RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Skin Cancer Awareness in Harney County Project Date: 1/3/2005 Burns is located in Harney County, which is part of the High Desert near the edge of the Great Basin. There is over 300 days of sun per year at the elevation of approximately 4,200 feet above sea level; obviously putting residents here are risk for increased ultraviolet radiation (UV) exposure. Presently in the United States skin cancer is the most common tumor diagnosis made each year with 1 in 5 Americans developing a skin cancer over his/her lifetime. Additionally, the incidence of skin cancer has been on the rise for the past 30 years with a doubling in the number of people diagnosed with melanoma every year. These facts combined with the unique climate of Harney County made working on skin cancer awareness an important topic. This project included making a patient friendly newspaper article to be published in the local newspaper that will run in conjunction with advertisements about an upcoming skin cancer screening clinic. The goal of the article was to inform the surrounding population about their risks for skin cancer, how to prevent it, and when they should seek medical attention. Research was conducted about the most up to date information about skin cancer then used to create the article to address the entire community, especially to inform those who may be at a higher risk of skin cancer. During this project input was sought from the providers here at the High Desert Medical Center and from the Dermatology Department at OHSU. The Use of Flexible Sigmoidoscopy in a Rural Family Medicine Clinic Project Date: 1/3/2005 Colorectal cancer is a largely preventable and yet prevalent cause of mortality in the US. Accordingly, professional organizations with published guidelines for screening recommend that all adults ages 50 or older receive screening for colorectal canter (1). Of the screening options available, colonoscopy is the most sensitive and specific test for detecting colorectal cancer (2). However, in many rural areas there is a shortage or even absence of colonoscopists. In one such town, Philomath, physicians at a family medicine clinic are working to fill this gap in cancer screening. Eligible patients of this clinic are actively encouraged to get screened via yearly fecal occult blood tests and flexible sigmoidoscopies once every five years. The sigmoidoscopies are performed in the clinic by the family physicians. This study assesses patient records of one of the Philomath physician's positive scope findings over the past five years. In evaluating follow-up colonoscopy and polyp biopsy results on these patients, it will be shown that flexible sigmoidoscopy is a useful tool in colon cancer screening. Not only can flexible sigmoidoscopy identify patients with polyps who are at higher risk for developing colrectal cancer, thereby helping to reduce the burden on limited colonoscopy resources, but it may also provide reassurance to those with negative findings. Colonoscopy awareness and compliance among patients of Strawberry Wilderness Family Clinic in John Day, OR. Project Date: 7/5/2004 Colon cancer screening can be a challenging issue in rural regions. The following study addressed several issues of colorectal screening such as availability, public awareness and compliance with colonoscopy at the Strawberry Wilderness Family Clinic in John Day, Oregon. A questionnaire was designed in order to evaluate compliance with colonoscopy among patients ages 50 and above. Compliance is defined for this study as the percent of patients who followed their doctor’s recommendation to have the colonoscopy procedure. All of the responses to the questionnaires were compiled and analyzed. Moreover, research was done in order to investigate the availability of colonoscopy for the patients in John Day. The overall compliance with the procedure was 76%, however 18% of the patients questioned were unaware of procedure in general. It was determined that the John Day community has a high rate of colonoscopy compliance. This was attributed to the fact that this screening procedure is readily available for patients in this rural community. Colorectal Cancer, Screening for Prevention: How well is Rural Oregon Doing? Project Date: 3/29/2004 BACKGROUND: Colorectal cancer is the third leading cause of cancer related death in Oregon, and it ranks fourth in incidence with five new diagnoses of invasive colorectal cancer occurring daily. The US Preventive Services Task Force recommends universal screening of men and women age 50 years or older for colorectal cancer. This study sought to evaluate how well physicians in John Day, Oregon were providing screening for their patient population. METHODS: Chart review to determine screening practices was completed with 100 randomly selected charts of current patient age 50 and older. Interviews with physicians in the community were held to identify barriers to screening, and hospital medical records were reviewed to determine if colonoscopy-screening rates had improved since the time when a surgeon performed the procedure rather than family physicians. RESULTS: Of the 100 charts reviewed, 36% of patients had been screened, 26 by colonoscopy, 5 by flexible sigmoidoscopy, and 5 with fecal occult blood testing. Three percent additionally had screening studies either recommended recently or were scheduled for the near future. The number of colonoscopies completed at Blue Mountain Hospital has increased considerably since family physicians have been trained to perform the procedure. There was an average of 13 colonoscopies performed over 3 years while a surgeon alone was performing the procedure compared to 36 completed in 2003 by three family physicians. CONCLUSION: While the number of people being screened for colorectal cancer each year in John Day is increasing, the majority of patients over the age of 50 years have not been screened for colorectal cancer. Barriers identified include inadequate insurance coverage for preventive procedures, lack of time for physicians to discuss the necessity of screening, and patient disinterest for the topic of colon cancer. North Ridge Estates: A Case of Hazardous Asbestos Waste in Rural Oregon Project Date: 3/29/2004 In 2001, the Oregon Department of Environmental Quality began clean-up procedures at a residential housing development in Klamath Falls, which had been deemed a past and present public health hazard due to asbestos contamination. The health risks associated with asbestos exposure have been well documented, and include lung cancer, mesothelioma, asbestosis, and pleural disease. I conducted a literature review of medical, historical, and governmental documents, and focused on the following four questions: 1) How much asbestos exposure were the 68 residents of North Ridge Estates subjected to? 2) What are the realistic present and future health concerns for that community? 3) Do adequate screening tests exist to help identify those people most at risk for developing asbestos-related disease? 4) What efforts are being made to monitor the residents of North Ridge Estates, and which agency, if andy, is responsible for monitoring the health of this community? The Frequency and Pattern of Dermatological Cases in a Rural Primary Care Practice in John Day, Oregon Project Date: 1/5/2004 Studies have demonstrated that up to one third of patient visits to general practice physicians are for skin problems. However, there is not much information on the frequency of dermatological diseases in rural areas in the United States. Objective: To evaluate the frequency and the pattern of dermatological diseases in a primary-care-practice population in John Day, Oregon in order to decipher the epidemiological medical conditions and to better address them. Results and conclusion: 27.7% of the diagnosis in a John Day primary care practice were of dermatological origin. Surprisingly, Actinic Keratosis was the highest dermatological diagnosis, accounting for 20%. This figure is high compared to other studies mainly due to the high outdoor activities and occupations in rural areas such as John Day. This demonstrates the importance of rural physicians having further training in diagnosing and managing pre-malignant skin changes and other conditions of high frequency in their medical population. This also enforces the use of teledermatology to better manage difficult dermatology conditions without having to send many patients out of town for consultations. Intervention: In order to educate the patient population about high rates of pre-malignant skin lesions, a pamphlet regarding skin cancers was designed and distributed to patients with high risk factors. Cancer Rates in Harney County: Is there an elevated incidence of cancer in this rural community? Project Date: 8/18/2003 Cancer is arguably one of the most important medical issues in the United States today, with 1,334,100 new cases predicted to be diagnosed in 2003. In a Burns, Oregon, family medicine clinic, it has been noted that a frequent concern among patients is the belief that the cancer rate is abnormally high in this community. This study atempts to address these community concerns that Harney County's cancer rate is higher than that of Oregon as a whole. An examination of county, state, and national data was performed to make this comparison across various types of cancer. Statistics were obtained online from the Oregon Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Statistical analyses were done to assure the significance of the findings. It was found in Harney County, the incidence rates of breast, colon, lung, prostate, and urinary bladder cancers is not higher than that of the state of Oregon. Furthermore, the overall cancer mortality rate is not higher in Harney County. This information can be used to alleviate patient fears that living in Harney County poses a risk for the development of cancer. In the clinical setting, this can serve useful in patient education by helping to identifying true risk factors and how to individually minimize them. Prostate Cancer in Florence: Listen to the Patients Project Date: 5/5/2003 Prostate cancer is the most common non-skin cancer diagnosed in men and the second leading cause of cancer death. Each year, about 220,900 men will be diagnosed with prostate cancer, and 28,900 will die from it (1). Age is the biggest risk factor. In fact, more than seventy percent of all prostate cancers are diagnosed in men over age sixty-five (1). In 2002, 15% of the population of Florence was composed of men over age sixty-five (2). For this reason, prostate cancer is important to this town and to its physicians. Much information concerning the screening and treatment of prostate cancer is readily available in books and online, however, there is no substitute for patient experience. This project provides this opportunity by looking at prostate cancer from the patient’s perspective. Eighteen men with a history of prostate cancer, from the Health Associates of Peace Harbor Internal Medicine practice, were interviewed concerning their experience with the disease. The patients were asked about their screening, diagnosis, and treatment. They were further questioned concerning satisfaction with their treatment choice, side effects from treatment, and finally, if they had any advice for the newly diagnosed patient or the physician treating him. At the time of diagnosis, the men ranged between the ages of fifty-six and seventy-nine, and they had undergone a variety of different treatment options. Thirteen of the men had experienced significant treatment-associated side effects, and six had their cancer reoccur. From these differing experiences comes a rich opportunity for the physician to learn. Colorectal Cancer Screening in the Bay Area Project Date: 11/4/2002 Colorectal cancer screening, though effective in the prevention and detection of cancer, continues to be underutilized by the majority of the population in the United States. This study attempted to examine the issue of colorectal cancer screening in Coos Bay, Oregon during a six-week rotation. First, a limited chart review was performed on patients aged 50 to 80 who had undergone either fecal occult blood testing in the past year, flexible sigmoidoscopy in the past five years, or colonoscopy in the past ten years. This determined that 50% of patients whose charts were reviewed were current with colorectal cancer screening. Next, the study included observation of physician approaches to screening as well as discussions about the views of local internists and their patients in regards to colorectal cancer screening. Discussions with patients found that the majority of those that were declining screening were doing so out of embarrassment or fear of discomfort during the screening test. And, though all internists at the Bay Clinic agreed that colorectal cancer screening is important, their time spent discussing this with patients was limited, particularly if patients did not immediately express a high level of interest in screening. Thus, a patient handout was developed that could be used as a resource to educate patients about colorectal cancer screening. Screening For Colorectal Cancer At Health Associates Of Peace Harbor In Florence, Oregon. Project Date: 1/2/2002 Colorectal cancer is a common cause of cancer related death that can often be prevented by routine screening. The aim of this study is to determine the proportion of patients of Family Physicians at Health Associates of Peace Harbor that have been screened for colorectal cancer, as well as to identify potential barriers to colorectal cancer screening specific to this clinic. The electronic medical records of 100 clinic patients over the age of 50 were reviewed for documentation of colorectal cancer screening, and the type of screening was recorded. Additionally, four family practice physicians were interviewed to identify potential barriers to colorectal cancer screening. Of the 100 medical records reviewed, 38 had received some form of screening (16 colonoscopy, 6 fecal occult blood tests, 15 sigmoidoscopy and 1 dual contrast barium enema). The major barriers to colorectal cancer screening identified by physicians were public awareness and acceptance of colorectal cancer screening and time constraints during patient visits. Additionally, all physicians felt that having a "Health Maintenance" section of the medical record would be helpful. The proportion of patients being screened at this clinic was comparable to national survey data showing that 44% have been screened. Specific recommendations to improve colorectal cancer screening rates are to introduce a "Health Maintenance" section of the medical record which documents recommended and performed screening tests for each patient, and to use this database to send patients information about recommended screening tests prior to complete physical exams. Colorectal Cancer Screening Practices at the Dunes Family Health Care Clinic Project Date: 9/ 24/2001 This study sought to examine the colorectal cancer (CRC) screening practices and rates among the family practice providers at Dunes Family Health Care in Reedsport, Oregon, as well as to increase patient awareness about the disease. There were four components of the study: a) written survey of the providers' screening preferences, b) chart review to determine screening rates, c) review of the adjoining hospital's surgery logbook to examine colonoscopy rates, d) creation of an article on screening for CRC to be included in the clinic's newsletter to patients. The providers' screening practices were also compared to national guidelines for screening recommendations. There was found to be an overall high rate of screening at the Dunes clinic, although this was provider-dependent. There was some variation in preference for screening exams among the providers, but all screening plans were within the bounds of most guidelines. Finally, some suggestions were made on how to increase screening rates, and patient groups at increased risk of not receiving screening were identified. Stage At Diagnosis Of Lung Cancer In A Rural Community: Is There A Need For Earlier Detection? Project Date: 7/2/2001 There has been recent evidence to suggest that the stage at which a lung cancer initially presents may be related to proximity to a major city or metropolitan area. Currently, the majority of lung cancers worldwide present with desseminated disease (Stage IV). However, several recent studies have indicated that people living in rural communities may present with more advanced disease. This study examined if this conclusion was applicable to Tillamook County, a rural Oregon community with a large smoking population and considerable lung cancer mortality. A random population of lung cancer patients was selected from an internal medicine clinic to determine at what stage their malignancies initially presented. Of 24 patients with lung cancer, 54% presented with widely disseminated disease, a proportion that consistent with the nationally observed estimates of lung cancer stage at diagnosis. Back to subject search page or search by preceptor site