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Community Services for Patient Referral Document
Jett Choquette
Patients have a need for referral to a variety of services that directly relate to their health and wellbeing that are not generally included in the traditional referral system of healthcare networks. These services include (but are not limited to) social work support, pandemic support, elderly services, LQBTQ+ services, intimate partner violence services, functional medicine, and substance use disorder and mental health support and treatment. Because these services are not part of the traditional healthcare referral system, healthcare providers may not have an up-to-date list of organizations and programs in the community that could provide these needed services. This is especially important in the current era when there has been increased turnover of healthcare workers at all levels leading to low institutional/community knowledge. To address this need, a community service patient referral document was developed after interviewing healthcare workers in the community and reviewing patient needs throughout the family medicine clerkship to inform resource selection.
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Trust Your Gut: Promoting gut health through updated nutrition education
Christina Cobb
Physician time and nutrition education are limited, yet lifestyle changes, including healthy eating, are often the primary intervention for both preventing & managing chronic conditions, such as cardiovascular disease, hypertension, and type 2 diabetes. There is growing evidence of the importance of gut health & the microbiome’s link to several aspects of health, including the immune system, mental health, and metabolic syndrome. Through collaboration with two dietitians, a "promoting gut health" patient handout was created and existing nutrition handouts were updated to reflect current dietary recommendations.
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Primary Care Management of Alcohol Withdrawal
Julie Connor
Alcohol use disorder (AUD) is prevalent yet undertreated in rural Vermont. Approximately half of those with AUD who stop drinking experience alcohol withdrawal. Alcohol withdrawal can range from uncomfortable to life threatening symptoms. Untreated alcohol withdrawal can also lead to recurrence of alcohol use. The mainstay for management of alcohol withdrawal has been inpatient or intensive outpatient programs. However, there are barriers to accessing these programs including availability of beds, patient reluctance, lack of transportation, not knowing about these programs, and cost. Primary care management of alcohol withdrawal is safe, accessible and has the potential to reduce symptoms of alcohol withdrawal, improve engagement with treatment for alcohol use disorder, and reduce alcohol related health complications. In this project, a patient instruction sheet and self-assessment of withdrawal symptoms to be used as part of a protocol for primary care management of alcohol withdrawal.
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A Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinic
James S. Contompasis
A Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinicA Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinic that provided protocols and consent forms for masculining therapy to the practitioners at that clinic who wish to prescribe gender affirming hormone therapy (GAHT)
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IPV: Why Don’t We Screen for Those Committing Acts of Violence?
Hannah K. Cook
State of the evidence for screening for IPV in men or those who are committing acts of violence.
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Adolescent Anticipatory Guidance
Anna M. Corbalan
This project focuses on creating an educational resource specifically for adolescents and young adults regarding the anticipatory guidance for this age group. Although adolescence is generally a healthy time for most, many health or social problems will start or peak during this time. Therefore, it is a crucial time to incorporate preventive guidance and increase health literacy to avoid unhealthy chronic behaviors in adulthood.
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Covid-19, Cold, Flu? What To Know and What To Do
Ryan Cournoyer
A review of Covid-19 symptoms vs the common cold and influenza. Discusses what to do if you think you are sick and when to seek medical care. Helping prevent community Covid-19 transmission and influx of mildly symptomatic patients into primary care clinic and emergency rooms.
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Basic At-Home Exercises for Common Areas of Pain
Willie Dong
Physical Therapy (PT) is often the first-line management for subacute MSK pain seen in the primary care setting. For various reasons patients may be opposed going to PT. For patients that are interested, there is often a latent period before an appointment can be made. Providing resources, including a pamphlet, with all-inclusive, simple at-home exercises may help to accelerate recovery.
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Increasing Awareness and Understanding of the Health Assistance Program: A Patient Resource
Arley Donovan
The Health Assistance Program (HAP) through the University of Vermont Medical Center/Porter Medical Center is a resource for patients in the Network who are struggling to pay for expensive but effective and clinically appropriate medications like injectables for diabetes, anticoagulation drugs or inhalers due to cost, underinsurance or interruption in insurance. The HAP/UVMMC Mail Order Pharmacy helps eligible low- and middle-income families who make at or below 400% of the federal poverty limit get prescription medications at no cost, even if they have insurance. Lack of awareness and understanding about this program by patients and providers could potentially lead to patients self-discontinuing important medications due to cost when they do not have to. This in turn may lead to worsening outcomes and unnecessary emergency room visits and hospitalizations.
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Improving Patient Education Surrounding Imaging Modalities
Tayler Drake
Musculoskeletal complaints are among the most common problems seen in family medicine clinics. Patients may expect that every musculoskeletal complaint requires imaging, however, they may leave the clinic without a referral to radiology. This discrepancy between reality and expectation may strain the patient-provider relationship. The goal of this project is to educate patients regarding imaging modalities and when it is appropriate for imaging to be ordered in the workup of a musculoskeletal complaint.
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Mammography among Nepali New Americans
Rose Eiduson
This presentation describes an effort to increase uptake of mammograms among Nepali New Americans at the Community Health Centers of Burlington, VT. After interviewing the Medical Director and hearing from patients about barriers to mammography, an infographic and Powerpoint slide was created and will eventually be translated into Nepali. Future efforts to improve uptake of mammography could include a preventative care course for New Americans and/or a coordinator assigned to preventative care efforts.
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Circumcision for the Male Infant: Patient Education and Cultural Humility
Grace E. Eisenbiegler
Male circumcision is a religious and cultural decision that has become increasingly medicalized. Many families make decisions about circumcision based on culture and family without true informed consent. There is a need for unbiased information, prior to delivery, about circumcision, so that families may make an informed decision that is right for them. A one page document was created as an addition to the clinic's pregnancy guide with information on risks and benefits of circumcision, complications associated with the uncircumcised penis, cultural significance, and care of the uncircumcised penis.
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Addressing Post –COVID-19 Pandemic Depression
Aria Elahi
This community project explores the impact of the COVID-19 pandemic on mental health, particularly focusing on depression, and introduces an intervention in the form of a pamphlet distributed at Newtown Primary Care. The pamphlet addresses individuals experiencing worsened depression due to the pandemic, regardless of COVID-19 infection status, and includes the PHQ-2 and PHQ-9 screening questionnaires for self-assessment. Insights from interviews with Newtown Primary Care were instrumental in designing the pamphlet.
Results reveal that the pandemic has substantially affected patients' mental health, increasing the need for resources. Patients diagnosed with pre-existing depression experienced worsening symptoms due increased stressors due to the pandemic compounded by current socioeconomic and health problems.
The pamphlet advises patients to take PHQ-2 and PHQ-9 tests and share results during primary care visits for further discussion. It offers mental health resources such as hotlines, including the Substance Abuse and Mental Health Services Administration National Hotline and National Suicide Prevention Hotline. Notably, the pamphlet highlights Nuvance Health's COVID Recovery Program for lingering post-COVID symptoms that impact mental health.
Ultimately, the pamphlet seeks to bridge gaps in mental health support, encourage and empower patients to seek help, and raise awareness about available resources with the aim of improving mental health outcomes.
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Home Exercise for Patients With Limited Access and Resources
Justin L. Esteban
Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise. Having a home workout program may prove to be beneficial to patients who don't have access to a gym, equipment, or are otherwise constrained by time.
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Mapping Pediatric Vaccination Schedule
Mialovena C. Exume
Taking care of a child can be daunting and parents/guardians/families often report not being sure of what vaccinations their child might need and when. This project aims to provide a map of the pediatric vaccination schedule from birth to 18 months. This project also provides a booklet to help families track vaccination in the hopes of increasing vaccination adherence and providing education on routine recommended childhood vaccines.
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Referred by your PCP
Lud H. Eyasu
A complication of a small or new primary care office is difficulty in providing additional support for patients outside of the office visit. Some referral center do not assist patients referrals for mental health providers and services. This project set out to create a list of in-network psychiatrists that can be distributed to patients at a New Canaan, CT primary care office to facilitate these patients' quest to find a mental health provider.
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Colorectal Cancer Screening Options
Juwairiyyah Fatima
Colorectal cancer is a leading cause of mortality in the United States. The USPTF recommends screening starting at age 45. Many options exist for colorectal cancer screening. This project explores the use of a handout explaining the various screening tests available to patients as a means of improving screening rate in one primary care clinic population.
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Supporting Caregivers of Patient with Dementia
John E. Fernan
Being a caregiver for an adult with dementia can be a demanding job. In 2021, an estimated 11 million family members provided 16 billion hours worth of care to people with Alzheimer’s and other dementia. Beyond the financial burden, the strain of caregiving also increases risk for emotional stress and can take a toll on physical and mental health. The goal of this project was to help reduce caregiver stress by increasing awareness of support resources. A template in the EMR was created to compile a list of these resources along with general caregiving tips. This template was made available to family medicine providers to share with patients who care for someone with dementia.
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Listen to Her Heart: Bridging the Gap in Recognizing, Preventing, & Treating ASCVD in Women
Stephen J. Foley
Atherosclerotic cardiovascular disease (ASCVD) is traditionally considered a male disease, yet it is the leading cause of death in women. This may be associated with the significant lack of research of ASCVD in women, leading to poor recognition, diagnosis, prevention, and treatment. The American Heart Association reports that a majority of women experience prodromal symptoms more than one month before a heart attack or stroke, and these symptoms are often underestimated. This project intends to help address the question: How can earlier detection of ASCVD risk in women reduce missed signs of acute myocardial infarction/stroke and thereby reduce preventable ASCVD hospitalizations? This project also hopes to increase physician and patient awareness of and engagement with the VT Dept. of Health's "You First" program to provide supplemental heart health screens and services for women.
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Increasing Awareness of Pharmacologic Interventions for Smoking Cessation
Jeremy Frank
Smoking is a large cause of morbidity and mortality in the healthcare system. Many patients are interested in quitting smoking but have not found an effective strategy that works for them. There have been times when patients have been receptive to a discussion regarding medication assisted cessation but ultimately were not prescribed any medications from their provider. Despite the fact that it has been proven that pharmacotherapy increases the chances of smoking cessation. The goal of this community health project is to create a change within the healthcare system by providing evidenced based recommendations regarding pharmacologic treatment in smoking cessation for both providers and patients to ultimately decrease the burden of smoking within this community.
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Improving IPV Screening & Access to Resources for Patients in Primary Care
Daniel J. Fried
Primary care providers can improve their screening protocols for intimate partner violence (IPV) and how they connect resources to their patients.
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Improving Housing-Insecurity Screening In A Rural Primary Care Setting
Heather G. Giguere
Housing-insecurity and homelessness have a direct impact on individual health, and are well established causes of premature morbidity and mortality (6). Screening for housing-insecurity leads to earlier identification, and more extensive engagement of services, which can help to mitigate the individual and public health ramifications of these social determinants of health (8). The aim of this project was to improve the screening process for housing-insecurity within an rural primary care setting.
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