Medicine and Health Sciences Commons^™

Improving Breastfeeding Supports In Primary Care Settings, Anya S. Koutras M.D., F.A.A.F.P., I.B.C.L.C

Family Medicine Scholarly Works

Background:

Although 84% of Vermont mothers initiate breastfeeding, only 26% exclusively breastfeed at 6 months of age. Surveyed physicians agree with the benefits of breastfeeding but claim insufficient knowledge and lack confidence in evaluating and managing breastfeeding, despite the availability of evidence-based strategies that address these concerns.

Objectives:

To increase the percentage of infants receiving a documented breastfeeding assessment at each well-child visit in the first 6 months.

To increase documentation of follow up plan in well-child exams in which a breastfeeding problem is identified.

To increase duration and exclusivity of breastfeeding and increase confidence of providers in performing a …

Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009-Ffy 2013, Mary Lindsey Smith Phd, Msw

Population Health & Health Policy

In Maine, a key objective of the IHOC CHIPRA demonstration grant is to collect and report on the Initial Core Set of Children’s Health Care Quality Measures (referred to as the “CHIPRA Core Measures”), a set of 24 standardized, evidence-based measures identified by CMS for use by State Medicaid and CHIP programs. This report presents the results of the 18 CHIPRA Core Measures that were collected using MaineCare claims, Vital Statistics or survey data and reported to the Centers for Medicare and Medicaid Services (CMS) for FFY 2013. Also included in this report are an additional three measures from the …

Concussion Management In Primary Care, James Levins

Family Medicine Clerkship Student Projects

Concussion awareness is a hot topic in youth sports, resulting in increased health care visits. There has been much change in concussion management over the past decade. VT passed a law (Act 68) implementing a concussion management program in schools. Not all primary care physicians are aware of how this law may affect their practice, nor are they all aware of some of the recent changes in concussion management. Improper concussion management can lead to prolonged symptoms, recurrent injuries and long-term sequelae.

Improving Vascular Health Of Patients With Diabetes Mellitus, Pishoy Haroun

Family Medicine Clerkship Student Projects

Some diabetic patients are reluctant to take the extra step in their long-term health care, which is particularly problematic as it relates to cardiovascular disease. In addition to difficulty controlling blood glucose levels, patients struggle maintaining an appropriate blood pressure. This is often due to a reluctance to maintain a proper diet, exercise regularly, and take certain medications. Studies have shown that compliance with exercise regimens falls from 80% at 6 weeks to 20% at one year. Many patients are reluctant to start on a statin, and some physicians are even hesitant to adhere to the new recommendations proposed by …

Awareness And Prevention Of Heroin Use In Springfield Vt And A Drug Recovery Resource Map Of Southern Vt, Yun-Yun Kathy Chen

Family Medicine Clerkship Student Projects

Since 2000, more than 770% increase in treatment of opiate addiction according to Governor Shumlin’s Vermont annual address. On July 11, 2014, there was a shooting incident in Springfield, Vt., that injured a convicted drug dealer and wounded two other people was triggered by a dispute over heroin. This project aimed to create an educational and interactive pamphlet that can be used in the Family Practice office at Springfield Health Center and beyond in order to encourage dialogue and de-stigmatize heroin use recovery.

Providers’ Views On Transition Of Healthcare For Youth With Developmental Disabilities, Cordelia Y. Ross

Family Medicine Clerkship Student Projects

Problem: Youth with DD have conditions that may limit their ability to function, with resulting social, emotional, or behavioral sequelae, and experience difficulty transitioning from child to adult health care. Also, adult providers may lack training and comfort level in working with patients with DD. For example, youth with ASD need an adult provider who understands autism but doesn’t see every health or behavior problem as a result of autism.

National Need: 1 in 6 children in the U.S. has a DD. Each year, almost half a million of these children transition into adulthood. As for ASD, 1 in 68 …

Fluoride Supplementation: Recommendations In The Primary Care Office, Dwight Parker

Family Medicine Clerkship Student Projects

Physicians in a Vermont family practice setting tend not to be very familiar with CDC/AAP/AAD recommendations regarding fluoride, especially when it came to rural areas in Vermont not on town or public water. Questions include: What are the pros and cons of fluoride supplementation? What are the indications for supplementation? How does one go about testing their well water? Which towns have fluoridated water, and what are their levels? What doses are recommended, and what options are there for treatment?

Hpv Vaccination In Vermont: Identifying Educational Resources For Adolescents, Shane Greene

Family Medicine Clerkship Student Projects

HPV vaccine is unique in that (1) it's not a required vaccine to enter school and (2) it's given at an age where patients have more agency over their medical care, so an adolescent who doesn't want to get the shot is often able to avoid it. In Vermont, there's a lack of educational material aimed at young adults about the benefits of the HPV vaccine.

Identifying And Treating Food Insecurity, Nicholas Field

Family Medicine Clerkship Student Projects

13% of Vermont households are food insecure, an increase of 45% since 2000. 25,400 children and 7,800 seniors in Vermont live with food insecurity. Based on metrics including poor health, hospitalizations, and lower educational productivity, food insecurity cost the State of Vermont $340,000,000 in 2010 alone.

Managing And Treating Allergic Rhinitis In The Primary Care Setting, Leah Novinger

Family Medicine Clerkship Student Projects

Screening and appropriate treatment of allergic rhinitis in the primary care setting is a challenge for providers due to time constraints. Providers in the practice desired more information about where in the community to refer patients with persistent allergic rhinitis and what information or test results they should send those specialists.

Marijuana Use Among Pregnant Women In Buprenorphine Treatment For Opioid Dependence, Tara Higgins

Family Medicine Clerkship Student Projects

New program, "Closer to Home," will allow pregnant women in buprenorphine treatment for opioid dependence to get treatment closer to home and deliver at Copley Hospital instead of being required to go to Burlington. This requires local physicians to prescribe buprenorphine to pregnant women. In creating the program, prescribing physicians have to decide policies around non-opioid substance use.

Increasing Awareness Of Adverse Childhood Experience (Ace) And The Benefits Of Inquiring About Ace, Maya Son

Family Medicine Clerkship Student Projects

Adverse Childhood Experiences (ACE), including childhood abuse/neglect, household dysfunction, and exposure to other traumatic stressors, have a large impact on health costs as well as social services, education, juvenile justice. Impact of ACE crosses socioeconomic boundaries. In 2011, the Vermont Department of Health reported that 58% of VT adults had experienced at least 1 ACE, and 17% of VT women had four or more ACEs.

Increasing Access To Community Support Groups For Patients With Mental Health Needs: A Guide For Primary Care Physicians, Daniel Haddad

Family Medicine Clerkship Student Projects

A large percentage of patients seen by primary care physicians suffer from mental health afflictions that are requiring increasingly more time and resources to treat. There is a lack of mental health providers to meet the needs of the community which result in 3-6 month waiting periods for patients to get an appointment with mental health providers. More mental health resources are needed to help family practitioners address this problem.

Hpv Infection Prevention In Males By Gardasil Vaccination, Russell Landry

Family Medicine Clerkship Student Projects

About 1% of sexually active males in the U.S. have genital warts. Each year 400 males get HPV related cancer of the penis, and 1,500 get HPV related cancer of the anus. 2-3 cases of Genital warts have been reported at Harwood High School (Moretown and Waitsfield), where the school nurse reports 1-3 males students each year seeking information about STIs (including HPV).

Vermont Radon Exposure, Gary Gilmond

Family Medicine Clerkship Student Projects

Radon is a natural, odorless and tasteless radioactive gas that is found in soil, rocks and water all over the US including Vermont. Long-term radon exposure is linked to over 21,000 lung cancer deaths a year in the US, second only to tobacco. Roughly 1 in 8 homes in Vermont are believed to have high radon levels. Vermont law does not require a radon test as part of a real estate transaction. Thus despite the danger of Radon exposure, the issue remains unrecognized by many Vermonters. Since 2000 only 15,488 state radon test kits have been ordered in Vermont.

Summer Physical Activity Log And Reward System For Children In Colchester, Vermont, Bryce Edwards

Family Medicine Clerkship Student Projects

- Childhood obesity has doubled in children and quadrupled in adolescents in the past 30 years.
- As of 2012, over 1/3 of children and adolescents in the United States are overweight or obese.
- A study from the CDC estimates that 1 in 3 children born In the year 2000 will develop diabetes in their lifetime.
- Obese children are at an increased risk for developing cardiovascular disease, diabetes and pre-diabetes, joint problems, sleep apnea, as well as social and psychological problems stemming from stigmatization and poor self-esteem. Overweight and obesity are also risk factors for multiple types of …

Opiate Abuse In Brandon, Vt: Empowering Support Systems, Raj Thakrar

Family Medicine Clerkship Student Projects

Primary care physicians and emergency physicians have reported a surge in opiate abuse within the state of Vermont. It is being labeled as a public health epidemic and crisis, with a 2013 mortality rate of almost double what it was in 2012. There are several factors that play a role in why Vermont has seen such a growth in opiate abuse, from easy access to opiate dealers in major urban cities such as New York, Boston, and Philadelphia to a decrease in law enforcement coverage in rural areas of the state. One major element, and the focus of this project, …

Common Naturopathic Therapies For Chronic Conditions, Jordan E. Perlman

Family Medicine Clerkship Student Projects

Complementary and Alternative Medicine has started to achieve greater public prominence – many patients report satisfaction and believe these therapies are cost effective. Allopathic physicians are largely unfamiliar with the supplements prescribed by naturopathic doctors, and have trouble integrating these therapies into traditional treatment plans. Patients are not trained to evaluate the safety or efficacy of their medication regimens, and rely on their primary care physicians to provide that service -– even if the majority of their "medications" are supplements recommended by an "alternative" provider.

Non-Pharmacologic Treatment For Infants With Neonatal Abstinence Syndrome (Nas), Michael Capata

Family Medicine Clerkship Student Projects

50-70% of babies born to mothers on Subutex and methadone during pregnancy show signs of withdrawing from these medications. This is known as Neonatal Abstinence Syndrome (NAS). In order to reduce the chance these children will need to be put on medication, it is important for them to be placed in a non-stimulating environment for the first five days of their life. Often, the mothers and families of these children are not aware of, or do not practice, non-pharmacological methods to reduce the amount of stimulation their children are exposed to.

Health And Community Resources For Older Adults In Chittenden County, Vermont, Matthew Jordan

Family Medicine Clerkship Student Projects

The vast number of resources available to older adults are widely unknown to both health care providers and the older adult population itself.

Using Local Resources To Build Strong, Healthy Families, Cornelia Willis

Family Medicine Clerkship Student Projects

Although obesity rates across all demographics continue to climb annually, when separated into income levels, the prevalence of obesity in poor adults and children are rising at a greater rate than middle class individuals. A recent publication by the Food Research and Action Center (FRAC) compiled a list of data points that indicated that, while the trend is gradually slowing, rates of severe obesity are about 1.7 times greater in children coming from families whose incomes fell below the poverty line than equal counterparts in the middle class income bracket. High fat, high carb foods are often the staple of …

Caregiver Burden: Finding Resources, Offering Support, Sarah Johnson

Family Medicine Clerkship Student Projects

- Definition: Informal caregivers are unpaid individuals (often a spouse, partner, family member, friend or neighbor) involved in supporting others in activities of daily living.
- Caregiver burden is an emerging public health issue largely attributed to longer life expectancy that not only increases the number of elderly individuals, but also the level of dependency in these individuals.
- Despite many formal support services, informal support continues to be the primary source of care for the elderly, dependent and disabled.
- Unpaid family caregivers will likely continue to be the primary source of long-term care in the United States as …

Food For Thought: Nutrition Education And Nutrient Delivery At Two Local Elementary Schools, Jenna Bodmer

Family Medicine Clerkship Student Projects

I designed a 20 minute powerpoint presentation and delivered it to healthcare providers in the area.
- Discussed the growing problem of obesity, and new federal regulations designed to curb it - Summarized data gathered in interviews at both schools
- Compared schools to each other
- Suggested changes that each school could make in the future
- Offered suggestions for changes in office practices and office collaboration with schools, for PCP's in the area

Alcoholism Self Assessments, Thomas Chittenden Health Center, Casey Wilson

Family Medicine Clerkship Student Projects

In the clinic we frequently see patients with self-admitted heavy drinking who are often in various stages of denial about their problems with alcohol. All the pamphlets and handouts available to patients at Thomas Chittenden Health Center and at Fletcher Allen Health Care are for patients who have admitted they have a problem with alcohol. These patients with admitted problems are the minority of patients with admitted heavy drinking. The patients who have not admitted their problem with drinking need a way to reflect on how their drinking is affecting their lives.

Improving Patient Education And Access To Anxiety Treatment, Heather Gardiner

Family Medicine Clerkship Student Projects

According to the World Health Organization, in developed countries, mental health accounts for more disability than any other group of illnesses. About 25% of adults in the United States are reported to have a mental illness. Anxiety disorders are the most prevalent class of mental disorders faced by individuals in the United States. Although anxiety disorders are treatable, only 34% of people diagnosed receive treatment.

School Based Yoga Intervention For Childhood Stress Management, Erica Marden

Family Medicine Clerkship Student Projects

Childhood stress can have immediate and long-term negative impacts on physical health, mental health, school performance, self-esteem, and relationships. For children in rural communities there are fewer resources available as recreational and therapeutic outlets for healthy stress reduction. Extracurricular activity involvement also puts significant financial and time burdens on families. There is a particular need to provide children in rural areas with tools to manage stress that can be incorporated into the school day and require few resources. Yoga is an excellent school-based activity that has proven benefits on physical and emotional health for both students and teachers. It has …

Promoting Public Water Fluoridation In Bennington Vt, Leah Fox

Family Medicine Clerkship Student Projects

The Centers for Disease Control and Prevention has recognized community water fluoridation as one of the ten greatest public health achievements of the 20th century. It reduces tooth decay over a person's lifetime by 25%. Over the past 40 years, there have been 6 failed attempts to fluoridate the drinking water in the town of Bennington. There is an overabundance of tooth decay affecting citizens of Bennington. The need for dental care in Bennington far outweighs the resources available.

Hand-Washing In The Fm Outpatient Setting, Madeline Eells

Family Medicine Clerkship Student Projects

The threat of healthcare-associated infections (HCAIs) is universal, affecting every healthcare facility and system around the world. The diagnosis of HCAI is complex and relies on diverse diagnostic criteria and methods. Although there are many routes of transmission of HCAI, one of the most easily preventable vectors is bacteria carried on healthcare workers hands.

Identifying And Coping With Adolescent Anxiety, Merima Ruhotina

Family Medicine Clerkship Student Projects

Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population. These disorders have a negative impact on the quality of life in a number of areas of functioning, including academic performance, social interactions, self confidence, and ability to enjoy daily life experiences and may impact future emotional health. Approximately 20% of youth ages 13 to 18 experience severe mental disorders in a given year. Almost one-half of youth ages 8 to 15 with a mental illness received no mental health …

Low T? Late Onset Hypogonadism, Cheng-Wei Huang

Family Medicine Clerkship Student Projects

Recently, there has been an increase in commercials and ads by pharmaceuticals pushing for testosterone supplementation by capitalizing on the sensitive subject of "low T" or decreased manhood and vague non-specific symptoms of low T. The idea that testosterone is something that occurs within our natural body and that we are only supplementing what’s originally there can be misleading. Many may interpret this as there is no harm but good, but the latest studies have shown otherwise. It is clear that there is a lack of proper understanding regarding testosterone treatment in the public, from when treatment would be suitable …