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Caregiver Burnout
Elizabeth Anne Lynch
Caring for someone with advanced health care needs, dementia, or a difficult diagnosis can take a mental, physical and financial toll on the caregiver. It is important for providers to recognize, address and assist caregivers in as many ways as possible. Providing physicians with a readily available patient-education template in Epic may improve outreach and communication with increasingly isolated patients and caregivers and improve care for all without burdening physicians more.
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Family Medicine Resident Education on Perioperative Management of Patients on Anticoagulation
Hanna Mathers
Family Medicine residents at CMMC in Lewiston, Maine manage patients in an outpatient clinic as well as on an inpatient family medicine teaching service. Many patients in the community are anticoagulated for native valve atrial fibrillation and undergo surgical procedures both in the inpatient and outpatient setting. Residents are often asked on to determine the necessity and timing of anticoagulation discontinuation for patients that they see. With patients on newer oral anticoagulants and various degrees of risk, it can be a challenge to make an informed choice. Residents have found that they would feel more confident in perioperative management of anticoagulated patients if they have a solid foundation in the principles guiding these decisions.
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Retinopathy Screening: Assessing Knowledge & Educating Diabetic Patients in Caledonia County, Vermont
Ian J. McClain
Diabetic retinopathy is the most common cause of severe vision loss in US adults. It is estimated that less than 50% of patients with diabetes consistently receive annual eye exams. Diabetic patients in rural communities may face additional barriers towards receiving recommended eye care as these communities generally have lower incomes, lower insurance rates and older populations. This project sought to educate diabetic patients about eye disease in a rural Vermont primary care practice using an active learning modality.
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Substance Use Disorder Treatment Decision Aid for Adults in Chittenden County Vermont
Elizabeth V. McLeod
Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena resulting in millions of dollars in pubic health costs and loss of life. Navigating the treatment options available in Chittenden County can be time consuming, difficult, and delay treatment. In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.
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Health Incentive: Reducing Waist Size while Expanding Wallet Size
Sean Meagher
Over 10% of Adults and 18% of children are Food insecure in Franklin County and nearly a third of the population lives in households with incomes at or below 200% of the federal poverty level, an indicator which offers a glimpse of individuals who may lack resources to meet basic needs. The implications of food insecurity and access to healthy food are significant. Diets low in healthy foods, such as fruits and vegetables, contribute to the high rates of chronic diseases and impact mental health. The Health Incentive Program(HIP) of Massachusetts was created to increase access to fruits and vegetables by providing a 100% reimbursement for SNAP users at participating locations. However, the program is grossly underutilized, thus the aim of this project was to create an educational brochure to improve utilization of HIP and increase access to healthy foods.
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Suicide Outreach in teenagers
Alexander Miller
Suicide is the second leading cause of death in young people aged 15-19. Vermont has a higher suicide rate than average. My project was focused on making a pamphlet to provide teenagers information as well as foster a discussion of mental health. I also looked at the community perspective on the issue.
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Oral Health Tips, Myths and Resources: A Guide to Lewiston Dental Care
Bridget Moore
In a 2016 study, only 61.5% of Androscoggin County, Maine residents had visited a dentist in the past year. Barriers such as access and education limit residents' ability to obtain proper dental care. Most dental problems can be prevented through education on how to properly take care of one's teeth such as using a toothbrush twice a day. In order to increase patient education, a pamphlet was designed to explain proper dental hygiene and misunderstandings about dental health as well as provide resources for obtaining dental health in Lewiston, ME.
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Real-time Flu Tracking at South End Community Health Center
Brian Muchmore and Jacob Shaw M.D.
There is no real-time tracking of influenza or influenza vaccination in the United States. This project is to prototype and grow a real-time flu and flu vaccination tracking system for the state of the Vermont. This will help providers be more aware of the vaccination status of their patients and will allow for important real-time analysis of a burgeoning epidemic was it to occur.
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Tobacco Cessation Support in New Milford, CT
Laura R. Nelson
Smoking tobacco is one of the most significant risk factors for several deadly diseases; nevertheless, roughly 13% of Connecticut residents smoke cigarettes. Most people who smoke cigarettes realize that it is bad for their health, but many don't understand why it is unhealthy, or just how unhealthy it truly is. Furthermore, quitting smoking is often extraordinarily difficult, due to the addictive nature of nicotine, and the increasing content of nicotine inside cigarettes over time. This project created supportive and educational pamphlets about tobacco use and cessation, and proposes that primary care doctors can help their patients quit smoking by providing pamphlets to patients who are tobacco users.
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Social Support Groups Focused on Substance Abuse and Addiction Available to Patients in Franklin County, Vermont
Michael Nilo
Substance abuse/addiction, especially of opioids, is a major problem in Franklin County, where resources are not easily accessible to patients struggling/in recovery. Educating patients about the availability of peer support groups/recovery centers and clinics in the community may provide an attractive resource for patients who need additional help.
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Eat, Sleep, Console for Neonatal Abstinence Syndrome Babies
Kathryn Patton
Neonatal Abstinence Syndrome (NAS) is a complex disorder that manifests with neurologic, gastrointestinal, and musculoskeletal disturbances and is most often associated with opioid withdrawal. In the US, 6 out of 1,000 babies are born to mothers who used opioids during their pregnancy. These babies go on to develop NAS. Androscoggin County, where Central Maine Medical Center is located, has an even higher rate of babies with NAS: 100 out of 1,000. Most institutions use the Finnegan Neonatal Abstinence Scoring System (FNASS) to guide pharmacologic treatment. This system assigns a score based on 21 clinical signs of withdrawal with a score ≥8 indicating a need for pharmacologic treatment. This system has never been validated nor has its score cutoffs been tested which may lead to over or under treatment of babies experiencing NAS. Eat, Sleep, Console is a novel approach which has shown to decrease average length of stay, pharmacologic treatment, and healthcare costs.
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Motivation to Prevent Chronic Disease or Complications
Ashton Hideki Pike
Motivational interviewing has been used with relatively positive success in behavioral interventions as a way to stimulate change in patient's habits and attitudes, yet there is little information available as to how to design and implement a plan of action. This becomes even more difficult for a patient who might be resistant to large changes in their behavior and habits. One approach that has potential promise is the use of a SMART goal intervention in conjunction with motivational interviewing to change unhealthy habits while assessing the progression and degree of commitment to those goals.
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Educating Patients on Cannabidiol (CBD)
Catherine G. Pratt
As the popularity of cannabidiol (CBD) increases, more patients are interested in trying a "natural" adjunct to more standard medications. But with no current FDA oversight, an estimated 70% of CBD products could be mislabeled. In Vermont, federal regulation requires hemp products to contain less than 0.3% THC, but this has only been tested one time at one location since the 2018 Farm Bill was passed. The goal of this project was to address common questions, recommend specific dosing, identify what to look for when purchasing, and list local and online resources for patients about CBD. An educational handout and a "smartphrase" were created to address these concerns.
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Emergency Medical Services in Hinesburg, VT
William Tyler Prince
Ambulance transport in Hinesburg, VT is currently provided by a service over 20 minutes away and will cease in June 2020. Town officials are currently trying to decide whether to expand local first response to include ambulance transport or to contract with Richmond Rescue, which is a well-established 911 transport service in a nearby town. Through literature/budget reviews and interviews with involved community members, it is apparent that although an independent Hinesburg EMS may have shorter response times, its volunteer corps is insufficient to sustain a transport service. Richmond Rescue can provide a higher level of medical care at a lower cost and should be contracted to provide ambulance transport.
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Reducing Benzodiazepine Use for the Treatment of Insomnia and Supporting Nonpharmacological Therapies
UnChan Pyon
Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.
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A Better Night’s Sleep: Improving Sleep Without Medication Through Behavioral Modification
Kyle Remy
Approximately 40 million Americans experience insomnia each year, defined by the American Academy of Sleep Medicine as unsatisfactory sleep that impacts daytime functioning. Sleep quality and duration affect daily functioning, quality of life, and overall health. Poor sleep quality/duration, increasing usage of technology before bedtime, and a growing reliance on medications for sleep have contributed to a nationally-recognized public health issue; The American Academy of Sleep Medicine has estimated annual costs of insomnia to be around $63.2 billion in worker productivity. Sleep hygiene is recommend by the American Academy of Family Physicians as a first-line approach to improving sleep. Patient education helps patients learn about healthy habits they can acquire for better sleep.
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Cyberbullying: A Resource for School-aged Children, Adolescents, and Parents in Milton, Vermont
James K. Rohwer
Cyberbullying occurs when harmful words or actions by one or more persons are intentionally and repeatedly directed against another person in the digital world through text message, social media, e-mail, apps, online video games, forums, etc. Today, more children and adolescents are connected to the internet than ever before, which puts them at risk of becoming victims of cyberbullying. Many victims, as well as parents of victims, may not be familiar with the resources that are available to them in the areas in which they live when concerns of cyberbullying arise. Therefore, the goal of this project was to create a pamphlet with information about cyberbullying, including local resources for victims of cyberbullying, to be made available to children, adolescents, and parents in Milton, Vermont.
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Transportation as a Barrier to Healthcare
Melissa Romero
Lack of transportation is large barrier to medical care, particularly in rural areas. Many patients decline medical appointments because they do not have access to a personal vehicle or other transportation resources. Consequences include missed appointments and higher healthcare costs for patients and providers in the future. Solutions will involve educating patients on resources available to them, simplifying access to current programs, introduction of new programs, and the collaboration of public and private entities to provide new services.
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Interventions for fall prevention in community-dwelling older persons
Gregory S. Roy
Falls in individuals over the age of 65 is a pervasive problem resulting in significant health and economic burden in our country. Thus, effective fall prevention strategies are an important public health measure, especially in an age group that is growing rapidly. Research has shown a multifactorial approach to fall prevention addressing environmental hazards, strength and balance, medications, and medical comorbidities to be most effective. Despite there being strong evidence to support this, many individuals are unaware of the factors that put them at risk and ways to mitigate them. An educational pamphlet containing evidence-based strategies to reduce fall risk was produced for distribution within the New Milford primary care clinic in New Milford, CT.
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Fostering Competent Healthcare for Transgender and Non-binary Patients
Alden York Sacco
Many transgender and non-binary individuals are hesitant to seek medical due to past traumatic encounters with physicians and medical staff, having to educate providers about their bodies, perceived bias, and fear of mistreatment. This reluctance to seek medical care, and even to disclose their transgender status, can result in poorer health outcomes due to delays in diagnosis, treatment, and prevention. An in-office training was designed to introduce clinicians and office staff to health care disparities facing transgender and non-binary people, appropriate pronoun-use and key terminology, strategies for creating a welcoming and gender-affirming environment for trans and non-binary patients, and useful resources and guides that can be used in clinical settings.
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Improving Awareness of Transportation Services in Lamoille County
Sienna Searles
This project was aimed to identify and address transportation needs of patients in Lamoille County to their medical appointments. A handout was created, which lists all of the transportation resources in the county that are available to patients. This handout was hung up in patient rooms and in the waiting room at Stowe Family Practice. This intervention was met with support from patients and staff at the clinic.
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Acute Respiratory Tract Infections and How to Treat Them
Shivani Seth
Acute respiratory tract infections (ARTIs) are one of the most common clinical encounters in primary care settings and they often lead to antibiotic prescriptions. However, more than 90% of ARTIs are caused by viral syndromes. Evidence has showed that interventions addressed at antibiotic prescription practices for ARTIs are critical to combatting the widespread overuse of antibiotics and increase in antibiotic resistance infections in the US. Providers report pressure from patients to prescribe antibiotics even when they are not clinical indicated and patients have several misconceptions surrounding the clinical course of ARTIs that lead to this behavior. A brochure was developed to address the symptoms and duration of various types of ARTIs, the supportive treatment that can provide relief, and the dangers of antibiotic overuse and resistant infections. This brochure can be used in primary care settings to reduce pressure from patients to provide antibiotics by educating them on antibiotics are rarely indicated for ARTIs.
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Screening for Developmental Delays During the Well-Child Visit
Ellen Walker Seyller
Due to recent staffing transitions, family medicine physicians at Newtown Primary Care in Danbury, CT are now managing the care of an increasing number of pediatric patients. The goal of this project was to develop a screening tool to allow practitioners to assess for developmental delays during well-child visits. The tool includes 10-question surveys for ages 1mo, 2mo, 4mo, 6mo, 12mo, 15mo, 2yo, 3yo, or 4yo with a scoring guide and a list of some concerning signs at each stage.
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Community-Based Exercise Education During Colder Months
Cole S. Shapiro
Approximately 50% of US adults and 75% of US high school students don't meet recommended weekly physical activity guidelines, and physical activity declines further during colder seasons. Resources describing local suggestions for physical activity should be made broadly available to community members, such as at their primary health care office.
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