Cordelia Y. Ross
Problem: Youth with DD have conditions that may limit their ability to function, with resulting social, emotional, or behavioral sequelae, and experience difficulty transitioning from child to adult health care. Also, adult providers may lack training and comfort level in working with patients with DD. For example, youth with ASD need an adult provider who understands autism but doesn’t see every health or behavior problem as a result of autism.
National Need: 1 in 6 children in the U.S. has a DD. Each year, almost half a million of these children transition into adulthood. As for ASD, 1 in 68 children (1 in 42 boys) meets ASD diagnostic criteria.
State Need: In Vermont in 2006, 540 children and adults with ASD (with 126 in Chittenden County alone) were being served by the Vermont Community Mental Health and Developmental Services programs. Since then, the number of children with ASD has grown approx. 20% per year.
Community Need: Hinesburg Family Practice currently sees 11 patients with a Code 299 diagnosis (pervasive developmental disorders) per year. These patients accounted for 25 visits during FY 2014. The patients range in age from 5 to 53 years (median age: 17 years).
Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population. These disorders have a negative impact on the quality of life in a number of areas of functioning, including academic performance, social interactions, self confidence, and ability to enjoy daily life experiences and may impact future emotional health. Approximately 20% of youth ages 13 to 18 experience severe mental disorders in a given year. Almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year. At Colchester family practice, all practicing physicians have a multitude of adolescent patients with a wide spectrum of anxiety disorders.
In the US, more than a third of adults are obese as well as 17% of children. A recent report estimates the annual cost of obesity in Maine amounts to approximately 452 million dollars. Additional reports estimate the cost of obesity to the entire country lies somewhere between 10-30 billion annually.
Encouraging patients to have healthy diet rich with whole grains, fruits, and vegetables, and to maintain regular exercise (150 minutes a week) are effective ways to combat higher BMIs and to stave off associated hypertension, coronary artery disease, type II diabetes, and dyslipidemia.
Problem: Studies have shown that only ~50% of patients with chronic conditions take their medications as prescribed. Patient nonadherence can be due to forgetfulness, desire to avoid adverse side effects, and high costs of medications, particularly in patients with low incomes, multiple chronic health problems, and no prescription coverage. Attempting to reduce medication costs by taking less than prescribed dose does not allow for full therapeutic benefits, and may put patients at increased risk for declining health. Consequences of cost-related nonadherence (CRN) and underuse: increased ED visits, psychiatric admissions, nursing home admissions, and decreased health status. In patients with asthma, medication nonadherence has led to increased hospitalization rates and other adverse outcomes. Up to 88% of patients with asthma do not properly follow their inhaled medication regimen. CRN behaviors are influenced by financial pressures and polypharmacy. However, physicians and other members of the health system may prevent these behaviors by fostering trust, prescribing cheaper medications, and providing access to prescription assistance programs.
- Young adults have the largest percentage of uninsured citizens of any age group in the United States. According to the CDC, 38.4% of the uninsured population in 2013 was between the ages of 19 – 34. This equates to 27.2% of 19 – 34 year-olds in 2013 not having health insurance.
- In Connecticut, 18-34 year-olds represent by far the largest demographic of those uninsured, at 43.3% , more than double the rate of the second highest uninsured demographic (45 – 54 year olds, with an uninsured rate of 19.2%). Unfortunately, this remains significantly higher than the national average.
- Danbury in particular has a total uninsured population of 34.0%, which represents the fourth highest percentage of uninsured citizens of all cities in the state.
Over the years, steps have been taken to 'streamline' the process when it comes to diabetic management in the Village Primary Care (VPC) practice. As more and more outcomes are monitored, it is important to both identify the shortcomings of the practice as far as diabetic management, and attempt to implement processes to ensure better outcomes. VPC is doing well in many areas (LDL/BP/BMI), but is lacking in monitoring and implementing certain areas of diabetic management: Recommending and tracking eye exams, HbA1c, Micro albumin, Foot exams.
Adverse Childhood Experiences (ACE), including childhood abuse/neglect, household dysfunction, and exposure to other traumatic stressors, have a large impact on health costs as well as social services, education, juvenile justice. Impact of ACE crosses socioeconomic boundaries. In 2011, the Vermont Department of Health reported that 58% of VT adults had experienced at least 1 ACE, and 17% of VT women had four or more ACEs.
Primary care physicians and emergency physicians have reported a surge in opiate abuse within the state of Vermont. It is being labeled as a public health epidemic and crisis, with a 2013 mortality rate of almost double what it was in 2012. There are several factors that play a role in why Vermont has seen such a growth in opiate abuse, from easy access to opiate dealers in major urban cities such as New York, Boston, and Philadelphia to a decrease in law enforcement coverage in rural areas of the state. One major element, and the focus of this project, is the lack of communication and awareness of resources for family members of abuse victims. Opiate abuse does not only affect the victim, it also affects their relationships, families, and friends. The major barrier to family members and friends seeking emotional, physical, spiritual, and mental support is the stigma that surrounds opiate abuse. If people don’t talk about the issue, this barrier cannot be overcome. There needs to be more information available to families, so they may seek out the appropriate resources and support needed to make strides towards helping their loved ones through their addiction’ This lack of communication among families in the community also contributes to the public health problem and the stigma of substance abuse; it results in a vicious cycle.
Fruits and vegetables are great, but they are not all created equally. In 2014, the Centers for Disease Control and Prevention published a study on which fruits and vegetables contain the most nutrients for preventing cancer, diabetes, and heart disease.
The top 41 have been named "Powerhouse Fruits and Vegetables."
Although obesity rates across all demographics continue to climb annually, when separated into income levels, the prevalence of obesity in poor adults and children are rising at a greater rate than middle class individuals. A recent publication by the Food Research and Action Center (FRAC) compiled a list of data points that indicated that, while the trend is gradually slowing, rates of severe obesity are about 1.7 times greater in children coming from families whose incomes fell below the poverty line than equal counterparts in the middle class income bracket. High fat, high carb foods are often the staple of a lower income family based on the assumption that they are more affordable, easier to prepare, and more time effective to gather, prepare, and consume. Because the cycle of poverty can be hard to escape, the cycle of high fat, high carb consumption is also passed on to subsequent generations. Unfortunately low income residential areas have a record of being "food deserts" where nutritious and fresh food is hard to find or overly expensive.
In the clinic we frequently see patients with self-admitted heavy drinking who are often in various stages of denial about their problems with alcohol. All the pamphlets and handouts available to patients at Thomas Chittenden Health Center and at Fletcher Allen Health Care are for patients who have admitted they have a problem with alcohol. These patients with admitted problems are the minority of patients with admitted heavy drinking. The patients who have not admitted their problem with drinking need a way to reflect on how their drinking is affecting their lives.
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