lacked a system for encouraging parents to bring children in for immunizations, so parents were interviewed to determine reasons for failures to vaccinate. The most common were forgetting well-child appointments and misconceptions about immunication, so a protocol was developed to address these issues. Parents filled out follow-up reminders at each visit which were later mailed to them, nurses provided education brochures and immunications checklists, and doctors responded to questions and concerns. Measles and pertussis rates even in immunized children directly correlate with the number of unvaccinated children, and cases of chickenpox dramatically declined after its addition to the immunication schedule in 1995. At-risk populations are the most common cause of doctor visits already, so increased immunization rates provide a safer environment for the very young, elderly and immunocompromised residents of Klamath Falls. Exercise For Residents Of Reedsport, Oregon The Importance Of and Opportunities For. Project Date: 8/12/2002 The obesity trend in the United States of America is on the rise. In Oregon, the number of overweight and obese rose from 55% in 1998 to 57% in 2002. Obesity has been proven to be associated with an increased incidence of heart disease, stroke, diabetes, high blood pressure, osteoarthritis, and some cancers. During my rural rotation at Dunes Family Health Clinic as a third year medical student in Reedsport, OR, I calculated the BMI on 53 of the patients I saw in clinic and found that 87.3% of the patients I saw were overweight or obese. Because obesity and lack of exercise are often coexisting conditions, I created a patient pamphlet which includes information on reasons why to exercise regularly, how to start a exercise program, and ideas for exercise in the Reedsport area. Prevention of Athletic Injuries in the 21st Century: Where do physicians fit in? A study of high school athletics in Klamath Falls. Project Date: 3/25/2002 It is estimated that 25 million scholastic and 20 million organized, community-based youth participate in sports annually in the United States. Injuries are the second leading cause of emergency room visits for youth and the second leading cause of injury in schools. Studies have shown that up to one half of all injuries sustained while playing organized sports by children and adolescents may be preventable. There are many reasons why sports injuries occur. Studies have identified the following frequent factors: lack of coaching education, inadequate preparticipation physical exams, hazardous playing fields, conditioning and training errors, inadequate safety equipment, poor fitness, poor nutrition, improper technique, inadequate supervision, lack of proper evaluation and body growth and development. Some of these "risk factors" are more modifiable than others. Specifically, the sports physical, lack of coaching education, training errors, lack of supervision, and lack of proper evaluation can be influenced directly with the help of physicians as health care providers and as respected community members. Other important aspects of injury prevention are the emergency response system and some means of surveillance to identify where to focus our resources. Recognition of cardiac risk factors among Hispanic patients of the West Salem Clinic. Project Date: 3/25/2002 This study sought to assess the major independent modifiable risk factors for coronary artery disease among the Spanish-speaking patients of the West Salem Clinic and to compare and contrast the results with these patients' self-assessments of their personal risk for the disease. The design is a self-assessment survey of 32 consecutive Spanish-speaking patients of the clinic and a review of their charts both attempting to assess cardiac risk factors including smoking, hypertension, hyperlipidemia, glucose intolerance, physical hypoactivity, and excessive body weight. Twenty patients' surveys and chart data were compared. Overall patients slightly underestimated their risk for CHD. Greatest discrepancy was found in the body mass category: 90% were overweight, including 80% who were obese wheras only 60% indicated that they were overweight. Among other findings, 85% did not know their cholesterol level and 80% never spoke with their health care provider about cholesterol; 50% did not know their ideal body weight; and 80% never spoke with their provider about their risk for diabetes. The report further provides some recommendations for patient education on these issues. Follow-up Frequency of Benign Hypertension at BAC Project Date: 2/11/2002 Hypertension is defined as systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg. Approximately 50 million Americans have hypertension, making it one of the most prevalent and burdensome diagnoses seen by physicians in the United States each year. Benign hypertension, the most common form, is a mild to moderate elevation in blood pressure without target organ (i.e. kidney, retinal, coronary) damage. The incidence of high blood pressure increases with increasing age and is one of the most commonly seen health problems treated by primary care doctors in communities with older populations. Appropriate frequency of follow-up of patients with hypertension is a controversial subject. Recommendations vary according to the evaluating discipline (internal medicine vs. cardiology), severity of disease, age, and compounding factors including co-morbid conditions (e.g. diabetes, coronary artery disease, renal disease) and whether or not the patient is on anti-hypertensive medications. The current guidelines for follow up of benign, uncomplicated hypertension from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health recommend that patients be seen by their primary care physician every 3 to 6 months for follow-up evaluation of their disease. Preventative Care And Management Of Risk Factors In Elderly Patients With COPD In Florence, OR Project Date: 1/2/2002 In the United States, COPD is the fourth leading cause of death. This retrospective study sought to examine preventative care practices and management of risk factors in elderly patients with COPD from the internal medicine clinic at Health Associates of Peace Harbor in Florence, Oregon. Endpoints examined included prevalence of smoking, annual influenza vaccination, and diagnosed depression. 21% of patients in this study were current smokers, and almost all had documented evidence of being advised to quit by their physician. 23% had received an annual influenza vaccination. 14% of patients had been diagnosed with depression, and almost all had documented evidence of treatment with pharmacologic therapy. This report discusses the need for development of improved comprehensive care for elderly patients with COPD and offers specific suggestions, including utilization of numerous community resources as a way to facilitate patient participation and development of a therapeutic alliance. Atrial Fibrillation and Stroke Prevention at Dunes Family Health Care (Reedsport, Oregon). Project Date: 11/5/2001 OBJECTIVE: This study sought to examine the approach of five physicians in a small, rural family practice clinic in Reedsport, Oregon in regards to preventing ischemic stroke in patients with nonvalvular atrial fibrilllation. This study also attempted to determine what effects the application of three current risk stratification models would have upon therapy indications for the patients in this practice. METHODS: There were two components to this study, (1) a chart review to determine the risk factors of and treatment for patients with recurrent paroxysmal and persistent nonvalvular atrial fibrillation and (2) a written survey of the provider's approach to anti-thrombotic therapy in patients with atrial fibrillation. The providers' practices were compared to current national guidelines for anti-thrombotic therapy in AF patients. RESULTS: There was found to be a high rate of anti-thrombotic therapy among patients with AF, even among those patients at low risk for stoke. The application of three models of risk-stratification resulting in very different results, the fractions of the cohort classified as low-risk varying from 7% to 37%. Finally, not all providers used risk-stratification for patients with atrial fibrillation, and when used, there is much variation in the use of risk factors by physicians in the decision whether to anticoagulate. CONCLUSIONS: Patients at Dunes Family Health Care have excellent rates of anticoagulation and anti-thrombotic therapy. Though the reasons for anticoagulation cannot be assessed, whether patient preference or physician advise, patients at low-risk for stroke may be better served by less aggressive therapy. Finally, when used, the providers studied had limited use of risk-stratification and may do well do incorporate more identifiable factors in the stratification of their patients. Ranking of IHS Community Health Objectives and Community Health Issues Identified by Warm Springs Residents. Project Date: 11/5/2001 Each year, the Clinic Directors of the Portland Area Indian Health Service formulate a "Clinical Objectives for Fiscal Year - SES Workplan" (see pages 2-4). It is a list of important topics of focus for improving the health of the communities served by the IHS clinics. This project was an attempt not to determine the extent to which these objectives are being met, as that is done regularly through chart review by IHS employees, but rather to ask the question of residents of Warm Springs: What do you feel are the Community Health Issues most affecting you and those around you? To that end, a survey (or, more accurately, two surveys, as the original was revised following review of responses) was presented to patients and staff at the Warm Springs Health and Wellness Center. Respondents were asked both to rank the objectives identified by the Area clinical directors and to add others which were not listed. Prevalence of Pneumococcal Vaccination; Among Diabetic Adults Served By The Health Associates Of Peace Harbor In Florence, Oregon. Project Date: 8/13/2001 Streptococcus pneumoniae (pneumococcus) is a bacterial pathogen that colonizes the upper respiratory tract and causes serious morbidity and mortality worldwide. Diabetics, although not more susceptible to the development of pneumococcal infection, are more likely to become bacteremic and require hospitalization than are non-diabetic persons. Furthermore, diabetics hospitalized with community-acquired pneumonia are more likely to die from the infection than are non-diabetic patients. Fortunately pneumococcal vaccination can reduce the occurrence of invasive pneumococcal disease and the associated morbidity and mortality. This community-based project was designed to assess the prevalence of pneumococcal vaccination among diabetic adults served by the Health Associates of Peace Harbor primary care clinic in Florence, Oregon as well as to determine the prevalence of pneumococcal vaccination among diabetic adults discharged from Peace Harbor Hospital, during a one-year period, with a diagnosis of bacterial pneumonia. Approximately 37% of sample diabetic patients at the Health Associates of Peace Harbor primary care clinic had received the pneumococcal vaccine. Diabetics 65 years of age or older were more likely (46%) to be vaccinated than those younger than 65 (26%). Fifty percent of diabetic patients discharged from Peace Harbor Hospital with a diagnosis of bacterial pneumonia had received the pneumococcal vaccine prior to admission. Those not vaccinated prior to admission had an average of 19 clinic and 2 emergency department (ED) visits in the 36 months prior to admission. The results of this community project indicate that the Health Associates of Peace Harbor primary care clinic would benefit from adopting the Healthy People 2010 objectives for pneumococcal vaccination of diabetics. Several strategies can be implemented to increase pneumococcal vaccination among diabetic adults including advocating more precise documentation standards, educating diabetic patients about the risk of pneumococcal disease, minimizing missed clinic vaccination opportunities and taking advantage of a wide variety of vaccination opportunities outside of the clinic. 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. Hepatitis A and B Vaccines in People Infected with Hepatitis C Virus Project Date: 7/2/2001 This project looks at the treatment of patients infected with HCV by doctors in primary care as compared with national guidelines and specifically evaluates the number of patients vaccinated for HAV and HBV. This was done by review billing records for primary diagnosis of Hepatitis C seen by Mid-Valley Medical Plaza in Lebanon, Oregon over a 2.5 year period and reviewing the injection procedures for each patient. Secondly, a questionnaire was used to interview physicians at MVMP regarding their approach to the management of patients with Hepatitis C. Records showed that only 14% of patients studied had received vaccines for Hepatitis A and 8% had received vaccines for Hepatitis B. The questionnaire demonstrates a uniform approach to the treatment of Hepatitis C using the national guidelines with the exception of vaccinations although, all physicians said they vaccinated their patients. The report reviews the frequency of adult vaccines and the importance of reminders in assuring better vaccination coverage. Recommendations are then made to use reminder sheets and suggest the plausibility of a Hepatitis C clinic to improve delivery of vaccines. Parental Attitudes about Vaccinations Project Date: 5/6/2002 This project was designed to provide information to pediatricians in a pediatric clinic in Coos Bay, Oregon about choices made by parents of patients between the ages of 3 and 18 months regarding vaccinations. Parents attitudes, behavior, and needs for information were assessed using written questionnaires. The attitudes, experiences, and suggestions of some of the parents who completed the written questionnaires were further explored through telephone interviews. Twenty parents completed the wriiten survey. Nine respondents said they had concerns about the possible side effects of vaccinations. Only 1 parent chose not to have her child receive a vaccination when recommended because of concerns about side effects. All 20 parents stated that they were adequately informed about vaccinations. Nineteen of the parents rated physicians as "very useful" sources of information about vaccinations. Some parents relied much on family, friends, the internet, and the media for information. Five parents participated in the telephone interviews. Although all had concerns about possible adverse side effects, they each agreed that vaccinations are "necessary" and explained that the benefits outweigh the risks. The origin of parents concerns and their suggestions are presented in the following report. Back to subject search page or search by preceptor site