RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Integrating Education on Postpartum Issues into Existing Birthing Classes for Pregnant Women Project Date: 10/12/2009 Although the prevalence of postpartum depression (PPD) amongst mothers on the Warm Springs Reservation is unknown, many of the risk factors for PPD are epidemic issues amongst this population. Risk factors include previous depression and social factors such as little support available from family or friends, difficult or stressful marriage or relationship, and stressful events occurring during pregnancy or after childbirth. Unfortunately, many of the prenatal patients seen at Warm Springs Wellness clinic have social stresses such as an unplanned pregnancy while they are young and single, past or current domestic violence, issues with alcohol abuse or family members and partners who abuse alcohol. These stressful and unstable social factors can become risk factors for the development of PPD. The Warm Springs Wellness clinic has many effective no-cost programs for parents including educational birthing classes, WIC, lactation consulting, home nurse visits after birth, free child car seats and parenting classes to help address many of the issues that affect mothers and their babies. Discussion and education around postpartum issues including PPD was one aspect that was missing from the great programs already established. As part of my project, I developed a presentation for expecting parents regarding postpartum issues and presented these topics to parents at prenatal clinic and birthing classes. I also created an educational pamphlet about the baby blues and postpartum depression for the Warm Springs Wellness Clinic to be displayed in patient rooms and provide more information on the issues and warning signs. Cesarean Section Rates at Harney District Hospital Project Date: 8/3/2009 Cesarean section rates as a proportion of live births continue to increase at a rather quick pace in the United States and in many other areas of the world. The CDC reported a 31.8 percent cesarean rate in the United States, a six-fold increase from cesarean section rates of the 1960s and 1970s, and the eleventh consecutive year with an increased rate. Cesarean sections are the most common surgical procedure performed in the United States, 1.4 million in 2007, yet the procedure enjoys very little scrutiny and analysis in comparison to other surgical procedures and medical interventions. Rates of cesarean section vary greatly between geographic areas and within cities at different facilities. Rural areas in the United States tend to have higher cesarean section rates compared with urban areas. This project compiled data from birth logs at Harney District Hospital between 2005 and 2009. The rate of cesarean sections as a proportion of live births increased steadily over this five year period. A further analysis of three years of live births at Harney District Hospital in Burns looked deeper into the indication for cesarean section at each delivery. The physicians who practice obstetrics at HDH had an interest in their cesarean section rate and how it compared with other facilities in Oregon but had not spent the time compiling the data Teen Pregnancy in Scappoose, Oregon and the Creation of an Educational Brochure Describing What to Expect and Available Resources for Pregnant Adolescents. Project Date: 12/29/2008 Although teen pregnancy rates have been declining in Columbia County since 1996, nearly 1 in 4 (23.5%) births are still to adolescent mothers aged 15-19 (1,2,3). Young woman in Columbia County face multiple challenges including higher rates of drug and alcohol use, lower economic status, earlier sexual debut, and most importantly lack of sexual education (4,5). During my clerkship in rural family medicine at OHSU’s Scappoose clinic, I saw many pregnant teenagers and was quite surprised by the questions they asked. The young woman that I saw had no idea what to expect, they did not know what resources were available to them, and some didn’t even understand their own anatomy. While researching this topic, I found that there is a great deal of effort being made in Scappoose (and Oregon as a whole) to convince parents that sexual education is important and to create curriculums that teach adolescents about safety and prevention. Prevention is always the best strategy when trying to combat health problems and I therefore understand why so much attention is being paid to prevention in the case of teen pregnancy, there is however less effort being focused on young woman who have already become pregnant. After identifying that education and resources for pregnant teenagers is an area of intense need in Scappoose, I set out to create a simple one to two page brochure that would answer common questions and concerns as well as list resources that would be helpful to young pregnant woman. Information to be included in the brochure was determined by talking with the young woman themselves and also through conversations with the physicians and nurses who take care of these woman at OHSU’s Scappoose family medicine clinic. This brochure will be handed out to pregnant teenagers who come to the Scappoose clinic for prenatal care, or those who attend the clinics prenatal classes. Targeted Sexual Education in Rural Communities Project Date: 8/4/2008 Youth growing up in our countries rural communities face a multifaceted challenge as they become sexually active. Statistically they are a high risk group - often with higher rates of alcohol use, earlier sexual debut, and frequently increased numbers of sexual partners at an earlier age. Compounding and interacting with this is the political climate in which these individuals come of age. Frequently, comprehensive sexual education is discouraged in traditionally conservative communities and school districts - often favoring abstinence-only based education that downplays the importance of contraception and discourages an open dialogue on topics of sexuality and sexual practices. These issues - along with socioeconomic forces at play in our rural counties and districts - lead to disproportionably high rates of teen pregnancy and STI transmission - even in areas where resources, providers, and adequate health care education are available and accessible. My project was designed to find the missing pieces of formal sexual education and directly target a short informational session to give students the skills and knowledge they need to make informed decisions about their health, their decision of how and when to engage sexually, and for those already sexually active - to serve as a reinforcing reminder on the importance of contraception and means of STD protection. Crisis Pregnancy Resources in Harney County Project Date: 6/30/2008 An unintended pregnancy can be a source of tremendous stress and angst for a woman and her family and may contribute to a poor pregnancy outcome such as preterm birth. The decision to continue the pregnancy begs the question of how one will obtain medical care, social and emotional support, childbirth and parenting education and the financial resources to support basic needs such as food, clothing, and diapers. In Harney County, resources outside of family support are limited. The goal of this project was to understand the breadth of and access to resources available in Harney County to women in a “crisis pregnancy” that choose not to abort. Crisis pregnancy was defined as an unplanned pregnancy in which a woman/family has insufficient personal financial, medical, educational, and emotional resources to provide for a healthy pregnancy and healthy child. Brief interviews were conducted with nurses, physicians, counselors, and community members that focused on what resources they had to offer in a crisis pregnancy situation, how many women access them for such resources, and what other agencies they would refer women to. Discovered resources were placed into four categories: medical, emotional/social support, educational, and financial/basic needs. All agencies could name a few other resources or programs applicable for referral, but none had detailed or comprehensive knowledge of the programs available. Recommendations were made for improvement in the access to and utilization of crisis pregnancy resources. A list of pregnancy resources and a binder of pamphlets was also compiled from the interviews for use at High Desert Medical Center. Obstetric Guide Project Date: 4/28/2008 West Salem Clinic and Total Health Community Clinic in Monmouth primarily serve low income, homeless individuals. Ten percent of the patients require obstetric care which is currently offered by three providers each having 10 deliveries per month on average. The clinics lack educational material that are practical, user friendly, and accessible to the women desiring pregnancy care at these facilities. For the past year, the clinic director has been interested in creating a brief, up-to-date, and readable manual of obstetric care. The goal of the manual is to offer as a free hand out to their patients as a guide for every step of pregnancy and to help providers become more efficient in managing the prenatal visits. Emergency Contraception in Baker County: Compliance with Laws Governing Access and Dispensing Project Date: 4/28/2008 In August of 2006, the FDA approved the emergency contraceptive Plan B to e available over-the-counter in pharmacies nationwide. In 2007, during the Oregon Legislative Assembly passed House Bill 2700, which requires health insurance plans in Oregon to cover prescription contraceptives. It also requires emergency rooms to provide information about emergency contraceptives to all female victims of sexual assault, and to administer emergency contraceptives to these patients while they are in the emergency room if they so desire. Interviews with the county's five pharmacists revealed that four of the five pharmacies in Baker County carry Plan B and dispense it over-the-counter to those 18 and older, and with a prescription to those 17 and under. Conversations with Emergency Department staff at St. Elizabeth Health Services revealed compliance with the spirit of the law, as it applies to victims of sexual assault. Access to emergency contraception in Baker County is further improved by the efforts of the health department, where it is available for free. The final area investigated in this project was the state of the high school health curriculum, which competently addresses contraceptives, including Plan B, and teaches students how to access birth control. A letter detailing these findings was distributed to health department workers as well as 7 physicians and 4 nurse practitioners in Baker City. Provision and Utilization of IUD’s in Linn County, OR Project Date: 4/28/2008 IUD’s are the most effective and least expensive long-term contraceptive. Outside the US, they are the most common form of birth control used by married women. IUD use in the US was curtailed due to concerns regarding safety after a number of cases of PID and TSS in the 1970’s. Since then, IUD’s have been redesigned to eliminate this safety issue and have an exemplary safety profile. Despite this, IUD’s continue to be underutilized leading to a significant number of unintended pregnancies and unnecessary patient suffering. This study attempted to determine the utilizations and provision of IUDs in Linn County, OR. This was accomplished by phone interview with the practice manager for all Family and Ob/Gyn practices in Linn County and utilized annual billing for IUD procedures from these practices. The results of this study indicate that in Linn County 1.2% of women between the ages of 15-49 use IUDs (vs 2% US and 13-14% worldwide) and that only 32% of qualified providers are actually providing IUDs. Based on the results of this study, Samaritan Health (which manages 90% of Family and Ob/Gyn practices in Linn County) agreed to organize an IUD CME course to encourage Linn County providers to increase IUD use. An Assessment of the Teen Birth Rate in Florence, OR Project Date: 2/11/2008 Florence, OR is largely regarded as an elderly community where people go to age gracefully. In a population where nearly twenty percent of its citizens are over the age of sixty-five years old, a public heath problem continues to brew quietly among a younger generation. The teen birth rate in Florence and surrounding areas is 1.7 times higher than the State’s rate, a statistic that appears even more exaggerated within this elderly community. Yet even among health professionals there is disagreement as to whether or not there is a problem with teen pregnancy in Florence. This project is an assessment of those perceptions and an evaluation of the availability of specific resources for sexually active teens such as contraceptive methods, emergency contraception, abortion, and adoption services. While access to all of these resources was found to be limited, the most underutilized was emergency contraception. Suggestions are offered as to how a subsequent project may be able to provide help in improving access to key resources and/or improve cooperation between Siuslaw High School and the Center for Women’s Health in generating a school-based clinic or outreach program. Barriers to such changes and a look at the historical aspect of this dilemma are also offered. Your Changing Body: A Look at Sexual Education in Coos County Project Date: 2/11/2008 My goal was to design a pamphlet that would provoke a conversation between the youth and adult, which can then be used as a foundation from which they could share their own morality and perspective regarding sexual health. I also wanted this pamphlet to be used as a starting point for a conversation regarding puberty and sexual health between parents and their children, as well as between pediatricians and their patients entering puberty. My goal was to also include resources, both within the Coos County area and on the internet, that parents, teachers, and youth could access to help educate them as to the options available from within their community when facing issues such as pregnancy, terminations, adoptions, and sexually transmitted infection (STIs) prevention and treatment. Contraception and Family Planning Education in Madras, Oregon Project Date: 1/1/2007 Jefferson County Oregon has the highest teen pregnancy rates in the state, however, it has doctors that are working to decrease that rate. To help them in the pursuit of this I developed a comprehensive patient handout explaining 17 different contraception options available. The handout is designed to allow patients to make the decisions about which contraceptive methods works best for their lifestyle. I attempted to increase contraception education giving a talk to and getting the handouts to be apart of the materials offered at the county birthing and parenting class. The result was a one page double sided handout that was well received by physicians, nurses, and staff at Madras Medical Group. This handout will help Madras health care professionals guide their patients in making contraception decisions. The birthing experience in Grant County, Oregon Project Date: 1/3/2005 John Day, like many other rural communities in Oregon, was recently faced with a dilemma: to continue obstetrical care by physicians despite rising malpractice insurance costs or as a community decide to no longer provide these services. While this debate directly influences the physicians and their patients, other allied health care workers in Grant County will also be affected. There are currently two options for obstetrical care in Grant County: the family practice clinic of Drs. Holland and Nichols or the local direct entry midwife, Sherry Lauer-Dress. The physicians provide standard medical care including routine lood work, ultrasounds and deliver at Blue Mountain Hospital. Sherry provides the same care by law, including access to order laboratories and ultrasounds at BMH, homeopathic medicine, and only does home deliveries. The question 1 addressed was threefold: 1. What percentage of women in Grant County are receiving first trimester prenatal care? 2. What form are they choosing- the traditional medical MD model or the alternative nurse-midwife model? 3. What does the lay midwife model entail? The methods include obtaining the breakdown of all birth certificates issued in 2004 from Grant County Health Department, conduction a chart-review of all the Blue Mountain Hospital deliveries, and interviewing Sherry Lauer-Dress and several postpartum patients. The results showed that Grant County issued fifty-seven birth certificates in 2004. Forty-eight of those were delivered at Blue Mountain Hospital (BMH), five were delivered by Sherry and four were delivered in hospitals in other counties. Ninety-five percent of BMH delivered patients had documented 1st or 2nd trimester prenatal care. The midwife patients had an average of 100% 1st trimester care. A summary of the interviews with Sherry and the postpartum patietns are presented in the results section. Emergency Contraception: Provider Attitudes and Prescribing in Jefferson County, OR Project Date: 5/10/2004 Emergency contraception is a safe, easy to use and relatively inexpensive method for preventing unwanted pregnancy. In spite of this, it continues to be underutilized for reasons that are not fully understood. This study was an attempt to examine the prescribing habits and attitudes of rural primary care practitioners regarding emergency contraception in the Madras, Oregon area. The design was a written survey of local primary care practitioners and emergency physicians. The overall response to the survey implied that primary care practitioners in the Madras area are open to the use of emergency contraception but most do not make it part of routine family planning discussions. The majority desire an informational handout to use as a tool for discussion of EC with patients. Emergency Contraception: Knowledge Among and Attitudes at Philomath Family Medicine Project Date: 3/29/2004 Unplanned pregnancy is a major medical, social and public health issue. In the United States, unintended pregnancies account for approximately one half of the 6 million annual pregnancies. These unintended pregnancies result in an estimated 1.4 million abortions and 1.2 million unplanned births each year. Despite better and more effective contraceptive tools, these unintended pregnancy rates persist. Research has demonstrated that emergency contraceptive pills (ECPs) are safe and effective in preventing intended pregnancies. However, for emergency contraception (EC) to be effective women need to know that it exists, how to use it, and be willing to use it. This project was conducted to assess both the awareness of and attitudes toward emergency contraception among female patients and health care providers at Philomath Family Medicine. Data was gathered through the use of two separate surveys: one for patients and a second for providers. Among the 36 women who completed surveys, the majority, 97%, had heard of emergency contraceptive pills, but 17-56% lacked at least one key piece of knowledge about emergency contraceptive pills that may preclude effective use. Additionally, among the 6 health care provider surveyed, all described themselves as at least somewhat familiar with emergency contraceptive pills and all had prescribed them in the past, 5 out of 6 had prescribed them in the past year. Planned Cesarean Section Pre-Admission Protocol Project Date: 9/29/2003 Planned cesarean sections place extra demands on the personnel of a small rural hospital such as Harney District Hospital (HDH) in Burns, Oregon. This project looked to identify items that must be addressed before the patient is taken to the operating room. Those steps that were time critical the morning of the procedure were established, and delineated from other items that could be completed the day before the procedure. A checklist and timeline was created to assist nurses in more efficiently preparing patients for their cesarean sections. A patient instruction sheet to be sent home the day before admission was also created to have patients arrive at the hospital better prepared and ready for surgery. Barriers hindering the use of Emergency Contraception in Lebanon, OR: Patient Access, Knowledge, Perceptions, and Attitudes Project Date: 11/4/2002 Each year, approximately 3.18 million women in the United States experience a pregnancy that is unintended at the time of conception, constituting 53% of all pregnancies. Similarly, in Oregon, 53% (n-31, 899) of all pregnancies in 1999 were unplanned. Located in Linn County, Lebanon consistently contributes to a county annual pregnancy rate that is among the highest in the state. While typically considered a problem afflicting teens and unmarried women, unintended pregnancy extends to all demographic groups: 77% of women over 40; 40% of married women; 82% of teens ages 15-19; and 88% of never-married women report pregnancies unintended at the time of conception. As a means to prevent pregnancy from occurring after unprotected intercourse has taken place, the Emergency Contraceptive Pill (ECP) is a safe and effective preparation that reduces the likelihood that a pregnancy will occur by 75-89%. In other areas of Oregon as well as nationwide, ECP has been touted as an effective means of decreasing the incidence of unintended pregnancy and its associated burdens. However, a recent local survey of female patients indicates that women in Lebanon know very little about ECP; consequently, one may surmise that it is a rarely used method of contraception. To investigate why ECP is seldom used in this area, this project consists of two parts; (1) an assesment of patient access to ECP information and prescriptions as a function of availability; and (2) a questionnaire administered to women ages 14-44 presenting to Family Practice and Internal Medicine clinics to assess patient knowledge, perceptions, and attitudes concerning ECP. Sex in the County, Coos County: Statistics, Sex Education, Social Change Project Date: 11/4/2002 With the United States currently leading the developed world in teen pregnancy and birth rates, teenage sexual activity is a major medical issue to be addressed. In an attempt to approach the problem from its roots of education this project focused on gathering data from surrounding school districts about their means of educating the students. The study was supported by the Coos County Prenatal Task Force and utilized a survey designed to glean information taught in the schools about contraceptives, prenatal care, STDs, and county resources. The survey was conducted with physical education/health teachers at 10 surrounding schools and the information was collated and then compared for uniformity in the county as well as contrasted with nationally researched sex education methods. Based on these comparisons recommendations for educational interventions were made and presented to the task force for activation. Examination of Adolescent Pregnancy in Klamath County: Is there really a high teenage pregnancy rate? Project Date: 7/1/2002 This study sought to evaluate the validity of the widely held belief that Klamath county has continued to have a high incidence of teen pregnancy and if valid seek an explanation for this higher than normal rate. Vital statistics from the Oregon Department of Human Services were reviewed for the year of 2000 and revealed that Klamath County has teen pregnancy rate that is not significantly different from that of the state of Oregon. Klamath County does however have a significantly higher teen birth rate and a significantly lower abortion rate. These results fail to support the belief that pregnancy rates are higher but are able to explain why such a belief exists as the actual birth rate is higher than the state average. A discussion was then held with three staff members from the Klamath County Health Department who specifically work with teenagers to offer theoretical explanations for why the birth rate is significantly higher in Klamath county. Reasons cited include poor access for pregnancy termination, poor education of teenagers about pregnancy, denial, and in some cases a desire to have children at a young age. Availability Of Abortion Services: Rocking The Boat In A Small Oregon Coastal Community. Project Date: 9/24/2001 This study examined the availability of abortion services in a rural Oregon coastal community in October 2001. All family practice and internal medicine providers were surveyed on their current practices of abortion counseling, referral, and provision. Seventy-five percent of the questionnaires were returned, with 78% of providers stating they see women of childbearing age. Of these providers, none would ever include discussion about abortion as a form of contraception with their patients, and only 57% would always discuss abortion as an option in an unwanted pregnancy situation. Furthermore, 14% of providers stated they would neither provide an abortion nor a referral for an abortion if they were specifically asked for these services. It is apparent from these results that abortion services are challenging to procure in this small community Back to subject search page or search by preceptor site