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Resource Guide to Empower Walkers in the Newbury Community
Kishan Patel
Short-term ProjectThe project identified the need and barriers to healthy and accessible forms of exercise in the Newbury community of VT. Surrounding areas of Groton, Ryegate, Wells River, and Haverhill in New Hampshire are also covered. Walking trails were identified as the most accessible form of exercise in the region for patients with metabolic syndrome visiting doctors at Little River Health Care in Wells River, VT,
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Improving Community Health with Affordable Internet Access
Joshua Jeremy Pothen
Short-term ProjectInternet access is associated with increases in health information seeking and benefits in health statuses. However, many individuals of low socioeconomic status (SES) lack Internet access, thereby creating significant disadvantages from a health perspective. In this project, we describe a potential project for providing affordable Internet access to a neighborhood of Newport, VT containing many SES individuals. This network includes a splash page that provides regular health event promotion and health information dissemination to everyone connecting the network. We then discuss how to determine the impacts of the Internet on multiple aspects of health within the community.
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Identifying Depression in the Elderly
Gayathri Prabhakar
Short-term ProjectDepression among the elderly is significantly under-diagnosed and inadequately treated. With Vermont's rapidly aging population, particularly in Addison County, increased diagnosis and treatment, whether behavioral or pharmacological, will lead to increased quality of life for aging individuals and their caretakers. This study aimed to increase patient education about the signs of depression as well as available community resources available to help this patient population.
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Tdap Vaccination in Pregnancy
Melissa N. Rafferty
Short-term ProjectSince Maine's incidence of pertussis is higher than the national average, primary prevention through vaccination is important to protect vulnerable populations such as newborns in the state. Maternal Tdap vaccination between 27 to 36 weeks of pregnancy is recommended by ACIP to boost placental IgG transmission to the fetus and prevent newborn morbidity and mortality. For quality improvement, maternal Tdap vaccination rates were examined at Eastern Maine Medical Center Family Medicine Center and Residency and an educational handout was developed.
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Creating a Welcoming Clinical Environment for LGBT Patients
Samy S. Ramadan
Short-term ProjectThe aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The effectiveness of these interventions was evaluated using the Healthcare Equality Index (HEI) scoring criteria developed by the Human Rights Campaign. Future interventions include registering competent and sensitivity trained providers to the GLMA (Health Professionals Advancing LGBT Equality) provider directory, including data fields for sexual orientation and gender identity as part of the electronic health record (EHR) for all patients, conducting a community needs assessment with local LGBT groups such as Outright Vermont and NEK LGBTQ Advocacy Committee, developing a partnership with the DHMC Transgender Clinic for additional training in the management of hormone therapies, and measuring LGBT patient satisfaction through phone interviews.
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Increasing Male Patient Awareness of Contraception Options
Saraga Pannala Reddy
Short-term ProjectThere are many effective contraceptive methods available, yet 46% of pregnancies in Vermont are unintended. The majority of educational initiatives to increase high-efficacy contraceptive use are directed only towards women, and not their male partners. This intervention aims to help primary care providers educate young male patients on contraception, using an engaging pamphlet. Improving male patient awareness and understanding of contraception options may help partners have open and informed discussions that lead to more consistent contraceptive use.
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Abortion Resources Patient Handout SmartPhrase
Andre A. Robinson
Short-term ProjectMany patients in Vermont need to seek abortion care outside of their regular doctors office. When a patient discovers that she is pregnant there should be a non-biased conversation about options as part of The Patient Centered Medical Home. This resource includes: where to go for an abortion, how to pay for it, who to call for support, and advice on how to avoid biased institutions.
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HPV Vaccination: Educating and Empowering the Next Generation
Sruthi Sakamuri
Short-term ProjectVaccination against Human Papillomavirus (HPV) is able to protect against 70% of strains causing cervical cancer and and 90% of strains causing genital warts, yet vaccination rates for boys and girls are still well below average vaccination against many other preventable diseases. Experts agree that patient education and strong physician recommendation of HPV vaccination of pre-teens and teenagers is essential in improving vaccination rates in CT. The objective of this project was to assess and improve understanding of HPV, its implications, and vaccination in a high school population in Danbury, CT. The education session significantly improved students' understanding of HPV vaccination and subjectively improved their confidence in becoming health advocates for HPV vaccination.
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Home Blood Pressure Monitoring Pamphlet
Isobel Ycasas Santos
Short-term Project- Home blood pressure monitoring aids in the proper diagnosis of an elevated blood pressure in the office.
- Written instructions on proper BP measurement at home is currently lacking at the UVMMC Family Medicine South Burlington site in addition to other affiliated sites. A home blood pressure monitoring handout can serve as another opportunity for hypertension control.
- Its utility as a diagnostic tool is dependent on proper BP measurement techniques. The HBPM will hopefully encourage the proper utility of the device.
- HBPM encourages patients to take control of their own health, and at the same time it facilitates discussion with their physicians
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Resources for Moms: Opiate Use in Pregnancy
Amy Schumer
Short-term ProjectSubstance use in pregnancy is not uncommon and the use of substances increases the risk of complications during pregnancy. In Vermont, opiate use in pregnancy is increasing as well as the number of people seeking treatment for opiate misuse. This project was designed to give pregnant mothers using opiates an idea of what to expect during their pregnancy as well as the resources that are available to them in the Springfield, VT area.
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Promoting Physical Activity Using Walking Poles in Senior Citizens of Southern Vermont's Deerfield Valley Region
Siyeon A. Seong
Short-term ProjectWalking poles have been shown to be beneficial in increasing physical activity and improving functional outcomes. Walking poles have been recommended during patient encounters using an informational pamphlet at Deerfield Valley Health Center in Wilmington, VT.
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Evaluation of Geo-Social Networking Application Use Among Young Adults
Caleb Seufert
Short-term ProjectBackground: Since 2009 geosocial networking applications (GNAs) have rapidly emerged as a new technological platform for users to communicate, date, and meet for sex. Popular GNAs include Tinder, Grindr, Bumble, Plenty of Fish, and many more. GNA’s are unique to traditional dating websites in that they allow users to connect with each other based on geographic proximity of their mobile phones. Given the pervasiveness of technology usage among young adults, it is important to understand the potential risks and benefits that GNA-facilitated communication poses on sexual health, emotional well-being, and safety. Popular GNA’s, like Tinder, estimate the majority of users are 16 to 34 years-old. Coincidentally the CDC reports half of the 20 million new sexually transmitted infections each year are among 15 to 24 year-olds. Examination of GNA use and its association with high-risk behaviors and sexual health outcomes among heterosexual young adults is warranted.
Methods: A focus-group was held with Western Connecticut State University’s (WCSU) Collegiate Health Service Corps Club (CHSCC) in an effort to create a survey for undergraduate and graduate students on campus. WCSU Institutional review board granted an exempt review status for the project. Through a collaborative effort, a 26-question survey was developed and administered to WCSU students ranging from 18 to 25 years-old. The number of surveys distributed was stratified based on three age groupings: 18-20 years-old (n = 19), 21-23 years-old (n = 20), and 24-25 years-old (n = 20). The survey contained questions regarding GNA’s usage and practice, student sexual health and practice, and overall safety and wellness.
Results: A total of 26/60 (43.3%) young adults surveyed reported using geo-social dating applications. The distribution of GNA use among the three age groupings did not differ significantly. The most popular applications used: Tinder (58%), Plenty of Fish (15%), OkCupid (12%), and Bumble (6%). The vast majority of students report using the apps for 11 months or less. A total of 80% of students stated they were sexually active, however over half reported either inconsistent or none-existent barrier method contraceptive use. The primary reasons for using GNAs was “curiosity/fun” and “companionship,” however a smaller minority reported seeking either romantic relationship, casual hook-ups, or sexual intercourse. Of the GNA users, a total of 48% reported they meet-up with other users either “sometimes” (29%), “somewhat often” (15%), or “often” (4%). The nature of these encounters included mostly conversation, texting, social activity, and a smaller minority reported dating, ‘hooking-up,’ oral sex, and sexual intercourse. Interestingly, over half the GNA users have worried about their safety at some point.
Conclusion: Survey results cannot directly equate GNAs with STD risk or prevalence, however they do encourage app-users to think about whether their own app-use places them at a sexual, emotional, and/or safety risk. Given the demonstrated prevalence of GNA use among young adults, it is important for the general public, health care providers, and app-users to understand the potential risks and benefits of this type of social networking platform.
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A Confidential SMS Texting Service for LGBTQ Youth Sexual and Reproductive Health
Matthew A. Shear
Short-term ProjectCompared to heterosexual youth, lesbian, gay, bisexual, and transgender youth are at higher risk for depression, tobacco, alcohol and other drug use, suicide, and unhealthy sexual behaviors. The #1 priority set by Vermont's LGBTQ youth was access to queer-inclusive sex education during middle and high school. In collaboration with OutrightVT, an LGBTQ youth service organization based in Burlington, we worked to expand access to a 24 hour text-messaging based reproductive health hotline 724-888-7277 (SASS).
The number and frequency of text messages submitted to the hotline pre- and post-intervention were used measure the increase in access/awareness.
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Barriers to Healthy Eating Among the Senior Populations in Brookfield, CT
Yueyue Shen
Short-term ProjectIn the U.S, the cost of diseases associated with unhealthy eating reaches $157 billion a year. In the Western Connecticut area, hypertension and diabetes are the top two reasons for admitting seniors to the hospital. Both of them can be managed by healthy diet and exercise. This project aims to identify the barriers to eating healthy among elderly in Brookfield, CT, and to discuss potential interventions that can be implanted to address the identified barriers.
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Intimate Partner Violence: Providing Resources to Patients and Facilitating Understanding
Andrew R. Sheridan
Short-term ProjectIntimate Partner Violence is defined as physical violence, emotional violence, sexual violence, psychological aggression and stalking against a current or former partner. High volume primary care offices like UVMHN Berlin Family Medicine address primarily medical concerns of patients. While this includes mental health, IPV is infrequently a part of doctor-patient interactions. This project assesses available data on IPV nationally and in Vermont. It aims to understand how IPV is currently addressed, recommendations regarding addressing it and provides resources to patients.
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Diabetes and Your Eyes: The Importance of Annual Eye Exams
I-hsiang Shu
Short-term ProjectDiabetes is the leading cause of blindness in the United States. With diabetes, one has a 25 times higher risk of blindness than the average American and each year in the US, there are more than 12,000 new cases resulting from diabetes. This significant risk of developing blindness is because diabetic eye changes often occur silently, without symptoms, until it is too late and permanent damage to your eye has already occurred. The two most important things a diabetic can do for eye health is to properly manage blood sugars and receive an annual dilated eye exam from an eye health professional. This will prevent development and progression of any new disease in the eye as well as detect any existing condition of the eye early enough such that it can be managed without complications. This project aims to improve the level of compliance for annual eye exams by diabetics at Milton Family Practice through an educational handout on how diabetes affects the eyes, the changes that can occur, and how their eyes should be examined annually.
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Provider Resources for Managing Complex Patients and Physician Self-Care
Elena Romana Siani
Short-term ProjectPhysician burnout has increased over the past decade and continues to increase each year. Patients with high levels of medical and social complexity can be difficult to manage and when standard treatments fail it is often difficult to know what to do next. This project aimed to address the presence of both physician burnout and the effect it can have on the care of patients and particularly the most complex ones. A list of resources for complex patient management and physician self care was compiled and presented for physicians at Berlin Family Practice.
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Promoting Strategies to Overcome Low Health Literacy and Improve Patient Understanding in Outpatient Setting
Samantha M. Siskind
Short-term ProjectOver 36% of US adults have low health literacy. This contributes to poorer health outcomes and increased costs for individuals and health care systems. Many strategies can be used to overcome the barrier of low health literacy and improve patient understanding in clinical encounters. As health care providers have been shown to underestimate patient's needs for information and overestimate their own ability to communicate effectively with patients, these strategies should be used universally. We prepared a presentation on health literacy, its epidemiology, risk factors and implications, and strategies to overcome low health literacy and improve patient understanding. We focused most heavily on Teach-Back, a strategy to assess patient understanding. We presented this to a group of residents and attendings at EMMC Center for Family Medicine and Residency. We prepared pre-presentation and post-presentation surveys to evaluate effect of presentation.
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Identifying the No Shows
Ryan M. Sofka
Short-term ProjectMissed clinic appointments have negative effects on the patients who skip those appointments, the clinic itself and the entire clinic population as a whole. Simply discharging those patients with flagrant absenteeism is not an option at clinics that are their only option. The targeting of strategies to those who frequently miss visits first requires their identification. This project sought to identify and characterize the "no show cohort" at the EMMC Family Medicine Center and Residency in Bangor, ME.
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Evaluating Relapse Risks for Patients in an Office Based Buprenorphine Treatment Program
Brianna Spencer
Short-term ProjectOpioid abuse is a serious problem in Maine with a societal cost of 1.4 billion dollars. Buprenorphine has been used as an office based treatment for addiction management. In Maine there is a provider shortage for substance abuse and a large need in the community for treatment. In fact, there were 272 deaths in 2015 attributed to overdose. It is important that once patients begin treatment they remain in treatment without relapse. At EMMC Center for Family Medicine we explored the risks for relapse from the provider perspective, patient perspective and retrospective chart analysis in order to guide future interventions at this treatment program.
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Accessing Reliable Health Information On The Internet
Nathaniel Sugiyama ,MS3
Short-term ProjectIn a low socioeconomic farming town at a rural family medicine clinic in upstate NY, I wanted to find a way to help reduce barriers to healthcare and help patients take an active role in their health using free internet resources. My idea was to help connect patients with reliable health information without needing to travel to the clinic, understanding that some patients may be limited in their ability to travel, take time off from work or afford the copays/expenses associated with seeing their providers. As such, I chose to investigate access to the internet, the ways in which users accessed the health information online, how patients liked to get their health information and their perceived barriers regarding using the internet to find reliable health information.
After analyzing survey results, I found that 90% of surveyed patients had internet access, 80% had 1 or more concerns regarding the use of the internet to find reliable health information, and 46% of surveyed patients would be interested in an informational packet that that included a list of suggested electronic resources which they could use to access reliable health information, if it were available. With this information, I decided to act on my survey data and produce a 20 page pamphlet covering a broad range of health related topics from mental health, general health, and mobile health, to patient assistance programs to help patients pay for their medications.
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Tackling Obesity in Rural Vermont
Abishag Suresh
Short-term ProjectObesity is a growing epidemic across the United States. It affects rural areas such as those in Vermont deeply. An intervention addressing this problem using a health and exercise brochure was undertaken. Future direction will need to fully address the effectiveness of this intervention and take on other goals.
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Exercise prescriptions to improve patient adherence to lifestyle modifications
Alex W. Thomas
Short-term ProjectPhysical inactivity is one of the leading causes of chronic preventable diseases, which are the leading causes of death in the United States. Vermont, specifically Washington County, is no exception: Heart disease, stroke and diabetes are 3 of the Top 6 causes of death. In Washington county, VT. Approximately 60% of residents are overweight or obese; >40% do not meet recommended physical activity guidelines. Physical inactivity is highest among patients with obesity, diabetes, hypertension and heart disease. Studies have shown that despite heightened awareness of the need for exercise many continue to have sedentary lifestyles. Recent reviews of exercise prescriptions have shown improved adherence and maintenance of exercise routines
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Linking Food Insecure Patients With Community Supported Agriculture (CSA)
Daniel Orlins Trigg
Short-term ProjectFood insecurity screening is needed to link food insecure patients to interventions that will help improve their nutrition and overall health such as annual community supported agriculture (CSA) shares. In Vermont, food insecurity is widespread, as 76% of Vermonters experience some level of food insecurity. This has serious health consequences. Food insecure patients are more likely to suffer from hypertension and diabetes than non-food insecure patients. Clinicians need to screen for and detect food insecurity. Several methods are available, yet clinician awareness varies. Providers can rely upon predictive metrics that utilize patient characteristics or simple question-based screening tools. This study found that physicians and physician assistants are prefer to screen for food insecurity using an established 2-item screen. However, they tend to underestimate the prevalence of food insecurity in the community in which they practice.
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Transportation is a Barrier to Healthcare in Central Vermont
Apoorva Trivedi
Short-term ProjectTransportation is a significant barrier to healthcare access in Central Vermont due to a variety of reasons that include low income households, poor access to public transportation, elderly populations, and populations with disabilities. Improving access to transportation is a goal for both the local public transportation authority and the UVMHN-Central Vermont Medical Center in Berlin, VT. The purpose of this project was twofold. The first goal was to find an underutilized transportation resource in the community by heavily researching the area's transportation system and coordinating the distribution of informational sheets regarding this resource with my family medicine clerkship site members. The second goal was to survey current patients and discover what the particular status quo and challenges are for the local community with regards to transportation in 2016.
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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