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Assessing accessibility in the primary care setting for people with disabilities in CT
Anika Advant
Accessibility goes beyond ADA compliance. It involves physical accessibility, and employing practices that allow and providing a space for people of all abilities to safely and freely seek medical care without judgement, shame, or barriers.This project aims to understand the current state of accessibility at the New Canaan Primary Care Office in CT, and to make recommendations for the health organization to increase accessibility for people with disabilities.
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Cigarette Smoking Cessation Tool
Pavan K. Anant
In Vermont, tobacco use disorder is a pervasive problem that closely rivals national averages. The Cigarette Smoking Cessation Tool seeks to identify patients with significant motivation to quit smoking cigarettes' and aims to connect them with appropriate local resources and clinic advocates.
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De-Escalation Training for Office Staff
Robin Tucker Angier
Office staff at Middlebury Family Health have experienced an increase in patient agitation, aggression, and verbal abuse since the start of the COVID pandemic. This project was aimed at providing the staff with de-escalation education to better serve themselves and their patients, as well as to decrease overall burnout and decreased quality of mental health.
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Provider Perspectives on Implementation of CDC Guidelines for Opioid Maintenance Therapy
Anayis M. Antanesian
The opioid epidemic remains a complex and significant public health crisis in the United States, impacting millions with opioid use disorder (OUD). Despite efforts to raise awareness and address individual risks, high rates of opioid overdose persist, underscoring the need for more extensive and integrated prevention and management approaches. Primary care providers play a pivotal role in lowering opioid-related mortality and improving patient outcomes through office-based treatments; however they face numerous challenges in prescribing opioids. To explore these barriers, a survey was distributed to providers, aiming to assess their views, comfort levels in prescribing opioids for chronic pain, and perceived ease of implementing CDC guidelines into their practice. As part of this project, a poster summarizing guidelines was created which could be conveniently referenced and would align with the clinic providers' preferences for prescribing opioids in the setting of maintenance therapy.
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Visual aids for setting up patient portal in rural primary care practice
Georgia A M Babb
With the use of the patient portal as a tool for patient-provider communication becoming increasingly integral to patient care, and it's becoming more important to ensure all patients have equal access regardless of any potential barries. In clinical visits, it's not uncommmon to observed conversations about portal use, including patient’s expressing having difficulties setting up the patient portal. Discussions with the team at Middlebury Family Health and the patient population, showed a gap in patient instructions or guides to setting up their patient portal. This work aimed to solve this barrier by creating and implementing visual aids to assist with portal activation.
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Bringing Stop the Bleed Training to the Community
Connor Barton
This project evaluates the training in bleeding control and its necessity within the community. With the rise in violence towards healthcare workers and gun violence in the United States, blood loss remains the leading preventable cause of death in violent situations. The "Stop the Bleed" course aims to educate the public on bleeding control techniques, equipping them to save lives. This project involved surveying residents at CVPH Family Medicine regarding their confidence in bleeding control methods before and after undergoing "Stop the Bleed" training. The objective was to enhance their proficiency and comfort with these techniques, allowing them to then bring these skills to the greater community.
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Safe Storage: prevention of Drug Misuse and Overdose with Locked Medication Bags
Emily Claire Battle
Safe storage of medications is critical to public health and safety in the state of Maine as well as across the country. Current public health efforts target education and prevention of accidental ingestion of medication by children and animals at home. This has become especially important in Maine with the increasing prevalence of substances used for treatment of opioid use disorder, as well as increasing prevalence of other non-prescription substances including fentanyl, cocaine, and methamphetamine. In Lewiston, Maine, interviews with public health leaders, patients, and providers at the Family Medicine Residency at Central Maine Medical Center reiterated concerns for the security of vital medications which are frequently lost or stolen, especially in those struggling with housing insecurity. This project attempted provide an intervention to promote public education, prevent substance misuse and overdose, and encourage patient-provider discussions about safe storage. This project entailed a didactic session to educate Family Medicine residents on the importance of safe medication storage, dissemination of locked medication bags to residents and behavioral health professionals, and placement of an educational display in the patient waiting room of the Family Medicine residency.
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Older Adult Interpersonal Violence
Haley Nicole Bayne
Older adult interpersonal violence educational poster for healthcare workers developed during the family medicine rotation for 3rd-year medical students. This project was developed in Newtown, CT.
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Reimagining the World of Healthcare: Implementing Artificial Intelligence into Family Medicine Practice
Julia Bernier
There is a significant shortage of primary care providers in the United States. Studies have found that a significant factor leading to primary care physician burnout is from overload from bureaucratic tasks, including charting. The use of Abridge, an AI service that records patient visits via audio and formulates a patient note, eliminates the need for the physician to document patient conversations during the visit, reducing physician burn-out and allowing more time to focus on the patient’s needs.
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Quality Improvement of X-Ray Imaging for Unspecified Chronic Knee pain and Suspected knee osteoarthritis in the Primary Care Setting
Ty E. Bever
Although a comprehensive history and physical exam are the mainstays of initial evaluation, plain X-rays are clinically indicated for chronic knee pain of greater than 6 weeks duration and acute traumatic pain in patients who meet specific evidence-based criteria, according to the American Academy of Family Physicians (AAFP). However, there remains significant variation in what radiographic protocols are used in clinical practice, specifically in terms of what radiographic views are ordered and whether the imaging is performed with the patient weight-bearing (WB) or non-weight-bearing (NWB). In fact, several studies have shown that non-weight-bearing knee radiographs are frequently ordered by general practitioners for chronic knee pain and suspected osteoarthritis despite evidence that WB images are more sensitive and accurate in the assessment of joint space narrowing. Therefore, evaluation of chronic knee pain with the use of NWB radiographs has the potential to delay diagnosis and management of early osteoarthritis (OA), lead to less accurate grading of the severity of OA and delay in specialist referral, and contribute to an increase in repeat imaging during specialist consultation.
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Utilizing a Community Resource for Diabetes Lifestyle Management
Max Breidenstein
Grace Cottage Family Health & Hospital identified diabetes as a level one priority for community health improvement. VeggieVanGo is a program hosted at schools and hospitals hosted by the Vermont Foodbank which provides fresh produce to those in needs. Lifestyles modifications are essential for diabetes management including consuming fresh produce. This project sought to increase awareness of the role of diet in diabetes management for patients at Grace Cottage Hospital who may use the VeggieVanGo program.
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Disaster Preparedness and Chronic Health Conditions
Jackson Bressor
With recent years bringing severe storms and flooding to Vermont more frequently, community members need to be more prepared than ever to overcome these disasters. Individuals with chronic health conditions face a unique set of challenges in these events, and require an extra level of planning. This pamphlet will outline some key steps for anyone with a chronic health condition to prepare for a disaster, with specific recommendations for individuals with diabetes and kidney disease.
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Healthcare Against Human Trafficking: Promoting Identification and Support
Michaela Busch
Through direct correspondence with providers and community partners in Lewiston, ME, human trafficking was identified as a prevalent issue not receiving enough attention. These discussions revealed lack of provider knowledge as a limiting factor in potential victims receiving resources and support. This project aims to address and shrink this knowledge gap via informational sessions, resident training, and partnering with nearby nonprofits who work to provide support to victims.
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Barriers to Advance Directive Completion in Burlington, VT
Avery James Campbell
Advance directive completion is lacking in the United States. Patients at a family medicine practice in Burlington, VT were surveyed to assess barriers to advance directive completion. An intervention was created and imposed to improve advance directive completion.
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Nonoperative Management of Hip Osteoarthritis
Hikmat R. Chmait
Chronic hip pain is an extremely common condition, significantly impacting the quality of life and mobility of affected individuals. The dissemination of comprehensive guidelines on nonoperative management of chronic hip osteoarthritis (OA) is essential for enhancing the quality of care provided by primary care providers (PCPs). These guidelines should encompass evidence-based recommendations on physical therapy, pharmacologic interventions, and lifestyle modifications tailored to the individual patient's needs. By equipping PCPs with standardized, accessible information, we can ensure consistent and effective management of chronic hip OA, ultimately improving patient outcomes and reducing the burden on specialized healthcare services. Enhanced education and resources for PCPs are imperative to bridge the gap in current practice and promote the optimal nonoperative care of patients with chronic hip OA.
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Improving Eye Care in Diabetic Patients in Vermont
Ashfi Chowdhury
Diabetic retinopathy is the leading cause of blindness in working age adults worldwide, yet up to 90% of vision loss can be prevented through early detection and timely treatment. In Vermont, approximately 8.5% of adults have diabetes, with less than 60% receiving regular eye exams. This project aims to address the knowledge gap and improve eye care among diabetic patients by creating and distributing an educational postcard. The postcard provides crucial information about the differences between various eye exams, along with guidance on where to seek care, which will enhance patient awareness and promote regular eye checkups.
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Patient Education on Long Term Anticoagulation Options
Hayden J. Christensen
Many patients with chronic conditions require long-term anticoagulation. Often they aren't sure of their options and have questions regarding their eligibility for Direct Oral Anticoagulants (DOACs) versus Warfarin. Here, a patient handout was developed to address common questions and assist in the decision making process when long-term anticoagulation is initiated.
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Preventing Falls in Older Adults: Resources and Patient Education
Cassidy Cottle
Falls impact around a third of adults over the age of 65 per year. This project alleviated some of the pressure in providing patient education on avoiding falls by collecting common recommendations and local resources and creating a standardized communication in the electronic medical record.
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Empowering Elders: Connecting the Milton Community to Local Resources
Caity DeCara
The proportion of Vermont's population aged 65 and older has been increasing. Vermont's rural landscape can contribute to isolation among older adults, which is a significant risk factor for mental health conditions like anxiety, depression, and suicidal thoughts. Socialization significantly impacts well-being by decreasing a sense of loneliness, enhancing emotional support, and improving cognitive health in older adults. My goal is to create a poster to outline resources of connection and activities near Milton to help residents build strong community networks and improve quality of life.
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A Vermont Physician's Guide to Eating Disorders
Jeyna Doshi
I created a guide about screening and treating eating disorders for family physicians in Vermont. Eating disorders are often underdiagnosed and undertreated. Physicians do not receive much training on eating disorders and often feel ill-equipped to treat patients with them. This guide will serve as a tool and include links to local resources.
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Patient guide to starting a GLP-1 agonist
Jenna G. Eaton
With the increasing prevalence of diabetes and obesity in Vermont, GLP-1 agonists are being prescribed more and more to help treat these conditions. Providers at Milton Family Medicine relayed that they have been prescribing them more as well over the recent years and have seen significant benefit for their patients. With increased use of these medications, patients continue to have many questions around how GLP-1 agonists work, their side effects, and how to pay for these expensive medications. There is a need to have education materials available at the office to answer these questions for our patients.
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Nutritional Support for Oncology Patients: Role for the PCP
Annabelle S. Feist
Adequate nutrition is a key prognostic factor in the treatment outcomes of patients with cancer diagnoses. Despite the increased morbidity and mortality of malnutrition, the importance of nutrition for oncology patients is often not well communicated and not well understood by patients. Part of this issue stems from the limited information most patient can absorb at any given doctors appointment, especially regarding their cancer. Primary care providers hold a unique position to fill this gap and have the information be heard and retained given their usual role in addressing overall health. This project compiles resources in an easily accessible and distributable manner so PCPs can provide their patients with cancer diagnoses important information without adding more time to already long and complex visits.
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Increasing Preventative Naloxone Distribution for Patients Receiving Prescription Opioids
Brian A. Fellenstein
Recent studies have shown that in office-based settings, while 10.67 per 100 visits included one or more opioid prescriptions, only 1 per 100 visits included naloxone as a co-prescription. Unfortunately, many chronic pain syndromes necessitate the use of opioids. While these prescriptions are reasonable, the data suggests that clinics across the country continue to use opioid medications per recommendations but fail to provide patients with Naloxone co-prescriptions and appropriate education.
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