Family Medicine Clerkship Student Projects

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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Promoting Strategies to Overcome Low Health Literacy and Improve Patient Understanding in Outpatient Setting

Samantha M. Siskind
Short-term Project
Over 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.
Identifying the No Shows

Ryan M. Sofka
Short-term Project
Missed 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.
Evaluating Relapse Risks for Patients in an Office Based Buprenorphine Treatment Program

Brianna Spencer
Short-term Project
Opioid 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.
Accessing Reliable Health Information On The Internet

Nathaniel Sugiyama ,MS3
Short-term Project
In 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.
Tackling Obesity in Rural Vermont

Abishag Suresh
Short-term Project
Obesity 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.
Exercise prescriptions to improve patient adherence to lifestyle modifications

Alex W. Thomas
Short-term Project
Physical 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
Linking Food Insecure Patients With Community Supported Agriculture (CSA)

Daniel Orlins Trigg
Short-term Project
Food 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.
Transportation is a Barrier to Healthcare in Central Vermont

Apoorva Trivedi
Short-term Project
Transportation 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.
Keeping Kids Safe: Bicycle Safety

Kelsey M. Veilleux
Short-term Project
Children bicycle safety is an important issue in the United States, especially in bike friendly areas such as Vermont. 112 children age 19 and under died in 2010 as a result of a bicycle related injury. Helmets are an easy way to protect children from bicycle related head and brain injury and death, but some people do not understand the importance of helmets or cannot afford to buy helmets. With the help of North Country Hospital we are striving to keep kids safe in the North East Kingdom of Vermont by teaching bike safety and providing helmets at discounted cost.
Childhood Obesity: A National Emergency

Elaine E. Wang
Short-term Project
Childhood obesity rates and the related public health costs are rising every year. Many projects have addressed family education on the importance of diet and exercise. However, though patients reportedly understand this concept, they are still have challenges implementing their knowledge. We seek to address this discrepancy with an educational brochure based on suggestions for parents from the American Academy of Pediatrics.
Evaluating Access and Barriers to Mindfulness Among Opioid-Dependent Patients in Bangor, Maine

Gwendolyn E. Warren and Jia Xin Jessica Huang
Short-term Project
Mindfulness has been shown to aid in addiction recovery and can help prevent relapse. The Family Medicine Center & Residency Program at Eastern Maine Medical Center (EMMC) in Bangor, Maine has provided mindfulness resources to their opioid-dependent patients; however, the center has no quantitative data on the current understanding and utilization of mindfulness techniques among this patient population. A survey tool was created and distributed to opioid-dependent patients in the clinic to identify barriers to practicing mindfulness. The collected data was submitted by one of the clinic providers in a grant proposal. Grant funding could go toward addressing these barriers.
Human Trafficking: Promoting Awareness and Facilitating Partnership

Stefan Kale Wheat
Short-term Project
Human trafficking represents a problem that remains largely overlooked, including within the healthcare community. However, healthcare providers represent an important first point of contact for potential victims of trafficking. Therefore, it is critical that healthcare providers, particularly in primary care, receive formal training on the subject to improve rates of identification. New screening tools that reduce the burden of knowledge for providers are being developed to bridge the gap until sufficient levels of provider education are achieved, but these tools will never take the place of direct provider education. Beyond education, healthcare institutions must seek to develop comprehensive policies and protocols regarding trafficking to promote both improved identification of victims and appropriate response once victims are identified. This project demonstrated the need for further education of healthcare providers in Lewiston, promoted awareness of tools and resources available to healthcare providers when dealing with human trafficking, and facilitated future formal training of healthcare providers at the family medicine residency clinic. It also initiated a partnership between invested parties in Lewiston, Maine and Burlington, Vermont to promote collaboration on the creation of protocols for approaching trafficking victims.
The Implementation of TeleHealth at Brookfield Family Practice in Brookfield, CT

Taylor Wolfgang
Short-term Project
Brookfield Family Practice recently implemented the use of TeleHealth into their practice. One of the identified limitations was patient interest and participation. This project examines the perceived barriers preventing patients from using the service, as well as the perceived benefits, and patient satisfaction.
Assessing Patient Barriers to Community Health Team Referral

Benjamin Scott Albertson
Short-term Project
Objective: To assess patient barriers to Community Health Team (CHT) referrals at Hinesburg Family Practice.

Methods: Patients of Hinesburg Family Practice who were referred to the CHT by a physician and subsequently declined to be seen within the last 15 months were interviewed via telephone to assess what barriers prevented them from accessing CHT services. Twenty five patients were identified and called a minimum of 3 times using contact information obtained from the EHR. Eleven patients were contacted, one of whom had since followed through with the CHT. Responses from the ten patients who met the criteria and responded were generalized into major categories of: Inconvenience, Not interested, Already had services in place, Never called, and Never referred.

Results: Inconvenience (30%), Not interested (30%), and Already had services in place (20%) were the three biggest barriers to referral, accounting for 8 of the 10 responses.

Conclusions and Recommendations: The biggest patient barriers to CHT referral compliance are inconvenience, lack of interest, and already had services in place. These barriers can be assessed by physician when considering making a referral to the CHT, and referral should involve shared decision making with the patient. Physicians should also emphasize the role of the CHT as an extension of patient’s care by physician. It became clear when speaking with patients and CHT members that there exists a gap in patient knowledge with regard to services available through the CHT.
Getting Real About Food: "Fed Up" & Nutrition Education

Hillary Anderson
Short-term Project
Getting Real About Food: “Fed Up” & Nutrition Education is a summary presentation designed to help facilitate discussion about the U.S. food industry and its impact on the American diet. The Grace Cottage Community Health team identified the 2014 documentary “Fed Up” as a critical learning tool to enhancing their community education programs for patients, providers, and staff members; this project focuses on summarizing key points and statistics as well as highlighting opportunities for pilot-testing and implementation across different community venues.
The Hidden In Plain Sight Program — A Novel and Interactive Approach to Substance Abuse Prevention and Education

Murtaza I. Bharmal
Short-term Project
Introduction. Despite stabilizing trends in alcohol, tobacco, marijuana, prescription medication, and illicit drug use reported by the National Institute of Drug Abuse, there is clear evidence that substance abuse is pervasive throughout Aroostook county as well as the state of Maine. Further research shows that parents often overlook everyday items that may indicate that an adolescent is engaging in some form of risky behavior. More so, parents are often apprehensive about talking to their children about risky behaviors and do not know how to appropriately manage these issues or where to seek help. Although there are many resources for substance abuse prevention, there has been little research into addressing these concerns in a more impactful, interactive approach.

Objectives. To teach adults how to:

- Identify signs, potential hiding places, and items that may point to risky adolescent behavior.

- Illustrate drug types, drug paraphernalia, and how drugs are used and why.

- Access available resources and what to do if risky behavior is suspected.

Methods. Participants are first debriefed about the workshop, followed by an initial survey that gauges each attendee’s understanding of substance abuse, signs of risky behavior, and prevention techniques. Participants are then permitted to explore an adolescent bedroom mockup where over 100 items are concealed. The coordinator then walks through the exhibit identifying the many items, followed by an information session about how to initiate a conversation with an adolescent and where to seek help. Finally, the program concludes with a question and answer session and follow-up survey that measures each participant’s new understanding of substance abuse, signs of risky behavior, and prevention techniques.

Results. To date, seven workshops throughout Aroostook County have been completed along with 25 evaluations. In the pre- and post-evaluations, six critical educational points were assessed. The table below reflects the percentage of participants that agreed or strongly agreed with each statement:

Statement

Pre-Evaluation

Post-Evaluation

I know the signs that may reveal risky teen behavior.

58%

84%

I know the hiding places that teens may use to hide risky behavior.

42%

97%

I know the supplies and tools that teens may use to hide risky behavior.

27%

97%

I know drug types, how they are used, and why.

24%

81%

I know what to do if I suspect risky behavior.

55%

81%

I know where to get help for substance abuse and other risky behavior.

58%

72%

Conclusions. Although in its early phases of development, the Hidden In Plain Sight program has shown promising results. Participants leave with a broader understanding of current trends in substance abuse among adolescents and are curious about how to learn more. As the program continues to hold workshops, we hope to better address each objective more clearly, further engage the community on this topic, and spread awareness about this effective, interactive, and eye-opening experience to community coalitions and other groups that have an interest in youth substance abuse prevention programming.
Lewiston Community Health Improvement Project

Bryce M. Bludevich
Short-term Project
Community Health improvement project about low back pain and alternative treatment options. Particularly focuses on different treatment options in Lewiston, ME.
Pre-Exposure Prophylaxis for HIV Prevention: a community-based approach to increased awareness among Vermont primary care providers

Nicholas Robert Bonenfant
Short-term Project
More than 1.2 million Americans are currently living with HIV and nearly 1 in 8 (12.8%) are unaware of their status. The incidence has been consistently around 50,000 new infections per year and of those newly diagnosed, the men who have sex with men (MSM) population carries the largest burden. Federal costs continue to rise for HIV/AIDS treatment nationally and this continues to represent a significant portion of healthcare costs here in Vermont. More needs to be done to prevent this chronic illness.

In 2012 the FDA approved a medication for pre-exposure prophylaxis (PrEP): Truvada. There is clear evidence of its effectiveness at preventing HIV infection in HIV-negative individuals through multiple clinical trials and it has been well tolerated by patients who have taken it.

Despite these facts, the general public, individuals at higher risk for becoming infected with HIV, and primary care providers have limited awareness of this powerful tool to reduce and perhaps eliminate new infections in Vermont. The most recent estimate of the number of providers who have prescribed PrEP, not including Planned Parenthood, is only nine.

Our proposed efforts target these unaware populations, beginning with primary care providers, by increasing awareness and education about PrEP statewide. This intervention is in line with current statewide campaigns to reduce the annual incidence of new HIV infections to zero in the coming years.
Mental Health Screening in Nursing Homes

Meghan Breen
Short-term Project
Depression and dementia are two of the most common mental health conditions in nursing homes. Screening for these conditions does not have to be difficult or time consuming, but doing it can significantly improve the health of nursing home residents. The WHO-Five for depression and the Mini-Mental Status Exam are both sensitive, specific, and time-sensitive. Using these screening in a nursing home in rural Vermont helped improve the accuracy of patient records and impacted medical care.
Creating an Effective Education Pamphlet on Sun Protection and Skin Cancer Prevention

Alexandra E. Brown
Short-term Project
Melanoma and other skin cancers are increasing in incidence in the United States. In Connecticut, the melanoma rate is higher than the national average. The public health cost of skin cancer treatment ranges from $2-$8 billion annually. The costs to the individual are also high and the diagnosis of an advanced stage cancer is always emotionally challenging for a patient and his/her family. Efforts should be aimed at primary and secondary prevention of skin cancer, and patient education is an important element of this goal. The creation and use of patient education pamphlets can help to increase patient awareness of sun damage and its sequelae.
Increasing Advanced Directive Utilization in Primary Care

Alejandro Castro
Short-term Project
Advance directives are a vital tool ensuring patient’s wishes regarding end-of-life care are met. End-of-life discussions with physicians are associated with fewer aggressive interventions and greater quality of life metrics. Increased utilization of advance directives by Vermonters could ensure the wishes of patients are met.
Influenza Vaccination in the Elderly

Ayse Nur Celebioglu
Short-term Project
Influenza is responsible for an estimated 300,000 hospitalizations and 23,000 deaths annually, the majority of which occur in elderly populations. Despite a physiologic vulnerability to this infection, every year millions of seniors do not receive the seasonal flu vaccine. This project set out to understand the myths surrounding influenza vaccinations in the elderly and to educate them on the different types of vaccines available.
Strides for Change: Incentivizing Hispanic Youth to Promote Exercise, Fitness and Wellbeing

Priyanka Chilakamarri
Short-term Project
The United Way of Western Connecticut's 2014 annual report on Danbury's Young Children found that Danbury's children are facing many physical fitness challenges compared to the state of CT. A study looking at 4th graders in a physical fitness test finds that Danbury students consistently have a harder time passing the fitness test. Of the population studied, 42.5% were ethnically Hispanic.
Healthier Living: Diabetes Management

Brandon Childs
Short-term Project
More than 55,000 Vermonters suffer from diabetes, which is the 6th leading cause of death in the state. There are currently 705 patients in South Burlington Family Practice with a diagnosis of diabetes. More than 100 of them are living with uncontrolled diabetes (elevated HbA1c > 8%) and have not yet obtained the necessary education to manage their chronic disease. Physicians must manage all patients diabetes goals and expectations in 15-30 minute appointments alone, but may refer patients to the Community Health Team for further diabetes education.
HPV Education and Prevention Amongst Danbury High School Students

Elizabeth Cochrane
Short-term Project
Human Papillomavirus (HPV) is currently the most prevalent sexually transmitted infection in the United States with an estimated 79 million people infected. In the state of Connecticut, HPV vaccination is not required for entrance into the 9th grade and because of this, there is less awareness of the importance of HPV prevention and immunization among high school students. As of 2013, 37.7-49.9% of females ages 13-17 living in Connecticut completed the HPV vaccine regimen. My objective for this project was to promote awareness about HPV infection and HPV vaccination among high school students.