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Low Back Pain in Family Practice
Marc R. Kostrubiak
Low Back Pain (LBP) is the worlds leading cause of disability and the second most common reason for visiting a physician in the US. LBP is the second only to heart disease in healthcare costs. In most cases a definitive cause is never found, however most cases are also self-limited. Patient education in this area is currently insufficient and many people expect to receive advanced imaging and treatments. Most of the time these are not indicated and may be harmful to patients. To address the gap in patient knowledge and improve health literacy a patient focused educational trifold pamphlet was created for use in the primary care setting. The pamphlet addresses common causes, evaluation and treatment of LBP and stresses the importance of physical therapy and physical activity to prevent recurrence.
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What's in your Cup? Increasing Transparency and Confidence in Alcohol Use Screening and Brief Intervention
Dylan C. Koundakjian
19% of Vermonters report drinking alcohol at levels which puts their health at risk, but many healthcare providers do not feel confident in addressing their patients' usage. This can stem from lack of experience with alcohol use, worries about stigma, and time constraints. However, data has shown that even 5-15 minute interventional conversations can significantly reduce a patient's risky drinking. This project aims to provide real-world, practical advice for having conversations around alcohol, and provides a conversion chart converting popular alcoholic beverages into standard drink equivalents.
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Treatment Referrals for Substance Use Disorders at BFA Fairfax (Vermont)
Adam Lacayo MPH
Nearly 4 of every 100 adolescents age 12-17 in our region had a substance use disorder in 2017, yet only 39% of these individuals received treatment for misuse of alcohol or illicit drugs that year. In many schools, only those students who find themselves in legal or school disciplinary trouble for substance misuse, or who request help, receive treatment referrals. The need to establish contact with students struggling with substance use problems, but who have remained “below the radar,” remains largely unmet, particularly in BFA Fairfax (Vermont), where the Substance Abuse Professional (SAP) position was vacated in early 2019 when grant funding expired.
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Caring for an Aging Loved One
meredith ann lackie
Caregivers serve as a critical extension of US health care system. Approximately 80% of adults requiring long-term care currently live at home in the community, and unpaid family caregivers provide 90% of their care. Among caregivers, 81 % feel inadequately trained for the skills they perform and those who report the highest burden are more likely to be less educated, to live with the care recipient, and to perceive they had no choice in assuming the caregiver role. The goal of this project was to identify local resources available for caregivers and to understand the barriers to accessing these supports. An educational booklet was created to increase awareness of these resources, to address frequently asked questions from caregivers of elderly individuals, and to connect them with local organizations.
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Enhancing Patient Access to Chronic Care Management in Brandon, VT
Olivia Grace Larkin
Although providers at Community Health Brandon and other Community Health Centers of the Rutland Region (CHCRR) locations are enthusiastic about the Chronic Care Management program, with tight schedules and an increasing number of 15-minute visits, it can be difficult to discuss the program with every eligible patient and find time to formally refer patients. The patient questionnaire aims to examine the efficacy of a standardized screening modality in referring patients directly to Chronic Care Management.
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An Educational Module for Adolescents on Cannabis Following its Legalization
Anna Lidofsky
Recreational use of cannabis has been recently legalized in Vermont. One year prior to its legalization, 42% of high school students in Washington County reported at least one-time use of cannabis. An educational module for adolescents was developed to address the increasing potency of cannabis and health risks associated with its use.
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Melanoma Surveillance
Samuel Logan
According to the CDC, in 2015 the rate of melanoma of the skin was 22.1 per 100 thousand people, the sixth most common cancer. In Vermont this rate was 35.8 per 100 thousand, higher than the national average. In Berlin, VT, it was noted that patients often are concerned about their nevi, but often do not know when it is appropriate to bring them to their physician's attention. A pamphlet was developed to assist physicians in educating patients on the characteristics of melanocytic nevi and encourage patients to speak to their physician when they find moles which meet these characteristics.
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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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