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Handout to Promote Diabetes Education in Spanish Speaking Patients
Javier Rincon
Hispanic adults are 70 percent more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician. In 2017, Hispanics were twice as likely to be hospitalized for treatment of end-stage renal disease related to diabetes, as compared to non-Hispanic whites. In 2018, Hispanics were 1.3 times more likely than non-Hispanic whites to die from diabetes. Lack of readily accessible educational material in different languages can lead to educational deficits in non-English speaking patients.
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Depression Screening and Suicide Risk Assessment in Older Patients
Faith Robinson
Older adults are at an increased risk of depression, but they are often undiagnosed and untreated. Depression is also a significant predictor of suicide in older Americans, who have among the highest rates of suicide of all age groups in the United States. Most older adults seek treatment in primary care settings and are less likely to use emergency interventions, so knowing how to screen for depression and suicide risk is crucial for primary care. Unfortunately, primary care providers, while being first-line for identifying depression, accurately recognize less than half of patients with depression. This pamphlet is aimed at increasing provider awareness of tools they can use to screen for depression and asses suicide risk in older patients.
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Improving Identification of Peripheral Arterial Disease In the Outpatient Setting
William Robinson
Over 7 million Americans are known to have peripheral arterial disease (PAD). However, it is well established that many more live with the disease and are simply undiagnosed, often due to variations in presentation. Presence of PAD is associated with significant morbidity and mortality, but when caught in its early stages, progression can be slowed with simple conservative measures. Therefore, a more targeted screening program with in-office ankle-brachial index capability (sensitivity and specificity >90% for diagnosing PAD) could identify a debilitating disease much earlier in its course regardless of symptom presentation, and create an opportunity to significantly improve preventative health in the outpatient setting.
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Improving access to and quality of self-guided physical therapy exercises at home for patients residing in regions with limited resources
Matthew R. Rzemien
Access to physical therapy can be a challenge for those residing in resource-limited settings such as a rural area like Essex County, New York. Nonetheless, musculoskeletal complaints are some of the most common reasons patients seek care in primary care clinics. In areas that lack the availability of formal physical therapy, clinicians often provide patients with instructions on how to perform exercises at home to help improve their pain. This project sought to bolster the resources available to distribute to patients to improve the quality of self-guided physical therapy exercises at home.
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Incorporating Social Stories into Patient Waiting Room
Ashwini Sarathy
Missed well child appointments are common across the country. In an effort to limit anxiety related to doctor's appointments, social stories were printed and offered to patients in the waiting room. The social stories went over common activities performed while at the doctor's office including taking blood pressure, height, weight, getting vaccines and physical exams.
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Screening for areca (betel) nut & quid use
Gabriela Sarriera Valentin MS
Standardized screening tools for patients who use betel quit and areca nut products do not currently exist. Given the increased risk of oral and oropharynx cancer development in this patient population, increasing awareness of this practice could result in decreased morbidity and mortality. The purpose of this project is to (1) increase provider awareness of this cultural practice and its associated health consequences, (2) to develop a screening tool, and (3) to propose suggested follow-up when concerning lesions are identified.
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Improving Safety for Recreational Water Sports at Candlewood Lake, CT
Brian L. Shaw II
Every year millions of people utilize bodies of water to participate in recreationally acitvity. Although the time spent outside and being physically active are widely endorsed as healthy habits, any body of water comes with safety risks that many do not anticipate. This project looked to improve safety for recreationally water sports and activity at Candlewood Lake, CT the largest lake in the state that is accessed by thousands evach year.
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Pre-visit questionnaire for diabetic patient visits
W. Evan Shaw
What role does a pre-visit questionnaire, such as a "diabetic distress tool," play in optimizing diabetic patient visits?
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Adolescent Substance Use: Standardizing Screening Methods in Clinical Practice
Bryan D. Shin
Adolescent substance use is a highly pervasive issue that strongly correlates with increasing depression and anxiety rates. Standardized screening tools for substance use, such as the CRAFFT or the Screening to Brief Intervention Tool, are freely available but not widely utilized for every patient encounter in clinical practice. This project aimed to improve standardization of substance use screening at a primary care clinic located in Castleton, Vermont through implementation of the CRAFFT tool as an automatically-loaded form in each adolescent encounter note. The goal was to improve substance use detection rates by facilitating efficient incorporation of standardized screening into the primary care provider's workflow.
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Consent Education for Adolescents
Paige T. Song
In primary care practices, prevention and early intervention is key. Educating adolescent patients about consent and reinforcing the topic early on may help to decrease the downstream prevalence of sexual violence.
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GUIDE2LABS: Integrated Patient Education in Epic
Jared Stone
This project aimed to build on a prior family medicine clerkship project which designed a pamphlet containing high-yield facts to help patients interpret common lab results. An Epic SmartPhrase was created from this information and made available for all users at Colchester Family Medicine. Fewer messages from patients inquiring about lab values would be expected to be routed to providers if this intervention were successful upon further evaluation. Future projects could create SmartPhrases which cover other frequently ordered tests, such as complete blood counts with differential, thryoid cascade, iron studies and urinalysis.
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Is there an app for that? Introducing Self-Guided Therapy-Based Mental Health Apps in a Primary Care Setting
Althea Jem Darbin Tapales
The prevalence of mental health disorders in Vermont continues to be an economic burden, especially in Addison County. The Addison County, VT Community Health Improvement Plan 2022-2025 identified “Access to Mental Health Services” as the top priority with a general concern regarding the affordability and demand of such services, and shortage of providers in the general community. Consequently, the shortage of mental health services along with the coronavirus pandemic resulted in a mental illness epidemic which led to an accelerated growth of self-guided therapy-based mental health apps. Most apps are affordable, accessible, and prioritize patient privacy which overcomes barriers to traditional mental health treatments such as cost, access, and stigma. Thus, the utilization of mental health apps not only offer a cost-efficient method for delivering empirically supported mental health interventions, but also serve as a potential solution in alleviating the mental health burden due to staff shortages across Vermont. However, such apps continue to be underutilized potentially due to provider and patient uncertainty in the effectiveness or credibility of such methods. Hence, providers, especially in-house psychologists/psychiatrists/behavior health specialists within primary care settings, require further advanced training on the APA framework as a screening tool to further guide the decision-making process around current evidence-based mental health apps and their potential use for low-risk psychiatric patients who are on their waiting list. The primary goal of this project is to generate a handout listing and briefly describing evidence-based and peer-reviewed therapy-based mental health apps that target various psychiatric conditions commonly encountered in a primary care setting in Addison County, VT using the OneMind PsyberGuide database and the updated APA evaluation framework criteria as guides. This handout can then serve as an accessible resource for both providers and patients seeking quality therapy-based mental health apps.
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Improving Access to Snowmobiling Safety Information
Sean Taylor
Snowmobiling is a common activity for rural people in areas like the North Country of New York state. There are inherent risks associated with an activity like snowmobiling, and a primary care office is a location at which patients and their families can be informed of recommendations from professional associations, state laws regarding the activity, and recommendations on safer practices and safety courses that are available. I modified an informational flyer that caters to patients in the Plattsburgh area of New York to try to encourage safer snowmobiling, especially for children.
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Anxiety Screening During At-Risk Ages of Development
Torrance Teng
Anxiety disorders, one of the most prevalent but still underdiagnosed mental health disorders, is often associated with other illnesses, both physical and mental conditions. Studies show that since the COVID-19 pandemic, incidence and prevalence of anxiety disorders have only increased, worsening the quality of life of people all around the world. This project explores the utility of implementing an anxiety screening to both identify at-risk individuals and assess what the perceived benefits of a screening would be from the patient perspective. The goal of this community health project is to help normalize mental health discussions while also promoting the community to obtain help and resources to better understand and cope with their anxiety.
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Alcohol Cessation Resources in Greater Danbury, CT
Rachel M. Thompson
There is an abundance of resources available to residents of the greater Danbury, CT area looking to reduce their alcohol consumption. However, a central repository of this information is lacking, and individuals seeking local services report feeling overwhelmed and confused by their search. This project aims to simplify the journey to getting help by providing patients at New Fairfield Primary Care with a brief physical pamphlet and extensive virtual database describing alcohol abuse and the variety of services available in their region. Supports detailed include medical providers, counselors, holistic therapies, hotlines, lifestyle changes, peer support groups, treatment centers, self-assessment quizzes, and more.
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Current Landscape of Screening for Abdominal Aortic Aneurysms in Females
Maxwell T. Tulimieri and John G. King
There is some controversy over if females are under-screened for abdominal aortic aneurysms (AAAs). The USPSTF 2019 AAA screening guidelines give an I recommendation for females 65-75 who smoke, yet the Society for Vascular Surgery (SVS) highly recommends with strong evidence a 1-time screening ultrasound for men or women age 65-75 with a tobacco history. This project entails a 10-minute recorded PowerPoint educational session for Milton Family Practice providers on the current landscape of AAA screening in females including differing practice guidelines and their histories, cause of said discrepancies, associated cost and insurance coverage, and suggested creative solutions to billing difficulties as well as provider response and feedback.
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Diabetic Foot Wound Care
Richard Q. Vuong
Diabetic foot wound care educational pamphlet developed during the family medicine rotation for 3rd-year medical students. This project was developed in Brookfield, CT.
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Affordable Housing in the Northeast Kingdom
Alayna M. Westcom
Housing is an important social determinant of health for each patient. Affordable housing can be hard to find in many rural areas across the state of Vermont. North Country Hospital identified affordable housing as one of the top community and social needs during the 2021 Community Needs Assessment.
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A Healthier Diet for Weight Loss
hannah White
Many patients presenting to clinic have the goal of weight loss to improve their health as obesity has many comorbidities. Many patients have multiple health concerns like Diabetes Mellitus, Hypertension, Hyperlipidemia, PCOS, or joint pain. Part of the management of their conditions include weight loss, but many patients struggle, for years, to lose weight. A referral to the Metabolic Weight Loss clinic in Newtown, which will provide patients with nutritional information, evidence based diets, medications, exercises, and more, can take up to 1 year to get an appointment. The goal of this project is to provide information to patients in clinic who are hoping to lose weight on strategies, nutritional education, tips and resources.
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Hazardous Materials in Firefighting: Educating the Exposed
Gregory J. Williams
This project interviewed volunteer firefighters at the Warren Fire Department to gain a better understanding of their concerns regarding exposure to chemicals while firefighting. It aims to provide information on mitigating the health risks posed by hazardous chemicals via a brochure.
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Suicide Screening at TCHC
William J. Yakubik III
Vermont is currently battling with a mental health epidemic and one of the consequences of mental illness is suicide and self-harm. According to the Vermont Department of Health Vermont’s suicide rate is higher than the national average and suicide is the 8th leading cause of death in the state. Every part of medicine especially primary care is struggling with providing adequate resources for the demand needed to provide quality mental health care. Thomas Chittenden Health Center (TCHC) is no stranger to these demands and is working on ways to ensure each patient has access to the care they need. The goal of this project was to create a screening tool to increase the ability of all providers to ensure the safety of their patients from self-harm. Utilizing various mental health and suicide screening questions a new screening tool was developed to be used for patients annually or those who have increased risk. This tool will then be used to help clinicians and staff at TCHC identify patients with suicidal ideation and navigate access to resources for those patients.
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Preventive Medicine Screening Measures
Isaac Adams
In order to make progress towards long-term health on a community level, it is imperative to address health needs on a population basis and using a preventive strategy to prevent the development of more serious illness. With this in mind, this project aimed to create a poster providing easy to understand information to patients with regard to health screenings. Specifically, it addressed screenings for diabetes and pre diabetes, colon cancer, lung cancer, and breast cancer.
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