RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Diabetic foot ulcers Project Date: 8/3/2009 The idea behind this project was to create a informative patient friendly handout with regard to diabetic foot ulcers. Diabetic foot ulcers are a common potential long term complication of diabetes. In the Mid Valley Medical Plaza about 2% of diabetic patients have this particular diagnosis. However currently there isn't a easy to understand, accessible resource to teach patients about diabetic ulcers. The goal of my project was to create a handout that would fulfill these requirements. A handout was created that was composed of 3 sections: what diabetic foot ulcers are and how they form, how to prevent ulcers and how to manage ulcers. The Usage and Understanding of the POLST Form among Independently Living Senior Citizens in Veneta, Oregon Project Date: 6/29/2009 Oregon has been very successful in implementing portable orders for end-of-life care via the POLST, which is used in nursing homes, hospitals and hospice. For elderly people that aim to stay in their homes until their final days, their introduction to the POLST is usually from a primary care provider. This project was conducted in the Garcia Senior Center lunch program in Veneta, Oregon, where many of the participants live-independently. The aim was identify if the POLST was being used, identify barriers to its use and to create a presentation to break through some of the barriers. In a total of 6 hours spent at the Tony Garcia Center, data was collected that showed the POLST was not commonly used. Barriers included lack of exposure to the topic, confusing medical terminology and the lack of enthusiasm to talk about end-of-life care. Additionally, two presentations on the POLST were given to break through some of the barriers and forms were filled out on a one-on-one basis. The result was an increased awareness and interest in making choices regarding end-of-life care, and an increase in the number of participants that have POLST forms filled out. Insomnia in the Elderly of Stayton, Oregon: Development of a Patient Handout for Improving Sleep Quality Project Date: 10/13/2008 Insomnia, whether it be difficulty falling asleep, staying asleep or simply poor quality sleep, is a common problem, estimated to transiently affect up to one third of adults. During a five week rotation in a family practice clinic of Stayton, Oregon, insomnia was identified as a common complaint. Diagnosis was established on the basis of patient history and treatment with medications was initiated, but non-pharmacologic treatments of insomnia were not discussed. Acquisition of information pertaining to the issue included casual conversation with practitioners and a review of relevant medical literature, as well as easily accessible online resources of patient information. From these sources, a patient handout for improved quality sleep was developed. Further investigation into the relevance of sleep hygiene education and insomnia in the region was accomplished through interaction and discussion with residents of assisted living facilities in the Stayton/Sublimity area, including the Lakeside Assisted Living Community and McKillop Residence. Visiting these local facilities confirmed that insomnia and sleep disturbance is a common problem that affects this community, particularly in the elderly. The positive response to the handout supports its potential as an education tool to be used in the primary care setting in the future. Access and quality of Hospice services for patients and physicians in Josephine County; continual strives towards quality assurance Project Date: 9/8/2008 Rural communities in Oregon are facing the aging population of baby boomers. As such the demand for physicians and Hospice services to deal with end of life care is in high demand. Nationally and within Oregon, rural hospices are faced with additional burdens of large square mileage areas of coverage, increased financial burden due to higher overhead costs and less Medicare reimbursement per patient, and late referrals to care with short lengths of stay. Through analysis of a physician survey about hospice experiences and interactions, interviews conducted with Hospice personnel and patients, and local and statewide annual reports for Lovejoy Hospice located in Grants Pass, OR was analyzed for its ability to address the aforementioned issues. It was found that Lovejoy Hospice through several methods such as attention to provider vs. patient locations, extensive annual fundraising, and finally a physician handbook and positive community presence and patient interaction, has addressed these problems and physician concerns with Hospice referrals and transition to care. However, through physician surveys and Hospice personnel interviews, it was identified that the transition to Hospice care could be smoother and that one are of improvement would be initiating earlier hospice planning so a plan was in place before acute patient decline. Therefore, the final product of this project was development of a patient/physician resource handout and pre-enrollment consult form providing physicians with an in-office way to initiate a conversation about end-of-life and hospice care, and brief patient epidemiology and end-of-life desires for Hospice to have on file in order to facilitate a smoother transition to Hospice care. Community Diabetes Education: Development of a patient handout for Madras's Diabetic Workshop Project Date: 9/8/2008 Diabetes has become an epidemic in the United States with over 7.8% of the population affected. Jefferson County is not immune to this phenomenon and Madras Medical Group (MMG) has a large population of diabetic patients. Although no cure to diabetes is currently available, much can be done to prevent complications, improve quality of life and manage the disease through patient education and vigilant care. This project will provide educational information on how diabetes is managed in the primary care setting and what patients can do to minimize complications of diabetes. This information will be presented in the form of an informational pamphlet and a power point presentation to the Madras community at a local diabetes workshop. The content of the pamphlet was a representation of most frequently asked information in the primary care setting based on observations of patient-physician interaction in the office. Information was gathered from clinic staff and online diabetes resources in order to create the educational materials to represent MMG at the workshop. The workshop was set up to introduce diabetic resources to the community and provide information to diabetic and pre-diabetic patients, their families, and those with risk factors for diabetes about the disease. Preventing Caregiver Burnout in Grants Pass, OR Project Date: 8/4/2008 At any given point, there are 34 million Americans who provide full or part-time care to aging family members or spouses1. Unfortunately, caregiver stress and burnout continues to be an under-recognized and under-addressed phenomenon, despite its association with increased morbidity and mortality in both caregiver and care-recipient. The goal of this project was to identify resources readily available and easily accessible to caregivers in Grants Pass, Oregon. The design included observation of physician interactions with caregivers and their dependents at WellSpring Family Practice and Three Rivers Community Hospital as well as exploration of local, state, and national support resources for caregivers. Finally, the end-product of this project was a pamphlet outlining essential steps for the caregiver and elucidating the most useful and comprehensive resources available. The pamphlet was made to be distributed in the physician’s office and various other health resource offices (e.g. CareSource, assisted-living homes). 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. 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. Community-based health insurance: an innovative solution for John Day’s un- and under- insured. Project Date: 3/19/2007 The community of John Day, Oregon has a number of un- and under-insured citizens who pay large amounts out-of-pocket on healthcare. Many wait to see an MD until they are sick and do not seek preventive care. They represent the fastest-growing group of uninsured in America: the uninsured who are employed and do not qualify for categorical eligibility for public programs (Medicare, OHP). Patients of the Strawberry Wilderness Community Clinic were surveyed regarding their demographics, insurance status, and opinions on a potential new healthcare plan. This plan, known as community-based health insurance (CHI) is used in developing countries and involves patients contributing a small amount of money per month ($10) to a risk-pool which can then defray healthcare costs among the community. There are certain limitations, and for John Day, the initial plan would only cover the cost of a clinic visit (no meds/labs). Nearly all un- and under-insured surveyed would be interested in this plan and willing to pay the proposed fee. Their concerns were about overuse of the system by a few. Physicians surveyed were all interested in the program, but had serious concerns about cost and too few patients for it to be economically feasible. Momentum for the plan would a barrier to implantation, as healthcare in the US seems to be “stuck” with a lack of innovation for new ways to ensure access. CHI would be one such way. Urinary Incontinence: Dribbling into the Golden Years Project Date: 3/19/2007 Reedsport, OR is an old logging town with an aging population. Unfortunately, its community is suffering from illnesses that increase with growing old, including urinary incontinence. Urinary incontinence affects up to half of all women eclipsing hypertension, depression, and diabetes in prevalence (Sutherland, 2004). It is associated with troubling morbidity such as falls, urinary tract infections, skin breakdown, depression, and social isolation (Resnick, 2004). Many women believe that urinary incontinence is a normal part of aging. Although the medicines and conditions that predispose urinary incontinence increase with age, UI is neither inevitable nor untreatable. With treatment, up to 90 percent of those with UI can improve (Khan, 2004). In towns like Reedsport, patients routinely wait up to 4 months for an appointment with an urologist. Fortunately, an urologist is only needed for the most recalcitrant cases, and family practitioners have the tools to diagnosis and treat the majority of patients. With this project I described the Reedsport community and why it carries a large burden from this problem. I also interviewed patients to better understand the problem and its impact. Then, I performed a literature review to learn how to best identify and treat UI. Finally, I created tools for diagnosis and patient education. Expanding Anticipatory Guidance in Columbia County Project Date: 1/1/2007 Columbia County has seen a significant increase in recent years in the number of single mothers with children younger than 5 living below the poverty level. Many parents in the community lack resources and access to parenting information. Various programs in the county provide services to young mothers and children, including Head Start, Healthy Start, and WIC. In addition, the OHSU Family Medicine Clinic at Scappoose serves patients primarily from Scappoose and St. Helens, the largest towns in the county. Providers in all facilities expressed a need for simple hand-outs to give to parents with anticipatory guidance and advice about parenting for children of different ages. Handouts were created with guidance for all well-child visits from ages 2 weeks to 5 years. Guidelines focused on age-specific information about nutrition, development, and safety. The materials were distributed to providers at the Scappoose Clinic and program directors for Columbia County Head Start, Healthy Start, and Columbia County Department of Public Health, which coordinates the county WIC program. Recruitment and Retainment of Rural Physicians: the difficulties found in the Frontier community of Grant County, Oregon. Project Date: 1/1/2007 Recruiting and retaining physicians in rural areas is an ongoing problem in the United States today. Physicians are trained in urban areas and often prefer to remain there to practice creating difficulty in recruiting to rural communities. If a physician does choose to practice in a rural setting they often feel isolated and overworked and usually remain for only a short time. This report analyzes the recruitment process of the Blue Mountain Hospital and a private clinic in Grant County, Oregon and identifies the difficulties in recruiting and retaining physicians in that area. Data were gathered from journal articles and interviews with local physicians and the hospital administrator. Grant County uses a variety of physician recruitment firms and word of mouth advertising, although in the last five years three of the new doctors have come through the Oregon Area Health Education Center. In the last eighteen years Grant County has had sixteen different physicians, each of them remaining only four years on average. In addition to lack of medical student exposure, local physicians identify various lifestyle and professional issues as barriers to recruiting and retaining physicians. I attempt to offer solutions to these issues including more selective recruiting and improved strategies to expose medical students to rural medicine "Music Therapy: what it is, what it does, and how it is used in Lebanon, OR" Project Date: 9/11/2006 “Music Therapy” is a term that has been used to define many different forms of alternative medicine practices, the most popular and studied of these being the use of live music by a Certified Music Practitioner (CMP) to ease pain, stress, depression, and anxiety. By the very nature of their health status, many patients who are chronically ill or near-to-death undergo significant stress and anxiety. This reduces their quality of life at a time when quality of life is essentially the only area left to make improvements in. While traditional medications are frequently used to make patients more comfortable, many patients and families desire a more “natural” or “spiritual” option. Music therapy can satisfy that desire. While the statistical evidence for music therapy’s efficacy is limited (like most alternative medical disciplines), the anecdotal and subjective responses to the sessions are very positive. In surveying the use of music therapy in the Lebanon/Albany/ Sweet Home area, I found that while all hospice patients in the area are offered music therapy sessions, less than 25% take advantage of the option. Of those that do, the therapy is met with an overwhelmingly positive response, with noticeable (though subjective) improvement in over half of the patients. Screening for Problem and Pathologic Gambling in Coos Bay, Oregon Project Date: 8/7/2006 Pathologic gambling and problem gambling affect as many as 5 to 15 million Americans. Primary care physicians are ideally situated to screen for maladaptive gambling behaviors and assist in patient referral and treatment. Using an adaptation of the NODS DSM-IV diagnostic screen for gambling problems, this project sought to determine the prevalence and impact of problem and pathologic gambling for patients seeking primary care at Bay Clinic in Coos Bay, Oregon where no such screening been done. Of fifty-two respondents, six (11.5%) individuals were identified as being probable problem or pathologic lifetime or past year gamblers; with 50% having a history of substance use disorder and 83.3% with a history of depression or mania. For the four respondents meeting criteria for problem and/or pathologic gambling in the past year, an average of 108 days and $2,266 dollars was spent for the year. Further study is needed, particularly to resolve concerns regarding the specificity of the adapted screening tool and possible reporter bias. Still, this initial work shows a high prevalence of probable problem or pathologic gamblers in the Coos Bay region and provides impetus for continued standardized screening. Underutilization of Hospice Services in the Treasure Valley Area: Are we referring patient too late? Project Date: 8/8/2005 OBJECTIVES: To assess utilization of hospice services in the Treasure Valley area and determine if these services are adequately being used. To determine the views and attitudes of family members and hospice care providers regarding timing of referral. SETTING: Treasure Valley including Ontario, OR, Fruitland ID, Payette ID and neighboring towns. DESIGN: Retrospective analysis of hospice patient charts and Family Evaluation of Hospice Care (FEHC) records from 2004 and 2005. In addition, hospice care providers were surveyed about the timing of referral and usefulness of services offered. PARTICIPANTS: Deceased patients at Heart’N Home Hospice and their surviving family members. Hospice staff including physicians, nurses, counselors, social workers, chaplains, home health aides, and volunteers. MEASUREMENTS: Length of time patients received hospice care, family’s opinion regarding timing of referral (too early, at about the right time, too late) and hospice providers’ perceived average length of stay on hospice and perceived optimum length of stay. RESULTS: Chart review of 126 deceased patients revealed a mean length of stay of approximately 3 weeks. 40 families completed the Family Evaluation of Hospice Care and up to 20% thought that the patient was referred too late and that lack of information was the most common reason. 80% thought that referral was made at the right time. The majority of hospice care providers who responded to the survey believe that the optimum length of stay is 6 month. In addition, most thought that patients stayed on average between 2 and 4 month on hospice. CONCLUSION: The results indicate that in the Treasure Valley area, many family members and hospice care providers feel that terminally ill patients are referred too late and that they could receive greater benefits from longer stays on hospice. The actual length of stay is consistent with that of hospice patients nationally which shows that we are in fact patients are admitted late in the process of end-of-life care. Future effort should focus on patient’s opinion of referral timing and level of awareness of referring physicians regarding prognosis and eligibility characteristics. Hopefully, this could lead to improvements in referral and admission practices. Health Literacy in Rural and Underserved Populations Project Date: 8/8/2005 Does offering health information on topics that are in high prevalence in underserved populations and have more negative outcomes in those populations, improve the health of the population, and are those services readily utilized? Health Literacy regarding diagnosis, disease pathology and treatment options are at a low in rural populations. Without an awareness of what disease processes may be occurring in a patient, it becomes more difficult for patients to help themselves, do the things that are within their own capacity to reduce their morbidity, with respect to their disease. Health Literacy is a key component to health care outcomes, and directly relates to compliance of treatment protocols and adherence to prescribed regimens. Without health literacy, it is more difficult for patients to understand the importance of adherence and more likely for adverse effects to result, and decreased efficacy in treatment outcomes. Low health literacy has also been shown to directly impact the overall health of a community and health education has been shown to improve specific outcomes like reduction in unnecessary office visits, poor health resource utilization and medication compliance. A questionnaire was designed to ascertain the general perception of the patient population of health literacy, and was given to patients as they checked in for visits. When a disease process was identified in a patient that was addressed at the conference, the patient was counseled as to the importance of health information and invited to attend BRIDGING THE GAP NORTHWEST 2005, free of charge. Bridging the Gap is a community education forum, bringing information, tools and resources to the community at large, specifically targeting those underserved populations that are at the highest risk for negative health outcomes based on literacy and economic status. Patients were also offered information on their specific condition, and were asked if they understood the information that was provided. Health Literacy in John Day, Oregon: A Patient Screen and an Evaluation of Educational Resources Project Date: 8/8/2005 According to the National Assessment of Adult Literacy (NAAL), forty-six to fifty-one percent of adult Americans are illiterate or functionally illiterate. This adds up to 90 million Americans who cannot synthesize information from complex or lengthy texts and cannot consistently perform quantitative tasks requiring two or more steps. The inadequate literacy skills of Americans are impacting health care in a big way. Numerous studies have linked low literacy with important negative outcomes in healthcare, including higher medical expenses and poorer management of chronic illness. This link between literacy and health has lead to the defining of health literacy as a separate component of functional literacy, and the responsibility to recognize and accommodate patients with low health literacy now lies with health care providers. The problem this project aims to address is that of assessing the health literacy among adult patients of the Strawberry Wilderness Clinic in John Day, Oregon and evaluating resources available both in the clinic and the community for patients with low literacy skills. The results of a health literacy screen of 74 patients using the Rapid Estimate of Adult Literacy in Medicine - revised show that 23% of adult patients in John Day read at or below the 6th grade level and are thus expected to have significant difficulty comprehending most written and oral medical information. There was no significant difference in literacy skills between elderly and young adults. An assessment of written materials available for distribution at the clinic revealed that there were no printed patient education materials designed for patients with low literacy. Finally, local adult basic education resources were found to be more than adequate for meeting the needs of adults wishing to improve their literacy at no cost. However, few people seem to be aware of these education resources. Single Parent Support Group Project Date: 3/21/2005 The United States is home to approximately fifteen and a half million single parents.1 Studies have demonstrated the risk of onset of depression among single parents is double that of their married counterparts with social and financial support being significant variables influencing depression2,3 The large number of mental health problems seen in primary care clinics makes this issue a commonly addressed complaint. This study attempted to identify single parent patients suffering from depression and evaluate the effectiveness of a social support group in helping to reverse their depressive state. The design was recognition of depression in single parent patients and then introduction of these patients into a group of other single parents within their community allowing social interactions and self-determined topics of discussion. While identifying single parents suffering from depression or those who simply had interest in participating in the support group was easily done, there was no existing support group in the community for single parents. Therefore the final product of this project was development of bimonthly support group for single parents with the goal to eventually incorporate family activities, a baby sitting cooperation and educational activities. Parents were encouraged to bring their children with the secondary goal of providing a safe environment for the children to interact with others in similar family structures. The group met for two hours twice during the five week rotation. In addition to self-directed discussion the group was provided with literature addressing various topics regarding parenting techniques, community resources, and self-help motivational information. The effectiveness of the social support group was evaluated by an anonymous survey provided after the second meeting. Patients' Views About End of Life Care in an Aging Population Project Date: 9/29/2003 Physician-assisted suicide was legally enacted in 1997 in Oregon. One year later in 1998, a survey was taken of patients in Reedsport, OR examining opinions about physician-assisted suicide. Since then, a significant demographic change has occurred, shifting the mean age of the population upwards. This project studied patients’ attitudes and knowledge base about end of life care in this aging community, including both physician-assisted suicide and hospice care. Improving The Quality Of Life For An Aging Population: An Analysis of the Accessibility and Availability of Services for Seniors in Benton County, Oregon. Project Date: 9/24/2001 Almost 13% of the population in the United States and 10.3% of the population in Benton County is over the age of 65. Studies predict that the 65+ age group will grow by 135%, while the number of people who are 85+ will grow by 401% by the year 2050. With this incredible rate of growth, the demands on society to develop specialized services that provide assistance for the elderly are profound. The needs of the elderly are extensive and include assistance with the activities of daily living, housing, transportation, nutrition, health care, social interaction, financial assistance, support groups, and end-of-life care. The purpose of this project was to analyze the availability, accessibility, quality, and use of services provided for seniors within Benton County, Oregon. The results of the study show that there are many, high quality services within Corvallis. These services appropriately address many of the needs of seniors and most of the services have an excellent rate of participation. However, several areas of weakness were also found that may prevent many seniors from accessing these services. These included the lack of a central resource agency, extremely high costs for many of the services, lack of an adequate transportation program, lack of adequate resources in rural communities surrounding Corvallis, and a limited number of resources for individuals who do not have a high level of function. If these areas are not addressed, the pressure of the aging population on Benton County may prevent many seniors from receiving a number of services that are required to provide dignity, respect, and a high quality of life. Back to subject search page or search by preceptor site