RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. Environmental Factors which Contribute to Obesity in Rural Communities: A Case Study of Coos Bay, Oregon Project Date: 10/16/2006 Studies suggest that the obesity epidemic disproportionately affects rural areas. However, it is difficult for people to change habits which contribute to obesity. Although patient education and counseling is an important step in changing behavior, even those patients who are aware of their condition and the necessary changes that need to be made to improve their health are unable to accomplish weight loss. Past efforts at changing behavior in Coos Bay have focused on counseling in the clinic setting, and are often ineffective due to time constraints and inability to exert influence over behavior outside of the clinic setting. Educational materials made available to rural physicians are un- or under-utilized. However, there are other methods for changing behavior. Studies show that the environment affects physical activity levels and obesity levels in a community. Environmental factors of rural communities like Coos Bay present unique challenges to successful weight loss when compared to larger cities like Portland. The main goal of this project was to study environmental factors of Coos Bay which may contribute to high rates of obesity and differ from those of more urban environments. This has important implications for the health of rural communities, and suggests that the health of a community can be substantially improved in an equitable manner by environmental modification. Improving Anticipatory Guidance in Rural Family Medicine Project Date: 8/7/2006 Anticipatory guidance is considered an important component of well-child care. Many adverse outcomes to pediatric populations are easily avoided with adequate and effective anticipatory guidance. The purpose of this project was to investigate the current practices of providing anticipatory guidance employed by health care providers at the OHSU Family Medicine at Scappoose clinic, and to seek ways of improving parental education and implementation. This project seeks to improve anticipatory guidance in rural family medicine through the development of handouts providing information for parents that correlates with verbal guidance given during the well-child visits from birth to 2 years of age. Providing good anticipatory guidance is an effective and important way to encourage health and safety in the pediatric population. High-Risk Obstetrics in Grant County, Oregon. (Nearest NICU: 151 miles) Project Date: 5/1/2006 High-risk obstetrical care can be scary, for both patient and doctor, no matter where it takes place. It can become even scarier, though, in a rural environment such as Grant County, OR, which is more than 2 hours by car from the nearest NICU. Occasionally during rural high-risk pregnancies, the decision must be made whether and when to refer high-risk patients to a more urban setting. This decision is an important one: not only might it affect the health of the mother and her offspring, but it might also impact the cost of malpractice insurance, thereby potentially affecting the entire community. For this project, I initially planned to use a literature search to identify indications for referral of rural high-risk obstetrical patients to an urban setting. I thought that I would discover several sets of guidelines about when referral to urban centers, or at least to obstetricians, is indicated. I planned to use these guidelines to develop a set of criteria to help doctors and patients in Grant County make their decisions. However, an extensive literature search did not reveal any such existing criteria. Next, I interviewed both doctors and pregnant women in Grant County. I have come to the conclusion that the decision of whether to transfer care to the city is a highly variable one and depends entirely on the comfort level and belief system of the patient and doctor who are making the decision. Each choice to stay or to go is a unique decision. With this new understanding, I now realize that my initial goal, of developing a set of uniform criteria that would apply to everyone, was not achievable. Rural medicine doctors and patients are not so easy to fit into a flowchart. Diabetes Management in Reedsport, Oregon, Is It Under Control? Project Date: 8/8/2005 Rural communities such as Reedsport, Oregon lack the majority of specialists that are present in urban communities. Because of this, most chronic diseases are cared for solely by the family physician. This project addresses the chronic care of diabetes in the Reedsport. This is done through chart reviews and a questionnaire of the physicians at the Dunes Family Health Care Clinic. It addresses the question of how diabetes is currently being managed in Reedsport, Oregon and suggests areas of improvement for increased quality of care in diabetic management. Prevalence of depression and effectiveness of treatment modalities at OHSU Scappoose Clinic Project Date: 7/4/2005 Depression is a common reason for primary care visits. Many patients suffering from depression incur tremendous emotional, physical and financial hardship making it an important topic to address. Treatment of patients with depression can be difficult because of patient's compliance, high rate of relapse and tendency to become chronic. However, studies have been done showing that a comprehensive approach for treatment of depression is both cost effective and increases patient's sense of well-being. Morever, the purpose of this study is to estimate the prevalence of depression at OHSU Scappoose Clinic and specifically look at types of treatments received, duration of treatment, which methods of treatment worked best and whether patients felt they had access to care. Methods: A survey was drafted that asked specific questions about duration of treatment, types of treatment received, treatments that worked best, age and sex, and access to care. The patients were handed a survey before appointments with nurse practitioner, physician assistant and physicians, and were given time to fill it out. This was done for a week's duration. Results: A total of 53 people were surveyed; 41 females and 12 males. Of those surveyed a total of 25 were depressed; 21 (51%) females and 3 males (33%). No significant difference in average age and duration of therapy was found for males and females. Drugs and combination therapy were used equally as frequent and 6 patients, 2 males and 3 females, said no method of treatment worked for them. Only 2 out of the 25 patients said they felt like they had no access to treatment. Conclusions: A considerable amount of patients at OHSU clinic with depression are not receiving care that works for them. A recommendation to make treatment of depression more comprehensive and conducive to the patient population will increase quality of care received at OHSU Scappoose Clinic. Preventative Health Maintenance in Asymptomatic Men of Florence Project Date: 3/21/2005 Men are more likely to die from 13 of the top 15 causes of death. Despite this, men are more likely not to visit a health care professional than women. The reasons are varied, but I believe a significant cause is lack of health knowledge. I believe that the use of mass media can be a useful tool to assist in educating asymptomatic men about health care issues. The focus of my project was to determine what screening and interventions would be most useful to the asymptomatic male. Recommendations are derived mostly from the USPSTF. I then published this information in the local paper so they would have a checklist of preventative health items. To determine the effectiveness of my project, I would propose that the PCPs in the area keep track of new patients and their motivation for visiting. Resource Gathering, Early Planning and Evaluation of Group Visits for the West Salem Clinic in the Early Phases of Implementing the chronic Care Model. Project Date: 11/10/2003 The management of chronic illness constitutes a formidable challenge to patients, practitioners, and the health care budget. The Chronic Care Model has been developed to address the increasing strain chronic illness is exerting on the health care system. The six pillars of the chronic care model are: Community resources and policies, Health care organization, Self-management Support, Delivery System Design, Decision support, and Clinical Information Systems. The West Salem Clinic is currently in the midst of a national two year Diabetes Collaborative aimed at implementing the chronic care model in the management of patients with Diabetes. In an effort to further progress to a chronic care model I researched and gathered resources on group visits and queried patients with diabetes on the interest in being involved in the group visit format, diabetes knowledge, self-management and health care utilization. I found that 60% of patients were interested in the group visit format, perceived knowledge of diabetes appears to be greater than actual knowledge, self-management appears to vary widely, and for this population utilization of their PCP for most patients occurs at every three months or less, with few patients requiring hospitalization for their diabetes. Bioterrorism Response Plan For Grant County. Project Date: 9/ 24/2001 Since September 11th, 2001, the number one thing that seems to be on everyone's mind is terrorism. Based on the definition of terrorism, acts committed with the purpose of terrorizing a population, the terrorist who committed the atrocities in New York and Washington were successful. Since the attacks, America has been scrambling to develop ways to prevent and respond to future terrorist activities. Of highest interest is toxic terrorism, which is the use of nuclear, biological or chemical warfare to create terror. By their very nature, nuclear and chemical warfare results in illness minutes to hours after the attack in persons close to the location of weapon release. Because of this, the first responders would be firefighters, police and emergency rescue workers, who would cordon off the area, decontaminate patients, and administer antidotes. However, in the case of biological terrorism, the effects of the biological attack may not be known for days to weeks and in persons widely dispersed from the site of release. Affected persons would present with an undiagnosed illness to clinics or emergency departments. Physicians would then have to recognize that the patient is affected by an unusual illness and treat with vaccines and antibiotics, making primary care physicians the method of surveillance for an unknown biological terrorist attack. While attending the American Academy of Family Physician Annual Congress in October of this year (2001), I noticed that the physicians in attendance were keenly aware that they would need to be vigilant in monitoring for signs of a biological attack, and that they were unprepared. It was noted in a recent Family Practice News that American physicians are not trained to recognize the signs and symptoms of agents that are likely to be used in an attack. What training that is available is geared to police officers and firefighters. The other concern is that once a physician has identified a patient, who is possibly affected by a terrorist agent, what do they do next. With this in mind, I returned to John Day with the idea that I would develop a bioterrorist response plan for Grant County. Back to subject search page or search by preceptor site