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Perceptions of Teleophthalmology
Kisha Kalra
One of the greatest burdens facing patients with eye-related pathologies is access to ophthalmologists in the area. Teleophthalmology is a way for eye examinations to be conducted in the easily-accessible primary care setting, with images sent to ophthalmologists for interpretation. This project addresses the perceptions of this model amongst patients and primary care physicians.
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Benign vs. Malignant: Improving Prevention and Detection of Cancerous vs. Non-Cancerous Skin Lesions Through Inclusive Patient Education
Simran Kalsi and Sam Afshari
Vermont consistently has one of the highest annual rates of melanoma in the United States. This is likely due to a range of factors including population demographics (predominantly white, aging population), active outdoor lifestyles, intense seasonal bursts of sun exposure, and inadequate Winter sun protection. The COVID-19 pandemic and its associated shutdowns have caused significant delays in healthcare delivery, further exacerbating the incidence and severity of melanoma. Primary care providers are therefore an increasingly essential first line of defense in detecting suspicious skin lesions and expediting treatment of skin cancer, but patients should be aware of when to seek evaluation. I developed a patient-centered educational bookmark (adapted from the American Academy of Dermatology) to improve public knowledge about when a skin lesion is likely to be malignant vs. benign. The bookmark was distributed to Thomas Chittenden Health Center in Williston, VT and the University of Vermont Medical Center Family Medicine clinic in Hinesburg, VT. Qualitative feedback was collected and categorized according to major themes including appearance, utility, and relevance to Vermonters. Future directions for this project include further distribution at local libraries, book fairs, and schools as well as quantitative evaluation of its efficacy as an intervention through population surveys.
I worked in collaboration with Sam Afshari for the distribution of this intervention across clinics and for collection of feedback. I distributed and collected feedback for Sam's presentation "Improving Identification of Dermatologic Conditions in Skin of Color" (see Slide 7 for details).
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An Assessment of Skills Before Pills, A Series Promoting Lifestyle Medicine
Kyle J. Kellett
Lifestyle medicine seeks to treat the root cause of chronic medical conditions through lifestyle medications, including diet and exercise habits, tobacco and alcohol use, and mental health. Skills Before Pills is a novel, multidisciplinary, 8-week group appointment series aimed at promoting lifestyle change to address chronic medical conditions developed by the physicians at South Burlington Family Medicine. The aim of this project was to construct a quality improvement survey to collect patient feedback on the series with the goal of continually improving the course to promote long-term, positive, change in behavior.
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Peri-Operative Optimization: Social Determinants of Health
Adam F. Kohutnicki
This project investigated how clinicians at a rural Vermont family medicine practice observed various social determinants of health (SDOH) of their patient population affected patients' preparedness for surgery. Two clinicians involved in the community, a practicing family medicine physician and a practicing social worker, were interviewed to collect qualitative data on how various SDOH they have observed through their clinical practice have influenced patients' preparedness for surgery. This information was then utilized to create a "dot-phrase" that clinicians can use as part of a patient's pre-operative visit in the outpatient setting to assess SDOH and plan subsequent targeted interventions to address those SDOH. The clinicians identified specific SDOH of primary concern that they believe should be addressed in the pre-operative visit: family dynamics, financial considerations, and transportation. The proposed intervention includes a "dot-phrase" that can be utilized by clinicians during these encounters to specifically address these SDOH and coordinate additional interventions to address areas of need. Further investigation into the specific costs and savings of such an intervention, additional SDOH to be included in such interventions, and additional collateral information from surgical perspectives is warranted.
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Outpatient pamphlet intervention providing Evidence-Based Stretches and Exercises for Non-specific Back Pain
Jason Lach
A pamphlet was created using stretches and exercises similar to those supported in a randomized control trial (Kim 2020) for treatment and prevention of non-specific lower back pain. The pamphlet with written instructions, pictures and links to instructional videos was created to provide an informational resource patients could use to relieve back pain at home and to promote core strengthening exercises to prevent further back injury injury. The pamphlet was available for two weeks and provided to a family medicine physician at Newtown primary care and a patient with non-specific back pain for feedback.
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Return to Play Following Covid-19
Tyler Landman
Covid-19 infections among adolescents have led to significant decreases in physical activity and fitness. Many adolescents have been subject to return to play clearance before being able to get back to their sport. Protocols are not only a moving target but are also different from school to school, and county to county. Many patients are not involved in the decision making process of when they get to play again, and furthermore end up being out of sport longer than they need to due to the ordering of unnecessary tests, and long wait times for them. The aim of this study was to provide triage nurses and clinical site supervisor the most up to date and easy to use return to play protocol; to prevent unnecessary doctor’s visits and allow patients to be more engaged in the return to play decision making process.
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Dietary Effects of Vitamin K on INRs
Michael A. Lawson
INR monitoring can be difficult for patients. Vitamin K plays a major role in the regulation of INR control and warfarin efficacy. Fluctuations in daily vitamin K intake can alter INR values, leading to coagulopathic adverse events. Consistent daily vitamin K intake may help patients improve INR control.
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Transgender Care within Family Medicine: Focusing on Feminizing Hormone Therapy
Stellar Levy
Transgender populations experience health disparities and barriers related to gender identity or expression. Many people who identify as transgender avoid or delay care because of perceived or real transphobia and discrimination by health care providers and institutions. Providers may benefit from easy access to information about people who identify as transgender and their health needs.
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When Patients Re-engage
Timothy L. Long
Patients can often feel overwhelmed or intimidated by a trip to the doctor's office. But when a patient has not seen a doctor in several years, those feelings can contribute to avoidance of the healthcare system in general. This project seeks to help assuage concerns and empower patients during their first visit back to a primary care physician.
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A Mobile App To Improve Patient Education In The Management of Chronic LBP
Cole Lutz
The purpose of this project is to educate patients about the treatment of CLBP through an interactive mobile app, with the goal of improving transparency regarding the risks and benefits of various interventions. Most patients with CLBP lack the time and knowledge to perform a thorough literature review to determine the rates of efficacy and complications associated with their treatment. A mobile app that summarizes this data and translates it in a way that patients can understand would facilitate clearer communication and expectations between patients and providers. With improved patient education, patients would presumably be more likely to participate in informed shared decision making with their provider regarding their car. Additionally, patients would be more likely to collaborate with their providers to select the least invasive treatments appropriate for their condition that are associated with the highest rates of efficacy and patient satisfaction. Ideally, this approach would result in improved patient outcomes and a greater proportion of patients being satisfied with their treatment.
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911 or Primary Care - Who Should I Call?
Jack F. Mangn
US emergency departments (EDs) are overcrowded & overwhelmed - especially in Vermont. An estimated 37% of all ED visits are for non-urgent complaints. Factors associated with frequent ED use for non-urgent complaints include overestimation of disease severity and lack of understanding of services provided.
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Accurate At-Home Blood Pressure Readings
Shivani Mathur and Shivani Mathur
Blood pressure follow-ups are some of the most common reasons for clinic visits. Patients are told to monitor their blood pressures at home and medication dosages are adjusted in clinic to reflect their blood pressure readings at home. However, many patients are not aware of proper blood pressure measurement techniques, which could lead to inaccurate readings and therefore, inaccurate treatment. This project will provide a simple infographic to increase compliance with accurate blood pressure measurements.
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Pediatric Anxiety - A Guide for Parents
Paul McCleary
As of April 2022, the United States Preventive Services Task Force (USPSTF) recommends that all children age 8-18 be screened for anxiety. Whether this recommendation is due to the many changes and stress stemming from Covid-19, the community was left with a need for insight into properly addressing this issue. Whether it be for parents at home or physicians in the clinic, clear educational pamphlets identifying alarm signs and home recommendations will benefit the community.
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Pediatric Preventative Health Education
Trevor AR McDonald
Current education by primary care providers on preventative lifestyle and health habits for the pediatric population could be more effective. Limitations include short visit times, confusing existing resources, and lack of engagement from patients and their families. This project aims to develop a concise, interactive handout with specific, actionable recommendations for children ages 5-10 for healthy behaviors that can lead to improvements in chronic diseases.
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Improving Access to Mental Healthcare for Primary Care Patients
Kaela Mohardt
Access to mental health resources both nationally and in Vermont has become a challenge for both primary care clinics and patients to navigate. Attributed to a multitude of factors including cost barriers, limited health professional availability, societal stigma, this is a behavioral health need that requires attention to improve success of patients receiving mental healthcare. This project focuses on addressing one aspect of that need from a clinical level, creating and updating a referral handout for both patient and provider use. The outcome of this project aims to increase the likelihood of successful patient referral to needed mental health resources.
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Evaluating the Awareness of Medical Staff in Regards to the Environmental Effects of Single-use, Disposable Medical Gloves
Nathaniel Moore
This study was performed to evaluate the awareness of medical staff in regards to the environmental effects of single-use, disposable medical gloves. The volume and cost surrounding medical glove usage, waste production, and environmental effects require further attention. This research project outlines awareness as the first step in the right direction with future hopes to find a more sustainable solution.
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Brief Overview of Service Animals and the Laws in Vermont
Lara Murnik
Very few people are well versed in the various recommendations, laws, and rights of various types of assistance animals. This problem becomes more apparent as you look into the healthcare system where you see clinicians, other healthcare workers, and hospital systems struggling to navigate this field, especially in regards to their patients. The purpose of this project was to create informational flyers that could help elucidate the different rights and roles of different types of assistance animals, provide a deeper look into service animals specifically in the state of Vermont, and create a universal template for EHR's that clinicians may share and use to better serve their patient's requesting emotional support animals (ESAs).
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Accessible and Affordable Medications: MaineCare Edition
Amanda Nattress
Addressing gaps in prescriber tools for accessible and affordable medications regarding the most common diagnoses in primary care. MaineCare Edition.
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Compiling Diverse Affordable Housing Resources for Distribution in Primary Care
Arjune Singh Nibber
During primary care office visits, patients often mention concerns regarding social determinants of health that are unable to be fully addressed in the limited time of the appointment. Often, these concerns center around housing concerns and related financial strain. Several such instances were documented during this rotation.
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Increasing Advance Directive Participation in Primary Care
Rhys Niedecker
Advance directives are a critical part of patient management and care, yet the majority of adults have not completed the documentation. Using fliers in exam rooms and encouraging provider engagement can help increase the proportion of patients who complete advance care documents in Family Medicine settings.
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Patient Education: OTC Medications for Upper Respiratory Infection
Lauren A. Okamoto
Upper respiratory infection (URI) is among the top three diagnoses in the outpatient setting. Symptomatic relief is the reason for the most visits related to this diagnosis in the first couple of weeks after the onset of illness. Patient education on OTC medications for this use is often a component of these visits. The goal of this project is to create a standardized tool for patient education and reference to improve efficiency of education as well as patient understanding and future use of resources.
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