Block Clerkship Projects

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Assessing Barriers to Mental Health Treatment

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.
Physical Activity and Fall Prevention in Older Adults, an Educational Intervention

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.
ACE’s Contextualization for Healthcare Workers

Nektarios Konstantinopoulos

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.
LGBTQ Inclusiveness in the Primary Care Setting

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?

Daniel Lambert

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.
Perinatal Depression: Breaking Barriers to Treatment

Florence Lambert-Fliszar

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.
Breaking the Bank: Cost of Cigarettes in Vermont

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.
Osteoporosis Education: An Insight into Risk Factors & Prevention

Alan Lee

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.
Restoring Self-Sufficiency with Suboxone Group Therapy

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.
Exercise Education for the Winter Season

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
PSA Perspectives

Kirsten Martin
Adolescent and Young Adult Medicine: Supporting An Often Forgotten Population

Isabelle Mason

The actions and lifestyle choices adolescents and young adults make have profound effects on their future health and well-being. Unfortunately, these patients are often scarce among family practice lineups, making it difficult for physicians to provide impactful preventative care. This project looks at how to help reach these oft-forgotten patients.
Prostate Cancer: Patient Education for Changing Guidelines

Richard Mendez

In May 2012 United States Preventative Services Task Force (USPSTF) recommended against prostate cancer screening, Grade D, with no other recommendation for providers. Since prostate cancer continues to be among the most common cancer in the United States among men, patients were exposed to previous guidelines during routine visits and require updated educational materials for primary care visits.
Combating Childhood Obesity

Rebekah Misir

Assessing childhood obesity in Danbury, CT and combating it through counseling.
Window of Opportunity for Opiate Dependence

Scott C. Mitchell II

Opiate dependence is a prevalent problem and there is a need for current regional information for those seeking to break opiate dependence. There is a small window of opportunity for these patients to seek and find help before they give up and return to using. This project provides a pamphlet with current resources for opiate dependent individuals to get help in a rapid period of time for the Bangor, Maine area.
Incontinence and Pelvic Floor PT in the Primary Care Setting

Nikolas A. Moring

Stress incontinence and overactive bladder are two causes of decreased quality of life in the general population. Many patients report a long latency between the onset of symptoms of incontinence and identification and treatment. This project aimed to provide educational materials to both providers and patients about incontinence to help better identify patients who may benefit from pelvic floor physical therapy. Pelvic floor physical therapy has been demonstrated as a safe, non-pharmacological intervention for stress incontinence which may be overlooked in the primary care setting.
Understanding Dual Energy X-Ray Absorptiometry (DEXA) Bone Scan Results and Treatments

Jennifer C. Morris

Patients come into the St. Albans NOTCH primary care office for a follow-up to their DEXA scan to learn about what their results mean and discuss any questions/concerns. This brochure will help to standardize the information presented by providers about the results.
Recommendation for Routine Prenatal Screening for Hepatitis C

Althea L. Morrison

Hepatitis C prevalence and incidence are on the rise, both nationally and in Vermont. This project aims to assess the feasibility and potential benefit of implementing routine prenatal Hepatitis C screening, as opposed to screening only patients who fall within the high exposure risk category. Routine prenatal screening is a simple and cost effective means of increasing the early detection and treatment of Hepatitis C.
Improving Awareness of Colon Cancer Screening in the Homeless Population of Burlington, Vermont

Alexis Nadeau

Homeless populations are significantly less likely to access preventative cancer screening, yet this is a major cause of morbidity and mortality in this population. In the general population, colorectal cancer affects 1 in 20 people and is the number 2 cancer killer. Rates of colorectal cancer screening are particularly low in homeless populations. A poster was developed and posted in the waiting room of Safe Harbor clinic, a homeless health care program center, in order to increase education and awareness about colon cancer screening and colonoscopy.
Building Confidence in the Prescribing and Monitoring of Pre-exposure Prophylaxis (PrEP) in Vermont

Scott Neary

Vermont has the goal of zero new transmissions of HIV in the state by 2020. PrEP is a key component of achieving this goal. As of 2016 less than 50% of physicians felt confident in discussing and prescribing PrEP to their patients. This health project created a reference for physician's to utilize when prescribing and monitoring patients on PrEP
Patient Education: Importance of Diabetic Foot Care

John Paul Nsubuga

Diabetes is about the leading causes of mortality in united states, estimated to cause greater than 80,000 deaths annually. With the ongoing obesity epidemic, the prevalence and incidence of this debilitating disease is on the rise. Diabetes the leading cause of non-traumatic lower extremity amputation in United states. These amputations are often preceded by infected non-healing foot ulcers. It is therefore of at most importance to continue educating diabetic patients on proper foot care management to prevent ulcer formation. This project aims to create a patient educational brochure about the importance of proper diabetic foot care, while providing easy to follow guidelines that will go a long way in helping prevent diabetic ulcers.
Lyme Disease Prevention in Western Connecticut

Tyler Oe

Lyme disease is a bacterial infection that is endemic to the Northeastern region of the United States, specifically Connecticut. Spread by the deer tick, Lyme can produce a constellation of symptoms that can adversely impact an individual. Living in Connecticut transfers a significant amount of risk to individuals and understanding the appropriate prevention techniques should afford protection from deer tick bites. Having a robust resource on preventative measures and signs and symptoms of Lyme will provide a foundation for minimizing the risk of getting Lyme disease.
Outpatient management of mood disorders by the family physician

Elizabeth O'Neill

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a "one-pager" table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.
Outpatient Management of Mood Disorders by the Family Physician

Elizabeth S. O'Neill

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a "one-pager" table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.
Patient Education on the Shingrix Vaccine

Arjun Patel

The CDC recommends that most adults over the age of 50 get the Shingrix vaccine for protection against shingles (herpes zoster). Many patients at the WCHN Southbury Primary Care clinic in Connecticut are eligible for vaccination but are unaware of this newer vaccine or are unsure if they need the vaccine based on their past medical history and vaccination history. A brief, easy to understand handout was made to educate patients on the Shingrix vaccine and address frequently asked questions.