Integrating Care: The Primary Care Provider’s Role in Age-Related Macular Degeneration in Eastern Maine
Homer Chiang and Steven CoffinShort-term Project
Objectives: To assess general patient knowledge of age-related macular degeneration (AMD), including risk factors, early signs, treatment options, and low-vision resources. We also aimed to assess primary care provider practice patterns including early detection, timely referral to ophthalmology, and management after diagnosis of AMD.
Methods: A 20-point patient questionnaire was distributed to all adult patients at check-in by front office staff at the Center for Family Medicine office in Bangor, ME. Additionally, a looping waiting room slideshow and informational exam room flyer were created for patient education. A 10-point online questionnaire was distributed to residents and faculty at the Center for Family Medicine and three other local primary care offices. A care management summary document was distributed to residents and faculty at each practice.
Results: Our sample included 46 adult patients and 23 primary care providers. 18% of patients reported adequate or expert knowledge of early signs and symptoms; 50% reported poor to no knowledge. Similarly, 18% of patients reported adequate knowledge of risk factors; 50% reported poor to no knowledge. 64% of patients did not know what AMD was, but 74% wish they knew more about the disease. Patients with AMD in one or both eyes, or who have family members with AMD, were more likely to be knowledgeable of signs, symptoms and risk factors.
70% of providers routinely ask about vision at Well-visits. However, 43% of providers somewhat or completely disagree that they can comfortably perform a fundus exam. 52% of providers somewhat or completely disagree that they can comfortably perform and interpret the Amsler grid test. 39% of providers wish they knew more about the risk factors for AMD, while 34% considered themselves to have adequate or expert knowledge of the risk factors. 43% of providers wish they knew more of early signs and symptoms of AMD, while 53% considered themselves adequate or expert.
Conclusions and Recommendations: Our study suggests that knowledge of AMD risk factors, signs and symptoms are lacking in the general adult population. However, the vast majority of patients desire to know more about the disease. While the majority of primary care providers inquire about vision at well-visits, the majority of providers felt that their ability to perform funduscopic exams and Amsler grid testing were inadequate. Additionally, the majority of providers expressed inadequate knowledge of risk factors, early signs, and referral guidelines; subsequently, an even higher percentage or providers expressed a desire to know more. Furthermore, most providers lacked knowledge of low-vision behavioral modifications and community resources to support patients with existing AMD. This demonstrates the value and need for additional AMD education for primary care providers and the general patient population.
Mustafa ChopanShort-term Project
Within the past decade bullying has captured the attention and interest of the media, researchers and policymakers. State laws have since enforced schools to implement anti-bullying programs. Ideally, the approach requires a multi-disciplinary effort directed at multiple levels of organization, but with limited resources schools often make do with what they can. This study looked at the effectiveness of community outreach, particularly from the medical field, in helping schools combat bullying.
Encouraging the use of asthma control questionnaires ATAQ and TRACK to improve asthma management and outcomes
Michael ChungShort-term Project
Many asthma patients suffer from poor control, are not frequently evaluated by spirometry, and historically have underestimated the severity of their symptoms when reporting them to providers. Asthma questionnaires can be used regularly to establish asthma severity, which can serve as a basis for appropriate management of asthma. This project aimed to motivate and/or educate staff at Hinesburg Family Practice to disseminate the ATAQ and TRACK asthma control questionnaires to youth with asthma.
Fighting the flu - Devising a novel approach to address patient concerns with the seasonal influenza vaccine - South Burlington, VT
Theodore CisuShort-term Project
In Vermont, it is estimated that influenza-like illness is responsible for $8.9 million annually in direct medical costs. The flu vaccination rate ranges from 33% to 56% across the nation, and Vermonters are vaccinated at a rate of approximately 49% each year. This program aims to provide a novel educational material to patients, specifically addressing concerns with the safety of the seasonal influenza vaccine.
Providing Medication Assisted Treatment for Opioid Use Disorder in Family Medicine Clinics in Vermont
Kelley W. CollierShort-term Project
Opioid use disorder is a nationwide issue and a serious problem in the state of Vermont. Medication assisted treatment (MAT) is currently being used to treat individuals with opioid use disorder. In an effort to address the opioid epidemic, more and more family medicine physicians in Vermont are becoming trained medication assisted treatment providers. This project aims to recognize some of the challenges faced by physicians who are currently prescribing MAT in family medicine clinics, as well as to identify the concerns of family medicine physicians who are not currently prescribing MAT. By determining barriers to providing MAT to patients with opioid use disorder in family medicine clinics, additional support and resources can be identified and implemented.
Sherilyn DeStefanoShort-term Project
This project outlines an intervention delivered at a family medicine residency program in Bangor, ME to increase residents' knowledge of the impact of low health literacy and supply them with communication techniques to help improve patient understanding. Over 36% of U.S. adults have basic or below basic health literacy skills and low health literacy has been shown to lead to poorer health outcomes, increased health disparities, and increased cost. Our presentation focused on communication techniques like Teach-Back, an evidence-based strategy that assesses patient understanding by asking patients to repeat back healthcare instructions in their own words, that has been shown to improve health outcomes.
Elizabeth S. DoughtyShort-term Project
Pertussis, also known as whooping cough, primarily affects infants less than 12 months of age and frequently requires lengthy hospital stays. Maine has the 3rd highest rate of documented pertussis cases in the nation. Guidelines for prenatal vaccination recommend women receive pertussis vaccination during the third trimester of every pregnancy in order to protect the neonate. A small community project was designed to investigate adherence to prenatal vaccination guidelines. Rates of vaccination and electronic medical record (EMR) documentation for patient refusal were investigated for Jan. 1, 2016 - Aug. 1, 2016. Implementation of interventions focused on improving the rate of pertussis coverage in this population will require further follow up investigation to assess efficacy.
Lindsey Marie EastmanShort-term Project
Unintended pregnancy rates in the United States are near 50%, but use of safe and effective long-acting reversible contraception methods, such as intrauterine devices, remain low compared to worldwide rates. Common misconceptions about intrauterine devices likely contribute to this stark contrast in use prevalence. This project aimed to assess patient understanding, awareness, and perception of intrauterine devices at a Family Medicine office in Connecticut. A pamphlet that includes a summary of contraception methods was produced and distributed with the goal of increasing knowledge of intrauterine devices as well as other contraception methods for patients in the primary care setting.
Peter EvansShort-term Project
The rates of Lyme disease are rising Vermont, with 710 reported cases in 2015. While preventable, the disease has significant sequelae and primary care offices in Brattleboro, VT are reporting high volume of calls from patients asking for more information about Lyme disease. Formal surveys of Brattleboro Family Physicians and their clinical support staff identify the need for a uniform triage protocol to answer patient calls, as well as further patient education materials, particularly regarding prophylactic antibiotic use following tick exposure.
Gilana FinogenovShort-term Project
At least 20% of all primary care visits are related to mental health. A limited number of patients are being referred to therapy, even though therapy is shown to be as effective as medication for disorders like depression and anxiety. A pamphlet was designed to explain what psychotherapy is to patients and to describe several common therapy modalities.
Timothy F. FlanaganShort-term Project
Recent changes in prostate cancer screening guidelines may create an opportunity for patient education. By creating a succinct hand-out on prostate cancer screening, providers enable their patients to understand screening, and provide sites with opportunities for further learning.
Emily Forbes-MobusShort-term Project
LGBTQ+ patients are at increased risk for discrimination and poor health outcomes. Many LGBTQ+ individuals report discrimination by health care workers, including being denied needed care. Culturally competent care improves overall health outcomes. Creating a welcoming clinical environment is an important component of culturally competent care.
Tabitha R. FordShort-term Project
Proper diagnosis and treatment of head lice is important in decreasing costs and the spread of pediculicide resistance, but many families do not know when or how to treat. The aim of this project was to provide a convenient educational resource on the recognition and management of head lice infestation for Vermont families.
Eunice FuShort-term Project
The majority of the highest utilizers of medical care are affected by mental health issues, yet multiple studies have shown that PCPs have mixed success in recognition and management of mental illness on their own. An integrated model of primary and mental healthcare is ideal to increase acceptability and availability of mental health services. However, there is a growing body of research demonstrating high rates of dissatisfaction with primary-specialty communication. Northwestern Counseling and Support Services has implemented a new care coordination model to address barriers to collaboration in Franklin and Grand Isle Counties. This project summarizes results of the 1-year evaluation of the model.
Rahul R. GentyalaShort-term Project
Home Health is a service that provides a variety of healthcare needs to those who are unable to get out of their home due to an illness, injury, or disability. Currently paper copies are in use for Home Health, which are harder to document, decreases efficiency, and increases error. Incorporating this into EMR will go a long way to solving these issues.
Maggie GrahamShort-term Project
At least 0.3% of the US population identifies as Transgender. Transgender and gender-expansive youth are presenting to primary care providers in increasing numbers. Many primary care providers in Vermont are not armed with sufficient information to care for and guide gender-expansive youth and their families. Trans* patients are at increased risk for discrimination and poor health outcomes. In order to address that problem, a basic guide to providing primary care services to trans-identified youth was created, along with a list of trans-competent providers in the area to whom primary care providers can refer patients.
Miles W. GrunvaldShort-term Project
Influenza contributes to millions of dollars in healthcare expenses, lost economic productivity and morbidity and mortality of the Chittenden County, VT population. Despite the dire costs of influenza illness, yearly vaccination rates remain low in Vermont and Chittenden County. This study utilized a survey that aimed to gauge the attitudes toward influenza vaccination of patients at the Hinesburg Family Practice. Results of this study suggest that patients under 35 have lower attitude scores (p= 0.035) and that patients with high school level education or bachelor’s level education are more likely to have a negative attitude towards influenza vaccination. Only 60 percent of the study population knew that they could not contract influenza illness from the influenza vaccination. An educational poster was designed for the sub-population that was most likely to have negative attitudes toward influenza.
Nazey Z. GulecShort-term Project
Do GwakShort-term Project
Many factors contribute to the accurate reporting of pap smear compliance in patients population. The factors identified during the study are system failure of EMR to track pap smear records and lack of communication among different clinics.
Matteen HakimShort-term Project
The city of Lewiston has a significant Somali population, but that population is very poorly represented in the patient population at CMMC and the Family Medicine Residency (FMR). This project was meant to elucidate the Somali perspective on this discrepancy in order to share it with physicians at the FMR as a first step towards fixing the divide.
Ethan R. HarlowShort-term Project
The CDC recommends that all 1-and 2-year-old children be screened for lead and that the most effective measure for mitigating lead poisoning in children is through primary prevention. This study evaluates lead screening rates at a Family Medicine Clinic in Williston, VT and seeks to gather community perspective on a potential failure of primary prevention in the town.
Olivia M. HarrisShort-term Project
Fatalities caused by overdose from opioids are increasing in Vermont. Evidence shows that Naloxone safely and effectively reverses the effects of opioids in overdose. This project aims to determine why physicians in VT Emergency Departments are not consistently distributing Naloxone to all patients with an overdose, and to increase awareness and implementation of this practice.
A Multi-System Approach to Help Prevent Teen Suicide in the Upper Valley: A Focus on the LGBTQ Community
Charlotte V. HastingsShort-term Project
LGBTQ adolescents are at much greater risk of committing suicide as compared to their straight and cisgender peers. This project focused on connecting various community organizations working on teen suicide and compiling a list of resources so that primary care providers might play a more pivotal role in providing mental health support to the Upper Valley’s LGBTQ teens.
Catherine HayesShort-term Project
Lewiston Maine has the second highest number of refugees in the state of Maine, with 191 total intakes in 2015. Refugee populations face unique health concerns, and providing care for refugees requires education and development of a specialized skill set. This project provided a reference for clinic providers to assist with medical intake screening visits for refugees.
Tinh Thanh HuynhShort-term Project
Hypertension is the most common reason for health office visits in the US and for the use of prescription drugs. Many patients fail to truly understand the diagnosis of high blood pressure and the various health consequences that comes with poor regulation such as cardiovascular disease, stroke and renal disease. This project was aimed to increase patient education on the implications of hypertension and its complications.