As the immune system tends to weaken over time, patients aged 50+ begin having increased risk for certain potentially preventable diseases, especially shingles and pneumonia. Although there are vaccinations to protect against these diseases, there are many significant barriers preventing patients from receiving the vaccines that they need, including potentially confusing guidelines, concerns over risks, and recent changes to vaccine recommendations. This project aims to produce a clear and concise educational brochure to help overcome some of these barriers, and to drive patient-provider conversation about their vaccine recommendations.
Anthony J. Gallegos
Recommending lifestyle changes to patients is a crucial part of a primary care physician's role. Guiding patients to make behavioral change is a challenge physicians must face on a daily basis, and based on current literature, it can be delivered more effectively in the form of motivational interviewing as opposed to traditional advice-giving. This project aims to provide physician's with a quick reference guide to Motivational Interviewing to display at their desk, as well as a template to be filled out with the patient detailing their plans for change. Together, these tools can improve the delivery of advice, and strengthen physician-patient relationships to more effectively achieve long-term health goals that require a behavioral change from the patient.
Francis G. Gause IV
PSA Screening Patient Information for 2017 guidelines
It can be difficult to locate a mental health provider in Vermont. Consequently, many individuals with mental illnesses look to their primary care physicians to fill this gap. This project highlights difficulties faced by patients with PTSD and complex PTSD in Chittenden and Addison counties in finding a therapist or psychiatrist. A resource handout was created with instructions on how to find a therapist in VT and a list of practitioners in Addison and Chittenden counties who specialize in trauma. In addition, a patient information sheet that answers some questions about PTSD and complex PTSD and also provides a list of mindfulness exercises that can be used by patients while they are waiting to find a mental health practitioner.
Opioid overdoses are a growing public health concern in Vermont and nationwide. Naloxone can save the life of someone who overdoses, if those around them know how to use it. This project investigates the feasibility of offering naloxone education as an element of routine primary care encounters with patients who do not use opioids themselves.
Radon is a colorless and odorless radioactive gas produced by the natural decay of uranium in rock and soil. Long term exposure to radon gas is the leading cause of lung cancer among non-smokers, and the second leading cause over all after smoking. Children exposed to unsafe levels of radon are particularly vulnerable because smaller lungs and faster respiratory rates are thought to result in higher radiation doses compared with adults. One in eight homes in Vermont contain unsafe levels of radon gas compared with one in fifteen homes nationally. Radon gas exposure is not currently addressed as a preventative health measure in primary care clinics. This intervention was aimed at creating a radon resource document embedded as a “smart phrase” in EPIC enabling clinicians to rapidly provide clear information for patients without encumbering time constrained appointments. The intent is to equip providers with a tool for introducing the topic of radon at pediatric well visits and give patients access to additional information included in their After Visit Summaries.
ACEs and Resilience: Increasing patient knowledge of Adverse Childhood Experiences and stress coping techniques
At The Health Center, a federally qualified health center in Plainfield, Vermont, providers have begun an initiative to screen patients during routine clinic visits for their Adverse Childhood Experiences score. In a population subject to the social, economic, and health-related challenges of rural Vermont, providers have identified the screening process as a vital tool for better understanding their patients' health. To better aid in both provider comfort and patient education during said interactions, a pamphlet was created to guide provider conversations concerning ACEs. The pamphlet details information about ACEs and health consequences, the importance of the relaxation response in dealing with toxic stress, and the ways in which we can help foster resilience in children.
Michael J. Hall
Intimate partner violence screening is recommended in all women of child-bearing age. Ensuring validated screening tool utilization and employing strategies to identify risk while providing non-judgmental support is critical to identifying patients and optimizing appropriate resource referral.
Russell D. Himmelstein
This project focused on Lyme Disease prevention, specifically for cub scouts from 5-10 years of age and their families.
Ideas on following a diabetic diet using ingredients from a dollar store.
Erin E. Hunt
The current standard of practice for postpartum contraception in Plattsburgh, NY, as well as much of the United States, is initiation of contraception at the standard 6 week postpartum visit. However, many women may be better suited for immediate postpartum contraception while still hospitalized in labor and delivery. Long acting reversible birth control (LARC), including hormonal IUDs, copper IUDs, and progesterone implants, were the contraception types focused on in this project. Family medicine residents at CVPH reported low confidence in postpartum contraception as a whole. Furthermore, they reported limited knowledge on immediate postpartum contraception. The primary aim of this project was to expand the resident knowledge base on postpartum contraception and encourage them to consider immediate postpartum contraception in certain patients via an educational session.
A large proportion of major depression in Vermont has a seasonal pattern. The most common form of Seasonal Affective Disorder is winter depression. Several evidence-based treatments exist for SAD including light therapy, CBT, and antidepressant medications. Adjunct therapies, like exercise and social interaction, can also help patients feel better during the winter. In the primary care setting, an educational handout/poster will aid in educating patients about SAD and treatment options, and encourage them to seek help.
Sarah Natasha Jost
Herpes zoster (shingles) is a viral infection that results in a painful rash and has a myriad of long-term complications, including post-herpetic neuralgia- chronic pain that does not resolved despite resolution of the rash. Over the last 20 years, incidence of shingles has increased by nearly 50% and now there are 2 vaccines available to prevent shingles. Shingrix was approved by the FDA in 2017 and has garnered public attention for its efficacy. I developed a brochure that gives patients information about shingles, Shingrix, and answers some frequently asked questions.
Amanda M. Kardys
In Clinton County, NY residents state that obesity, chronic disease, physical inactivity and low wages are top concerns. Many of these identified problems are tightly integrated and exacerbated by a lack of exercise education in this population. To address this, an exercise education pamphlet was created to be distributed to individuals in the community. The pamphlet focuses on discussing barriers such as time and cost of exercise, as well as enabling individuals with stretching information and local resources.
Promoting health literacy about added sugars, with a focus on patients with limited English proficiency
Excess consumption of added sugars has been linked to the development of obesity, diabetes, and cardiovascular disease. The sequelae of such health conditions accrue significant public health costs - both in terms of healthcare spending as well as associated co-morbidities and mortality. Chittenden County, Vermont is home to at least 6,300 new Americans, many of whom have limited English proficiency (LEP). Although office visits can provide crucial advice regarding proper nutrition, written resources available for LEP patients are lacking. This project aimed to meet that need through development of an infographic-rich handout that both promotes healthier grocery store choices and educates patients about added sugar. While it can be useful to those at all literacy levels, the heavy use of visuals was intended specifically to make the handout accessible for those with little to no English proficiency.
Britta J. Kilgus
It has been well established that individuals with mental illness and substance use disorders face numerous barriers to accessing adequate health care treatment including inability to pay, lack of insurance coverage, lack of provider availability, and stigma. The 2016 Community Health Needs Assessment for Washington County, Vermont identified substance use and mental health as priority health needs for the county. The purpose of this project was to evaluate the specific barriers individuals with mental health and substance use disorders are experiencing in Waterbury, Vermont. A survey was distributed to patients being seen at Waterbury Family Practice with behavioral health or substance use disorder diagnoses. The results demonstrated that approximately half of respondents felt they experienced barriers to treatment. The most commonly sited barriers were financial difficulty and lack of provider availability.
Caleb Daniel Knight
Falls in adults over 65 years of age constitute a significant health burden in our country, and this age group is growing rapidly. Falls are addressed with a multifactorial approach, addressing comorbidities, medications, and the physical environment, however, an effective point of intervention accessible by most older adults is physical activity. A brief educational presentation about the morbidity and mortality associated with falls, and the protective effects of physical activity, was provided to Meadowbrook Healthcare subacute nursing home residents in Plattsburgh, NY. Questions were encouraged and answered afterwards, and copies of the presentation were left for the residents to review in hopes of increasing motivation to participate in the Meadowbrook Healthcare rehabilitative classes and exercises.
There is a well-established causative relationship between Adverse Childhood Experiences (ACE’s) and pathology. Despite strong supporting evidence, some healthcare workers are unaware of how deep this relationship is. I conducted an educational session surrounding ACEs targeting healthcare workers in an attempt to contextualize the relationship between ACE’s and consequent disease.
Joseph J. Lahey
Despite public health efforts in recent years to provide additional care to the LGBTQ community, many health disparities still exist. It is difficult to address these problems due to the lack of organized data being received from health care institutions. Many medical offices have failed to provide a comfortable environment for LGBTQ individuals. This project illustrates a presentation given to staff at a primary care office on how to make the clinical environment more inclusive to LGBTQ individuals in order to provide adequate care.
Provider Opinion: Should We Screen and Counsel Parents of Teen Drivers Regarding Texting/Distracted Driving?
Adolescent texting and driving has been directly responsible for the deaths of 11 teenagers every day. 33% of teenagers in Vermont admit to texting and driving making it one of the most prevalent risky behaviors in their age group. Currently there is no routine screening recommendation for parents with adolescent drivers addressing texting and driving. Mobile application information can improve parental monitoring and prevent texting and driving habits from forming in adolescents.
Depression in the perinatal period is a common medical issue in Vermont, affecting about 10% of women. Multiple and severe consequences of depression during this time are seen for both mothers and babies, including lower breastfeeding rates, fewer healthcare visits for the child, and psychopathology in the child later on. The goal of this project is to identify and address some of the barriers we currently face in identifying and treating women for depression. Major barriers women encounter in seeking help involve poor recognition of symptoms facing increasing stress of motherhood, stigma, as well as neglecting to attend to mental health preemptively. An educational pamphlet for mothers was developed to address these issues.
Ryan Erik Landvater
Smoking is still the leading preventable cause of death in the USA with 75% of current smokers expressing a desire to quit, though a meager 2-3% succeed. Previous research has shown that financial incentives for smoking cessation are among the most efficacious. Vermont has implemented high taxation to these ends, though many smokers still do not grasp the financial burden it poses on their discretionary income. A handout was developed that conveys both the cost of smoking at a pack rate over set time frames and provides potential savings rendered by nicotine replacement therapy. The handout will be made available as part of patient instructions printed via the electronic medical record system used by UVM.
In longitudinal studies of women residing in northern latitudes (i.e. Vermont), bone loss was most pronounced during winter months when sun exposure and weight-bearing activities are more limited. Although information about screening and treatments for osteoporosis are widely available to patients, there appears to be a gap in education about risk factors that predispose one to this silent yet deadly disease as well as strategies for prevention according to several community interviews that I conducted. In response to my conversations about osteoporosis, I decided to focus my intervention on educating the community about osteoporosis risk factors, recommended weight-bearing exercises, and the types of foods that contain adequate amounts of vitamin D and calcium. A poster serving as an educational guide was created by compiling information from the National Osteoporosis Foundation and the CDC. The poster will hopefully increase awareness about osteoporosis risk factors and motivate patients (both females and males) to start conversations with their healthcare providers on how to best prevent osteoporosis.
Jacob Thomas Lehman
No different than many other Northeastern states, Maine continues to face an opioid epidemic. Drug-induced deaths continue to rise each year and Lewiston, ME remains no exception. In 2017 Maine saw 418 deaths related to drugs, a number that is only increasing every year. There remains a rising need for effective treatments such as medically assisted therapy. Starting in 2018, the Family Medicine Residency at the Central Maine Medical Center created such a group and began treating patients. The scope of this research is to track improvements in self-sufficiency among patients and to aide in advertisement of the program. Programs like this often remain unknown to those seeking treatment.
Benjamin H. Lin
This project aimed to identify barriers and provide a list of resources within the Addison County community to enhance access to exercise during the winter months.
Exercise Education for the Winter Season
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