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Improving our response to positive food insecurity screening at Colchester Family Practice
Callie Linehan
My project is to raise awareness of food insecurity among providers, and identify resources and next steps providers can take to help patients who screen positive for food insecurity using the AAP-recommended Hunger Vital Sign.
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Patient-Oriented Smartphone Apps to Improve Health & Wellbeing
Geordie C. Lonza
Patients have the ability to improve their health outcomes, but their capacity to do so is sometimes underutilized due to misunderstandings or ineffective engagement in their healthcare. Nearly everyone owns a smartphone today, and there are innumerable patient-oriented smartphone apps in both the Apple and Android app stores. However, the clinical utility of these apps has not been widely studied. It is possible that we can incorporate the use of technology such as smartphone apps into our recommendations to patients in order to improve their management of their chronic diseases and their abilities to make lifestyle modifications.
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Lyme Disease Education: Prevention and Response to Tick Bites
Nicholas S. LoSchiavo
Lyme disease is a major public health concern in Vermont, and is only becoming more prevalent. There were nearly 800 probable cases of Lyme disease in 2016, compared to 100 cases in 2006. Untreated Lyme disease has significant effects on overall health including cardiac disease. Lyme disease also has severe impacts on public health costs, and is responsible for roughly $1 billion annually. A Lyme disease handout for patients at a primary care outpatient center in Vermont was designed to help educate the public on disease prevention and progression.
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Combating Diabetes in Chittenden County: A Healthcare Provider Referral Campaign to Increase Patient Participation in the Vermont Diabetes Prevention Program
Samantha Magier
As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes does not definitely progress to type 2 diabetes if interventions are made, including healthier eating and physical activity to promote modest weight loss. The CDC has developed evidence-based curricula for lifestyle intervention in prediabetics with intensive individual counseling and motivational support on effective diet, exercise, and behavior modification. One of these curricula is currently run through the CDC-led National YMCA Diabetes Prevention Program (YDPP). Participation in this program reduces the risk of developing type 2 diabetes by 58% across all ethnic groups and sexes overall and by 71% in individuals over age 60. The Vermont YDPP had 325 participants in 2016, with only 21% (n=70) of those referrals to the program coming from healthcare providers. Healthcare providers have a unique role in the community of being the voices of health promotion. With the correct provider awareness of the YDPP and patient identification, awareness, and education, an increase in the percentage of YDPP-referring healthcare providers can increase the overall YDPP participation in Chittenden county. As of 2016, 60,038 people in Chittenden county have prediabetes, but only 8,026 are diagnosed, and an additional 52,012 people could be diagnosed with prediabetes by their healthcare professional and referred to the YDPP. This campaign intends to serve as a pilot project to create provider and patient awareness of the YDPP, identify patients with prediabetes, and ensure providers screen and refer prediabetic patients to the YDPP. Through exam room posters, panel query management, electronic medical record reprogramming, and targeted patient intervention, this study aims to increase YDPP patient participation via healthcare provider referral and refine the model for adaptation and implementation in other healthcare centers throughout Chittenden County.
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A Multimodal Approach to Hypertension: Behavioral Modifications on a Budget
Jayne Manigrasso
Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.
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Rutland City Public School At Risk Youth Mentorship
Michael J. Marallo
This after school program’s purpose is to address the unique challenges of Rutland, VT Middle/High School students with multiple psychosocial risk factors (as determined by comparison to the ACE questionnaire) through mentorship, health and life skills education, and by guiding the development of positive coping skills. Activities will allow for self-expression outside of the classroom in a safe environment. Focus will be placed on assisting paraeducators and teachers with meeting goals that are appropriate for each individual student.
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Teaching Value-based Care: A Framework for a Family Medicine Resident Clinic
Alexander W. Marchese
Milton Family Practice is home to the University of Vermont’s Family Medicine residency program. As efforts to improve the value of health care increase, graduate medical education accreditation organizations may begin to reward and penalize residency programs based on their commitment to teaching and providing value-based care. Residency programs currently lack a clear strategy to prepare residents to assess and deliver value-based care. In this presentation, I present the VALUE Framework (Patel, Davis, & Lypson 2012) for the University of Vermont Family Medicine residency program to teach residents to assess and deliver value-based care for their patients during preceptor sessions.
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Breast Density Notification: A Primary Care Summary
Nicole Lin Mendelson
On January 15th, 2017 Vermont Senate Bill 157 took effect requiring healthcare facilities that perform mammography to provide patients information that identifies their individual breast tissue classification. 40-50% of women fall into the category of having increased breast density. Increased breast density reduces the sensitivity of mammography and increases the chance that cancer will not be detected. Additionally, women who have dense breasts are at an increased risk for developing breast cancer. Supplemental screening provides an opportunity to increase detection of breast cancer, but comes with an increased rate of false positives. With this new law in place, there is a need to educate primary care physicians on the risks and benefits of available supplemental screening technologies so that they may appropriately counsel patient that wish to proceed. This project resulted in an educational document and presentation to primary care physicians at Berlin Family Practice with the aim of raising awareness about the topic, providing education on the screening options/counseling patients, and providing a forum to discuss how patients will be affected.
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Addiction Recovery Support: Connecting Primary Care Providers and Community Resources
Amber J. Meservey
Addiction to drugs and alcohol is a pervasive problem throughout Vermont and the U.S., and only a fraction of those needing help receive it. The vast majority of admissions to substance abuse treatment programs do not come from healthcare providers, who report a lack of preparedness in managing addiction screening and referrals. Recognizing that Family Medicine Providers are likely to be caring for many patients struggling with substance abuse, this project aims to improve provider familiarity with local resources. In particular, this project focuses on promoting long-term retention in self-help group programs, as these have been demonstrated to be the most approachable form of help for many presenting in the primary care setting.
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Talking To Your Teens About Pregnancy
Sergio Andres Munoz
Teen parents are at risk for a variety of adverse life outcomes. The rate of low birth weight and premature delivery is higher among teen mothers than the average population. Teen pregnancy and birth are major contributors to lower educational achievement and income as they are less likely to graduate High school and college, leading to increased rates of poverty among teen mothers. This project aims to educate parents of at risk teens on how to approach the topic with their kids and to provide them with a list of online sources to aid in the process.
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Radiation Risks and Safety
Hyunsoo Joshua No
Patient and physician requests for the use of X-Rays, CTs, and other radiation-producing medical imaging are increasing in the US. Both public and physician awareness of radiation knowledge is limited. Studies suggest that the general public is not concerned about exposure to ionizing radiation from medical procedures due to the widespread notion that healthcare professionals have received extensive training in the radiation principles and are competent in minimizing risk. Pamphlets providing simplified information, available for both providers and patients, may provide as an effective intervention to help educate both physicians and the public about radiation risks and safety.
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Promoting Awareness of the Opioid Epidemic in Rural Vermont
Kathleen Olson
Vermont is in the middle of an opioid epidemic. Heroin use fatalities are on the rise and the number of people in treatment for opioid use disorder in Rutland County has tripled in recent years. Despite this widespread problem, community members of Rutland County feel that there is reluctance to talk about opioid misuse and lack of awareness. This project aims to bring awareness, provide resources, and encourage people struggling with opioid use disorder to seek treatment.
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Aging Well: Informing Seniors About Local Resources Throughout The Aging Process
Sravana Paladugu
A large portion of the Franklin County population is elderly and above the age of 60. They have many unique socioeconomic barriers to healthcare that add to the difficulty of maintaining independence in the community. This has been a burdensome public health cost for not only this community but for Vermont as a whole. The goal of this project was to inform local seniors of services provided by Age Well VT that could enable them to stay at home for longer. This was carried out by designing an Age Well VT handout that could be easily read and utilized by elderly patients at the Fairfield Street Health Center.
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Opioid Prescribing: New Vermont Regulations for Providers
Lloyd Patashnick
Opioid abuse is serious problem in Vermont with an estimated yearly health cost of $38 million. In 2015, 28% of Windham county residents were prescribed opioids. In order to combat the ongoing crisis of opioid prescription abuse, the State of Vermont will implement new prescribing regulations which will take effect in July, 2017. To ensure compliance with these new regulations, health care providers need to be educated to allow for a seamless transition in patient care.
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Barriers to Affordable Prescriptions in Rural Vermont
Niketu P. Patel
This project aimed at understanding why people in Rutland County, Vermont struggle with buying medications for their health. The project implemented and proposed several methods to help the population of Rutland area better adapt to the growing cost of prescriptions via $4 medication lists, rebates, samples, etc.
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Promoting Antibiotic Stewardship
Saurabh Patel
Antibiotics are not always prescribed optimally in the outpatient setting for common respiratory illnesses. Providers also spend time reiterating the same facts to patients about antibiotics and why their use is not warranted for their common cold symptoms. By providing a visual aid that can capture the attention of patients and present concise, easy to retain facts, we may lessen the amount of time providers spend counseling. At the same time, we are able to get patients to contribute to the fight against antibiotic overuse, antimicrobial resistance, and healthcare associated infections.
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Adolescent Sex Education
Carolyn Payne
This project identified a significant need for adolescent sex education and curriculum development in Vermont and the United States. A comprehensive sex education presentation was developed, reviewed by experts in the field, and piloted at The Boys and Girls Club of Burlington. Subjective results were positive and future strategies to teach students, evaluate effectiveness, and expand impact were developed.
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Marijuana Use Counseling During Pregnancy
Adam Petchers
Penobscot County, Maine has among the highest rates of marijuana use in the country, and Maine has recently voted to legalize recreational use of marijuana. Research has shown that pregnant women frequently seek out and are dissatisfied with information regarding the safety of marijuana use during pregnancy. We surveyed Family Medicine providers at the Center for Family Medicine at Eastern Maine Medical Center in Bangor Maine regarding their counseling of pregnant patients on the topic of marijuana use. From the results, we created an information sheet to aid providers in marijuana use counseling with pregnant women.
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Sports Injury Prevention in Danbury, CT
Cori Polonski
Sports Injuries, especially overuse injuries, cause a significant amount of morbidity and public health cost, especially for young athletes. Importantly, many of these injuries can be prevented with proper training and some novel approaches to warm-up and training. To address this concern, I worked with Orthopedic Specialists of CT and the athletic trainers at Danbury High School to come up with some educational materials for patients on effective ways to prevent sports medicine injuries.
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Rural Teens and Stress
Morgan R. Pratt
Stress is significantly associated with risk taking behavior and increasing depression/anxiety among teens. There is no shortage of stressors experienced within the teenage years.This project's aim is to create a pamphlet that can be available for teens in rural Vermont. It will contain apps for healthy lifestyle, stress, mood, mindfulness as well as local help line numbers for teens in crisis and signs and symptoms of anxiety and depression.
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Narrative Medicine: Improving Patient Care and Shifting Office Culture
Yazen Qumsiyeh and Julia Shatten
Chronic pain and depression are both prevalent in the Unites States and often co-exist in the same population. According to the literature, there is no consensus between providers as to the best practice of treating chronic pain and concomitant depression. Narrative Medicine, a medical model that uses a patient’s illness narrative to make meaning of their disease, allows patients to tell their stories of chronic pain and other important aspects about their life, while it helps providers better understand patients’ experiences with pain. This project will assess the current culture and attitudes of providers treating chronic pain conditions at the Center for Family Medicine at Eastern Maine Medical Center. It will also assess their current understanding of Narrative Medicine and the Northwestern Life Story Interview. We found that providers who dread visits with patients with chronic pain conditions are more likely to feel less confident when treating those patients.
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Connecting Seniors in Franklin County Vermont to Community Resources
Autumn Reilly
Vermont currently has the second oldest population in the country and the elderly population is continuing to increase. Senior citizens define aging successfully as having good health, strong friendships, and being able to participate in activities. In order to meet the needs of seniors it is important to find ways to better connect them with available community resources. The aim of this project was to create a pamphlet of community resources available to seniors in Franklin County, Vermont to aid in connecting them to community involvement and support.
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Breast Cancer Screening - Helping Patients Choose
Fran Riley
Breast cancer imaging has been covered broadly in the lay press. Many questions have been raised in the past few years, which bring confusion to patients in terms of risks vs benefits. In addition, new research shows dense breasts to be a significant risk factor to developing breast cancer, warranting additional modalities. All of this requires the patient to have an understanding of the risks versus benefits so they can choose what's best for them. This project creates an information brochure for patients, using numbers to give patients objective perspective to inform their decision.
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Preventing Falls in the Elderly
Rebecca Robbins
Falls are the leading cause of fatal and non-fatal injuries for older Americans, leading to 27,000 deaths every year and almost 3 million emergency room visits. Many view falls as just part of getting older; however fall risk can be significantly diminished through appropriate screening, education and community programs. Through literature review and talking to members of the local community, I learned about how fall risk is assessed along with what education and programs are provided for those at increased risk of falling. This project sought to educate patients about simple steps that can be made to decrease their fall risk and to educate providers about screening tools available to assess fall risk and how to work with patients who have an increased risk of falling.
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