RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Community Based Diabetic Retinopathy Screening: Non-mydriatic Imaging and Telemedicine Project Date: 9/10/2007 Diabetic retinopathy ranks as the leading cause of preventable blindness in the United States. Early detection and treatment can preserve vision, yet a fraction (~25%) of those at the highest risk receive annual screening for diabetic retinopathy. A new process that combines non-mydriatic retinal imaging with telemedicine at the primary care level promises to change this discrepancy. Within ten years of widespread implementation, Australia now screens most of its populace annually. Comparable success in being reported in this country where the strategy is gaining acceptance. Virginia Garcia Memorial Health Center now annually screens ~55% of its diabetic registry after it teamed up two years ago with Pacific University's School of Optometry for remote retinal reading. The feasibility of setting up an analogous program at the WSC was investigated here. Barriers were identified to avoid pitfalls in process set-up to allow smooth integration of retinal image capture within a scheduled diabetic visit. Funds from a CareOregon grant will be used to purchase a non-mydriatic camera. With the aim of preventing blindness due to retinopathy, the goal is increase annual eye exam screening among the WSC diabetic registry from 37% to >70%, a national standard set by the Diabetes Disparities Collaborative. Proposal for the implementation of a vision screening protocol in the clinical practice of Dunes Family Health Care, Reedsport, OR Project Date: 10/16/2006 Vision problems impact patients of all age. Impaired vision affects 10 to 15 percent of preschoolers. It is also a common problem among older adults and has been identified as an independent risk factor associated with increased risks of falls and potential fractures in this population. Routine vision screening in the general population can lead to earlier detection of poor vision and appropriate referrals to prevent or reduce vision-related disabilities. A comprehensive literature review was conducted to summarize recommendations on vision screening in the general population. Sources include the USPSTF, AAFP, AAO, AAP, and the NIH. A protocol was then designed to implement, in time-efficient manner, the recommended vision screening tools and tests. The proposal was presented to the family practioners of Dunes Family Health Care in hopes of persuading the adoption of the protocol to improve the detection of vision impairments in the patient population. Diabetic Retinopathy Screening at the West Salem Clinic Project Date: 7/3/2006 Diabetes mellitus is a common disease in the United States with an unfortunate catalog of debilitating complications. One of these complications, retinopathy, is the main cause of blindness in our working population. While blood sugar control is the primary method of preventing and treating all diabetic complications, including retinopathy, specific treatment is available for retinopathy and vision preservation. This project focused on the ways that a rural and underserved community identifies diabetic patients with retinopathy, and investigated one means of improving the screening rate. Non-dilated eye exams, performed in the primary care office, using a retina camera and a remote retina specialist evaluating the retina images, is an effective way of bringing the screening to the people. Published reports and a local farm-worker clinic using this model were investigated. Purchasing a camera and initiating a screening program is a promising opportunity. If enough of those screened have insurance to pay for the exam, the clinic can afford to screen those patients who are uninsured. Further investigation is required to identify an accessible and affordable option for treatment for those are found to have a positive screen for retinopathy. Evaluation of Diabetes Mellitus Management in John Day, Oregon: Are current standards of care being implemented? Project Date: 2/13/2006 Diabetes Mellitus is a major medical problem in the United States, affecting 6% of the population. Due to the morbidity and mortality associated with diabetes, standards of care have been designed to help reduce complications of the illness. As part of maintaining its status as an Oregon Federally Certified Rural Health Center, the Strawberry Wilderness Community Clinic (SWCC) is required to perform yearly chart reviews. The purpose of this project was to develop a chart review form for diabetes screening and treatment based on established diabetes guidelines. This form was then used in a chart review of thirty patients, ten from three physicians, to assess if SWCC is currently implementing these guidelines in its practice. Results of the review demonstrated that physicians are meeting guidelines for HbA1c measurement, use of ACE inhibitors, reviewing self monitored blood glucose readings, and checking creatinine annually. Areas of improvement were found to be screening for dyslipidemia and microalbuminuria. The biggest deficits in care were found to be in ensuring that patients received yearly dilated eye exams, visual foot inspection at each visit, comprehensive foot exams annually, and using aspirin therapy in patients > 40 years of age. These results can be used by the SWCC to help design methods to improve deficits in diabetes management and therefore reduce morbidity associated with the disease in their community. Ontario Health Initiative for Children Project Date: 1/2/2006 The prevalence of childhood obesity has more than tripled in the past 2 decades. As this number continues to rise, it is imperative that children become more educated about how they can live healthier lifestyles. The CDC indicates that the rise in obesity within the US is primarily due to poor nutritional intake and decreased physical activity levels.(5) This project focuses on educating the Ontario community and specifically the 4th grade classes at Alameda Elementary about how to balance good nutrition with daily physical activity. In accord with the CDC recommendations about health education and clinical experience, a poster was created to convey straightforward, attainable goals relevant to all age groups. This medium was chosen to create a publicly displayed message visible throughout the community: at the Treasure Valley Pediatrics clinic, Alameda Elementary, the upcoming Ontario health fair. Hopefully, this will help increase awareness about the importance of nutrition and physical activity in Ontario and lead to a healthier, more active youth. Low Vision in Lebanon: Resources to maximize quality of life with permanent vision loss Project Date: 7/4/2005 Visual impairment and blindness affects 2.94% of Oregonians and in the near future is expected to affect even more of the progressively aging population. A significant number of those affected have vision loss that is not correctable by surgery, medications, or glasses, placing them in the category of low vision. Vision loss and blindness can be psychological and physically devastating and requires unique coping skills and support. It is important to properly educate patients with vision loss about the resources available to them and emphasize that their quality of life can be better maintained by utilizing these resources. This project sought out the resources available to low-vision individuals in Lebanon, OR. Meetings with a low-vision specialist, a patient with low-vision who attends support groups in Lebanon, and representatives from Oregon Commission for the Blind and Vision Northwest made possible the investigation of resources. Low-vision evaluations by a specialist provide evaluation of daily functionality, optimize use of vision aids such as magnifiers and other tools, allow patients to experiment with tools before buying, and provide a specialized refraction for low-vision individuals. Oregon Commission for the Blind provides home evaluations by specialists for safety, independence, and use of low-vision tools. Additionally, they provide vocational rehabilitation and training, counseling for patients and families, scholarships, assistance with mobility tools such as white canes, and donation service for low-income individuals. Vision Northwest is a non-profit provider of low-vision assistive devices and also has a donation service for people with limited income. A monthly support group meets in Lebanon and allows its members to share tips on living with low-vision, emotional coping mechanisms, and has presentations with particular relevance to low-vision by members of the community. An informational handout was developed to summarize low-vision resources in Lebanon for patients and providers. Utilization of Eye Care Services by Patients of Scappoose, Oregon Project Date: 2/7/2005 Blindness and visual impairment currently affects over 3 million Americans and this number is growing. Visual impairment and blindness are easily prevented in many circumstances through timely eye screening and treatment. Rural populations are traditionally limited in availability of specialized care. The aim of this project is to determine patterns of utilization of eye care services in the rural town of Scappoose. To achieve this goal, patients were surveyed during a 2 week period regarding their risk factors, utilization of eye care services, and vision coverage. Seventy-three patients completed the survey. All of the patients were over 18, with a mean age of 46.57 years. Nineteen patients reported having existing eye disease that included age related macular degeneration, glaucoma, and multiple sclerosis. Seventeen patients reported a history of diabetes, 35 % of these patients had not received a comprehensive eye exam in the past 2 years. The most common reasons given for failing to seek eye care were lack of vision insurance and lack of tangible vision problems. Based on the findings of this survey, an informational brochure was produced for patients. This brochure focused on: 1. Highlighting current screening recommendations, 2. Educating patients regarding common eye disorders, and 3. Providing uninsured patients with resources to obtain vision coverage. This brochure was made available to patients in the clinic waiting room. The four primary care providers at Scappoose were also provided with copies of a recent review article tailored to PCP’s that highlights the recommended role of PCP’s in preventing blindness and visual impairment. Informal discussions were held with each provider to highlight the findings from this project and emphasize their role in vision screening. Diabetes Mellitus is a common disease. Project Date: 2/7/2005 Diabetes mellitus is a common disease that is seen by a family practitioner on a daily basis. Aggressive glycemic control and preventive monitoring have been shown to help prevent end-organ damage. Many patients in the West Salem Clinic have not had a dilated eye exam in the last year. A chart review of these patients was conducted to identify areas of improved compliance. Several areas were identified including lack of data entry, lack of referral tracking, and lack of referrals. The area of most influence is with having providers use the diabetic logs that have already been provided. Lack of insurance is a minor problem and several solutions are discussed. Community Resources for Patients with Diabetes Requiring Yearly Eye Exam Project Date: 1/5/2004 The West Salem Clinic is found actively engaged in implementing the Diabetes Collaborative II by applying the Chronic Care Model. Last year’s significant gains in improving the proportion of patients with HbA1c less than 8%, LDL-C less than 130mg/dl, and increased empowerment of self-management goals for patients with diabetes has given a new outlook in terms of dealing with chronic diseases such as diabetes. The Chronic Care Model, through its extensive integration of clinical information systems, self-management support, delivery system design, community resources and policies, health care organization, and decision support, has been monumental in achieving these tremendous advances in the care of patients with chronic diseases. As part of my community project, I explored community resources in the Salem area particularly in regards to eye clinics that provide charitable care and/or discounted fees for a yearly eye exam of uninsured patients with diabetes. I also attempted to do a survey on how the uninsured patients of the West Salem Clinic are fairing with regards to their recommended annual screening eye exam. As the result, I was able to find close to twenty eye clinics that offer or are willing to offer assistance for patients who do not have the resources to get an eye exam on their own. However, the part of my project that deals with the survey was not successful since I was able to contact only 3 out of 14 registered uninsured patients from WSC database. Most of the patients had either moved away or did not leave their contact information when they left the Mission (a temporary shelter that houses homeless individuals in the Salem area). Eye Health Care In A Coastal Oregon Community. Project Date: 1/2/2002 This study sought to determine whether patients in a primary care clinic (Bay Clinic of Coos Bay, Oregon) received regular eye examinations as recommended by the guidelines of the American Academy of Ophthalmology (AAO), and whether their age, insurance status, and/or need for corrective lenses influenced how often they had regular eye exams. Brief questionnaires regarding utilization and insurance coverage of basic eye care services were distributed to Bay Clinic patients between January 10 and February 1, 2002. One-third of those surveyed were age 65 or greater; 97% of these required some vision correction, and 91% had eye exams within two years of the study. In contrast, only 77% of patients younger than 65 required lenses, and only 77% had exams within the past two years. Type of insurance coverage had little influence on time of last exam, with 79% of privately insured, 81% of publicly insured, 100% of those with public insurance privately supplemented, and 100% of uninsured patients having exams at most two years ago. Need for corrective lenses had significant effect on time of last exam: 90% of those who required vision correction had exams within two years, while only 48% of those not requiring lenses had exams over the same period. The report also discusses the importance of regular eye examinations and the guidelines of the AAO. The Impact of Patient Education on Routine Screening of Common Treatable Ocular Diseases in the Elderly Population of Florence, Oregon. Project Date: 5/6/2002 This project was designed to achieve two goals: 1. To estimate the adequacy of routine screening of several common treatable eye diseases (cataracts, glaucoma, and macular degeneration) in the elderly population in Florence, Oregon. 2. To educate this subset of the population on the importance of such preventative care in order to increase the percentage of those receiving adequate screening. The project is a study in which the subjects were given a 20-minute interactive lecture on the topics of cataracts, glaucoma, and macular degeneration and then given a questionnaire. Of the people surveyed, 32.26% were not receiving adequate screening for cataracts, glaucoma, and macular degeneration. However, of this group that was receiving inadequate preventative care, 60% reported that they were more likely to seek such care as a direct result of the lecture. In addition, 96.77% of all the subjects reported that they felt the lecture was beneficial to their understanding of the eye disorders discussed, and as a result, 83.87% stated that they were more likely to continue to receive or seek out preventative eye care as a result of the lecture. These results suggest that there is a significant percentage of the elderly population in Florence, Oregon who are not receiving adequate preventive eye care and that this percentage may be decreased through a community education program. Back to subject search page or search by preceptor site