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Assessing Adherence with Naloxone Prescription Guidelines for Chronic Pain Patients: Recommendations for Improvement
Elizabeth O'Neill
Although the Vermont statute governing prescription of opioids for chronic pain states that patients taking over 90 morphine milliequivalents daily or opioids with a benzodiazepine should receive a naloxone prescription, there is no mechanism within the Chronic Opioid Protocol report at Colchester Family Medicine to assess adherence to that policy. This project sought to determine if there is a gap between patients who should receive a prescription and patients who have a prescription to see if there is a need to alter the Chronic Opioid Protocol or provide greater monitoring to ensure patient safety while on opioids for chronic pain.
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Xylazine as an Emerging Risk in Vermont: Harm Reduction for Primary Care Providers and Patients
David J. Patlak
Xylazine, a sedative primarily used in large animals, has emerged as an increasingly prevalent adulterant in the illicit opioid supply in the state of Vermont. Xylazine use poses significant health risks to individuals who use illicit substances due to increased risk of overdose in conjunction with opioids and chronic injury, especially skin ulceration and necrosis. This project focused on increasing education and awareness around xylazine in opioid user populations and primary care providers who work with these patients. The project's outcomes and effectiveness will be evaluated through assessments and feedback from healthcare providers. By equipping healthcare professionals and patients with knowledge and resources, this intervention will contribute to reducing the adverse health outcomes associated with xylazine use, thereby improving patient care and public health in the state of Vermont.
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Increasing Awareness of Respiratory Syncytial Virus (RSV) and RSV Immunizations
Joanna Pierce
Respiratory syncytial virus (RSV) is a common seasonal respiratory virus that can cause severe respiratory infection in infants, young children, and older adults. Recently, the FDA approved RSV vaccines and monoclonal antibody products to help protect individuals at risk of developing severe infection. Since these approvals, there has been an increase in questions about RSV and immunizations from patients and healthcare professionals. This project aimed to create educational materials about RSV and immunization guidelines, safety, and efficacy for patients and healthcare staff. The goal of these educational materials was to increase awareness of RSV, increase discussions between healthcare providers and patients about RSV and immunizations, and to increase RSV immunization rates among at risk populations.
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Assisting Rural MAT Patients Through Peer Social Support
Anthony Plochocki
Throughout the COVID19 Pandemic, there has been a spike in opioid relapse and opioid overdose related death. This problem, though multifactorial, can be attributed to lack of social outlets for MAT patients. Now that different social support groups are reopening, there is a greater emphasis placed on groups for patients suffering with alcoholism rather than those suffering from opioid addiction. This project hopes to plant the seeds for group therapy for MAT patients, giving them a social outlet with the hopeful outcome assisting patients with forming non-user networks.
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Community resilience in Vermont after the 2023 flooding event
Alex Poniz
Between July 10th-11th 2023 Vermont experienced catastrophic flooding after receiving prolonged heavy rainfall of up to 9” over 48 hrs. Damage from the 2023 event rivals the historic destruction of Hurricane Irene in 2011 and is exceeded only by the Great Vermont Flood of 1927, an event predating modern flood controls. We collected oral histories from Vermonters to better understand their lived experience of the flood and its impacts, and identifed common themes related to community and individual resilience.
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Implementing a Patient Resource Guide on Intimate Partner Violence (IPV) at a Connecticut Primary Care Practice
Mahima R. Poreddy
Intimate partner violence is an ongoing public health crisis in the United States. According to the Connecticut Coalition Against Domestic Violence, nearly 39,000 victims were served in 2021, which was a 5% increase from the year prior. As intimate partner violence continues to affect numerous lives in Connecticut and across the nation, the risks of seeking assistance in these situations prevent those experiencing domestic violence from accessing support services. The cost of intimate partner violence can range from an increase in health care utilization to restricted access to safe housing. The Ridgefield Primary Care practice does not currently have educational materials or resources displayed regarding domestic violence or sexual assault. By designing a brochure on intimate partner violence, primary care patients will have increased awareness of local and national services. The patient resource guide highlights how to identity intimate partner violence, including emotional abuse as well as physical or sexual abuse. By increasing awareness on this subject and including contact information to access support, patients are better equipped to seek assistance safely and connect with their medical provider.
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Bridging Cultural Barriers to Perinatal Mental Health Care in New Americans
Madeline Yvette Powell
Perinatal mental health outcomes are worse in New Americans, particularly in refugee patients. Mental health stigma and cultural differences in views on mental illness impact New Americans’ willingness to discuss mental health concerns with healthcare workers. This is in addition to language barriers, time constraints, financial barriers, and general mistrust of medical professionals.
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Improving Knowledge of Contraceptive Options in Teenage Male Populations
Anthony Quach
Despite a plethora of contraception available on the market, nearly 50% of pregnancies in Vermont are unintended. Currently, most educational initiatives aimed at improving contraceptive usage are targeted towards individuals with uteruses, and not their partners with penises. Both qualitative and quantitative data suggest that there are significant gaps in this latter population’s knowledge about contraception for various reasons like limited contraceptive education within formal sexual education in schools, lack of parental and/or physician discussions about contraception, and various complex social and cultural factors. This intervention aims to bridge the knowledge gap in this population by using an educational pamphlet. Improving the awareness and understanding of contraception options in populations who do not actively use contraception may help partners have more open and informed discussions that lead to more consistent contraceptive use.
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Improving Depression Screening Protocol and Subsequent SBIRT Referrals
McLaine S. Rich
As a federally qualified health center, Lamoille Health Family Medicine receives annual data evaluating their performance in a number of categories. They exceeded expectations in screening eligible patients for depression, yet did not see the same success in referrals following a positive screening. After discussing with nursing and physician staff it became clear that there were discrepancies regarding office workflow/specific responsibilities. Moreover, some physicians expressed that they were unsure exactly how to handle positive screening results. This flowsheet developed will alleviate confusion in who is responsible for each step of screening, and uses evidence based guidelines for when to refer to mental health counselors vs. other interventions.
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Handout to Promote Diabetes Education in Spanish Speaking Patients
Javier Rincon
Hispanic adults are 70 percent more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician. In 2017, Hispanics were twice as likely to be hospitalized for treatment of end-stage renal disease related to diabetes, as compared to non-Hispanic whites. In 2018, Hispanics were 1.3 times more likely than non-Hispanic whites to die from diabetes. Lack of readily accessible educational material in different languages can lead to educational deficits in non-English speaking patients.
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Depression Screening and Suicide Risk Assessment in Older Patients
Faith Robinson
Older adults are at an increased risk of depression, but they are often undiagnosed and untreated. Depression is also a significant predictor of suicide in older Americans, who have among the highest rates of suicide of all age groups in the United States. Most older adults seek treatment in primary care settings and are less likely to use emergency interventions, so knowing how to screen for depression and suicide risk is crucial for primary care. Unfortunately, primary care providers, while being first-line for identifying depression, accurately recognize less than half of patients with depression. This pamphlet is aimed at increasing provider awareness of tools they can use to screen for depression and asses suicide risk in older patients.
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Improving Identification of Peripheral Arterial Disease In the Outpatient Setting
William Robinson
Over 7 million Americans are known to have peripheral arterial disease (PAD). However, it is well established that many more live with the disease and are simply undiagnosed, often due to variations in presentation. Presence of PAD is associated with significant morbidity and mortality, but when caught in its early stages, progression can be slowed with simple conservative measures. Therefore, a more targeted screening program with in-office ankle-brachial index capability (sensitivity and specificity >90% for diagnosing PAD) could identify a debilitating disease much earlier in its course regardless of symptom presentation, and create an opportunity to significantly improve preventative health in the outpatient setting.
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Improving access to and quality of self-guided physical therapy exercises at home for patients residing in regions with limited resources
Matthew R. Rzemien
Access to physical therapy can be a challenge for those residing in resource-limited settings such as a rural area like Essex County, New York. Nonetheless, musculoskeletal complaints are some of the most common reasons patients seek care in primary care clinics. In areas that lack the availability of formal physical therapy, clinicians often provide patients with instructions on how to perform exercises at home to help improve their pain. This project sought to bolster the resources available to distribute to patients to improve the quality of self-guided physical therapy exercises at home.
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Incorporating Social Stories into Patient Waiting Room
Ashwini Sarathy
Missed well child appointments are common across the country. In an effort to limit anxiety related to doctor's appointments, social stories were printed and offered to patients in the waiting room. The social stories went over common activities performed while at the doctor's office including taking blood pressure, height, weight, getting vaccines and physical exams.
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Screening for areca (betel) nut & quid use
Gabriela Sarriera Valentin MS
Standardized screening tools for patients who use betel quit and areca nut products do not currently exist. Given the increased risk of oral and oropharynx cancer development in this patient population, increasing awareness of this practice could result in decreased morbidity and mortality. The purpose of this project is to (1) increase provider awareness of this cultural practice and its associated health consequences, (2) to develop a screening tool, and (3) to propose suggested follow-up when concerning lesions are identified.
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Improving Safety for Recreational Water Sports at Candlewood Lake, CT
Brian L. Shaw II
Every year millions of people utilize bodies of water to participate in recreationally acitvity. Although the time spent outside and being physically active are widely endorsed as healthy habits, any body of water comes with safety risks that many do not anticipate. This project looked to improve safety for recreationally water sports and activity at Candlewood Lake, CT the largest lake in the state that is accessed by thousands evach year.
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Pre-visit questionnaire for diabetic patient visits
W. Evan Shaw
What role does a pre-visit questionnaire, such as a "diabetic distress tool," play in optimizing diabetic patient visits?
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Adolescent Substance Use: Standardizing Screening Methods in Clinical Practice
Bryan D. Shin
Adolescent substance use is a highly pervasive issue that strongly correlates with increasing depression and anxiety rates. Standardized screening tools for substance use, such as the CRAFFT or the Screening to Brief Intervention Tool, are freely available but not widely utilized for every patient encounter in clinical practice. This project aimed to improve standardization of substance use screening at a primary care clinic located in Castleton, Vermont through implementation of the CRAFFT tool as an automatically-loaded form in each adolescent encounter note. The goal was to improve substance use detection rates by facilitating efficient incorporation of standardized screening into the primary care provider's workflow.
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Consent Education for Adolescents
Paige T. Song
In primary care practices, prevention and early intervention is key. Educating adolescent patients about consent and reinforcing the topic early on may help to decrease the downstream prevalence of sexual violence.
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GUIDE2LABS: Integrated Patient Education in Epic
Jared Stone
This project aimed to build on a prior family medicine clerkship project which designed a pamphlet containing high-yield facts to help patients interpret common lab results. An Epic SmartPhrase was created from this information and made available for all users at Colchester Family Medicine. Fewer messages from patients inquiring about lab values would be expected to be routed to providers if this intervention were successful upon further evaluation. Future projects could create SmartPhrases which cover other frequently ordered tests, such as complete blood counts with differential, thryoid cascade, iron studies and urinalysis.
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