Family Medicine Clerkship Student Projects

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  Healthcare Gaps in Migrant Farmer Populations

  Elena P. Martel

  Short-term Project

  Various healthcare gaps have been identified in migrant farmer population, including preventative care, continuity of care for chronic conditions, occupational hazards and work related injury, and mental health services. Barriers to accessing care include lack of transportation, non-English speaking populations, and lack of education regarding US healthcare systems. For this project, flu vaccines were provided to migrant farmers at their homes throughout Vermont. Over 250 vaccines were provided by the Vermont Department of Health. Future directions include annual mobile flu clinics, continuing this model for Covid vaccines, and implementing a global health course for fourth year medical students aimed at addressing migrant farmer healthcare needs.

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  Conversations about safe firearm storage with patients: why and how

  Rose Martin

  Short-term Project

  This project outlines the need for firearm safe storage counseling in the medical encounter and provides some evidence-based suggestions regarding how to approach conversations about safe firearm storage with patients.

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  Increasing Influenza Vaccination Access among Migrant Farmworkers on Dairy Farms in Northern Vermont

  Allyson R. Miller

  Short-term Project

  An immediate need exists to provide influenza vaccination to migrant workers on dairy farms in Northern Vermont as vaccination is not accessible to the farmworker population within the current framework that exists. The importance of widespread distribution of the influenza vaccine, especially during the COVID-19 pandemic, has been established but significant barriers to access prevent the migrant farmworker population from receiving the vaccine.

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  Lifestyle Changes During the COVID-19 Pandemic and Their Impacts on Cardiovascular Disease Risk Factors

  Francis T. Mtuke

  Short-term Project

  The COVID-19 Pandemic has been particularly stressful for a wide array of patients, which has manifested in a number of ways. At the Brookfield Primary Care Clinic in Brookfield, CT, one of the ways that this was most prominent was through the change in the way patients exercised and ate. The impact this will have down the line is unknown, but this study aimed to assess the degree to which these changes have permeated the lives of patients.

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  Emphasizing Year-Round Physical Activity of Seniors in Vergennes, Vermont

  Carley R. Mulligan

  Short-term Project

  Many senior citizens in the Vergennes community are active in the spring, summer, and fall with various activities, community groups, and walking. However, in the winter with colder temperatures and less sunlight, these activities are difficult to maintain, even more exacerbated by the current Covid-19 pandemic. Encouraging maintenance of physical activity throughout the winter months in Vermont is difficult, but can provide many benefits to these individuals both physically and mentally.

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  Medication-Assisted Treatment in the Hudson Headwaters Health Network

  Jordan Munger

  Short-term Project

  Background: Opioid use results in over 45,000 overdose deaths annually in the US, with rural areas disproportionately affected. While medication-assisted treatment (MAT) for opioid use disorder (OUD) is an effective intervention available through outpatient primary care, less than 25% of patients with OUD are currently in treatment. This study explored factors associated with patient retention in an MAT program offered by Hudson Headwaters, a Federally Qualified Health Center that serves a vast and mostly rural region of Northeastern New York.

  Methods: We included a total of 354 patients diagnosed with OUD who had at least two appointments for MAT between December 2016 and November 2019 in this analysis. We ran univariate and multivariate regression analyses to examine factors associated with overall retention.

  Results: The median age at the first MAT visit was 35.2 years (IQR=12.0), and 50% of patients self-identified as female. Overall, the one-year retention rate was 74.7% (95%CI=68.6-81.4). Increased risk for lower retention was seen among men (HR=1.7, 95%CI=1.0-2.8) and those not commercially insured (HR=3.2, 95%CI=1.1-8.7). Receiving MAT directly from a primary care provider greatly reduced the risk of lower retention (HR=0.4 ,95% CI=0.2-1.0). Roundtrip, median travel time to access care was 27.2 minutes (IQR=33.1). Although 12% of patients drove over 60 minutes to get to their MAT clinic, travel time and distance was not associated with retention.

  Conclusions: While some surveys have suggested that patient access to MAT clinics is a significant barrier to treatment, for this chiefly rural population, ease of access as measured by travel time and distance was less influential on outcomes than other patient- and provider-level factors. Potential recommendations to improve retention include engaging primary care providers in MAT provision and the use of case management services to address other socioeconomic barriers to treatment.

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  HHHN Clinicians' Beliefs, Barriers, and Motivations Surrounding MAT

  Casandra Nowicki

  Short-term Project

  Medication-assisted treatment (MAT) consists of using medications that act on the same receptors as opioids to treat opioid use disorder (OUD). MAT providers require formal training and a DEA waiver in order to prescribe certain medications. Providers were asked to complete a survey about the beliefs, barriers, and motivations surrounding MAT to provide valuable insight into what the future of MAT might look like at a specific nonprofit network of community health centers in upstate New York.

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  Finding the Silver Linings of the Cyberattack

  Kathleen R. O'Hara and Leah Miller

  Short-term Project

  Our project aimed to identify the effects of the UVM Health Network cyberattack and subsequent month-long network downtime on the South Burlington Family Medicine providers and clinic staff. We interviewed staff members about positive adaptations made by the team during the downtime, and inquired whether they planned to keep maintaining any of these changes once the electronic systems returned.

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  Assessing Telehealth as a Mode of Healthcare Delivery

  Ambrose Orr and Adrian Berg

  Short-term Project

  With the rise of the COVID-19 Pandemic many healthcare providers are emphasizing video messaging software to maintain ongoing patient care while respecting health guidelines that recommend social distancing and isolation measures. It is a known issue that while some patients may face barriers to healthcare in the form of transportation and timing of appointments, others might encounter barriers in the form of lack of internet access. This project seeks to identify the level of patient access to this model of healthcare and assess overall satisfaction and patient attitudes towards this adaptation.

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  The Primary Care shortage in Vermont and Medical Student Interest in Primary Care

  Kenneth Michael Palanza

  Short-term Project

  The state of Vermont is currently faced with a primary care workforce shortage. There are currently not enough primary care physicians to meet the states needs and the problem is expected to get worse. The primary care physician workforce is aging, there is an inability to recruit primary care providers to Vermont, and there is stagnant interest of medical students in fundamental primary care fields such as family medicine. The aim of this project is to examine the barriers medical students identify that decreases their interest in pursuing a career in primary care, specifically family medicine, and how systematic changes can be implemented to lead to increased interest in the field and future practice in Vermont.

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  The Primary Care shortage in Vermont and Medical Student Interest in Primary Care

  Kenneth Michael Palanza

  Short-term Project

  The state of Vermont is currently faced with a primary care workforce shortage. There are currently not enough primary care physicians to meet Vermont's needs and the problem is expected to get worse. The primary care physician workforce is aging, there is an inability to recruit primary care providers to Vermont, and there is stagnant interest of medical students in fundamental primary care fields such as family medicine. The aim of this project is to examine the barriers medical students identify that decreases their interest in pursuing a career in primary care, specifically family medicine, and how systematic changes can be implemented to lead to increased interest in the field and future practice in Vermont.

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  Healthcare Provider Awareness of Food Insecurity Resources in Berlin, VT

  Melanie P. Parziale

  Short-term Project
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  Migrant Farm Workers Flu Clinic

  Alice Peng

  Short-term Project

  Vermont's dairy industry relies heavily on migrant workers. These migrant farmworkers are mostly Latino and undocumented thus ineligible for health insurance. The Open Door Clinic in collaboration with UVM Extension Bridges to Health and Colchester Family Practice provided free satellite flu clinics to Northern Vermont Latino dairy farmworkers. This project served 12 dairy farms and vaccinated 48 farmworkers.

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  A Motivational Interviewing Approach Toward Mask Wearing in Franklin County, Vermont

  Ashleigh N. Peterson

  Short-term Project

  COVID-19 has caused significant morbidity and mortality in Vermont and worldwide since the start of the pandemic. Wearing cloth face masks has been proven to limit viral spread, but few studies have quantified how many people are wearing masks or what their reasons are for doing so. This study aimed to assess and encourage mask use in Franklin County, Vermont by piloting an in-office motivational interviewing intervention at a primary care office.

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  Physical Activity Level in School-aged Children during COVID-19

  Tran Phuong

  Short-term Project

  Due to COVID-19 restrictions, school-aged kids are not engaging in normal physical activities per usual, such as physical education class and team sports. This paper addresses the health concerns and community perspectives of decreased physical activity in pre teens and teens during this pandemic. Further, it provides recommendations to stay active for 60 minutes a day of moderate to vigorous exercise.

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  Increasing Oral Health Care for the Elderly in Plattsburgh, NY

  Megan E. Prue

  Short-term Project

  Poor oral hygiene can have many adverse systemic effects in the elderly, including aspiration pneumonia. This project explored ways to increase dental care in the elderly, with the aim of decreasing rates of pneumonia along the way.

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  Improving Community Understanding of Lyme Disease Prevention and Treatment in the Age of Misinformation in Digital Media

  Olivia E. Quatela and Samuel Raszka

  Short-term Project

  Approximately 30,000 cases of Lyme disease are reported to the CDC annually, but the CDC estimates that 300,000 individuals in the US become infected. The average cost of Lyme disease is $3,000 per patient over the course of the disease costing the US healthcare system approximately $1 billion per year ($712m – $1.3b). An additional $1 billion is spent annually on treating post-treatment Lyme disease syndrome. Despite the prevalence of Lyme disease and the availability of credible patient education materials, misconceptions and knowledge gaps are still evident among community members, media sources, and some providers. There is a need for continued community education and recommendations for evidence-based treatment for this disease.

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  Coping Skills for Daily Life: Cost-Effective Strategies to Prevent and Address Mental Health Disorders

  Shae Ian Rowlandson

  Short-term Project

  Mental health disorders, along with their associated cost and negative outcomes, have continued to persist in Vermont and have become one of the largest, growing challenges to public health in the United States. Unfortunately, Vermont does not appear to have enough resources or providers to optimally address it. Concurrently, coping strategies of minimal cost that have the potential to prevent or address mental health disorders may often be underutilized or misconstrued by the population. A pamphlet providing information on evidenced, cost-effective coping strategies was designed and distributed to providers and patients to enable patients with the skills to help themselves and adapt to their mental health needs, independently.

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  Adverse Childhood Experiences: Raising Awareness & Creating Easier Access to Resources

  Christina Sanchez-Grew

  Short-term Project

  Adverse Childhood Experiences (ACEs) such as abuse, neglect, and witnessing household dysfunction are common throughout the United States and are occurring in our own communities. ACEs impose immediate health risks to children but also are associated with poor health outcomes in adulthood including higher rates of cancer, heart disease, chronic lung disease, obesity, depression and substance use. The goal of this project was to contribute to prevention strategies for ACEs. This was accomplished by using flyers to raise awareness and educate the community on the prevalence and outcomes of ACEs, and by using QR codes to make parenting resources easily accessible.

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  Improving Hepatitis C Screening in Vulnerable Populations

  Connor Scagnelli

  Short-term Project

  A one-time HCV test has been recommended for all individuals in the Baby Boomer generation. National data shows an increase in HCV rates among younger generations, especially those with substance use disorder. In this quality improvement project, HCV screening rates were collected and analyzed from Hudson Headwaters Health Network (HHHN) and The Ryan White Program in Glens Falls, NY. A survey was disseminated to all HHHN providers to assess current screening practices and to identify barriers to screening and strategies to increase screening. From this analysis, it was determined that HHHN would benefit from and be able to increase screening rates in at risk populations by adopting a universal HCV screening policy. Weeks after this presentation was delivered, the AMA announced it was supporting the USPSTF's draft recommendation for universal HCV screening in all adults over the age of 18, in accordance with this projects conclusion.

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  Safe Disposal of Unused Pharmaceuticals in Vermont

  Sarah E. Sherman

  Short-term Project

  This community project aimed to research local infrastructure for the safe disposal of unused pharmaceuticals and provide a user friendly summary to be made available to patients. In doing so, the long term goal was to increase participation in drug disposal programs to improve the health of the community by decreasing drug diversion, use of expired medications, and improper disposal resulting in environmental accumulation.

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  The Green House Project: Accessible, Empowering and Sustainable Communities for the Elderly

  Jessica Sikka

  Short-term Project

  Many members of our geriatric community face challenges in attending appointments with their healthcare providers. The many barriers to healthcare that these patients face can range from financial to physical ones. Home health visits have become an invaluable resource for these patients. However, home healthcare is an expensive resource that many patients cannot afford. The Green House Project aims to empower elders and patients with barriers to healthcare, who thrive in the home health setting, by building communities where patients are treated with equality and mutual respect regardless of economic status.

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  Transportation is a barrier to accessing primary care in Vermont

  Max L. Silverstein

  Short-term Project

  Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. Rural patients are especially vulnerable to transportation barriers: In Chittenden County specifically, older adults surveyed reported difficulty with transportation, with 69% delaying medical appointments due to transportation barriers. Based on the data collected in this study, even among patients at South Burlington Family Medicine, distance from the office is correlated with declining important medical appointments.

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  Transportation is a barrier to accessing primary care in Vermont

  Max L. Silverstein

  Short-term Project

  Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. Rural patients are especially vulnerable to transportation barriers; in Chittenden County specifically, older adults surveyed reported difficulty with transportation, with 69% delaying medical appointments due to transportation barriers. Based on data collected in this study, even among patients at South Burlington Family Medicine, distance from the office is correlated with declining important medical appointments.

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  Transition of Care for Newly Homed Individuals

  Kayla Sturtevant

  Short-term Project

  Homeless individuals often do not receive the appropriate level of health care to manage multiple otherwise controllable medical conditions. Continuity of care is often a challenge. Individuals may temporarily establish care with a provider but become lost to follow up when they move away or establish permanent housing. They can become lost to follow up for other reasons as well, including relapse, an inflexible work schedule, mental illness and many others.