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. Screening for Chlamydia Trachomatis Project Date: 10/12/2009 Chlamydia is the most common sexually transmitted bacterial infection in the U.S. with particularly deleterious consequences for women. Alicia Hills, communicable disease nurse and educator at the Department of Public Health in Baker County, has been tracking the rise in Chlamydia positivity throughout Baker County since 2007. Data from DHS in Oregon demonstrates an increase in the incidence of Chlamydia in Baker County overall from 2003 to the present. The rise in positivity may be attributed to greater access to female providers since 2003, an increased risk for false-positive tests due to the lower prevalence of Chlamydia in Baker County as compared to the average for Oregon state, and easier screening methods implemented by clinicians in the area. A universal Chlamydia screening protocol was discussed and implemented at the Eastern Oregon Medical Association and the Baker County Public Health Clinic. In addition, educational pamphlets from DHS discussing sexually transmitted infections will now be offered to patients being screened for Chlamydia. Emergency room physicians agreed to encourage at-risk patients to be tested at the Public Health Clinic. A powerpoint presentation used to educate adolescents and young adults in Baker County about sexually transmitted infections was revised and updated. 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 Exploring the decrease in the percentage of women receiving pap tests at the Warm Springs Health and Wellness Center--reasons why and strategies for improvement Project Date: 8/3/2009 According to the Government Performance Results Act (GPRA) report, the percentage of women age 21-64 receiving pap smears at the Warm Springs clinic has steadily decreased from 74.1% at baseline in 2000 to 58.3% in the past year. The current goal for the clinic is 90%, and the goal of this project is to determine what has contributed to the decrease in pap test rates and what can be done to increase the percentage of women receiving these exams. First a survey was distributed to the health care providers at the clinic to explore reasons for the decrease in pap tests and to gauge community awareness. Based on the responses given, an educational pamphlet was put together for patients including information about pap tests, HPV, and how to prevent cervical cancer. Enhancing Domestic Violence Screening and Outreach at Santiam Medical Associates by Addressing Barriers Faced by Battered Woman in Rural Communities Project Date: 4/27/2009 This project aims to evaluate the preparedness of Santiam Medical Associates to recognize and refer victims of domestic violence (DV) to resources. Another key objective was to illuminate the myriad of barriers faced by victims of DV in rural communities and the ways in which providers can become better equipped to assist these victims. It is thought that 1 in 10 women in Oregon between the ages of 20-55 (more than 85,000 women), have been physically or sexually assaulted by a current or former intimate partner in the last five years.1 Nearly one-third of American women (31%) report being physically or sexually abused by a husband or boyfriend at some point in their lives.2 Women in rural communities face specific challenges to accessing resources. Rural physicians can play an integral role in improving the lives of their battered patients if they are aware of the problem and provide a safe and confidential environment for women to disclose. During my rotation, I administered an anonymous survey to the employees of the Santiam Family Medical office to assess their awareness of DV, preparedness to ask about abuse, whether they felt equipped to refer patients to appropriate resources and their thoughts on barriers women face while seeking safety from abuse in Stayton. Based on the results of the survey, I collaborated with a non-profit domestic violence organization to develop a training workshop for the staff on addressing DV in a medical setting. In addition, I was able to provide prevention and education materials on DV for the physicians and staff to distribute to patients in need of information and community resources. Planning for Obstetric Emergencies Project Date: 2/9/2009 Obstetric emergencies can be extremely tense situations especially when the health of a newborn infant or mother may be compromised. Planning for these particular emergencies can help provide efficiency and strategy in implementing the best care for the mother and the newborn. It was found at the Madras Medical Group and Mountain View Hospital in Madras, Oregon that that a basic plan for obstetric emergencies had not been established. For my community project, I helped establish an obstetric emergency medication kit that would be stocked and easily accessible in the OB unit for obstetric emergencies. Having a protocol in place and necessary medications in one easily accessible place can reduce the amount of stress and anxiety that often accompanies such obstetric emergencies. Incidence of Caesarean Deliveries In Rural and Urban Areas: Do our small towns have the answers to solve the bigger issue? Project Date: 2/9/2009 Caesarean births are rising in the US and have been for the last decade. There are likely many contributing factors, and just as likely there is no easy answer for how to reverse this trend. While we may look to patient preference, physician discretion, and changing medical standards for a part of the explanation, this paper attempts to break down this growing problem to see if there are parts of the country that are effected more than others. In the town of John Day, Oregon, the rise in caesarean deliveries has grown high above the national average and it is even higher still above Oregon’s urban center of Portland. But while the effects of this trend towards caesarean delivery is more apparent in this rural setting, the town of John Day may also be able to show us a clue to stopping this rise. In the final year of data analysis, 2007, the town saw a rapid decline in the incidence of its caesarean deliveries, interestingly enough this year also marked the highest number of deliveries, by caesarean or vaginally. While this paper does not leave its reader with the answer for how to solve the rise in caesareans, it does offer the next step in researching how John Day was able to buck the trend. 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. Postnatal and Well-Child Care in Grant County Project Date: 9/8/2008 Grant County is a rural area made up of 7250 residents and is primarily agricultural. The four physicians in John Day provide the primary care, obstetrics, gynecology and emergency care for these residents. Some have been under the impression that the infants they deliver do not always follow up with preventative care in the clinic. In this six week rural rotation it was also observed that some of the infants coming to the doctor were not always coming in for well-child visits. In a respective study of the two years of deliveries at the Blue Mountain Hospital it was found that 96.3% (n=107) of the infants had follow up visits. However, 11.7% of these had limited follow care, some not having any well-child visits. Grant County has the usual barriers to care, such as lack of insurance, low income, etc., but also had some unique rural barriers as well, including a long commute to see a doctor and a lack of physicians in the area. Recently John Day has lost two physicians and is looking to replace them. The absence or limited follow-up care of 15.0% could create a barrier to providing preventative care to the population in Grant County. Screening for urinary Incontinence in Women > 50 years of age in Warm Springs, OR: An underdiagnosed issue Project Date: 9/8/2008 Urinary incontinence (UI) is a significant health issue with substantial social impact. However, this issue is often unaddressed by health care providers in one of its major populations, older women. The goal of this study is to illustrated the degree to which urinary incontinence in woman ages 50 and up is underdiagnosed in Warm Springs, OR. Warm Springs Health and Wellness Center is an Indian Health Services clinic and the only clinic on the reservation. A sample population of women ages 50 and up coming to the Warm Springs Health and Wellness Center medical offices between September 23 and October 6, 2008, were screened for UI using the previously validated MESA questionnaire for urinary incontinence. Surveys were scored and UI prevalence according to the MESA questionnaire was compared to prevalence according to IHS ICD-9 codes for UI. According to a VGEN search of EHR (electronic health record), Warm Springs Health and Wellness Center only had a 13.0% prevalence of UI women in aforementioned sample population. However, according to the MESA questionnaire at least 58.7% this sample population had some form of UI. Not only is UI unaddressed in this community, but patient knowledge and educational information is lacking. Therefore, the final product of this project is an educational pamphlet on UI. Social gatherings and community is a very important part of this population, hopefully addressing undiagnosed and untreated UI may be improve the quality of some of these women, allowing them to actively participated in community functions and gatherings without fear or embarrassments associated with UI. 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. 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. Prevalence and patterns of breastfeeding in Scappoose, Oregon: Development of two handouts Project Date: 7/2/2007 The decision of mothers whether or not to breastfeed their infants has historically been influenced by trends and attitudes within our society rather than by an understanding of the benefits of breastfeeding. Lack of support by the partner or family has been demonstrated to be a major barrier for mothers to continue breastfeeding. This study examines the prevalence and pattern of breastfeeding among infants presenting for well-child exams to the OHSU Family Medicine Clinic in Scappoose, Oregon. The design of this study utilizes both quantitative and qualitative methods and included patient data base research, interviews with providers, childbirth educators and the WIC program nurse as well as observation and direct participation in prenatal and postpartum care clinics and a 4-week childbirth education class. The participation in the clinics and the class allowed for direct patient education opportunities and instruction on breastfeeding techniques. From the findings, two patient handouts were created, one explaining the benefits of and myths about breastfeeding, the other given detailed instruction on breastfeeding techniques and partner support. The handouts were available during the final days of the rotation and will assist the clinicians whenever women request information on breastfeeding during their visits to the clinic and serve as a guide to one-on-one instruction about breastfeeding techniques. In addition, they are to be made available during subsequent childbirth education classes and to provide a framework for future breastfeeding classes. Urinary Incontinence: Dribbling into the Golden Years Project Date: 3/19/2007 Reedsport, OR is an old logging town with an aging population. Unfortunately, its community is suffering from illnesses that increase with growing old, including urinary incontinence. Urinary incontinence affects up to half of all women eclipsing hypertension, depression, and diabetes in prevalence (Sutherland, 2004). It is associated with troubling morbidity such as falls, urinary tract infections, skin breakdown, depression, and social isolation (Resnick, 2004). Many women believe that urinary incontinence is a normal part of aging. Although the medicines and conditions that predispose urinary incontinence increase with age, UI is neither inevitable nor untreatable. With treatment, up to 90 percent of those with UI can improve (Khan, 2004). In towns like Reedsport, patients routinely wait up to 4 months for an appointment with an urologist. Fortunately, an urologist is only needed for the most recalcitrant cases, and family practitioners have the tools to diagnosis and treat the majority of patients. With this project I described the Reedsport community and why it carries a large burden from this problem. I also interviewed patients to better understand the problem and its impact. Then, I performed a literature review to learn how to best identify and treat UI. Finally, I created tools for diagnosis and patient education. The Role of the Primary Care Provider in Identifying And Treating Postpartum Depression Project Date: 2/12/2007 Postpartum depression (PPD) is a significant public health problem in the US affecting approximately 1 out of 8 women. Antenatal depression can also occur and when present, is a risk factor for PPD. Although the prevention and treatment of PPD (or perinatal depression) is a public health priority, screening for the disorder is not typically standard of care and therefore PPD is often under diagnosed and inadequately treated placing women, infants and families at risk. Because multidisciplinary primary care providers usually have the most mother/child contact, they are in a prime position to screen for depression and identify risk factors that might lead to PPD. Risk factors such as poor partner/family relationships, lower socioeconomic status, unemployment of self/partner and lack of social support are not uncommon in Eugene, Oregon. The purpose of this project was to: 1. Increase the awareness among the PeaceHealth system (PHS) primary care physicians and midwives of the importance of identifying, treating and/or referring cases of PPD. 2. Introduce a validated screening tool for identifying women at risk of developing or suffering from PPD. 3. Provide a referral list for the treatment and support of PPD. 4. Invite clinician participation in the Lane County PPD Consortium, 5. Provide a PPD screening tool for the PeaceHealth Sacred Heart Hospital labor and delivery social workers. Methods: The patient statistics justifying this project came from 2006 and reflect the number of all PHS physicians’ patients who gave birth at the PHSHH. Information was gathered through conversations with PHS physicians, ancillary staff, the Lane County PPD Consortium and several others. An informational packet (IP) was prepared and distributed to individuals involved with the identification, treatment, referral and quality care of patients with PPD. Findings/Results: Last year, the percentage of diagnosed cases of PPD among PHS primary care physicians’ patients who gave birth at PHSHH was .18%. This is far short of the estimated prevalence of 10-20%. Screening for PPD is not standard of care for primary care doctors in the PHS. Many doctors reported they did not have time to use the IP screening tool and there was a general lack of knowledge of the importance of the role of the primary care provider in addressing the problem of PPD. There were no reported cases of PPD diagnosed during the five week clerkship. Breast Cancer Patient Resources in Grant County, Oregon. Project Date: 2/12/2007 Breast cancer is a major medical concern for women in the United States. Women currently are thought to have about a 1 in 7 lifetime risk of developing breast cancer. This means that even a small community such as John Day, Oregon in rural Grant County likely has many women who have dealt or are dealing with a diagnosis of breast cancer. The goal of this study was to attempt to determine if there is a need for breast cancer patient resources in Grant County and if so what resources are currently available to meet this need. Although there is not an oncologist in Grant County or a site for chemotherapy infusion or radiation, there are still likely many breast cancer patients/survivors living in the area who may need support and resources outside of those provided when going out of town for treatment. The design of this study was observation of materials available at health care provider clinics as well as interviews of local health care providers and breast cancer patients and survivors. The final outcome of this project was to develop a database of contacts for local resources as well as to obtain a handout of national resources for the local health care provider offices. 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. Breast Cancer Screening in Grant County, OR Project Date: 2/12/2007 Breast Cancer is one of the most common malignancies in the United States today. In fact, it is the most common non-skin cancer. It is also the second most deadly type of cancer behind lung cancer. While the disease is not preventable, it is highly treatable as long as it is caught at an early enough stage. Screening for breast cancer has been standardized and there are screening guidelines and goals defining the percent of the population that need to be screened to meet these criteria. In my clinical experience in John Day, OR, I noted that many patients were not up to date with their breast cancer screening. The goal of this project was to define the current screening rate in Grant County and identify areas for improvement. I found the overall rate to be lower than both the state and national average. There were several identified barriers contributing to this low level of screening, the most obvious being lack of information at the point of service. At the conclusion of this project I supplied updated and more visible information for patients regarding breast cancer screening. Hormone Replace Therapy for Menopause Symptoms: Creation of a Patient Guide to the Risks, Benefits, and Alternatives Project Date: 5/1/2006 Hormone Replacement therapy (HRT) for the relief of menopause symptoms has been available to women for more than a century. For the majority of this time the use of HRT has been steadily gaining popularity despite warning signs of potential risks. Results in 2002 from the Women's Health Initiative (WHI), however, dramatically decreased the use of HRT by demonstrating small but significant increases in cardiovascular and cancer risk with HRT. The latest report of HRT and breast cancer risk, published within the last month, has renewed the barrage of media coverage and concern over HRT. Women today who are tyring to decide how to deal with menopause have the challenging task of interpreting a very complex set of data in an arena where there are potentially misinformed sources. The purpose of this project was to deliver a patient education handout that succinctly and accurately summarizes the risks, benefits, and alternatives to HRT. Promoting Women Physicians in Tillamook County Project Date: 2/13/2006 Tillamook County not only has a shortage of primary care physicians, but it also has a shortage of women primary care physicians. There are a disproportional number of female physicians in Tillamook County compared to urban areas. 83% of primary care physicians are male in Tillamook county despite a strong demand for female primary care physicians. Dr. Parsons has repeatedly tried to recruit a female internist with no success. There are many barriers to recruiting female primary care physicians to rural areas, specifically partner job unavailability, role of primary caregiver in the family, overfeminization/overloading of their practice, and gender stereotypes/community receptivity. This paper examines these problems in depth and offers some further solutions to these barriers. It also summarizes how a program was set up to encourage young women in Tillamook to pursue scientific professions, such as physicians, in hopes that they would someday return to practice in their own community. Increasing Awareness and Screening of Postpartum Depression in Klamath Falls Project Date: 10/17/2005 Postpartum depression occurs in approximately 10-22% of women nationally. Risk factors for developing postpartum depression include being a single parent or in an unstable relationship, living at a lower socioeconomic level and having a lack of social and emotional support. Given childbirth is considered such a joyous time in a woman's life, having symptoms of depression can cause women to feel guilty or ashamed. As a result, postpartum depression is under-reported and often physicians do not readily inquire about it. It is an important illness to recognize because not only can it be debilitating for a woman, but it can interfere with essential maternal-infant bonding and can have long-term consequences for the child such as behavioral, cognitive and social developmental problems. Many women in Klamath Falls become mothers at a young age and lack financial resources, stable relationships and emotional and social support. Based on these displayed risk factors, one can infer that postpartum depression is a problem for some women in Klamath Falls. It is therefore important for women to be informed and adequately screened for postpartum depression. As a community project, postpartum and pregnant patients were surveyed to assess the need and interest for more information and screening for postpartum depression. Similarly, several doctors were consulted and expressed interest in providing women written information on postpartum depression and better access to a definitive screening tool. Based on this feedback, an educational pamphlet was created for women with information on understanding the disease, recognizing the symptoms, and knowing the treatments and was made available in the clinic. Similarly, a screening tool specific to postpartum depression was made accessible to the doctors in the clinic to facilitate more consistent screening. Barriers to Breastfeeding in a Low-Income, Predominantly Hispanic Community. Project Date: 9/12/2005 Despite the clinical evidence that supports the nutritional and developmental advantages to breastfeeding, the initiation, duration and exclusivity of breastfeeding remain low in the United States. The barriers that exist for women wishing to breastfeed are multifactoral, especially for low income mothers. However, by providing support and education, primary care physicians are in a pivotal position to address breastfeeding complications during routine examinations and potentially increase breastfeeding rates. An analysis was conducted to assess what breastfeeding difficulties exist for mothers at the West Salem Clinic. Patients delivering within the last six months were interviewed about their desire to breastfeed, the support they received and complications they experienced. Problems such as perceived decrease in milk supply, sore or cracked nipples or latching difficulties were consistent with other published reports. However, barriers unique to this population included cultural perceptions, financial and educational obstructions as well as language difficulties. By identifying the obstacles that exist for breastfeeding mothers, primary care providers might be better able to offer more continued support, thereby improve breastfeeding outcomes. The Idiosyncrasies of Rural Mental Health: Taking a closer look at women's perceptions of available mental health services, as well as their own psychosocial risk factors, Grant County, OR. Project Date: 10/18/2004 Mental health disorders are a major public health concern in the United States. Although access to services can be limited in rural areas, this study attempted to explore both perceived barriers to mental health care, as well as personal psychological and social risk factors that may affect emotional well-being. A survey was devised to address three categories: (1) the impact of psychosocial risk factors, (2) perceptions of local mental health services, and (3) the role of the rural doctor in treating mental illness. Because of their statistically increased risk of experiencing depression and anxiety, women eighteen and older were identified to complete this survey. Results showed that although women in Grant County tend to have a low severity and frequency of identified risk factors, they have a considerably low self-esteem. This is particularly evident amongst the surveyed elderly population. While this may not directly contribute to mental illness, it can increase vulnerability to those already at risk. Women appear to be accessing mental health services as needed, and generally perceive their family physician to be an additional good resource. This emphasizes the central role that primary care doctors play in rural mental health. 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. Assessing and enhancing women's awareness of heart disease in the Coos Bay area. Project Date: 11/10/2003 Heart disease is the leading cause of death in women, but most women do not believe heart disease will affect them. The death rate from myocardial infarction is higher in women; this is believed to be due to women not pursuing immediate care, as well as the lack of physician awareness of cardiac symptoms in women. Coos County is one area in Oregon where the rate of deaths from heart disease in women is particularly high. The goal of this project was to increase the community¹s awareness of heart disease in women, as well as to provide medical personnel with new information on women¹s symptoms and management. First, a survey was performed to assess risk factors and views within the population. Next, a pamphlet was created, directed towards women, that discussed statistics, risk factors, and references for information on women¹s heart disease. It also listed some of the symptoms of cardiac ischemia and provided instructions for what to do if someone experiences them. Finally, a presentation of the survey results, pamphlet details, and some points for physician awareness was given to the staff at Bay Area Clinic at the completion of the project. Breast Cancer Screening of Postmenopausal Women Project Date: 9/29/2003 With the growing percentage of elderly Americans, osteoporosis and its consequent health risks are becoming an increasing public health concern. Routine screening guidelines have been proposed by many health organizations to evaluate the bone density of those at greatest ri9sk of osteoporosis, especially postmenopausal patients receive screening at a rural family medical outpatient clinic in John Day, Oregon. A chart review was performed and found that only 21% of postmenopausal women age 65 and over had been screened while 50% of postmenopausal women between ages 50 and 65 had been screened. Patients who had been screened were more likely to have come in for routine physical exams at which time appropriate screening test were recommended. Of those patients who had not been screened, many visited the clinic onlyfor treatment of acute medical conditionsof for follow up of a focused chronic medical condition. Recommendations for improved screening rates include increasing patient awareness of osteoporosis prevalence and morbidity as well as taking advantage of focused patient visits to recommend bone density screening. Hormone Replacement Therapy in Baker City, Oregon Project Date: 9/23/2002 The Women's Health Initiative Study about Hormone Replacement Therapy (HRT) has had an important effect on the prescribing practices of physicians. To assess the effect on the practices of Baker City physicians, a short survey was sent to the medical providers in Baker City who were most likely to prescribe HRT. The survey asked questions about how they learned of the study and if the data reported had caused them to change their prescribing habits. The most common modes of learning of the study were through the lay press and self-study. The study caused the majority of the providers to reduce the number of HRT prescriptions they write, especially for women with risk factors for coronary heart disease, stroke, breast cancer, and pulmonary embolism. Concerns about Hormone Replacement Therapy in Florence, Oregon: Development of an Educational Handout for Patients Project Date: 8/12/2002 Hormone replacement therapy (HRT) has been prominently featured in recent television news broadcasts and newspaper articles, since one trial of an observational study - the Women’s Health Initiative - was stopped because the number of cases of breast cancer caused by hormone replacement therapy had exceeded acceptable safety limits. Always a difficult choice for women, HRT has become an increasingly complex treatment for both patients and physicians. Of the postmenopausal women in the United States, approximately 40%7 opt to use HRT for some length of time, though many women discontinue therapy within a few years of initiation. Because the Health Associates of Peace Harbor serves a primarily elderly population in Florence, Oregon, menopausal and postmenopausal women comprise a large part of clinic practice. Thus, HRT is a relevant and important topic to many of the female patients, whose concern regarding their possible increased risk of breast cancer and thromboembolic disease with use of HRT appears to have increased recently due to extensive media coverage. This project consists of use of observation and informal surveys to define a population - menopausal and post-menopausal women on HRT – and a need – accessible information on HRT. After consideration of the clinic’s use of informational handouts on other health topics, and the need for a form of education on HRT that is both efficient and easy to use, recent journal articles and online sources were used to create a double-sided, one-page educational patient handout. 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. Knowledge Is Power: Rural Women's Access To Contraceptive Information. Project Date: 1/2/2002 Despite advancements in contraceptive technologies over the past two decades, unintended pregnancy, particularly teen pregnancy, rates remain high in the United States compared to other industrialized nations. Almost half of all pregnancies in the U.S. each year are unintended. Numerous factors contribute to this problem, many of which are personal, political, economic, or cultural in nature. Providing information is not the only way to increase women's contraceptive use. There are other barriers to care that have as much or more of an impact on access, particularly in the rural setting. But lack of information is not a very difficult obstacle to overcome if it is acknowledged and addressed. Contraceptive knowledge is one of the few modifiable risk factors for unwanted pregnancy. This project consists of three components: assessing patient access to contraceptive information and services, taking action to improve access, and recommending changes that may benefit some patients. Back to subject search page or search by preceptor site