RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Health Literacy and Patient Knowledge of their Chronic Illness in a Rural Population with Hypertension Project Date: 8/3/2009 Health literacy refers to the ability of an individual to obtain, process, and understand health information needed to make informed decisions about managing their health. Limited health literacy is common in the United States and is important because it is related to health knowledge, health behaviors, and health outcomes. In this project, the health literacy of a population of primary care patients with hypertension in Grants Pass, OR was assessed and then patients completed a questionnaire asking basic questions about the risks and management of this disease. The goal was to assess the level of patient knowledge regarding their chronic illness and to see if that correlated with health literacy status. Patients were found to have a good overall understanding of blood pressure goals, risks of untreated hypertension, and strategies to reduce blood pressure. Patients were least likely to understand dietary strategies to reduce blood pressure and only about one-third could correctly list all blood pressure medications they were currently using. Patient education materials regarding dietary management of hypertension were obtained for use in the clinic and several strategies for maximizing patient education were presented to the staff of the clinic. Because of homogeneity in health literacy status in the study population, associations between health literacy and patient knowledge was not possible. Health Screening Awareness in Grants Pass Project Date: 12/29/2008 Preventative health services are central to individual health while maintaining low overall health care costs. While on my rural clerkship in Grants Pass I found that patients of the Grants Pass Clinic were largely unaware of health maintenance screening guidelines. Further, while performing colonoscopies, I noted the age of most patients was higher than I expected. I then accessed the local OHP plan, OHMS, for claims data for colonoscopies amongst 50 year-olds and mammograms amongst 40 year-olds. This demonstrated the poor compliance of the Grants Pass community with recommended health screening, ranging between 7-15% of patients for these services. I addressed this problem by creating an informative pamphlet to be distributed to OHMS members and to be displayed within the Grants Pass clinic. I hope to increase local compliance with health screening by 10% in the next year. Burns Biggest Loser Part 2: Finding Reliable Healthy Weight Loss Information In a Small Rural Community Project Date: 12/29/2008 Over 66% of Americans are overweight or obese. In urban areas, there are a variety of weight loss classes, clubs, and programs available to the individual motivated to lose weight. Paradoxically, in rural areas like Burns, Oregon the prevalence of overweight and obesity is greater than the national average, yet the weight loss resources are scarce. If a resident of Burns, Oregon wants healthy weight loss information there are few local resources, none of which offer free weight loss education, guidance, and monitoring. One option for such an individual is MyPyramid.gov, a free interactive web site that offers personalized diet and physical activity assessment, and encourages healthy self-monitoring behaviors. Investigating primary care provider perceptions and practices regarding smoking cessation in Florence, Oregon; and the development of a cost focused informational pamphlet Project Date: 12/29/2008 Rural areas have been shown to have higher rates of tobacco use than urban or suburban areas.(1) These higher rates have led to significant morbidity and mortality in rural populations.(3) Although state and national data has shown declining smoking rates over the past several years, these declines have not occurred as rapidly in rural areas.(2) Previous studies have found that rural smokers tend to want specific smoking cessation counseling from their doctors, including medication costs, efficacies and a specific plan.(2) This study investigated the perceptions and practice patterns of primary care physicians in Florence, in order to assess which smoking cessation tools were being used and whether Florence providers give specific weight to issues like cost and efficacy. Questionnaires were given to Family Medicine and Internal Medicine physicians concerning smoking cessation. These questionnaires showed that providers find smoking cessation to be an important goal, but that they may be underestimating the number of smokers in their practices. All of the providers mentioned patient motivation and willpower as barriers to smoking cessation, while two mentioned the cost of the therapies. Half of the providers preferred Chantix to other pharmacotherapies. With the goal of providing specific information to patients on cost and effectiveness of the different smoking cessation options, a pamphlet was developed for provider and patient use during counseling. Tobacco Cessation Group Visit Project Project Date: 10/13/2008 Tobacco abuse in the United States remains a leading cause of preventable death and disproportionately affects Medicaid recipients. At my rural site, a clinic serving exclusively Medicaid and OHP patients, an approximate 45 percent of our adult patients smoke. A significant percentage of those smokers are afflicted by smoking related illnesses such as heart disease and COPD. Having identified this at-risk population, we set forth to plan and implement a tobacco cessation group visit that is consistent with principles set forth in The Chronic Care Model and the Future of Family Medicine Project (FFMP). Adult smokers with smoking related illnesses were invited to participate based on their desire to quit. Of the 7/15 patients invited participated in the group. At the visit, our care team documented vitals and spirometry values, facilitated a group discussion about quitting, provided a brief informational presentation, and counseled patients individually regarding their plans for tobacco cessation. The visit resulted in 5/7 patients setting a quit date and creating an action plan for quitting! Several barriers to participation were identified including scheduling and transportation. A follow-up group visit is planned for January 2009, and current plans are to continue with new cohorts in the future. Reducing Obesity in Veneta, Oregon: Is TOPS (Take Off Pounds Sensibly) Part of the Solution? Project Date: 10/13/2008 Obesity is a major health issue for Americans including residents of Veneta, Oregon. A survey of the electronic medical record used at Dr. John Allcott’s Veneta clinic revealed 495 patients with a Body Mass Index (BMI) over 30 (medically obese) out of his 1483 active patients. While observing Dr. Allcott it became apparent that he refers many of his obese patients to a group program for weight management called TOPS (Take Off Pounds Sensibly). In order to learn about TOPS, assess its effectiveness for Dr. Allcott’s obese patients, and determine whether it could be part of a refined obesity initiative patients were interviewed, a local meeting was attended, the TOPS website was explored, and the medical literature was searched. A review of weight loss programs including Weight Watchers and TOPS concluded that TOPS helps some people and is inexpensive, but given the lack of scientific studies demonstrating its effectiveness the decision to join should be left up to the individual. Personal success stories were compelling, but other patients identified barriers that turned them away from TOPS. Survey of the electronic medical record revealed that out of the 110 (22 male, 88 female) patients who were referred to TOPS, 24 had insufficient chart data to analyze, 39 (45%) decreased their BMI overall, 41 (48%) increased their BMI overall, and 6 (7%) had unchanged BMIs. Limitations exist in determining which patients were truly attending TOPS meetings and given that nearly half saw an increase in BMI and half saw a decrease in BMI, the objective evidence is unconvincing. However, given the many compelling success stories heard it was determined that TOPS should be a key component of the menu of options for weight loss. The final product was the development of a system for addressing weight management with obese patients in the Veneta clinic which includes identifying patients with BMIs > 30, a screening question asked by the medical assistant, and recommendations by the physician. This system has been implemented in the Veneta clinic and will hopefully help reduce obesity, its comorbidities, and its unnecessary cost. Portion Size? Serving size; Teaching Healthy Living Choices in Scappoosereatment of Chronic Pain Project Date: 6/30/2008 Obesity is a growing epidemic in the United States of America. This along with low health literacy, especially in rural areas, leads to increased obesity in these areas. Rural areas also suffer from physician shortages making the time spent with patients more and more valuable. The goal of this project was to make the most of time spent at the doctor’s office to educate obese patients about portion control. The design was a PowerPoint presentation about how food portions and therefore caloric content has changed over the past 20 years. This presentation also included information about exercise requirements to burn these extra calories. In order to maximize the time spent at the doctor’s office, the presentation was set up to run on the computer in each exam room while the patient waited for the doctor at OHSU’s Family Medicine Clinic in Scappoose, Oregon and was shown to 15 obese patients. Development of the Jefferson County School Wellness Policy Project Date: 12/31/2007 During the past 20 years, there has been a dramatic increase in the prevalence of obesity in the United States, with more and more children becoming overweight and/or obese. It is thought that as much as 14% of 2 - 5 year old children and 19% of 6 - 11 year old children in the U.S. are overweight. This is becoming a growing health concern as there is a clear increase in morbidity and mortality associated with being overweight and obese due to increased risks of coronary heart disease and type 2 diabetes. Although obesity-associated morbidities occur most frequently in adults, overweight children and adolescents are more likely to become overweight or obese adults. Conversely, health-conscious and active children are more likely to maintain these habits into adulthood. The Jefferson County school district has received federal funding for a Community Health Improvement Project (CHIP) aimed at reversing the growing trend of childhood obesity in Central Oregon. To complete the first objective of the CHIP, a Wellness Policy was developed to be presented to the 509J school district for approval. This Wellness Policy is aimed to motivate and assist students aged kindergarten through twelfth grade to maintain and improve their health and prevent disease by shaping the children’s attitudes toward physical fitness, nutrition, and health. It focuses on improving district-wide school policy in four main areas: health and nutrition education, physical activity and physical education, nutritional standards, and policy review. Optimizing Well-Child Visits in Coos Bay, OR Project Date: 3/19/2007 Well-child visits make up a large part of a general pediatrician’s daily schedule. Due to time constraints and the plethora of information to be addressed, there is a growing desire among the pediatricians of North Bend Medical Center in Coos Bay, OR to make these visits more efficient and effective from both the physician and parents’ perspective. This project aims to identify the general structure of well-child checks (WCC) and the content covered during the visit that is important from both an educational standpoint and of concern to the parent/patient. The design involved a search through literature examining the content and purpose of WCC, improvement strategies, and barriers presenting in rural settings, as well as informal discussions with pediatricians and parents in North Bend Medical Center. As a means of pinpointing what topics directly concern the parent, a questionnaire listing common developmental, psychosocial, safety, and family issues was created. It is thought that specifying concerns through such a questionnaire will help tailor the visit to an educational discussion regarding issues that both the pediatrician and parent believe are in the best interests of the pediatric patient. Heart Disease and Diabetes Handout for Kids Project Date: 1/1/2007 Heart disease and Diabetes are two of the most common diseases now present in the U.S. In the National Health Survey of 2004, the percent of non-institutionalized adults with diagnosed heart disease was 11.5 and the number of annual deaths was 654,092. In 2004, heart disease was responsible for 1/3 of all deaths. Diabetes is also of epidemic proportions. Approximately 7.2 million people have Type II Diabetes in the U.S.(actually diagnosed). According to the National Diabetes Statistics fact sheet, (NIDDK of 2003) approximately 1 in 17 or 5.88% or 16 million people in USA have diagnosed and undiagnosed diabetes. Diabetes is the nation's seventh leading killer and contributed to about 187,800 deaths in 1995 Two known risk factors for these diseases include smoking and obesity. Despite this, the incidence of obesity in adults and children continues to rise, and smoking has increased in young adolescents. For these reasons, we feel it is extremely important to begin educating young children about heart disease and diabetes, and give them basic tools to avoid these diseases. To accomplish this in the rural family practice setting, a children's book was created which outlines the basics of these diseases and encourages healthy eating, exercise and not smoking as three methods to help prevent heart disease and diabetes. The book will be used in the office setting as a tool to open up conversation and learning opportunities around these issues. In addition, a one-page handout summarizing the above will be given to the patients to take home as a reminder of what they learned. This is the beginning of an early education regarding the importance of lifestyle choices in the future health of our nation. Say Cheese: Public Opinion Regarding Community Water Fluoridation in Baker City, OR Project Date: 1/1/2007 Dental caries (tooth decay) poses a significant health risk to the residents of Baker County. Reputable health-professional organizations such as the CDC, WHO, AAFP, American Public Health Association, and Institute of Medicine support community water fluoridation as a safe, effective, and inexpensive way to prevent dental health problems. A majority of the US population has access to fluoridated water, but Baker County has not yet implemented this proven health improvement measure. In order to gauge public opinion regarding community water fluoridation in Baker, a survey was developed with the support and input of several local health providers, and widely distributed amongst varied segments of the community. Analysis of the survey results revealed barriers to public acceptance of water fluoridation. The gaps in dental health knowledge will be addressed as part of a following public health education campaign to be developed by nursing students. The group of local healthcare providers and students involved will organize the Baker medical community through meetings and strategy sessions in order to educate, collaborate, and hopefully unite in the campaign of fluoridation. In addition, the logistics of instituting fluoridation in the Baker County water supply was researched and outlined. 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. Preventive Medicine and Clinical Preventive Services for Patients Project Date: 10/17/2005 Preventive medicine and clinical preventive services today are a cornerstone of care for maintaining the health of any population. The activity of health maintenance is conducted by providing periodic health examinations and screening to identify an unrecognized disease or risk factor through history taking, physical examination, laboratory test, or other procedure that can be applied in short order. Screening tests can rapidly sort out apparently well persons who have a disease or a risk factor for a disease from those who do not and therefore are an important part of preventive medicine. However, many patients are unaware of or misunderstand the purpose of these preventive medicine measures which can ultimately lead to higher rates of morbidity and mortality if not accomplished or may even cause distrust in the current health care system due to the perception that a test or procedure is unnecessary. This project was created to help patients gain a better understanding of preventive medicine services. It provides a patient handout that describes the purpose of preventive medicine and lists medical conditions and screening options according to specific patient groups. This is intended to aid in both patient education as well encourage patients to ask questions and enable them to become more directly involved in the decision-making process that affects their health and health care. The preventive services described are compiled from the current U.S. Preventive Services Task Force guidelines and recommendations for clinical preventive services from the American Academy of Family Physicians. Warm Springs Health and Wellness Center Mortality Review of 2002-2003 Project Date: 9/12/2005 Mortality studies are an important and valid tool for evaluating the healthcare issues that affect a community. This project is a mortality review, recording the causes of death of patients of Warm Springs Health and Wellness Center in 2002 and 2003. Patient information was recorded by age at death, sex, immediate cause of death, manner of death, and associated co-morbidities such as alcohol, smoking, and seat belt use. Results from this study were compared to US mortality statistics in 2002 and 2003, and to previous Warm Springs mortality data for 1991-2000. The current study included the deceased from a population of 6464 active patients who received their care at Warm Springs Health and Wellness Center. The average age of death in Warm Springs over the two-year period (Jan. 2002 - Dec. 2003) was 45.5 years. This is lower than the average age of death during 1991-2000 of 46.7 years, and the average US life expectancy of 77.5 years in 2002 and 2003. This mortality review found that an average of 72% of deaths in Warm Springs were from natural causes, 20.5% from accidents, 4.3% from suicides, and 2.6% were from homicides. Complementary and Alternative Medicine in Astoria, Oregon: Examination of community needs and practices, with creation of a patient handout to aid in discussion and decision-making. Project Date: 8/8/2005 This project examined the frequent use of complementary and alternative medicine among patients at the Pacific Family Medicine clinic in Astoria, Oregon. The availability and knowledge of information for physicians and patients on alternative medicine was assessed and found to be in need of improvement. A set of pamphlets was created that provided advice on decision making regarding alternative medicine, listed useful resources, and provided some specific information on selected alternative therapies, medicines, and supplements. These handouts were distributed to the providers at the clinic for use as patient handouts, references, and discussion aids. Don't let Osteoporosis get you down: Fall prevention in Reedsport, Oregon Project Date: 4/25/2005 Osteoporosis is a disease that affects ten million Americans. Each year, one and a half million of them will sustain a fracture. The purpose of this project was to gather research about fall prevention in order to prevent fractures in people with osteoporosis. The Cochrane Database of Systematic Reviews was accessed to find the latest research concerning fall prevention. Of trials identified that were likely to be beneficial, six specific interventions were suggested. Of these interventions, those most applicable to the inhabitants of Reedsport were chosen for a patient education handout. Final recommendations included specific modifications of the home environment and behavior at home, evaluation and treatment by a physical therapist, and withdrawal of psychotropic medication. Alcohol Misuse in Benton County Project Date: 4/25/2005 Alcohol misuse is strongly associated with health problems, disability, death, accident, injury, social disruption, and violence. In the United States, alcohol abuse generates nearly $185 billion in economic costs. In general, alcohol misuse is under diagnosed by the primary care physician. The purpose of this community project is to assess the magnitude of the problem of alcohol misuse in Benton County, methods of detecting alcohol problems in our patients, examine the most successful treatment programs for achieving and maintaining sobriety, and the availability of alcohol treatment programs in Philomath, OR and Benton County. Employee Wellness At The Corvallis Clinic Project Date: 3/21/2005 Philomath Family Medicine is part of the Corvallis Clinic which employs 570 people in 3 clinics. Over the past year, several employees have mentioned their interest in company-sponsored fitness programs and activities. Many people working at the Corvallis Clinic feel that obesity is a major problem among employees in their organization. While informal walking groups and weight loss support groups exist, there is no explicit program in place to help employees maintain their health. This project was created to explore the possibility of creating a wellness program for Corvallis Clinic employees. This project focused on three things: 1) Assessing a local wellness program already in place at Samaritan Health Services (not affiliated with the Corvallis Clinic) 2) Gathering information on interest, ideas, and feasibility of a wellness program for the Corvallis Clinic 3) Making recommendations for a wellness program at the Corvallis Clinic The Forty Assets: A Needs Assessment for Adolescent Well-Being in Burns Project Date: 8/9/2004 In response to a series of adolescent suicides in a single year, Burns developed the Positive Parenting Group to promote healthier adolescent development. They have modeled community interventions based on the Forty Assets program, as developed by the Search Institute. In this project, 124 students from Burns High School were surveyed to ascertain the extent to which adolescents in this community have developed positive assets. The strengths of adolescent development in Burns include family support, clear boundaries established by adults, high expectations by adults, and positive personal values. The community has fewer assets in the areas of adolescent empowerment, the constructive use of time by youth, and a sense of neighborhood support. This data can help community groups and future medical students develop interventions targeting teen involvement in service, community activities (social or religious), or school activities (including sports, arts, or other clubs). Service-related activities are encouraged to promote community interaction in a setting where resources are limited for the creation of new programs. The St. Elizabeth Health Services Annual Blood Draw: The Evidence For and Against the Use of Routine Blood Testing as a Health Screening Tool Project Date: 3/29/2004 Many of the leading causes of death and disability can be prevented given the appropriate interventions. Thus, providing preventive services is a cornerstone of modern day primary care practice. Routine screening examinations and laboratory tests are major mechanisms by which preventive medicine is carried out in practice and should ideally be based upon recommended guidelines developed from the best currently available evidence. The focus of my community project was to research the evidence in support of and against the use of routine blood testing as a health-screening tool for the St. Elizabeth Health Services Health Fair in Baker City, Oregon. I planned to submit my results as well as my recommendations to the governing authorities of this event for further review. As a result of my investigation I found sufficient evidence to support the practice of routine lipid screening for men >35 and women >45 years of age. Insufficient evidence existed to support routine screening of CBC, CMP, TSH, PSA, LDH and Uric acid. Conflicting recommendations existed regarding the practice of fasting glucose screening mainly due to the fact that no clinical trial has been conducted to establish whether systematic screening of asymptomatic individuals for type 2 diabetes improves health outcomes compared with initiating treatment after clinical diagnosis. Sufficient evidence did exist, however, to recommend routine screening of fasting glucose in individuals with hypertension or hyperlipidemia. Given the high prevalence of these comorbidities in the U.S., especially among the population screened at the annual blood draw, routine fasting blood glucose testing may indeed prove to be an effective health screening practice in Baker County despite the lack of current evidence in support of it. A Philomath Senior Center * Wellness Program * Project Date: 7/7/2003 Abstract: Many communities have developed senior centers to serve the diverse needs of their elders. They are as varied as the communities and seniors that they serve. Senior centers help keep older people active, healthy and independent while strengthening the web of relationships between individuals and their communities. Many, many types of activities and programs are available at senior centers, depending on the local context, needs and interests. These include health and wellness programs such as support groups, informational talks, and various clinics. The level of programming varies considerably. Philomath presently has no senior center, but a group of local people is working to change this. They hope to restore the historic College of Philomath building and have proposed this as a home for a local Philomath Senior Center. The project is just in the beginning stages but energy is gathering for addressing the questions and doing the work. They would join thousands of other communities who have developed and maintain a local senior center. A Bright Future for Well-Child Checks in Coos Bay, Oregon: Implementation of National Guidelines and Survey of Parental Satisfaction Project Date: 8/12/2002 Bright Futures is a national child health promotion and disease prevention initiative that provides guidelines for health supervision visits (ie. well-child checks). The purpose of this project was to (1) compare well-child checks performed by pediatricians at NBMC & Bay Clinic in Coos bay, Oregon with Bright Futures guidelines, and (2) conduct a survey among parents regarding their satisfaction with patient education materials received during the visits. Well-child checks at NBMC and Bay Clinic correlate approximately 85% and 75% with Bright Futures guidelines, respectively. The survey completed at NBMC reveals a generally high level of satisfaction with patient education materials. Back to subject search page or search by preceptor site