RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Harney County Influenza Strategies 2009 Project Date: 10/12/2009 This project is a general outline of the organization of local resources and planning used during the 2009 Influenza Pandemic to provide adequate and appropriate care to citizens in Harney County in relation to influenza prevention, triage, and treatment. There was a large surge of influenza-like-illness (ILI) in the community in mid-October, during which time resources including vaccines, Tamiflu, and hospital space were of limited quantity and maintaining a high level of coordination between the hospital, clinic, pharmacies, and health department were all critical. Swine Flu Epidemic: What are patient and health care workers attitudes and knowledge of the H1N1 influenza and vaccine in Florence Oregon? Project Date: 10/12/2009 The H1N1 flu is an epidemic that has already reached 48 states, and has killed 672 people, and hospitalized over 17,000 (1). Patients are asking about the H1N1 flu and vaccine on a daily basis and many are very concerned. Health care workers are also frequently discussing these issues. Two surveys were developed to question the opinions and knowledge base of both patients and health care workers regarding the H1N1 flu and vaccines. There appears to be some lack of knowledge about the H1N1 vaccine and flu. People of all ages are concerned about the flu, and age doesn’t determine who thinks they do or do not need a vaccine. The majority of people are receiving information from the television about H1N1, and very little from their doctor’s office. There is a need for greater patient education about the vaccine and the flu. In regards to health care workers that were surveyed, doctors are well vaccinated, and MA’s are not. Many patients (on average 50% or more) are asking about the vaccine and flu. Most workers are providing very minimal information to patients regarding the vaccine and flu. Workers are being approached by family members and the community about the vaccine and flu. Only 13% of workers feel they are confident of their knowledge of the vaccine and flu. In conclusion, patients and health care workers are in need of education about the H1N1 flu and vaccine. Preparation and prevention are key concepts for health care workers and patients to understand (2). 2009 H1N1 Influenza – The Response of Klamath Falls, OR to “Swine Flu” Project Date: 9/7/2009 The 2009 H1N1 flu virus spread rapidly throughout the world and created significant concern bordering on panic wherever it went. Klamath Falls, an area with around 50,000 individuals (15,000 of them minors) in southern Oregon, was no exception. The aim of this project was to explore the effect of, and response to, the “swine flu” in the community. To this end I drew off experiences working at the Klamath Pediatric Clinic, developed an educational handout to give to patients and their families, and interviewed public health and school district officials. I was also able to participate in the local hospital’s infection control meetings as they developed their policies regarding 2009 H1N1 and sit in on lectures and webcasts from the AMA/CDC and OHSU Grand Rounds. Rapid Influenza Testing in the Cottage Grove Community Hospital Project Date: 8/3/2009 The goal of this project is to determine the number of positive and negative cases of influenza that have been detected with the QuickVue rapid influenza test at the Cottage Grove Community Hospital (CGCH) between 7/9/09- 8/25/09. CGCH encompasses an emergency department, medical ward, and outpatient clinics in Cottage Grove, a community of 18,000 in the southern part of Lane County, Oregon. The first screening test used by CGCH in the workup of acute influenza is the QuickVue Influenza test, which detects influenza A and B antigens directly from a patient’s nasal sample. The basic demographics of the patient population tested at CGCH during the study period is outlined, and the most common symptoms of patients presenting with influenza are identified. The sensitivity and specificity of the QuickVue test is discussed along with the prevalence of influenza (specifically the novel H1N1 influenza A virus) in the region. H1N1 Influenza: Patient Education and Preparation in Jefferson County Project Date: 8/3/2009 With the most current novel influenza virus pandemic sweeping our planet, no locale however small seems immune. Although Jefferson County has yet to confirm a case of H1N1 this year, its residents are still worried and questioning what this coming flu season will bring. After attending the H1N1 Influenza Preparedness Summit in Salem as well as meeting with local representatives from the health department and surrounding clinics, I have learned that patient education with a consistent message will be the key to preventing a widespread outbreak in this community as well as abating much of the fear surrounding this pandemic. My goal in this project was to create materials for the Madras Medical Group (MMG) clinic to use this coming season to educate its specific patient population about H1N1 in order to encourage early preventative measures and limit spread among the community. Through a presentation to the MMG on the current H1N1 status in our state, my goal was also to provide clear and accurate information on treatment and prevention to the medical staff so that they might pass this information along to their patients, families and friends. Non-Medical Exemptions to Immunization in Josephine County, OR Project Date: 6/29/2009 Religious and personal-belief exemptions to mandatory childhood vaccinations are increasing in states across the country with Oregon having the fourth highest overall rate. Within Oregon, Josephine County regularly ranks near the top in terms of annual "religious" exemptions to immunization. Oregon's process for attaining an exemption is easier than in most states. While Oregon does not have a "personal belief" exemption, state law defines "religion" broadly as "any system of beliefs, practices or ethical values." In this study, I looked at rates of religious exemptions within Josephine County as well as factors associated with "vaccine hesitancy". I found that vaccine-hesitant and non-hesitant parents did not differ in terms of engagement in religious or other groups. Vaccine-hesitant parents, however, were significantly more likely to use friends or the internet as sources of vaccine information but significantly less likely to use health-care providers. This student emphasizes the importance of outreach by health-care providers to vaccine-hesitant communities and stresses the importance of crafting firm but constitutional laws mandating childhood vaccines. Updating Clinic Procedures and Policy regarding VFC vaccinations at the High Desert Medical Center Project Date: 6/29/2009 Vaccines for Children is a division of DHS that offers vaccines to public and private clinics for dispersal to underserved kids. With the DHS’s current goal of vaccinating 90% of children in the US, providing vaccines at a discounted rate for economically disadvantaged children is vital for protecting the health care of many communities. 4 Up until recently, High Desert Medical Center in Burns, OR was offering VFC vaccines to their eligible clients. However, this spring the VFC recalled 2 years worth of vaccines given by the clinic from 2007 to 2009 due to a defective refrigerator. Part of the requirements of re-instating VFC vaccines at HDMC included a staff-wide review of VFC policies for administration, storage, and handling of the vaccines. The VFC guidelines were reviewed, and nurses in clinic were interviewed about current clinic vaccination procedures. An abbreviated version of VFC vaccination policy was created and presented at the clinic’s monthly nurses’ meeting. In addition, a clinic-specific SOP was created for administration and documentation of vaccinations during well-child checks for both VFC and privately insured children. Inactivated Influenza Vaccine Rate and Implications in Diabetic Patients in John Day, Oregon Project Date: 4/27/2009 Flu vaccination is an important preventative focus of diabetic care. Deaths and hospitalization from influenza are uncommon among the general population. However, diabetes puts people at higher risk for severe flu illnesses, secondary complications and death. Given the high prevalence of diabetes and the development of the diabetic questionnaire in John Day in November 2008, I would like to use this opportunity to understand whether the influenza vaccination rate is improving with the utilization of the questionnaire. The project is designed as a retrospective study for the inactivated influenza vaccination status on diabetic patients seen for the last two years in Blue Mountain Hospital, Strawberry Wilderness Community Clinic. A total of 307 diabetic patients were selected for the study. The result shows the rate of influenza vaccination increased from 30% in 2007 to 38% in 2008. Identifying Children Vaccinated from March 2007-April 2009 at the High Desert Medical Center in Burns, OR Project Date: 4/27/2009 When 2 years worth of vaccines from the Vaccines for Children program were retrospectively deemed defective due to refrigerator temperature irregularities, the High Desert Medical Center needed to identify the children who may need revaccination or titres from that time. 221 children were identified using billing codes for pediatric vaccine administration, representing over 1000 injections for the common childhood vaccinations. Estimated cost of VFC vaccines alone used in that period was over $45,000. Limits to identifying this population risk were an inability to identify payer type (private vs. the VFC) as only the VFC is recalling the vaccines. Vaccination Hesitancy in Lebanon, OR Project Date: 2/9/2009 Increasingly more Oregonian parents are hesitant to adhere to physician-recommended vaccination schedules for their children. This student attempted to a) accurately describe the rate of vaccine hesitance and b) define reasons behind this hesitancy in Lebanon, OR. Rates of non-vaccination in Lebanon were computed by data from the Linn County Public Health Office. Patient opinions regarding vaccines were collected from 30 patient interviews. The interviews were formatted on a questionnaire created by the investigator. In addition, conversations were conducted with pediatricians and DHS officials regarding this subject. Based on the data from Linn County Public Health, Lebanon has a lower rate of vaccine refusal than the state average. Parental concerns regarding vaccines appear to reflect those expressed in a large-scale statewide study, chiefly among them 1) the belief that children are generally vaccinated at too young an age and 2) concern for a link between vaccines and autism. Enriching the Cancer Dialogue: The Development of a Patient Handout that addresses underlying roadblocks against parental acceptance of the HPV Vaccine Project Date: 12/29/2008 Cervical cancer remains the second leading cause of cancer-related deaths in women across the globe. In the United States alone, it claims the lives of 3,700 women each year. Infection by the human papillomavirus remains the leading cause of cervical cancer. Since the 2006 release of the first FDA approved HPV vaccine, marked controversy has emerged surrounding the administration of the vaccine to young adolescent girls in an attempt to target women prior to their first sexual encounter. This has led to diminished acceptance of the vaccine by parents as their daughters approach adolescence, a trend clearly observed in a rural Oregon community at a time when rural areas continue to mark the highest yearly incidence of HPV infection. Attempts to identify roadblocks to parental acceptance of the HPV vaccine were made through observation of patient encounters coupled with an examination of online parenting blogs and forums and augmented by a search of the medical literature. The final product of this project stemmed from the information gathered in the creation of a new patient handout that more directly addressed the most important underlying concerns expressed by parents who were reluctant to accept the HPV vaccine’s administration to their daughter. Rate of Immunization in Florence and Parental Concerns Preventing Complete Immunization in Children at the PeaceHealth Family Medicine Clinic Project Date: 10/13/2008 Childhood vaccinations remain an important tool in preventing disease in individuals and populations. For example, since the introduction of the Hib vaccine, there has been an 80% decrease in invasive Hib disease. However, vaccines have recently been at the center of a media storm due to a hypothesized link between vaccines and autism. Much work has gone into researching this link and there is solid evidence to reject the causal hypothesis between the MMR and autism, however parents remain concerned. This project seeks to look at the rate of immunization in the rural coastal community of Florence according to the CDC vaccination schedule of 4:3:1:3:3:1 by age two and the barriers that exist to complete immunization. Here, I report that Florence has an immunization rate of 72% in 2006, which is similar to Lane County and Oregon rates, but remains below the national average. Furthermore, the physicians at the PeaceHealth family medicine clinic in Florence report the three most common concerns of parents that potentially prevent complete immunization are concern about autism, concern about the mercury-containing preservative thimerosal and concern about immune system overload. I summarized the evidence that dispels these three common myths in a brief handout for parents. A Look at the Availability of the HPV and Meningococcal Vaccines in the North Santiam Canyon Project Date: 8/4/2008 Vaccination has become a huge part of preventative health in the U.S. and around the world. We've seen illnesses such as small-pox virtually eliminated from the population by successful vaccination programs. The first day I was in clinic, a girl came in requesting the HPV and Meningococcal vaccines and I was surprised to learn that neither of these were offered at the clinic I was at. This study looked at the availability of these two optional and expensive vaccines in the greater Santiam Canyon area. A phone survey of the local physicians was used to assess the availability of the vaccines and to ask about resources outside of these communities that they might utilize to provide this vaccine for their patients. Finally an informational handout was made that outlined basic information about each vaccine, resources available to help pay for them, and a phone number for a resource that provided the vaccine should their own clinic not provide them. 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. Raising Awareness of HPV and HPV Vaccination Among Eligible Females in Jefferson County Project Date: 3/17/2008 The Human Papilomavirus (HPV) is the most common sexually transmitted infection worldwide and is second only to HIV in the cost burden to the United States health care system. Eighty percent of sexually active men and women will acquire HPV infection at some point in their lifetime . The Quadrivalent HPV vaccine was approved by the FDA in 2006 for use in 9 to 26 year old females. Trials of the HPV vaccine have shown 98 to 100 percent efficacy in preventing type specific HPV infection and 90 to 100 percent efficacy in preventing CIN 2/3. By informal interviews with health care providers and information from two local clinics, it is estimated that the HPV vaccine is being underutilized in Jefferson County. Based on information from two local clinics, approximately 10% of 15 to 24 year old females in Jefferson County were vaccinated for HPV in 2007. The goal of this community project was to increase HPV vaccination rates by raising awareness of HPV and HPV vaccination among eligible females in Jefferson County. To accomplish this goal a lesson plan was created using information from the CDC Department of Health and Human Services that targeted 10th grade students and met Oregon and National Health Standards. The lesson plan was well received by the head of the health department at Madras High School and will be integrated into the 10th grade Health 1 curriculum beginning this year. Identification and Analysis of Barriers to Influenza Vaccination and Development of Patient Brochure as a Mode of Intervention in Stayton, OR Project Date: 2/11/2008 Seasonal influenza is a significant contributor to morbidity and mortality of Americans, particularly in at risk populations (adults > 50 years, children < 5 years, and persons with chronic disease, immunosuppression, or compromised respiratory function). The most effective means of influenza prevention remains yearly vaccination. This study attempted to identify barriers to influenza vaccination in a Stayton, OR family practice clinic. The design was five week observation of clinic and hospitalized patients with diagnosed influenza or influenza-like illness and their response to a family physician’s intervention regarding influenza vaccination. From these observations, a survey was developed and distributed over 7 clinic days, which asked patients to indicate if they received this year’s flu vaccine and if not, why? Based on survey data, gaps in patient knowledge, as well as systemic barriers to vaccination were identified. Interviews with local influenza vaccination sites were conducted in person and by phone to gather information about shot availability, cost, and type of vaccine offered. While patients were generally aware of availability of yearly flu vaccine, the majority declined due to misconceptions or lack of information regarding the influenza vaccine. No intervention, outside of physician counseling, was identified to target the local population’s low utilization of the flu vaccine during this brief observation period. Therefore, the end product of this project was the development of a patient brochure tailored to the responses of the “Influenza Vaccine Survey” to be distributed in clinic, and a recommended change in policy for local influenza vaccination sites. What Are The Barriers To Childhood Vaccinations In Lebanon, Oregon, And What Can We Do About Them? Project Date: 12/31/2007 Undervaccination of children is a nation-wide problem. Every year, children die from vaccine-preventable diseases as the nation fails to increase the average up-to-date (UTD) at 24 months vaccination rate above 71%. Many resources are being developed to overcome barriers to increased vaccination rates, including computerized immunization programs that collect vaccination records on children in a geographical area rather than in a particular clinic. Mid Valley Medical Plaza (MVMP) in Lebanon, Oregon, is fortunate to live in a state with an established computerized immunization record, Oregon Immunization Alert (OIA). At MVMP, however, this valuable resource was not being fully utilized. The purpose of this project was to examine the current vaccination delivery system at MVMP and design a simple, efficient, and effective protocol to implement the use of OIA into the care of the family physicians’ pediatric patient population. The hope was that this would lead to increased vaccination rates. The study began with a quantitative study to determine the UTD rate of a small sample of the patient population, which revealed similar vaccination rates between MVMP and the nation. Interviews with healthcare workers revealed similar barriers in the clinic in Lebanon, Oregon as are faced in clinics across the nation. An extensive literature search on the barriers and solutions to vaccination delivery supported the integration of OIA to help improve vaccination rates in the pediatric patient population of MVMP. The protocol was then designed. In order to effectively convey the need for change, and therefore the worth of creating and implement a solution, a formal proposal to implement the simple protocol was developed. Reminders to providers and parents as an intervention to address below-goal immunization rates Project Date: 9/10/2007 Rates of immunization at the Strawberry Wilderness Family Clinic were compared to those of other rural providers in Oregon and found to be lower than expected. The clinic staff was consulted to identify aspects of the immunization protocol which needed improvement. This lead to 1) creating a reminder to providers in the clinic EMR for children past due on immunizations and 2) assembling postcards to be sent to parents of past due children. These methods have been shown in the literature to improve immunization rates. Impact of these changes will be determined in future reviews of the clinic's rates. Additional interventions in clinic protocol, such as standing orders, and programs, such as Oregon AFIX, should be employed if rates continue to be below goal. Evaluation of Childhood Immunization Delivery in John Day, OR Project Date: 9/10/2007 Childhood immunizations are an important public health initiative in preventing what were once common causes of childhood morbidity and mortality. Rural children may face increased barriers to immunizations due to living in medically underserved areas. In John Day, OR, the Grant County Health Department provides and tracks the immunizations for all of the patients seen by Dr Holland. The objective of this study was to evaluate immunization delivery, compare records between the clinic and the health department, and suggest strategies by which immunization rates can be improved. An analysis of all of Dr Holland’s patients aged 19-35 months (22 children) was conducted using patient charts and health department immunization records to determine immunization status at 24 months, as well as percentages of late starts and missed opportunities. These results were compared with similar data from January 2006 for Dr. Holland’s clinic recently released from the Rural Oregon Immunization Initiative (ROII). The percentage of children up to date with the recommended series of 4 DTaP; 3 IPV; 1 MMR; 3 Hib; 3HepB; 1 Varicella was 72%, which is an improvement from the rate of 57% found by the ROII. The percentage of children up to date by 35 months was 77%, that of late starts was 18% and of missed opportunities 9%. While these rates are all improved from the ROII data from 2006, they are not yet reaching the Healthy People 2010 goal of 80% or better coverage. The rates could be improved by decreasing the percentages of late starts and missed opportunities, by improving communication between the health department and the clinic, and by addressing parents concerns and fears about immunizations. The clinic will begin using the ALERT immunization registry to better track immunizations and remind patients of due vaccines. All children found by this project to be behind on their vaccines were notified and encouraged to complete the series. The human papillomavirus vaccine: Provider attitudes and barriers to utilization in Roseburg, OR Project Date: 7/2/2007 The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. In the U.S., 6.2 million new infections occur annually, most in people 15-24 years old. HPV is necessary but not sufficient to cause all cervical cancer, all anogenital warts, and 90% of anal squamous cancers. During 2002, 126 women developed invasive cervical cancer and 45 died of the disease in Oregon. A quadrivalent HPV vaccine (against 6, 11, 16, 18) was FDA approved June 2006 for use in all 11-12 year old females, with a vaccination range of 9-26 years old. The vaccine is 100% effective against cervical cancer and genital warts. Provider attitudes and barriers to vaccination with the HPV vaccine have not been studied recently, so a survey was sent out to 37 health care providers in Roseburg, OR (included MD/DO, PA-C, NP in Family Medicine, OB/Gyn and Pediatrics). 57% of surveys were completed and returned. 71% of providers provide the HPV vaccine. Barriers to vaccinating include cost to both the patient and the provider, as well as difficulty in getting adolescents to come to well visits, and parental tendency to pay less attention to vaccines after age 5. 67% of providers do not agree with mandating the HPV vaccine in Oregon, citing reasons such as cost, insufficient evidence, and questioning government involvement. Although the HPV vaccine is a breakthrough in cancer prevention, more time must be spent investigating barriers to vaccination before mandating the vaccine will be possible. Is your car or truck maintenance more current than your patients? Project Date: 7/2/2007 In Oregon we have yet to reach the Healthy People 2010 goals for Cervical Cancer screening and Colon Cancer mortality (Oregon Partnership for Cancer Control, 2005). These are only two of the multiple goals we have yet to achieve, but it shows that we need to improve the current system of patient education and motivation. Although there are many obstacles to reaching the recommended goals, my project focused on literacy, simplification, and consolidation through 3 population specific handouts. Throughout the project I found it odd that most cars are provided with a maintenance schedule that states at predetermined intervals the vehicle needs to have routine care, yet our personal health screening recommendations are not in a usable format for the general population. They are constantly evolving depending on the latest research, and the vaccine schedules can be extremely difficult to understand. While in Baker City, Oregon I created one handout each for men and women 18 and older that included vaccinations and cancer screenings based on the current recommendations of the U.S. Preventative Service Task Force (USPSTF), CDC, and American Academy of Family Physicians. I also created a schedule in a checklist format for parents that included recommendations for vaccines, well child exams, dental, hearing, and vision for children birth to 18, based on USPSTF, CDC, American Academy of Family Physicians, and American Academy of Pediatric Dentists. The goal was to assist patients in using the available resources in a simple and accurate format in order to improve screenings and vaccinations. They were provided to Eastern Oregon Medical Associates and Baker County Health Department. Implementing the New HPV Vaccine: developing informational resources for patients and clinic tools for its use Project Date: 2/12/2007 A new vaccine is available that protects against the most common types of HPV that cause cervical cancer, but the patients of the High Desert Medical Center have limited information available to them about this vaccine, and the clinic itself has not begun using it. This project had two goals: first I attempted to help create informational resources about this new vaccine, and secondly, to help implement its use in the clinic. To achieve increased patient education, a brochure was developed to be distributed to patients at the clinic. An article about the vaccine and cervical cancer was also written that will run in the local newspaper. To help the clinic put the vaccine into use; I worked with IT staff to add reminders and schedule tracking of the new vaccine. I also acquired the cost information from the most commonly used insurance companies in the area. HPV Vaccination in the Illinois River Valley: A survey of attitudes and availability, with recommendations for increased vaccination Project Date: 2/12/2007 Gardasil, the vaccine against 4 strains of the Human Papilloma Virus, is currently a hot topic among women’s health providers and also the mainstream media. My project attempted to identify the best method for improving vaccination rates amongst young women in the Illinois River Valley. I found that no providers in the Illinois River Valley offered the vaccine, due to lack of demand, prohibitive costs and difficulty in purchasing. Young women who were interested in receiving the vaccine were referred to the County Health Department a 25-35 minute drive, which was prohibitive for some patients. Although, I would have liked to be able to recommend that providers in the IVR offer the vaccine to their patients, my research was not able to support that conclusion. Instead, I recommend provider education and a concerted effort to encourage vaccinations through the School Based Health Programs and continued referral to the County Health Department. Acceptance and Use of the HPV Vaccine in Lebanon, OR: Creation of an educational patient handout to increase awareness, acceptance, and use of HPV vaccines. Project Date: 1/1/2007 A vaccine against HPV and Cervical Cancer was recently FDA approved for use in the United States, representing a major public health advancement and effective method for decreasing the prevalence of an aggressive malignancy. This study attempted to assess the educational resources available for patients about the HPV vaccine as well as the use of the vaccine in a rural family practice clinic in Lebanon, Oregon. The design was to observe current methods of patient education for the HPV vaccine and the number of times the vaccination was given over a five week rotation. Informal interviews with physicians in the clinic, as well as patients, were conducted to access common questions and concerns about the new vaccine. The process of obtaining the vaccine as well as the rate of administration was assessed with the physician interviews, as well as talking with clinic staff. Due to the relatively short duration of vaccine availability and lack of informative yet concise materials, patients were uniformly unaware of the accurate details about the HPV vaccine and no vaccines had been given. Since the vaccine had a designated target population, those eligible were easy to identify and the barrier to patient education was seen to be the lack of an educational handout. Not only does the possible recipient need information, but the captive audience includes young females starting at age 9, which often includes parents in the educational equation. Therefore, the final product of this project was a concise yet appropriately informative patient handout to explain HPV; it’s relation to Cervical Cancer, and the HPV vaccine to adolescent females 9-15 years old and their parents to increase accurate awareness and subsequently utilization of the vaccine. Barriers to Utilization of the Human Papillomavirus (HPV) Vaccine at the Cottage Grove Hospital & Clinic; Development of Provider Education Materials Project Date: 9/11/2006 The Human Papillomavirus (HPV) is responsible for up to 99.7% of cervical cancer. A new HPV vaccine recently approved by the FDA has demonstrated significant efficacy in preventing persistent, high-risk HPV infections when administered prophylactically. Due to the novelty of this vaccine, however, many providers are unaware of the details of its availability and of their patients’ ability to procure the vaccine at affordable rates. In addition, vaccination is not yet widely accepted by patients or parents, for a variety of reasons. The goal of this project was to investigate the barriers to vaccination at the hospital and clinic in Cottage Grove, Oregon, a facility serving approximately 18,000 patients, 31.5% of whom are aged <25. A literature search was performed for information regarding HPV and the efficacy of the vaccine. Availability of the vaccine was confirmed by the hospital’s pharmacy. Several major insurance carriers were contacted regarding coverage for the vaccine. Availability and insurance coverage of the vaccine was found to be much greater than most providers had previously believed. A secondary goal of the project was to develop provider education materials aimed at minimizing barriers to immunization with this promising new vaccine. This was achieved by the production of a single-page, double-sided, tri-fold informational handout. Provider response was positive, and several providers who had not previously prescribed the vaccine offered it to their patients, some of whom began the 3-shot series immediately. 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. 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. Tracking Childhood Immunization Records: the Utilization of Oregon Immunization ALERT in Baker City. Project Date: 9/12/2005 In Baker City the public health department is the only entity that immunizes pediatric patients. There is no system in place for the transfer of patient information between the health department and the rest of the medical community in Baker City. Oregon Immunization ALERT is a statewide database of immunization information for Oregon’s pediatric population whose aim is to track the immunization status of every child 0-18 years of age with the ultimate goal of insuring complete and timely immunizations for all. Baker County Health Department enters each child’s records on ALERT, but the community doctors and hospital personal do not access the program. Increasing the usage of ALERT at Eastern Oregon Medical Associates (EOMA) medical office and by introducing ALERT to the St Elizabeth Hospital Emergency Department could serve to bridge this gap between the health department and the community health care providers. Practitioners at EOMA were retrained on how to access ALERT and the importance of following the immunization status of their patients was readdressed. This resulted in plans put forward to incorporate ALERT records for each patient age 0-12 into their electronic records system with the ability to update the records at each office visit. The nurses and doctors in the emergency department were introduced to ALERT, given access codes, and trained on its use with an emphasis placed on using it to determine DTaP status. The results in St. Elizabeth’s emergency department are less certain. There was resistance to the use of a computer based program and uncertainty of ALERT’s value in the emergency setting. A follow up letter with reminders of passwords and how to access ALERT will be sent to the emergency department in two months time. By accessing ALERT, physicians will be better informed on the immunization status of their patient and better able to encourage prompt vaccination or catch up immunizations as needed. By increasing the knowledge of a patient’s DTaP status in the emergency department, the risk of adverse immunization reactions will decrease. Meningococcal Disease in Klamath Falls, OR Project Date: 7/4/2005 Meningococcal disease is an important cause of morbidity and mortality in the United States. This project attempted to identify barriers to the utilization of vaccination against Meningococcal disease in Klamath County. These barriers surfaced following a small outbreak of meningococcal disease in Klamath Falls. The two major barriers identified had the same underlying issue - a lack of education. The first barrier, lack of knowledge of the citizens of Klamath Falls, was identified through informal surveys. The response to this barrier was to create a pamphlet aimed at increasing patient awareness of meningococcal disease and the vaccines that exist to prevent it. The second barrier, lack of knowledge of health care providers, was gauged through informal interviews. Though multifactorial, it was due, in large part, to the fact that a new meningococcal vaccine was very recently released and most providers did not possess the most current knowledge surrounding this vaccine. This was addressed by creating a concise, clinically relevant summary of meningococcal vaccinations in the form of a memo. These two measures were designed to target the root of the problem, the need for education of both patients and providers. 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. Newborn Discharge Packet for Siskiyou Pediatric Clinic Patients Project Date: 9/13/2004 This project was designed to provide a brochure of important information for parents of newborns at the Three Rivers Community Hospital in Grants Pass, OR. Multiple resources exist to provide support and advice to parents of newborn infants. However, most of these require the use of internet access or the financial ability to purchase parenting books. Pediatricians supply many free handouts that parents can collect, but many of the parents I talked with indicated a desire for a quick reference source that gave them bulleted points outlining key information and guiding them in when to access their pediatrician. Interviews were conducted with new parents, nurses in the Family Birth Center and the pediatricians at Siskiyou Pediatric Clinic in Grants Pass, OR in an attempt to determine the most important topics to include and what the best format to present this information. A brochure format was believed to provide the best presentation of information for this community. Further data collection determined five main areas for the newborn brochure, including newborn safety, immunizations, well-child checks, local contact numbers and guidance on when a new parent should call the pediatrician. The product of this project is a brochure entitled "Newborn Information That Every Parent Needs to Get Started" that will be given to every parent in the Family Birth Center before discharge from the hospital. 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. 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. Evaluate Immunization Delivery and Suggestion of Strategies Project Date: 8/18/2003 Immunizations are one of the most successful preventive interventions. Unfortunately, not all children receive this intervention equally or on a timely basis. The objective of this study was to evaluate immunization delivery, address barriers to immunization, and suggest strategies by which rates can be improved at Dunes Family Health Center (DFHC) in Reedsport, OR. In conjunction with the Oregon Immunization Program, a retrospective analysis of all children ages 12-35 months, who received at least one vaccination at DFHC with dates of birth ranging from July 16, 2000 and July 15, 2002, was conducted. Analysis of 103 immunization records yielded coverage rates for children 2 years of age, as well as percentages of late starts and missed opportunities. The up-to-date coverage rate at DFHC for children at age 2 years that are fully covered with 4 DTaP: 3 Polio: 1 MMR: 3 Hib: 3HepB is 46%; 6% of children were found to be up-to-date by the date of assessment. The percentage of late starts is 14%, and that of missed opportunities is 28%. Decreasing both the percentage of late starts and missed opportunities by addressing barriers and deficiencies in immunization delivery would improve coverage rates. A Glance at Immunizations in Baker City, OR Project Date: 7/7/2003 Childhood immunizations continue to pose a challenge within the public health sector. Baker City, OR, possesses a rare immunization program in that the County Health Department immunizes 94.5% of the children in Baker County. The immunization rate of children ages 12-35 months in Baker County is 64%. This project examined immunization rates of the county as a whole in comparison to immunization rates of pediatric patients under the care of one Baker City physician. A list of patients between the ages of 12 months and 5 years was obtained from the Baker Clinic database. Permission was obtained from the patients' parents or guardians, and the patients' immunization records were then reviewed through the County Health Department. A total of 46 patient immunization records were reviewed. The immunization rates for children aged 12-35 months and 36 months to 5 years were 72.7% and 91.6% respectively. While these rates were higher than those of the county rates, the immunization goal still aims for close to 100%. Further investigation may be warrented to evaluate any missed opportunities or barriers that may impede immunizations. A clinic-based immunization program may also be necessary, but challenges remain in order to reach this stage. Childhood Immunization in John Day, Oregon: Development of A Patient Education Handout for Use In the Clinical Setting Project Date: 7/7/2003 The development and application of widespread vaccination to prevent disease is considered to be one of the most notable public health achievements in history. The immunization campaign in the United States has succeeded in reducing the incidence of devastating childhood illnesses dramatically, nearly eradicating many diseases from the population at large, but immunization rates are dropping both nationally and within the State of Oregon. In Grant County in 2001, only 73.6% of children between age two and three had received all the recommended vaccines. Among other reasons, many children are not being vaccinated because of parental fear, ignorance, and misguidance due to anti-vaccine information presented on the Internet and by the mass media. The Strawberry Wilderness Family Clinic in John Day, Oregon lacked vaccine information available to parents in a condensed format that addressed the importance of timely childhood vaccinations in general. A concise, one-page handout was created to address the concerns of parents regarding childhood immunization and was implemented for use in the clinical setting. 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. 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. 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