RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Oregon Senate Bill 528: Expected effects on the Willamette Valley Project Date: 9/7/2009 This study discusses the principal argument for the passing of Senate Bill 528 and the impact that field burnings have on the health of the surrounding communities. While there are documented studies that look at the correlations between negative health outcomes and field burning, few studies have looked solely at the direct causative effects. The Use of Pre-Printed Order Sets for Inpatient Community Acquired Pneumonia Treatment to Increase Compliance with National Quality Measures in a Rural Hospital Project Date: 8/4/2008 Physician order sets for specific inpatient diagnoses are a potential method to decrease the incidence of medical errors. Computerized physician order entry (CPOE) is the gold standard of order sets and has been shown to decrease adverse events in larger hospitals. However, the cost of implementing CPOE is often financially infeasible for smaller, rural hospitals. An alternative is to CPOE is the use of pre-printed physician order sets for inpatient treatment. This study analyses the use of pre-printed order sets for meeting national quality measures for the treatment of community-acquired pneumonia in a 21 bed rural hospital located in Florence, Oregon. The data set collected was too small to draw any conclusion whether pre-printed order sets increased compliance with national standards. However, the pre-printed order set was used on only 22% (7/32) of pneumonia patients in the study. Increasing physician usage of the order set will be necessary to determine if pre-printed order sets are more effective in achieving national benchmarks. “The asthma burden in Lebanon, OR: development of a patient handout for education of newly-diagnosed and current patients with asthma” Project Date: 9/10/2007 With a population of 13,940, Lebanon, Oregon comprises 13% of the total population of Linn County and is the second largest incorporated town in the area. Given the vast amount of dedicated land to farming, agriculture is the largest industry in the county. It should be no surprise then, that Linn County has a large frequency of respiratory ailments. Compared to the other 35 counties in Oregon, Linn County has the highest prevalence of asthma (11.9%), more than a one-quarter more than Multnomah County (8.9%). With an increased prevalence of asthma in the county, it is essential that patients have readily accessible resources for education on this respiratory condition. This study attempted to identify those available resources and then develop a concise and comprehensive handout for a Lebanon family practice clinic. The design was observation of family physician’s interactions with newly-diagnosed and active patients throughout the course of a six week rotation in a high prevalence setting. A cursory investigation of available handouts yielded a lack of material on respiratory ailments. Therefore, the final product of this project was the development of a basic educational patient handout for those who have been recently diagnosed with asthma and those who desire more information on asthma. The goal was that this handout would work by improving knowledge about a common disease, foster discussions between patients and physicians, and provide patients with additional resources for further education. Hepatitis C and Associated Methamphetamine Abuse in Grant County, Oregon. Is it a Problem? Project Date: 8/6/2007 Hepatitis C (HCV) is a chronic blood born disease that can lead to long-term disability and death. It is most often transmitted through injection drug use. In Oregon methamphetamine is often the drug of choice for injection drug users, and there is significantly higher rate of HCV infection among this population. Methamphetamine is considered a major problem throughout Oregon in rural, suburban, and metropolitan communities. Rural Grant County is no exception to this, and it has a population of people addicted to the drug. However, when compared to neighboring rural Umatilla County it appears to have a smaller population of methamphetamine users with a lower incidence of HCV infection. This is most likely due to the fact that few people in Grant County inject the drug, but instead tend to smoke it or snort it. Also, the smaller population size of Grant County may make it easier for law enforcement officials to target drug users. However, county residents interviewed feel that methamphetamine use does pose a threat to their community. Also, if users switch from current methods of use to injecting the drug, the HCV infection rate would be likely to increase. Gasps in the Night: Improving CPAP Compliance in the Primary Care Setting of Coos Bay, Oregon Project Date: 3/19/2007 Although continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), it is sometimes intolerable to patients and compliance can be a major obstacle. Primary care providers may not be aware of the resources available to improve compliance and without early intervention the patient may ultimately fail the therapy. In addition, appropriate screening tools need to be integrated into the Electronic Medical Record (EMR) to diagnose sleep apnea, facilitate appropriate referrals for sleep studies, and to follow up after therapy has been initiated. Therefore, it was undertaken to determine what kind of resources can be given to primary health care providers to improve CPAP compliance among their patients with OSA. Influenza and other respiratory illnesses Project Date: 2/12/2007 Influenza, also known as “the flu,” is a viral infection of the nose, throat and lungs that affects roughly 10-20% of Americans each year. Occasionally, a certain subset of people stricken with influenza will attain a high level of sickness that requires acute care. Every year, approximately 200,000 people are hospitalized and 36,000 die because of influenza and its complications. Up to March 1, 2007, 84 cases of influenza have been diagnosed in the state of Oregon. This study attempts to identify the incidence of laboratory-diagnosed influenza in a Stayton, Oregon family practice clinic and compare it with the statewide incidence as well as the incidence of other respiratory illnesses seen in the clinic. The design was a prospective study of patients diagnosed with influenza during a five-week rotation. From this study, it was determined that Stayton alone contributed to 5% of the influenza cases diagnosed in Oregon, which is notable because according to the 2005 population census, Stayton represents 0.2% of the Oregon population (7,700 out of 3,641,056). Also, greater than 50% of the Stayton family practice clinic patient population (25% pediatrics and >35% 65 years old and over) are considered at risk for influenza. This study demonstrates the high incidence of influenza in Stayton, OR and the subsequent need for heightened awareness by both patients and physicians to ensure rapid detection of the disease for effective primary and secondary prophylactic treatment as well as to highlight the importance of promoting influenza vaccine not only to at-risk groups, but also to the general population. The final product of this study was the development of a patient handout, because none previously existed at the family practice clinic, to increase patient awareness and education on the matter. Does Increased Field Burning Affect the Trends of Emergency Room Visits for Respiratory Symptoms at Santiam Memorial Hospital? Project Date: 8/7/2006 This rural health research project sought to determine if peak grass seed burning within Stayton Fire District boundaries affected the number of Emergency Room visits to the Santiam Memorial Hospital for respiratory symptoms. This study considered primary and secondary respiratory diagnoses on ER admissions reports during the peak burning periods in August of 2005 and 2006. Considered diagnoses included acute and chronic forms of bronchitis, sinusitis, rhinitis, asthma, emphysema, pneumonia, conjunctivitis and upper respiratory infections (8 categories). The number of ER admissions for respiratory symptoms was compared with the acreage of field burning in the Stayton Fire District over 21 to 24 day periods with the 7 or 8 days of heaviest burning acreage wedged between two equal length periods of significantly lighter burning. While a positive trend of increased respiratory symptoms was present in 2006, in 2005 the trend was negative. Due to a limited sample size and several probable confounding factors, there was not much statistical significance to this study but perhaps a framework has been established for further inquiry. Assessment of Baker High School Students' Perception of the Appropriateness of Antibiotic Use for Upper Respiratory Tract Infections Project Date: 3/20/2006 Antibiotic resistance is no less a public health problem in rural settings than it is in urban settings. One factor contributing to the development of antibiotic resistance is inappropriate prescription of these drugs for viral respiratory tract infections. In this study I developed a short presentation focusing on the differences between viruses and bacteria and the most frequent causes of respiratory tract infections. The presentation was given to high school sophomores in health classes at Baker City High School. A pre- and post-presentation questionnaire was employed to gauge the success of this presentation; post-test results indicate that students had a better understanding of the differences between viruses and bacteria after the presentation. Chronic Disease Management in Grant County Project Date: 3/20/2006 Problem: Almost half of all Americans have a chronic disease which may lead to extensive morbidity and mortality. Traditionally, diseases such diabetes mellitus (DM), hypercholesterolemia, and asthma are managed on a reactive, acute need basis. Pro-active physician-patient management of these three diseases reduces disease morbidity and mortality. The Grant County Public Health Department is writing a grant for $60,000 to try to improve Grant County’s health care of these diseases. To write and effective grant proposal, the department needs to learn what PCPs in the community are currently doing to manage the diseases and to propose ideas for improvement. Methods: An interview survey was conducted with all of the eight PCPs in Grant County about their current management of DM, hypercholesterolemia, and asthma. They were also asked what challenges they had managing each of these diseases, and what suggestions they had to improve the management of these diseases. Findings: Most PCPs actively monitored DM, many monitored hypercholesterolemia, and only one actively monitored asthma. Poor patient motivation and understanding as well as computer and time limitations were viewed as the largest challenges. Group education classes, such as the group diabetic dietitian class, were viewed as the most helpful resource. In addition, the majority of PCPs think a tickler file would be helpful. Conclusion: Grant County PCPs are currently using a variety of methods to manage DM, hypercholesterolemia, and asthma. All of expressed a desire for improve disease management, mentioning several clinical and community suggestions. Stroke Disease in Klamath Falls: Public Awareness of Symptoms and Risk Factors Project Date: 2/13/2006 Cerebrovascular accidents are serious medical events that are responsible for significant morbidity and mortality in the United States. In the case of thrombotic or embolic strokes, early intervention with thrombolytic therapy often leads to improved outcomes. However, early intervention often depends upon patient and public awareness of stroke symptoms and understanding of the need to seek medical attention promptly. This study attempted to determine knowledge of stroke disease and risk factors of residents of Klamath Falls, Oregon. This was accomplished by a voluntary, written survey of outpatients at the Klamath Family Practice Center (KFPC). The survey was designed to determine patient knowledge of stroke causes, symptoms, and risk factors, as well as patients’ individual risk factors for stroke and the distance they live from the local hospital emergency room. Analysis of survey responses showed deficiencies in patient knowledge of causes of stroke (57% sensitivity, 86% specificity), risk factors of stroke disease (57% sensitivity, 86% specificity), and symptoms of a stroke (67% sensitivity, 81% specificity). Additionally, there was little or no correlation between individual patients’ risk factors and their knowledge of stroke disease and its symptoms. Based on the results of the survey, efforts were made to improve public awareness of stroke symptoms and risk factors. Increasing vaccination rates in the elderly Project Date: 1/2/2006 Prevention of disease is one of the most important roles of the primary care physician. Vaccination is a simple and effective way to increase the health and decrease the healthcare spending in all communities across the nation. The elderly are particularly vulnerable to infectious disease and yet vaccination rates are low among the large elderly population of Josephine County. Over one in five people in Josephine County are over the age of 65. Nearly ten thousand over the age of 65 are 5 times increased risk of invasive pneumococcal disease due to inadequate pneumococcal vaccination. Over ten thousand elderly are at increased risk of hospitalization and death due to low influenza vaccination rates. The influenza vaccination itself is effective in decreasing hospitalization due to respiratory illness by 76% and death due to respiratory illness by 79%. In addition, each flu vaccine given saves an average of $47 in health care spending by those who receive it. This project’s ultimate goals are: to understand the vaccination rate and programs already in place within the county health department to increase vaccination rates in the elderly; to increase the vaccination rates in the elderly in Josephine County by supplying primary care physicians with a simple, concise information sheet for patients to help them understand the risks and benefits vaccination with the Influenza and Pneumococcal vaccines. This information was gathered from large cohort studies or RCT’s in the primary literature and these references were supplied along with the information sheet to primary care physicians in the area who wished to use them. Follow up research could be done in the peak influenza vaccination season to determine the effectiveness of the County Health Dept. planned interventions outlined in this project. Asthma in Northeast Portland: Examining the increased prevalence in the underserved Project Date: 10/17/2005 Asthma is a chronic inflammatory disorder of the airways that can be controlled with proper medications. Seventeen million people, 5% of the population, are asthmatics in the United States. The prevalence of asthma amongst children and adults is higher in Oregon than the rest of the nation. Morbidity and mortality is highest in patients who live in the inner-city or who come from low income homes. There are many social, economic, environmental, and pharmacological factors that lead to increased asthma rates among this population. The purpose of this project is to assess the factors that lead to increased asthma rates in Northeast Portland, assess the most effective asthma prevention and treatment programs, and to assess the availability of interventions that are currently in place in the Portland area. Spanish and English Asthma Action Plans in Klamath Falls, OR Project Date: 10/17/2005 Asthma is a serious health concern among the pediatric population in the United States. It affects approximately 9 million children under 18 and accounts for at least 2.9 million visits to pediatricians each year. Asthma is the most common chronic illness of childhood, and hospitalization rates for childhood asthma have increased despite improvements in asthma therapy. While asthma affects people of all races and ethnicities, the under-treatment of asthma among certain racial and ethnic minorities is well documented. There are two main causes that have been found thus far as reasons for this disparity. The first reason is lack of access to appropriate health care for minorities and underprivileged populations in general. The second reason is that the health care provided is inconsistent with the guidelines of the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute (NHLBI). While the lack of provisions of adequate health care for all of the nation’s children is appalling, this paper will be focusing on the second issue, the general lack of adherence among pediatricians and family practitioners nationwide, including Klamath Falls, Oregon, to follow the guidelines of the NHLBI, by not distributing appropriate information on asthma to the Spanish-speaking population or to the general population as a whole. The purpose of my project was to assess how many primary care clinics in Klamath Falls, Oregon, provided asthma action plans in English or in Spanish to their patients and to provide asthma action plans to those clinics that didn’t have any. Assessing Occupational Asthma at Bright Wood Corp in Jefferson County. Project Date: 8/8/2005 Bright Wood Corporation is the largest employer in Jefferson County. Bright Wood, privately owned by the Stovall Family, is a group of secondary wood processing facilities that have many occupational hazards that contribute to the morbidity and mortality of the Central Oregon community. Bright Wood has done a respectable job lowering the acute injury rates, but many long-term morbidities have not been studied. Prior studies in occupational medicine highlight occupational asthma as a potentially unappreciated morbidity associated with wood dust. The objective of this study was to evaluate asthma rates within the community and comparing them to asthma rates within the Bright Wood employees seen at Madras Medical Group. Improving patient awareness of stroke disease Project Date: 7/4/2005 According to the American Health Assocation (AHA), stroke is the leading cause of long term disability in the United States today. Four million Americans currently live with the chronic effects of strokes, with another 700,000 strokes occurring each year. In addition, studies show that for all strokes, 50-70% of patients are able to recover functional independence, with another 15-30% remaining permanently disabled. Due to the long-term medical care and disability that is so often needed, the annual cost of stroke treatment has soared to $57 billion annually in the United States alone. Thus, the need to recognize stroke risk factors and educate those at risk has become increasingly important to healthcare practitioners. The AHA, American Stroke Association and National Stroke Association all agree that studies have proven the existence of a variety of stroke risk factors, which are all classified as controllable or uncontrollable. Examples of controllable factors include smoking, obesity and alcohol consumption while uncontrollable problems include family history and age. By virtually any outcome measures defined, study questionnaire results show that baseline knowledge of strokes among West Salem Clinic patients is sufficient at best. In addition, comparison of questionnaires with corresponding patient chart info provide evidence that stroke knowledge actually declines linearly with stroke risk, exactly the opposite preferred trend. After completing the study questionnaire, all subjects were furnished with materials containing basic information regarding stroke disease background, risk factors and symptoms. In addition, other methods to improve patient awareness of stroke disease are considered. A standardized admission order for COPD exacerbations at Blue Mountain Hospital in John Day, OR Project Date: 4/25/2005 COPD is an extremely common chief complaint in the aging population and an exacerbation of COPD is one of the most common presenting complaints at the Blue Mountain Hospital emergency room in John Day, OR. Physician admission orders can be as diverse as the physicians themselves and may also represent a significant point of confusion for nursing and respiratory therapy staff. This project was designed to produce a COPD exacerbation standardized admission order that incorporates individual physician preferences, proven efficacious therapies, local formulary and logistical restrictions, but also an easy-to-read document to which hospital staff can refer for high-quality patient care. Investigation of the Pneumococcal Vaccination Policy at Holy Rosary Medical Center in Ontario, Oregon Project Date: 4/25/2005 Pneumonia, bacteremia, and meningitis are common clinical manifestation of pneumoccoccal disease caused by streptococcus pneumoniae. Pneumococcal disease causes more death than any other vaccine preventable bacterial disease, and antibiotic resistance, especially against penicillin, has emerged. A vaccine to prevent pneumococcal disease has been available for decades, but is currently underutilized. The ACIP recommends implementing a standing order policy to increase vaccination rates. Holy Rosary Medical Center in Ontario, Oregon developed a vaccination policy that includes a standing order and a screening tool, but vaccination rates have not increased. This study investigated possible obstacles preventing the implementation of the vaccination policy. The three largest obstacles appear to be making sure that copies of the screening tool and preprinted order form are readily available and placed on every chart, educating the staff about the policy, and adequately communicating with the patient's primary care provider. Pneumonia: A retrospective review of cases in 2003 at Lower Umpqua Hospital in Reedsport, Oregon Project Date: 10/18/2004 Pneumonia remains a common and deadly disease, afflicting more than 4.5 million people a year in the US alone. It is the 6th leading cause of death and the most common infectious cause. Furthermore, it has increased as a cause of hospitalization, especially among those who are above the age of 65. The population of Reedsport, OR has become increasingly older in age, and with this increase in elderly may come in increase in the prevalence of pneumonia. With other issues such as lack of adequate influenza vaccine, increased health care costs, and increased antibiotic resistance, small independent community hospitals such as Lower Umpqua are faced with numerous future challenges in care for its patients. This project, which will study pneumonia cases over the time period of January 1, 2003 to December 31, 2003 at Lower Umpqua Hospital (LUH), will allow for a review of aspects of presentation, diagnosis and treatment of this sometimes fatal disease. Goals of this project include identifying demographics of patients presenting with pneumonia to LUH, identifying co-morbidities, identifying diagnostic strategies utilized by admitting physicians, identifying strategies of treatment, and determining outcome of treatment choices. Finally, I hope to compare results of my data to national standards or other retrospective studies of pneumonia over a selected time period. Data examined in this project include month of presentation to LUH, patient demographics (sex, age), co-morbidities, diagnostics (symptoms, signs, labs, imaging), localization, tests of bacteriology (sputum, blood), aspects of treatment, length of stay, and eventual outcome. The hope is that these results will be used as a baseline for future comparisons of the incidence of community and nosocomial acquired pneumonia at LUH, will allow the admitting physicians to see trends currently employed in diagnostics and treatment at their hospital, and finally a way to determine if patients at LUH are currently receiving the most efficient and effective treatment as defined by national organizations as the American Thoracic Society and the Infectious Disease Society of America. 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. "Keeping Coughing Kids Home": A Description and Analysis of the 2004 Pertussis Epidemic in Benton County. Project Date: 5/10/2004 The national incidence of pertussis has gradually increased over the past several years. Since 2003, Oreogn has gained national attention as the incidence of pertussis appeared to increase at an alarming rate to a 40-year high for the state. Adults and adolescents are believed to be the primary reservoir for the bacterium whereas the disease causes the most morbidity and mortaility in infants less than 1-year-old. Benton County currently has one of the highest numbers of reported cases of pertussis in 2004 in the state. This study sought to provide a descriptive analysis of the current trends of this vaccine-preventable illness in Benton County using the most current data provided by the Benton County Health Department (BCHD) as well as an interview with departmental personnel to discuss the public heatlh measures undertaken to reign in the epidemic. The data from BCHD revealed that the majority of cases were school-associated 92% and occurred in the Corvallis school district with 34.2% of the cases occurring in Corvallis High School primarily between 3/14-4/11/04. Community physicians were responsible for treating both confirmed and presumptive cases (total 110) in addition to lowering the antiobiotic prescribing threshold for upper respiratory tract infections with a protracted cough. The BCHD has responded to the epidemic by regularly communicating with schools and parents. The department has many interventions planned during the anticipated peak months of the epidemic this summer. It is unclear whether the increased number of reported cases is simply due to increased surveillance or more disease, but is likely a combination of both. Pediatric Asthma Screening in Scappoose, Oregon Project Date: 11/10/2003 Asthma affects 15 million Americans and 4.8 million children in the United States . In Oregon, 8.2 % of adults and 7.5 % of children are asthmatic, a total of 275,000 Oregonians . Discussion with my preceptor revealed a lack of data regarding the prevalence of asthma in Columbia County and specifically the rural area around Scappoose, Oregon. This paper explores the development of a rural clinic-based pediatric asthma screening program by 1) considering the objectives for a rural screening protocol; 2) evaluating three questionnaires designed for national- and school-based asthma monitoring for their use in a clinic-based program to meet these objectives; and 3) conceptualizing a pilot study to administer this screening tool in Scappoose. The top priorities for this screening program were to detect new asthmatics as young as possible with an inexpensive, time efficient, and simple screening tool that is easily understood by all age groups. The Brief Pediatric Asthma Screen (BPAS) was best suited to achieve these objectives, as it has only five questions with a sensitivity of 75 % and a specificity of 81.2 %. A pilot study is recommended in which this questionnaire would be administered to all children visiting the clinic for one year to screen for known and unknown asthma sufferers. After the first three months of the pilot study, the questionnaire should be assessed for effectiveness in satisfying the objectives of the asthma screening tool. A permanent rural clinic-based pediatric asthma screening program could be established after this pilot year, such that the questionnaire could be administered to all children as part of the review of systems and in well child exams. This asthma screening program would be viable in the rural setting of Scappoose, Oregon in Columbia County or in any primary practice. Sleep Apnea in a Central Oregon Community Project Date: 9/29/2003 Sleep apnea is increasingly being recognized as a disease associated with significant morbidity and mortality. Recognizing the relevance of this topic, the community oriented primary care project sought to investigate sleep apnea in a Central Oregon community. Data were collected from patient records at the local Health and Wellness Center to determine the extent of the problem within the active patient population. The prevalence and distribution of sleep apnea in the community were evaluated. In addition, co-morbid conditions and their particular significance to the community were considered. Findings indicate that the active patient population within this Central Oregon community with a diagnosis of sleep apnea mirrors the characteristics of those with sleep apnea in larger studies. Patients with sleep apnea in this Central Oregon community are more likely to be male, middle-aged, obese, and have significant co-morbidity. Co-morbidities most commonly included psychiatric conditions, dyslipidemia, type 2 diabetes mellitus, and hypertension. Strategies to improve identification of patients with sleep apnea and to prevent future morbidity from sleep apnea within the community were developed. Evaluation of Occupational Asthma in Ontario, Oregon Project Date: 7/7/2003 Asthma is a common problem in the general population. Most of us are aware of the more common precipitating factors of asthma, such as allergens, exercise, infections, medications, and emotions. Fewer of us are familiar with those associated with occupational asthma. I became interested in occupational asthma during my rotation in Ontario, Oregon because my preceptor was a pulmonologist and because much of Ontario’s economy depends on industry and agriculture that works with known occupational hazards. In comparing the estimated prevalence of occupational asthma in the literature with the actual prevalence in my preceptors practice, I began to wonder whether or not occupational asthma was being under-diagnosed in Ontario. To evaluate this, my preceptor and I came up with a three part system to crudely estimate undiagnosed cases of occupational asthma relative to general asthma. Asthma Screening, Health Education and Referral - Community Health Education Coalition Health Fair, Coos County, Oregon Project Date: 9/23/2002 The National Asthma Education and Prevention Program (NAEPP) addressed the growing number and rate of asthma-related hospitalization and emergency room utilization in this country. For example, since 1994, the prevalence rate increased 75%, death rate increased 56%, and hospitalization rate increased 3%. To ensure effective control of the disease, NAEPP highly recommends multidisciplinary approach - education, prevention, social and medical interventions. Most of what is currently known about asthma distribution, utilization of ER, subsequent follow-up with a PCP and prevalence of high-risk population is based on surveys at the national level. Unfortunately, not enough data is available in small counties, such as Coos County, Oregon. To investigate the prevalence of asthma in rural Oregon community, we conducted a prospective screening study on adult population, ages 18 years above. The screening test was conducted as part of the Community Health Education Coalition (CHEC) Coos County Elder's health fair on Oct 12, 2002 in Pony Village Mall and Oct 22, 2002 in Mill's Casino in Coos Bay, Oregon. Community-acquired pneumonia Project Date: 9/23/2002 Community-acquired pneumonia (CAP) is a common reason for admission to the hospital. All patients admitted to the Blue Mountain Hospital in John Day, OR with a diagnosis of pneumonia for a one year period (September 1, 2001 to August 31, 2002) were identified and their charts reviewed. In addition to basic demographic data, diagnostic studies and antibiotic therapy used were identified. These data were compared to the current existing recommendations for diagnosis and treatment of CAP. The results of this comparison were then distributed to all of the physicians in John Day to help them to continue to make informed decisions regarding the diagnosis and treatment of CAP. "Assessing the Understanding of Respiratory Syncytial Virus in a Rural Community" Project Date: 2/11/2002 The major cause of lower respiratory infections in children worldwide is a virus, respiratory syncytial virus (RSV). Usually self limited, RSV can be treated at home, but up to 3% of infants infected require hospitalization. The purpose of this community project was to gain an understanding of the Reedsport, Oregon, area residents' comprehension of a viral respiratory illness symptoms and treatments. From this information, an educational handout specifically about RSV bronchiolitis was created. 124 patients at the Dunes Family Health Care Clinic ranked various "cold and flu" symptoms by frequency of office visits and answered different true/false questions. Results showed the symptoms of difficulty breathing, a cough with phlegm, and fever greater than 101F accounted for the greatest number of clinic visits. Results from the "true/false" section of the questionnaire revealed over one half of the responders (51%) erroneously answered "true" to the following question: "A viral respiratory infections needs antibiotics to be treated properly." Based upon the results, it was concluded that many patients probably don't understand the difference between viral and bacterial respiratory infection and the subsequent treatments. From this conclusion, a handout was created to educate patients about infant bronchiolitis and RSV. 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. Back to subject search page or search by preceptor site