Jameson T. Loyal
The state of Vermont has one of the highest incidences of skin cancer, and in particular melanoma, in the entire country. In fact, melanoma is the fifth most common cancer diagnosed in Vermont. The purpose of this project is to determine the impact of skin cancer on the state of Vermont and to develop a patient-centered educational brochure in which to educate patients on skin cancer and ways to prevent it. Through interviews with subject experts it is clear that one of the best ways to prevent skin cancer is through education. The informational brochure on skin health met a need in the family medicine clinic. Moreover, a survey was created to determine patients’ knowledge on the topic of skin cancer as well as to determine the effectiveness of the brochure. Finally, an abbreviated version of the brochure as well as a skin lesion history and description form was created for the electronic medical record.
Elisabeth P. Lucas
A student project exploring how breastfeeding is addressed among different patient care teams in a federally funded clinic and using Electronic Health Record data to determine patient needs. Future recommendations included.
Low back pain (LBP) is the most common type of pain reported by U.S. adults across all age groups and is the leading cause of disability worldwide. Up to 80% of individuals will experience LBP at some point in their lives. 411 patients ages 20-98 were seen over a one-year period for LBP at Castleton Family Health Center in Rutland County, Vermont. Patients and providers both saw a benefit to having educational materials on LBP in the office.
An estimated 100 million Americans suffer from chronic pain. A substantial number of them have been prescribed opioid medication for pain management. Evidence has accumulated that opioid medication is inefective for long-term pain control, and that it is associated with increased risk of overdose and accidents, diversion, dependence and misuse. Doctors are increasingly attempting to reduce levels of opioid use in their patients, and some patients with chronic pain are reluctant to decrease their use. This project aimed to provide information to both doctors and patients about this issue.
Molly A. Markowitz
According to the Office of Refugee Resettlement, between the years of 1989-2013, 6310 refugees have settled in Vermont. Studies have found that when non-English speaking patients receive professional interpreting services, there is an increase in the recommendation of preventive health services and a decrease in the investigative tests utilized. Currently at UVMMC, there isn't an easy and accessible way for healthcare providers to obtain health information in different languages for patients. Thus, the aim of this project was to create an easy and accessible way for healthcare providers to access health information in different languages and then promote its utilization.
Stephen M. Maurer
Smoking is a modifiable risk factor for cardiovascular disease. Upstate New York has a high adult smoking rate of 20.9%, compared to a New York state rate of 16.2% and a national rate of 18.1%. The Affordable Care Act has increased resources available that can help smokers quit, including tobacco use screenings, cessation interventions and stop smoking counseling; however, several patients that smoke are unaware of the resources available to them when they are ready to stop smoking. Multiple Cochrane Reviews on the effectiveness of smoking cessation programs demonstrate that some cessation interventions are more effective than others; however, some cessation resources remain unavailable to upstate New Yorkers.
1/3 of older adults over the age of 65 fall, 10% of these falls can lead to serious injuries like hip fractures. The average length of life for someone who fractures their hip is 6 months. The risk and reasons for falling are multifactorial and often take a long time to assess. There are a few evidence based recommendations for reducing fall risk, yet a lack of awareness of these recommendations, and community resources to address this need. This project aimed to create a standardized assessment tool based on literature research and available community resources to facilitate fall risk assessment targeted at the most vulnerable population, and risks that have proven interventions.
An evaluation of screen time and media use in children. This project looks to education healthcare practitioners about the effects of current media practices in the United States on children. A presentation was given to healthcare practitioners at a family medicine practice and a brochure was created to distribute to families in the waiting room. Practitioners reported an increase in knowledge regarding the subject of screen time in children, an increase in their comfort level in in discussing these effects with patients, and increase in their ability to effectively communicate the media guidelines of the American Academy of Pediatrics.
Patient Education: Assessing the Barriers to Utilize & Create Effective Educational Resources for Type 2 Diabetes Mellitus (T2DM)
Alexandra K. Miller
Despite a myriad of diabetic information, group classes and diabetic patient educators, patient’s with poorly controlled diabetes persist. Educating patient's on diet and lifestyle modifications are particularly challenging for the patient and provider and making the changes are even harder. The use of printed patient education material in a primary care setting and referral practices to diabetic educators was evaluated by distributing a brief survey to staff in a primary care office. The convenience sampling showed that some staff did not offer printed materials at all and patient's seldom requested these resources. The referral practices and preference of counseling patient's on diet and exercise was provider specific. Practice guidelines may benefit patient's and increase participation in group classes and prevention programs that focus on behavioral changes, diet and lifestyle modifications.
Lindsay R. Miller
Health literacy is one aspect of overall literacy that has an enormous impact on patient health outcomes, including knowledge of disease, health markers, general health status, and number of hospitalizations, among others. More than 1/3 of the US population has basic or below basic health literacy status. In Chittenden County, diabetes and heart disease deaths are higher than the state average; these diseases require complex personal care and management. Health care providers working at Milton Family Practice in Milton, VT, often noted that patients were often unwilling to disclose literacy issues and there were often problems communicating instructions to patients when providers were unaware of their literacy status/abilities. Residents working at Milton Family Practice were given three simple screening questions that were validated to assess patients' health literacy status with good sensitivity and specificity. These questions are quick and easy to use and avoid many issues with embarrassment or stigma. Residents were also provided local community resources to refer patients to who may benefit from additional help, including the Milton Public Library and the Milton Family Community Center.
David M. Nguyen
Causes of childhood and adolescent obesity are multi-factorial: sugary beverages, snack foods, portion size, activity level, environmental factors, socio-cultural factors, family factors and psychological factors to name a few. There are both immediate and long-term health effects for childhood obesity. Ultimately, it plays an economic burden with an estimated national medical cost of obesity-related illnesses in adults to be 209.7 billion. This pamphlet is an easy to read resource with the purpose of educating parents and adolescents about the hidden sugar in everyday snacks.
Please see the updated version of this presentation: Ohkura, Michael; Bonefant, Nicholas; and Upton, Michael D., "A Sex-Positive Approach to Healthcare, and Truvada as HIV Pre-Exposure Prophylaxis (PrEP)" (2018). College of Medicine Faculty Publications. 3. https://scholarworks.uvm.edu/comfac/3
Nationally, incidence of new HIV infections has hovered around over 50,000 per year and men who have sex with men (MSM) carry the largest burden. In Vermont, 56% of individuals newly diagnosed are MSM, with 25% of diagnoses among youth ages 13-24 years old. Despite the proven efficacy and approval of daily Truvada (emtricitabine + tenofovir) as Pre-Exposure Prophylaxis (PrEP) against HIV infection, provider understanding and awareness of its use has remained extremely limited in Vermont with last estimates at just over 9 providers familiar with PrEP (excluding UVM Student Health, Planned Parenthood, and UVM Medical Center infectious disease department). Based on a UVM College of Medicine student public health project which identified provider training and education as the largest barrier to prescribing PrEP, this ongoing project aims to familiarize Vermont primary care providers with language and sexual history taking in MSM, emphasize accurate identification of higher risk times for HIV infection in an individual's lifetime, and encourage consideration for PrEP as a powerful element of a comprehensive sexual health program.
The role of healthcare providers in stopping domestic violence against women, a public health crisis, through promoting a culture of universal screening and community education.
The project identified the need and barriers to healthy and accessible forms of exercise in the Newbury community of VT. Surrounding areas of Groton, Ryegate, Wells River, and Haverhill in New Hampshire are also covered. Walking trails were identified as the most accessible form of exercise in the region for patients with metabolic syndrome visiting doctors at Little River Health Care in Wells River, VT,
Joshua Jeremy Pothen
Internet access is associated with increases in health information seeking and benefits in health statuses. However, many individuals of low socioeconomic status (SES) lack Internet access, thereby creating significant disadvantages from a health perspective. In this project, we describe a potential project for providing affordable Internet access to a neighborhood of Newport, VT containing many SES individuals. This network includes a splash page that provides regular health event promotion and health information dissemination to everyone connecting the network. We then discuss how to determine the impacts of the Internet on multiple aspects of health within the community.
Depression among the elderly is significantly under-diagnosed and inadequately treated. With Vermont's rapidly aging population, particularly in Addison County, increased diagnosis and treatment, whether behavioral or pharmacological, will lead to increased quality of life for aging individuals and their caretakers. This study aimed to increase patient education about the signs of depression as well as available community resources available to help this patient population.
Melissa N. Rafferty
Since Maine's incidence of pertussis is higher than the national average, primary prevention through vaccination is important to protect vulnerable populations such as newborns in the state. Maternal Tdap vaccination between 27 to 36 weeks of pregnancy is recommended by ACIP to boost placental IgG transmission to the fetus and prevent newborn morbidity and mortality. For quality improvement, maternal Tdap vaccination rates were examined at Eastern Maine Medical Center Family Medicine Center and Residency and an educational handout was developed.
Samy S. Ramadan
The aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The effectiveness of these interventions was evaluated using the Healthcare Equality Index (HEI) scoring criteria developed by the Human Rights Campaign. Future interventions include registering competent and sensitivity trained providers to the GLMA (Health Professionals Advancing LGBT Equality) provider directory, including data fields for sexual orientation and gender identity as part of the electronic health record (EHR) for all patients, conducting a community needs assessment with local LGBT groups such as Outright Vermont and NEK LGBTQ Advocacy Committee, developing a partnership with the DHMC Transgender Clinic for additional training in the management of hormone therapies, and measuring LGBT patient satisfaction through phone interviews.
Saraga Pannala Reddy
There are many effective contraceptive methods available, yet 46% of pregnancies in Vermont are unintended. The majority of educational initiatives to increase high-efficacy contraceptive use are directed only towards women, and not their male partners. This intervention aims to help primary care providers educate young male patients on contraception, using an engaging pamphlet. Improving male patient awareness and understanding of contraception options may help partners have open and informed discussions that lead to more consistent contraceptive use.
Andre A. Robinson
Many patients in Vermont need to seek abortion care outside of their regular doctors office. When a patient discovers that she is pregnant there should be a non-biased conversation about options as part of The Patient Centered Medical Home. This resource includes: where to go for an abortion, how to pay for it, who to call for support, and advice on how to avoid biased institutions.
Vaccination against Human Papillomavirus (HPV) is able to protect against 70% of strains causing cervical cancer and and 90% of strains causing genital warts, yet vaccination rates for boys and girls are still well below average vaccination against many other preventable diseases. Experts agree that patient education and strong physician recommendation of HPV vaccination of pre-teens and teenagers is essential in improving vaccination rates in CT. The objective of this project was to assess and improve understanding of HPV, its implications, and vaccination in a high school population in Danbury, CT. The education session significantly improved students' understanding of HPV vaccination and subjectively improved their confidence in becoming health advocates for HPV vaccination.
Isobel Ycasas Santos
- Home blood pressure monitoring aids in the proper diagnosis of an elevated blood pressure in the office.
- Written instructions on proper BP measurement at home is currently lacking at the UVMMC Family Medicine South Burlington site in addition to other affiliated sites. A home blood pressure monitoring handout can serve as another opportunity for hypertension control.
- Its utility as a diagnostic tool is dependent on proper BP measurement techniques. The HBPM will hopefully encourage the proper utility of the device.
- HBPM encourages patients to take control of their own health, and at the same time it facilitates discussion with their physicians
Substance use in pregnancy is not uncommon and the use of substances increases the risk of complications during pregnancy. In Vermont, opiate use in pregnancy is increasing as well as the number of people seeking treatment for opiate misuse. This project was designed to give pregnant mothers using opiates an idea of what to expect during their pregnancy as well as the resources that are available to them in the Springfield, VT area.
Promoting Physical Activity Using Walking Poles in Senior Citizens of Southern Vermont's Deerfield Valley Region
Siyeon A. Seong
Walking poles have been shown to be beneficial in increasing physical activity and improving functional outcomes. Walking poles have been recommended during patient encounters using an informational pamphlet at Deerfield Valley Health Center in Wilmington, VT.
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