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Assessing Patient Barriers to Community Health Team Referral
Benjamin Scott Albertson
Objective: To assess patient barriers to Community Health Team (CHT) referrals at Hinesburg Family Practice.
Methods: Patients of Hinesburg Family Practice who were referred to the CHT by a physician and subsequently declined to be seen within the last 15 months were interviewed via telephone to assess what barriers prevented them from accessing CHT services. Twenty five patients were identified and called a minimum of 3 times using contact information obtained from the EHR. Eleven patients were contacted, one of whom had since followed through with the CHT. Responses from the ten patients who met the criteria and responded were generalized into major categories of: Inconvenience, Not interested, Already had services in place, Never called, and Never referred.
Results: Inconvenience (30%), Not interested (30%), and Already had services in place (20%) were the three biggest barriers to referral, accounting for 8 of the 10 responses.
Conclusions and Recommendations: The biggest patient barriers to CHT referral compliance are inconvenience, lack of interest, and already had services in place. These barriers can be assessed by physician when considering making a referral to the CHT, and referral should involve shared decision making with the patient. Physicians should also emphasize the role of the CHT as an extension of patient’s care by physician. It became clear when speaking with patients and CHT members that there exists a gap in patient knowledge with regard to services available through the CHT.
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Getting Real About Food: "Fed Up" & Nutrition Education
Hillary Anderson
Getting Real About Food: “Fed Up” & Nutrition Education is a summary presentation designed to help facilitate discussion about the U.S. food industry and its impact on the American diet. The Grace Cottage Community Health team identified the 2014 documentary “Fed Up” as a critical learning tool to enhancing their community education programs for patients, providers, and staff members; this project focuses on summarizing key points and statistics as well as highlighting opportunities for pilot-testing and implementation across different community venues.
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The Hidden In Plain Sight Program — A Novel and Interactive Approach to Substance Abuse Prevention and Education
Murtaza I. Bharmal
Introduction. Despite stabilizing trends in alcohol, tobacco, marijuana, prescription medication, and illicit drug use reported by the National Institute of Drug Abuse, there is clear evidence that substance abuse is pervasive throughout Aroostook county as well as the state of Maine. Further research shows that parents often overlook everyday items that may indicate that an adolescent is engaging in some form of risky behavior. More so, parents are often apprehensive about talking to their children about risky behaviors and do not know how to appropriately manage these issues or where to seek help. Although there are many resources for substance abuse prevention, there has been little research into addressing these concerns in a more impactful, interactive approach.
Objectives. To teach adults how to:
- Identify signs, potential hiding places, and items that may point to risky adolescent behavior.
- Illustrate drug types, drug paraphernalia, and how drugs are used and why.
- Access available resources and what to do if risky behavior is suspected.
Methods. Participants are first debriefed about the workshop, followed by an initial survey that gauges each attendee’s understanding of substance abuse, signs of risky behavior, and prevention techniques. Participants are then permitted to explore an adolescent bedroom mockup where over 100 items are concealed. The coordinator then walks through the exhibit identifying the many items, followed by an information session about how to initiate a conversation with an adolescent and where to seek help. Finally, the program concludes with a question and answer session and follow-up survey that measures each participant’s new understanding of substance abuse, signs of risky behavior, and prevention techniques.
Results. To date, seven workshops throughout Aroostook County have been completed along with 25 evaluations. In the pre- and post-evaluations, six critical educational points were assessed. The table below reflects the percentage of participants that agreed or strongly agreed with each statement:
Statement
Pre-Evaluation
Post-Evaluation
I know the signs that may reveal risky teen behavior.
58%
84%
I know the hiding places that teens may use to hide risky behavior.
42%
97%
I know the supplies and tools that teens may use to hide risky behavior.
27%
97%
I know drug types, how they are used, and why.
24%
81%
I know what to do if I suspect risky behavior.
55%
81%
I know where to get help for substance abuse and other risky behavior.
58%
72%
Conclusions. Although in its early phases of development, the Hidden In Plain Sight program has shown promising results. Participants leave with a broader understanding of current trends in substance abuse among adolescents and are curious about how to learn more. As the program continues to hold workshops, we hope to better address each objective more clearly, further engage the community on this topic, and spread awareness about this effective, interactive, and eye-opening experience to community coalitions and other groups that have an interest in youth substance abuse prevention programming.
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Lewiston Community Health Improvement Project
Bryce M. Bludevich
Community Health improvement project about low back pain and alternative treatment options. Particularly focuses on different treatment options in Lewiston, ME.
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Pre-Exposure Prophylaxis for HIV Prevention: a community-based approach to increased awareness among Vermont primary care providers
Nicholas Robert Bonenfant
More than 1.2 million Americans are currently living with HIV and nearly 1 in 8 (12.8%) are unaware of their status. The incidence has been consistently around 50,000 new infections per year and of those newly diagnosed, the men who have sex with men (MSM) population carries the largest burden. Federal costs continue to rise for HIV/AIDS treatment nationally and this continues to represent a significant portion of healthcare costs here in Vermont. More needs to be done to prevent this chronic illness.
In 2012 the FDA approved a medication for pre-exposure prophylaxis (PrEP): Truvada. There is clear evidence of its effectiveness at preventing HIV infection in HIV-negative individuals through multiple clinical trials and it has been well tolerated by patients who have taken it.
Despite these facts, the general public, individuals at higher risk for becoming infected with HIV, and primary care providers have limited awareness of this powerful tool to reduce and perhaps eliminate new infections in Vermont. The most recent estimate of the number of providers who have prescribed PrEP, not including Planned Parenthood, is only nine.
Our proposed efforts target these unaware populations, beginning with primary care providers, by increasing awareness and education about PrEP statewide. This intervention is in line with current statewide campaigns to reduce the annual incidence of new HIV infections to zero in the coming years.
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Mental Health Screening in Nursing Homes
Meghan Breen
Depression and dementia are two of the most common mental health conditions in nursing homes. Screening for these conditions does not have to be difficult or time consuming, but doing it can significantly improve the health of nursing home residents. The WHO-Five for depression and the Mini-Mental Status Exam are both sensitive, specific, and time-sensitive. Using these screening in a nursing home in rural Vermont helped improve the accuracy of patient records and impacted medical care.
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Creating an Effective Education Pamphlet on Sun Protection and Skin Cancer Prevention
Alexandra E. Brown
Melanoma and other skin cancers are increasing in incidence in the United States. In Connecticut, the melanoma rate is higher than the national average. The public health cost of skin cancer treatment ranges from $2-$8 billion annually. The costs to the individual are also high and the diagnosis of an advanced stage cancer is always emotionally challenging for a patient and his/her family. Efforts should be aimed at primary and secondary prevention of skin cancer, and patient education is an important element of this goal. The creation and use of patient education pamphlets can help to increase patient awareness of sun damage and its sequelae.
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Increasing Advanced Directive Utilization in Primary Care
Alejandro Castro
Advance directives are a vital tool ensuring patient’s wishes regarding end-of-life care are met. End-of-life discussions with physicians are associated with fewer aggressive interventions and greater quality of life metrics. Increased utilization of advance directives by Vermonters could ensure the wishes of patients are met.
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Influenza Vaccination in the Elderly
Ayse Nur Celebioglu
Influenza is responsible for an estimated 300,000 hospitalizations and 23,000 deaths annually, the majority of which occur in elderly populations. Despite a physiologic vulnerability to this infection, every year millions of seniors do not receive the seasonal flu vaccine. This project set out to understand the myths surrounding influenza vaccinations in the elderly and to educate them on the different types of vaccines available.
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Strides for Change: Incentivizing Hispanic Youth to Promote Exercise, Fitness and Wellbeing
Priyanka Chilakamarri
The United Way of Western Connecticut's 2014 annual report on Danbury's Young Children found that Danbury's children are facing many physical fitness challenges compared to the state of CT. A study looking at 4th graders in a physical fitness test finds that Danbury students consistently have a harder time passing the fitness test. Of the population studied, 42.5% were ethnically Hispanic.
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Healthier Living: Diabetes Management
Brandon Childs
More than 55,000 Vermonters suffer from diabetes, which is the 6th leading cause of death in the state. There are currently 705 patients in South Burlington Family Practice with a diagnosis of diabetes. More than 100 of them are living with uncontrolled diabetes (elevated HbA1c > 8%) and have not yet obtained the necessary education to manage their chronic disease. Physicians must manage all patients diabetes goals and expectations in 15-30 minute appointments alone, but may refer patients to the Community Health Team for further diabetes education.
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HPV Education and Prevention Amongst Danbury High School Students
Elizabeth Cochrane
Human Papillomavirus (HPV) is currently the most prevalent sexually transmitted infection in the United States with an estimated 79 million people infected. In the state of Connecticut, HPV vaccination is not required for entrance into the 9th grade and because of this, there is less awareness of the importance of HPV prevention and immunization among high school students. As of 2013, 37.7-49.9% of females ages 13-17 living in Connecticut completed the HPV vaccine regimen. My objective for this project was to promote awareness about HPV infection and HPV vaccination among high school students.
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Decreasing the Smoking Rate at EMMC Family MedicineCenter and Residency in Bangor, ME
Alex Coffman
Maine's rate of adult current smoking is 20%, which is significantly higher than all other New England states (Connecticut 16%, New Hampshire 17%, Massachusetts 16%, Vermont 17%, and Rhode Island 17%). The national adult smoking rate in the US is 17.8%. An estimated 2,200 Maine adults die each year from their own smoking.
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Chronic Pain Management with High Dose Opioid Medication
Joshua Cohen
Chronic pain management with non-abuse deterrent high dose opioids is a necessary but dangerous practice. This project addressed physician opinions about this sensitive issue and audited patient records to assess documentation compliance with VT rules. The goal is to standardize communication and documentation in order to improve safety for patients, physicians, and the community at large.
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Identifying Sleep Disorders and Proper Sleep Hygiene in School-Aged Children
Kathryn Colelli
Sleep is a daily struggle for many people. Children in particular often suffer from sleep restriction and poor sleep hygiene. Poor sleep can have a negative impact on their physical, social and emotional health. Children in our community are rarely educated about sleep disorders or sleep hygiene. The goal of this project was to create a learning tool to help facilitate sleep education in children.
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Obesity Intervention and Prevention
Bridget Ann Colgan
Obesity is a prevalent health concern at Berlin Family Practice, with 41% of the patients seen in the past two years with a BMI greater than or equal to 30, many suffering from comorbid diseases of hypertension, diabetes, high cholesterol, and stroke. In an effort to assist patients in making lifestyle changes to improve nutrition, activity level, and weight loss, this project aims to incorporate the Vermont Department of Health's Weight and Health Profile into patient visits. Feedback from both practitioners and patients on how to improve and update this tool will be provided to Vermont Department of Health Physical Activity and Nutrition program in an effort to optimize its effectiveness and help patients with healthier eating, weight loss, and increased activity, thereby reducing incidence of obesity and associated comorbidities.
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Increasing Provider Awareness Regarding Act 39 in Middlebury Vermont
Kyle F. Concannon
Vermont passed the Patient Choice and Control at End of Life Act (Act 39) in 2013 and as knowledge of this law is increasing in the community more patients are requesting it. To address the need for further education, an educational pamphlet was produced and provided to practitioners in Middlebury Vermont, many of whom had patients request Act 39.
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Education in Over the Counter Medications, for High School Freshmen
Ian Crane
Over the medications offer numerous benefits, allowing short term treatment of symptoms, and reducing unnecessary Doctor’s visits for things like viral illness. Yet these medications also have potential for misuse. Roughly 10% of Danbury High School students abused OTC medications in 2013.
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Bridging the Gap Between the Primary Care Physician and Accessible Resources for Patients with Mental Health Needs
Tracey DaFonte
Mental illness and maintaining mental health is a significant problem in the world, the United States, and here in Vermont. The burden of mental illness can lead to disability, lost work productivity, and at its worst, suicide. Vermont ranks 14th in the United States for rates of death by suicide. Many people struggle every day with mental health needs from depression, anxiety disorders, ADHD, and more. The aim of this project was to create a mental health resource card that can be used in primary care offices to provide patients with information to get the help they need and attempt to increase the percentage of patients who address mental health issues with their primary care provider.
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Burnout Prevention in Primary Care Providers
Dylan M. Devlin
Burnout is a pervasive problem in primary healthcare. Mindfulness training has been shown in decrease symptoms associated with burnout and improve overall patient care. This project attempts to evaluate the rates of both burnout and mindfulness in healthcare workers within Rutland County, Vermont. A survey was distributed to both administrative and primary healthcare workers within the Community Health Centers of the Rutland Region system to determine if employees suffer from symptoms of burnout as well as their willingness to participate in mindfulness training.
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Radon: The New Carbon Monoxide
Katherine M. Evans
Radon is derived from breakdown of uranium naturally found in the environment all across the globe. Some geographic locations have higher levels of radon than others. Like carbon monoxide, radon is colorless and odorless. It is the second leading cause of lung cancer in the United States. Human exposure happens primarily via buildings: 1 in 8 Vermont homes exceed the recommended level. In Brattleboro, 1 in 5 homes exceed the recommended level, but between January 1993 and January 2014, the Vermont Department of Health received only 329 home testing kits from Brattleboro.
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Provider Resources for Smoking Cessation Counselling
Pierre Galea
Tobacco is still the leading cause of preventable death. The Vermont Department of Health has instituted smoking-related goals for "Healthy Vermonters 2020." One resource that is useful for providers who counsel patients to quit smoking is 802quits. Strategic utilization of this resource and implementation within the healthcare center, is invaluable for providers, and is an effective tool to reach patients and support them throughout their journey.
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Lyme Disease Awareness in Downeast Maine
Justin L. Genziano
Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.
Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project is to provide patients with concise and accurate information to help alleviate this concern.
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Over the Counter Medication Education Approach
Gurpinder Gill and Ian Crane
OTC meds are essential because they give the patient the ability to avoid an unnecessary visit to the doctor's office. They also allow the health care provider to better focus on those with more serious illnesses, and some patients do not have appropriate health care access and rely solely on non-prescription meds. However, patients who use OTC meds do have a tendency to underestimate the serious risks of these meds such as potential for abuse, toxicity, adverse effects, drug interactions, and the delay in seeking a physician's advice.
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Determining Barriers to Oral Health Care in Bennington County
Taylor Goller MS-3
Bennington County has some of the worst oral health outcomes in the state of Vermont. A survey was designed to assess current oral health problems, maintenance habits, and barriers to oral health services access. Results are preliminary.
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