Skin cancer is the most common cancer in the United States. There are three main types of skin cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. While Melanoma is less common than Basal Cell and Squamous Cell Carcinoma, it has a higher mortality rate. If diagnosed in earlier stages, Melanoma has a significantly better prognosis and lower patient costs. Most skin cancers are diagnosed through skin biopsies. Vermont has one of the highest rates of skin cancer. The goal of this project was to develop a patient handout to bring patient awareness to skin cancer and describe the different types of skin biopsies (shave, punch and excisional), as well as Mohs surgery.
Megan N. Eubank
Almost half of all US adults have hypertension (high blood pressure), which is a major risk factor for heart disease and stroke. Hypertension can be controlled through a combination of diet, exercise, and medications. The DASH diet has been proven to lower blood pressure in as little as two weeks. I created a brochure and Epic SmartPhrase that explains and simplifies the DASH diet for patients.
A significant portion of patient visits at Milton Family Practice are related to one or multiple aspects of metabolic syndrome. Exercise is a common topic during these visits either brought up by patients or providers. This project focused on creating a handout for patient education with answers to commonly asked questions pertaining to exercise and resources in the community.
Prevalence of mental health issues has increased during the time of COVID-19. There are many contributing factors to consider, the main one reported has been social isolation due to quarantine precautions. Members of the community have spent extended periods of time at home and away from their loved ones during this pandemic. Many patients have reported many life events occurring including deaths in the family without the ability to even mourn with their family members. This has taken a toll on the community, especially in Vergennes where this small tight knit community that has relied on its tight social bonds for wellness. There has been a trend of depressive symptoms rising in the community as well as an increase in reported anxiety. There is a shortage of mental health services through therapists and psychiatrists during this time, and a possible solution is the use of technology, specifically phone apps to aid with mental health concerns for members of the community who are unable to meet with a specialist. This project consists of a handout containing 7 apps for mental wellbeing reviewed by the Anxiety and Depression Association of America (ADAA).
Nina Feinberg and Naomi Koliba
According to the 2019 Youth Risk Behavior Survey, LGBT middle and high school students are twice as likely to be bullied and are five times more likely to attempt suicide.
Coping with a stressful environment at school puts LGBT youth at risk of detriment to mental health, educational inequities, and even physical harm.
Adults at school who have relationships with youth are in a position of power to uplift and advocate for LGBT youth, and to educate those around them to create a safe environment for everyone to learn.
While teachers and other staff may offer students support, they may be unable to answer healthcare related questions that gender questioning adolescents have.
A document was created integrating resources centered on LGBT+ youth in Chittenden County, in Vermont, and across the country.
The document contained a series of questions and answers that adolescents may have about gender and what a doctor’s appointment would include.
An online version of the document was given to Milton High School and Champlain Valley Union High School to distribute to all students via email.
Both interviewees agreed that Milton High School staff are well-versed in the basics of pronoun use, but could use more training to apply their knowledge to support students.
Both interviewees also agreed that additional staff-wide training has been challenging during the COVID-19 pandemic but would be beneficial in following years.
Brad R. Fiske
Conversion of research protocol into QI project at Norwalk Community Health Center. Goal is to implement waist circumference as a vital sign.
How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention
In recent years, a number of pre-exposure prophylaxis (PrEP) medications and dosing strategies have become available to patients to help prevent human immunodeficiency virus (HIV) infection. The primary objective of this research was to assess current PrEP awareness and prescribing practices of family medicine providers at the Hinesburg Family Medicine practice in Hinesburg, VT.
In the primary care setting, patients frequently bring in a list of various supplements or herbs that they are taking for a variety of medical conditions, including anxiety, with the hope to engage in a conversation with their PCP about whether these various supplements are safe and worth the cost. Physicians are often limited by a lack of training on the topic and/or by time constraints in the clinic. Thus, this aspect of care is not well addressed. This project includes the creation of a patient education sheet containing information about common herbal/natural supplements used for anxiety. It highlights the current evidence for efficacy, adverse effects, and drug/medication interactions. By providing some basic information on natural anxiety treatments, this aspect of care that is important to patients may be better addressed.
This project is a continuation from the Addressing COVID-19 Vaccine Hesitancy project. As time has progressed since the Pfizer, Moderna, and Johnson & Johnson vaccine were first distributed in the United States, more individuals are getting vaccinated. However, there is still many individuals who are hesitant to get the COVID-19 vaccine. CDC has been addressing this by encouraging medical providers to educate their patients about COVID-19 and the COVID-19 vaccines. With the recall and resumption of Johnson and Johnson, engaging in conversations about the mRNA vaccine technology, efficacy, and safety of the vaccines may help reduce public hesitancy. An educational handout that was created by a prior medical student was distributed at the Brookfield Family Practice. A survey was created and distributed to the patients. The survey looked at patients’ demographics, if patients were vaccinated, and whether the handout provided guidance in understanding more about COVID-19 and the vaccines.
Recent years have shown a dramatic increase in the popularity of electronic vapor products, which include e-cigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens, and mods. While emerging data shows that adolescents are becoming more aware of the dangers posed by these products, more than 3.6 million US youth still use e-cigarettes. As of February 18, 2020, a total of 2,807 hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) cases or deaths in the United States have been reported to CDC.
This project had two goals: to create a tool to help facilitate discussions between providers and their adolescent patients around vaping, and to create an infographic that would simply and clearly provide adolescents with information about the dangers of vaping as well as resources to quit.
Aram S. Garewal
COVID-19 vaccine hesitancy in the United States is a major roadblock in the fight against a raging pandemic. Education on mRNA vaccine technology, efficacy, and safety may help reduce public hesitancy. An educational handout was created and distributed at the Brookfield Family Practice to help alleviate COVID-19 vaccine hesitancy in the local community.
Physician and patient education materials regarding the incidence of bladder cancer in Vermont, the absence of recommended screening, and discussion of risks of bladder cancer with emphasis on private well water testing through the Vermont Department of Health.
Charlotte B. Gemes
Many parents at Community Health Center of Burlington have questions about infant care after their baby is born and do not know where to turn to find the answers, An Infant Care Guide is therefore being developed to help new parents on basic topics. The section "Safe Sleep for Newborns" was developed and added to already developed chapters to provide parents the basics on safe sleep.
Updating Evidence-Based Patient Education Resources for Sleep: Sleep Hygiene and Benzodiazepine Discontinuation
Carolyn Geraci and Madeline Fritz
There is a major need for patient education around the topics of sleep hygiene and benzodiazepine sleep aid discontinuation in the family medicine clinic setting. Current patient-focused educational materials need updating and are not comprehensive enough. We therefore created new handouts and smartphrases which integrate into the electronic medical record system with the goal of educating patients on these topics.
Keira L. Goodell
At Milton Family Practice in Milton, VT, individuals diagnosed with pre-diabetes are referred to a clinical nutritionist and sent home with patient instructions about blood sugar and carbohydrates. For those who decline a meeting with the clinical nutritionist, the patient instructions are not an adequate substitute. This project focused on the creation of a SmartPhrase to be added to patient instructions outlining common high-carbohydrate foods and options for lower-carb alternatives.
In addition to its important role in the maintenance of physical health, exercise has been shown to have numerous benefits for mental health. Recent studies indicate that even brief engagement in physical activity can make a positive impact on the treatment of pre-existing anxiety and depression - as well as the prevention of future symptoms. Despite this relationship between exercise and emotional wellness, regular activity in the United States is still exceedingly low, and exercise remains an underused tool by healthcare providers in the treatment of their patients’ anxiety and depression. The goal of this project was to assess patient engagement in and barriers to exercise, as well as their understanding of its benefits for mental health as perceived by providers at CVPH Family Medicine Center, and to create a patient-centered resource emphasizing the significance of physical activity in reducing the burden of anxiety and depression.
Dietary recall by patients is time consuming & inefficient. This project aims to develop a screening tool to accurately and efficiently track patient's diets over the course of multiple healthcare visits.
Evaluation of growth in clinical genetics competency among PCPs participating in the UVMHN Genomic DNA Testing Program
Recently UVM Health Network Family Medicine practices have implemented “The Genomic DNA Test” pilot program to begin a concerted effort toward offering genetically informed primary care to all patients. The program aims to increase the number of participating primary care providers stepwise over time. However, some providers may find integration of genomic testing and discussion of clinical genetics issues with patients to be challenging given the relatively recent change toward emphasis on these topics in medical training curricula. The aim of this project was to develop a pilot survey to gather information from current participating providers about how participation in the genomic testing program has influenced their personal knowledge of and comfort with clinical genetics topics and patient counseling.
Increasing Patient Access to LGBTQ+ Healthcare through Expanding the Vermont Diversity Health Project
Numerous studies have documented various disparities in health outcomes and barriers to healthcare access for LGBTQ+ individuals. One major way to combat this is to increase access to healthcare for LGBTQ+ patients and increase provider knowledge of how to best care for them. Through expanding the Vermont Diversity Health Project database of providers and having providers participate in LGBTQ+ Best Practices trainings (both hosted by Pride Center of Vermont), we may reduce LGBTQ+ health disparities in our local community.
obhijit d. hazarika
In Lewiston, Maine the opioid epidemic is a public health crisis resulting in overdose-related deaths, infectious disease transmission, and public health costs. Harm reduction through resources such as syringe service centers, peer counseling, and Narcan distribution can help negate the negative health impact of substance use disorder. This project focused on creating a list of local harm reduction resources for providers so they can educate patients on how to be as safe as possible when using substances.
There are many current barriers to participating in exercise and physical therapy in the elderly. Using reputable online resources, we created a handout containing a list of exercises that can be completed safely at home without equipment. It was designed for elderly individuals, as inactivity tends to increase with age and this population is particularly vulnerable to the deleterious effects of inactivity. The strength and flexibility exercises primarily target the back, hips and core, common problem areas in the elderly. The handout will contain links to further resources for more in-depth physical therapy exercises and will be tailored for administration in a primary care setting.
Catrina Hood and Jacob Shaw M.D.
The Reach Out and Read (ROR) program is an evidence-based model of literacy promotion used to deliver anticipatory literacy guidance and books to parents and caregivers of children, ages 6 months through 5 years, at well child visits with Primary Care Providers (PCP's). The objective of this project was to assess provider familiarity with and utilization of ROR at the Community Health Centers of Burlington (CHCB) via anonymous survey.
Smoking Cessation Associated Weight Gain: The Role of Diet and Exercise Counseling in Quitting Smoking
Benjamin D. Kagan
Weight gain is a common unintended consequence of quitting smoking due to a combination of physiologic and behavioral factors. Counseling focused on diet and exercise reduces weight gain associated with smoking cessation. Reduction of weight gain related to smoking cessation maximizes the health benefit of quitting tobacco.
This project explored the challenges of remaining active during Vermont winter for patients with chronic disease. It further complies resources in the community for maintaining activity levels over the winter months.
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