Reducing Benzodiazepine Use for the Treatment of Insomnia and Supporting Nonpharmacological Therapies
UnChan PyonShort-term Project
Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.
Katherine CliffordShort-term Project
About one third of adults in the U.S. get insufficient sleep, defined as less than 7 hours of sleep per 24 hour period, with similar statistics in Chittenden County, Vermont. Poor sleep/insomnia is a common complaint of patients visiting their primary care providers, and has many important consequences for physical and mental health. While sedative hypnotic medications and over the counter sleep aids are commonly used, they have many important side effects. Cognitive behavioral therapy for insomnia (CBT-I), which includes sleep hygiene techniques, is recommended as an effective, first line nonpharmacologic intervention for chronic insomnia. This project sought to create an educational patient handout to promote sleep hygiene techniques, a behavioral intervention aimed to improve sleep in the patient population at Hinesburg, VT.
Cody J. CouperusShort-term Project
Mental health illness is a pervasive and incurs tremendous cost onto society. Patients benefit from a multi factorial approach to treatment including non-pharmacological methods. This project includes development of a handout utilizing compiled resources and motivational interviewing to facilitate patient use of these interventions.
Francis G. Gause IVShort-term Project
PSA Screening Patient Information for 2017 guidelines
Provider Opinion: Should We Screen and Counsel Parents of Teen Drivers Regarding Texting/Distracted Driving?
Daniel LambertShort-term Project
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.
Ryan Erik LandvaterShort-term Project
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.
Richard MendezShort-term Project
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.
Althea L. MorrisonShort-term Project
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.
Allison B. RobbinsShort-term Project
Complications of stasis dermatitis including venous ulcers, osteomyelitis, and cellulitis all significantly increase morbidity and mortality of disease. Progression beyond stasis dermatitis and avoidance of the aforementioned complications are preventable with patient education and adherence to basic therapies including compression stockings and lifestyle modification. Therefore the goals of this project were to: assess the community’s understanding of stasis dermatitis and their awareness of its complications; use this information to help healthcare providers tailor their preventative health counseling accordingly; and provide education for patients on stasis dermatitis, its complications, and therapies/behavioral changes to prevent disease progression.
Ruby L. RussellShort-term Project
Studies show that correct patient technique using inhalers is correlated to the number of times they are taught and reminded by a health care professional. As a step toward addressing this problem, I propose increasing inhaler use teaching, utilizing EMR tools as well as online modules, and increasing the comfort of providers with teaching inhaler use. This may be achieved through the use of PRISM dot phrases titled .INHALERNAME, accessing teaching videos during a patient visit, and having patients demonstrate technique at each visit.
Garyn WorrallShort-term Project
Integration of Behavioral Health Specialists and mental health education is an important goal for the Community Health Center of Burlington (CHCB) Vermont. An educational brochure on depression was created with symptoms, definitions, self care, and ways to receive support from both CHCB, local, and national resources.
Grace Culley AdamsonShort-term Project
Smoking is the number-once preventable cause of death, contributing to more than 1 in 5 deaths per year in the United States. Statistics indicate that 90% of adult smokers tried their first cigarette before the age of 18. In Vermont, the rate of youth smoking dramatically increases between middle school and high school, and individuals in the State with lower incomes have significantly higher smoking rates than those with middle and upper class incomes. Whether a youth decides to try smoking is strongly influenced by their peers’ smoking behavior and beliefs, and several studies have shown that peer-led tobacco prevention strategies may be more effective in curbing youth smoking rates than formal, classroom interventions led by teachers and other adults. This project focused on training middle-school youth leaders in Winooski, Vermont, the lowest-income community in its county, to learn about the harms of tobacco use and to become ambassadors of smoking prevention efforts within their school district.
Ashley D. AdkinsShort-term Project
Many patients in the outpatient setting are placed on diets with sodium restrictions by their primary care physician for management of a variety of chronic diseases. Patients often have difficulties adhering to these diets, a primary reason being unawareness of the sodium content of many foods that make up the American diet. This project aims to increase awareness for these patients and to provide education for them to make more informed decisions about their health. A poster was made for providers to display in their practice that illustrates the sodium content of various food groups. The foods were selected based on recommendations and research from the CDC and American Heart Association. Future evaluation of the efficacy of this project would be elicited by a patient and provider questionnaire after the posters have been displayed for 6 months or more. This questionnaire could then be used to modify the posters to better fit this specific population and assist providers in this facet of patient education.
Dexter C. AllenShort-term Project
Problem: Patients on Suboxone (buprenorphine-naloxone) therapy break compliance by taking higher Suboxone doses, by supplementing with Suboxone purchased illicitly (“off the street”), or by taking other opiates and illicit drugs (cocaine), excluding marijuana. Need: Physicians and Medication-Assisted Treatment (MAT) counselors would benefit from an approach to counseling and treating their patients that would better address the specific vulnerabilities that Suboxone patients face that threaten their compliance.
Kristen J. BartlettShort-term Project
Cases of Lyme disease have been steadily rising in Vermont every year. Though the public is becoming more aware of its presence, there is a great deal of misinformation regarding its prevention and treatment.
Amy M. BerkmanShort-term Project
Interacting with the medical system can be intimidating for all youth, including those who are transgender. The goal of this project was to provide information about community resources and medical terminology and treatments that transgender youth may encounter during the medical transition process. The target audience is those that attend a community center dedicated to LGBTQ youth.
Christopher BernardShort-term Project
Research suggests that around 300,000 people are diagnosed with Lyme disease each year and that around one billion dollars is spent on healthcare for Lyme disease alone. Vermont has the highest rate of incidences of Lyme disease per 100,000 persons in the United States. While Lyme disease is certainly a major community health issue in Berlin, VT there are many other tickborne diseases that are becoming increasingly prevalent such as Anaplasmosis, Babesiosis, Powassan virus disease, and Borrelia miyamotoi disease. An educational handout was created providing helpful information for both community members as well as healthcare providers. For community members the information focuses on tick bite prevention strategies, how to safely remove a tick and common symptoms of tickborne diseases seen in Vermont. For the providers the information focuses identification of ticks, in-depth signs and symptoms of tickborne disease, lab tests and results, diagnostic testing and appropriate treatment methods. This handout was provided to Berlin Family Medicine for distribution to patients and providers in hopes of combatting the rising incidence of tickborne diseases in Vermont.
Familial Hypercholesterolemia in Lewiston/Auburn, ME: Directed Education Towards Improving Community Awareness
Omkar Betageri, Dervilla McCann, and Bethany PickerShort-term Project
There is a need for an improved awareness about Familial Hypercholesterolemia to promote prompt treatment and long-term management amongst a population disproportionately affected by the disease, namely Franco-Americans in Lewiston-Auburn, Maine
Nathan L. CentybearShort-term Project
Influenza vaccinations have changed over the years and many patients have concerns regarding the vaccine, such as safety and effectiveness. The goal of this project was to help educate patients regarding common concerns identified in the communities of Berlin and Montpelier, VT surrounding the influenza vaccine. Community members were interviewed to identify commonly asked questions. These questions were used to create an educational flyer, which was made available to patients at the Berlin Family Practice.
Suven CooperShort-term Project
The National Institute of Mental Health estimates the number of adults with a diagnosed mental disorder is nearly 1 in 5, this equates to about 43 million Americans. The national shortage of psychiatrists has hit Vermont particularly hard. There has been both a lack of funding and a lack of psychiatrists. For example there is often a waiting line for acute level 1 beds at the Vermont Psychiatric Care Hospital since it opened after the flooding of the state hospital in 2011. In light of the shortage of resources and psychiatrists in Vermont it is important to maximize the limited time that family practitioners have with patients with mental illness. With regards to diagnosing bipolar spectrum disorder the best method is using the Mood Disorder Questionnaire (MDQ) which is a 17 question survey and practical for an outpatient setting. A study examining the validity of the MDQ found that it provided good sensitivity (0.73, 95% [CI]=0.65–0.81) without sacrificing specificity (0.90, 95% CI=0.84–0.96). Another study was conducted in a community setting and it was found that the MDQ had a sensitivity of 0.28 and a specificity of 0.97. The MDQ has been proven to be effective in a psychiatric outpatient setting and been proven to be less effective or limited in the outpatient setting. However we must weigh the risks and benefits. In a setting like Vermont, with restricted resources, limited inpatient beds, lack of psychiatrists and a population of individuals with undiagnosed bipolar spectrum disorder the MDQ can prove to be more useful than harmful and can aid in identifying patients who potentially have bipolar spectrum disorder.
Andrew CorseShort-term Project
Studies consistently show that LGBTQ individuals are at higher risk for substance abuse, tobacco use, suicide, HIV, and chronic health conditions. The Community Health Centers of Burlington recently created a specialty clinic called the Be You Clinic, which will focus on delivering healthcare to LGBTQ persons, by LGBTQ-affirmative and –knowledgeable providers. This project sought to spread awareness of this new clinic by advertising.
Julia Lane CowenhovenShort-term Project
Lewiston, Maine has seen a recent surge of asylum seekers, refugees, and migrants, mainly from African Countries, termed New Mainers. Community health outreach workers (CHOWs) are front line public health workers who are trusted members of the community being served, which enables them to serve as a liaison between providers and their patients. Educating providers on the role of CHOWs may increase their utilization in the clinical setting and improve the quality of care for the New Mainer population in Lewiston.
Patrick CrudenShort-term Project
Survey analysis of hypertensive patients in an outpatient family medicine practice aimed at efficiently improving clinical management and health literacy.
Kristen M. DaltonShort-term Project
One of the most effective ways to assist patients with diabetes is to empower them to manage their diabetes through lifestyle change. However, figuring out what to eat when you have diabetes can be very confusing. This project attempted to provide simple lifestyle changes patients could make.
Ashley L. DeebShort-term Project
Seasonal affective disorder may be a significant issue in Lewiston, ME due to it's latitude. In addition, lack of transportation and poverty are also issues in this community. This project attempts to address treatment and increase awareness of SAD in Lewiston.
These projects were completed by students in the University of Vermont Family Medicine Clerkship. Block Clerkship Projects were completed during a five-week period, while Longitudinal Clerkship Projects were completed over the course of a 12-month longitudinal clerkship.
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