Primary Care Commons^™

Bridging Language Barriers In Clinical Screening: Leveraging Large Language Models (Llms) To Generate Bilingual Screening Surveys For Patients With Limited English Proficiency (Plep), Tyler Vandyk

Family Medicine Clerkship Student Projects

This study addresses the critical need for accessible clinical screening in communities with a high incidence of Patients with Limited English Proficiency (PLEP). Recognizing the limitations of existing interpreter services and the scarcity of validated translations for standard clinical surveys like PHQ-9 and GAD-7, we developed a novel approach leveraging Large Language Models (LLMs). Our method utilizes GPT-4 to create bilingual versions of these surveys, which are then formatted into printable PDFs via a Python script and LuaLaTeX compiler. The resulting surveys, validated for translation accuracy and cultural competency, are made accessible through a Google repository. Preliminary results demonstrate that …

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

African American And Caucasian Perceptions And Attitudes Toward Colorectal Cancer Screening: A Qualitative Study, Peter Warren, Stacie Pankow, Yvette Rother, Peggy Wagner

The Qualitative Report

This study examined the attitudes held by both African Americans and Caucasians regarding colorectal cancer screening and the reasons why they avoid screenings even when clinically indicated by their physicians. Colorectal cancer (CRC) is one of the most common and easily preventable types of cancer in the United States. If diagnosed and treated early prior to metastasis, the five-year colorectal cancer survival rate is approximately 90%. However, many patients avoid screening procedures for colorectal cancer due to a number of reasons. Qualitative data was gathered from focus groups and found four major themes that emerged in both groups: (1) reported …

Adolescent Substance Use: Standardizing Screening Methods In Clinical Practice, Bryan D. Shin

Family Medicine Clerkship Student Projects

Adolescent substance use is a highly pervasive issue that strongly correlates with increasing depression and anxiety rates. Standardized screening tools for substance use, such as the CRAFFT or the Screening to Brief Intervention Tool, are freely available but not widely utilized for every patient encounter in clinical practice. This project aimed to improve standardization of substance use screening at a primary care clinic located in Castleton, Vermont through implementation of the CRAFFT tool as an automatically-loaded form in each adolescent encounter note. The goal was to improve substance use detection rates by facilitating efficient incorporation of standardized screening into the …

Improving Retinopathy Screening For Patients With Diabetes: Optometrists Accepting New Patients On Medicaid 
+/- Interpreter Services, Kassondra M. Little

Family Medicine Clerkship Student Projects

For patients with diabetes, screening for microvascular complications like retinopathy requires annual retinal photography or dilated fundoscopy to identify and mitigate processes that can cause preventable blindness. Yet, by measures at the state and federal level, the percent of patients achieving this care is below target. At the Community Health Centers of Burlington (CHCB), the barriers responsible for this include uncertainty among patients and providers about which local optometry offices accept Medicaid, are scheduling new patients and have interpreter services available. This project aimed to improve retinopathy counseling, the achievement of retinopathy screening and the time burden placed on providers …

Screening For Areca (Betel) Nut & Quid Use, Gabriela Sarriera Valentin Ms

Family Medicine Clerkship Student Projects

Standardized screening tools for patients who use betel quit and areca nut products do not currently exist. Given the increased risk of oral and oropharynx cancer development in this patient population, increasing awareness of this practice could result in decreased morbidity and mortality. The purpose of this project is to (1) increase provider awareness of this cultural practice and its associated health consequences, (2) to develop a screening tool, and (3) to propose suggested follow-up when concerning lesions are identified.

Pamphlet Of Preventative Immunization And Screening Recommendations For Adult Women, Annie Glessner-Fischer

Family Medicine Clerkship Student Projects

This project seeks to consolidate common immunization recommendations and preventative screening recommendations for adult women 18 years and older, based on the U.S. Preventative Services Task Force and Centers for Disease Control and Prevention recommendations. This resource should be offered to patients of the primary care office, with the goal of providing information in a concise and approachable manner that allows patients to review general recommendations on their own, generate questions or express concerns about their health, and encourage patients to advocate for their own health and well-being. With this intervention, the broader goal is to increase immunization rates and …

Implementation Of Adverse Childhood Experiences Screening Tool For Providers In Primary Care Pediatrics, Morgan P. Via

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Adverse childhood experiences (ACEs) are recognized by the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) as contributing factors to poor health outcomes in childhood and beyond. Many pediatric providers are aware of the importance of ACEs, yet most do not participate in routine screening. The goal of this project was to implement ACEs screening at a semi-rural pediatric primary care office, aiming to screen 50% of eligible patients over 6 weeks. A secondary goal included increasing provider knowledge of and comfort with discussing ACEs through participation in an online training module.

Methods: Families …

Keep An Eye On Your Ocular Health: The Importance Of Routine Eye Exams, Kiana Heredia

Family Medicine Clerkship Student Projects

When it comes to scheduling preventive health screening exams, eye exams are often overlooked. Individuals may not understand the importance of their ocular health, and many assume a basic vision screening is comprehensive. However, that is not the case and eye diseases are common and can go undetected for a long period of time before symptoms appear. Seeing a licensed optometrist or ophthalmologist for comprehensive eye exams is important for detecting eye disease in the early stages when treatment is available to prevent vision loss is most effective.

Implementing A Screening Tool For Insurance Coverage To Improve Cost-Related Medication Nonadherence Among Medicare Beneficiaries, Jennifer Lor

Family Medicine Clerkship Student Projects

No abstract provided.

Increasing Screening For Barriers To Transportation At A Family Medicine Clinic In Rural Upstate Ny, Noah Sorkow

Family Medicine Clerkship Student Projects

Inconsistent access to reliable transportation is a significant barrier to medical care in rural New York. Lack of transportation results in missed medical appointments, poor management of chronic conditions, and increased preventable emergency room visits. Increasing routine screening for this social determinant of health can reveal underlying barriers to care, promote referrals to case workers and increase resource allocation. This project sought to increase routine screening via the promotion of smart phrases to be included in routine wellness documentation in the EMR, in conjunction with a didactic session for current family medicine residents.

Preventive Medicine Screening Measures, Isaac Adams

Family Medicine Clerkship Student Projects

In order to make progress towards long-term health on a community level, it is imperative to address health needs on a population basis and using a preventive strategy to prevent the development of more serious illness. With this in mind, this project aimed to create a poster providing easy to understand information to patients with regard to health screenings. Specifically, it addressed screenings for diabetes and pre diabetes, colon cancer, lung cancer, and breast cancer.

Anxiety Screening In Pediatric Populations, Shubhankar Joshi

Family Medicine Clerkship Student Projects

This project is aimed to elucidate guidelines for addressing newly changed recommendations for pediatric anxiety. Similar to the depression screening PHQ2, we hope to establish/develop a similar questionnaire that would serve as a quick screening tool and then further steps for treatment and recommendations on anxiety diagnosis.

Patient And Clinician Characteristics That Predict Breast Cancer Screening Behavior In 40–49-Year-Old Women, Sarina Schrager, Claudia Evaristo, Terry Little, Lori Dubenske, Elizabeth S. Burnside

Journal of Patient-Centered Research and Reviews

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women’s breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between …

The Impact Of An Evidence-Based Multi-Component Intervention On Colorectal Cancer Screening In Primary Care At A Healthcare System, Ahnnya Slaughter

Student Scholarly Projects

Practice Problem: Colorectal cancer is the second leading cause of cancer death in the United States; many of the deaths are preventable with early detection. Adherence rates for colorectal cancer screening with fecal immunochemical test kits (FIT) was below the national benchmark at this facility.

PICOT: The PICOT question that guided this project was: Among veterans 50 – 75 years old requiring average risk colorectal cancer screening (CRCS) seen in primary care at a veterans affairs healthcare system facility (P), how does the use of a multi-component intervention (I), compared to the usual care (C), affect the number of …

Reflections Of An Earliest Established Screening And Testing Facility For Covid-19 In The Largest Metropolis, Pakistan, Fatima Kanwal, Karishma Kanhya Lal, Asra Qureshi

Department of Family Medicine

As the world struggles to deal with the COVID-19 pandemic, this article talks about the experience and findings of the first COVID-19 screening facility in a tertiary care hospital in Karachi, Pakistan. Department of Family Medicine at Aga Khan University (AKU) took initiative where COVID-19 screening of stable patients first began in a dedicated area. Since testing kits were limited and community spread had not started, nurses would screen every walk-in patient based on the presence of fever, cough, travel history and exposure to COVID-19 positive patient in the last 14 days, and advise swab testing if indicated. Out of …

Anal Cancer Screening At Truman Health Services, Peter D. Tran, Harshdeep Babbar

Quality Improvement/Patient Safety Symposium

Anal Papanicoloau Screening at Truman Clinic

Anal cancer is a squamous cell cancer associated with human papillomavirus (HPV), the same virus that is associated with cervical cancer. Although vaccination against HPV has been shown to be effective in reducing overall rates of infection, the number of new anal cancer cases has been rising for many years. In HIV-infected men and women, the incidence is even higher of anal cancer than in the general population. Current rates in an HIV-infected MSM population have been estimated to be as high as 70-144 per 100,000, with some studies of HIV-infected individuals showing that …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

A Tailored Multicomponent Intervention In Primary Care For Survivors Of Adverse Childhood Experiences (Aces), Rebecca L. Peterson

Evidence-Based Practice Project Reports

Adverse childhood experiences (ACEs) include 10 traumatic events of abuse, neglect, and household dysfunction that occur before 18 years of age. Adverse childhood experiences affect greater than 60% of the population, and approximately one in six individuals affirm that they have experienced four or more types of ACEs. They are associated with negative, long-term health outcomes in adults, including 9 out of the 10 leading causes of death in the United States (Centers for Disease Control and Prevention, n.d.; Felitti et al., 1998). The purpose of this evidence-based practice project was to implement a tailored, multicomponent intervention to mitigate the …

Keeping Primary Care Providers Informed About Detecting Skin Cancer In Young Adults, Riley J. Spears

Evidence-Based Practice Project Reports

Skin cancer is a common, life-threatening disease that affects anyone, regardless of age or skin color (American Cancer Society [ACS], 2020). The incidence of melanoma is on the rise for young adults, with an estimated 2,400 new cases for individuals aged 15 to 29 (ACS, 2020). Although skin cancer is highly preventable, clinical guidelines are inconsistent regarding skin cancer screening. The purpose of this evidence-based practice (EBP) project was to determine if the implementation of the INternet curriculum FOR Melanoma Early Detection (INFORMED) program would improve primary care providers’ (PCPs’) confidence about skin cancer and the number of completed and …

The Primary Care Provider’S Role In Screening And Intervening In The Human Trafficking Of Adolescents: A Systematic Literature Review, Brittany Schmid

All Graduate Theses, Dissertations, and Other Capstone Projects

Human trafficking (HT) is a growing concern within the United States (U.S.) and internationally. With the alarming number of HT victims presenting for medical care, primary care providers (PCPs) are in a unique and privileged position to encounter HT victims within the healthcare system. Adolescents, in particular, are vulnerable to HT because of minimal life experiences, inadequate social support, and limited coping mechanisms (Ertl et al., 2020). Failure to recognize and intervene in cases involving HT victims who are minors is detrimental to the individual’s health, wellbeing, and safety. With the assistance of education and training, community resources, guideline adoption, …

Devoloping A Primary Care Screening Protocol For Post-Miscarriage Depression, Sean Muniz

Family Medicine Clerkship Student Projects

Spontaneous abortions occur in 20-33% of pregnancies, and 10-30% of these women have clinically significant depression. These women are often unscreened by either PCPs or OBs for depressive symptoms. We developed a screening protocol using the PHQ-2 to assess for depression in patients who have had a spontaneous abortion. The protocol utilizes a nursing care manager to follow up with patients who either were seen in the ED or self report spontaneous abortions to the PCP office. Follow up phone calls should be made within 2 weeks and at 6 weeks post spontaneous abortion, with offers for in-person follow-up given …

Non-Medical Cannabis Use Screening And Advising, William Dean Brown

Family Medicine Clerkship Student Projects

No abstract provided.

Dietary Health Screening, Luke Hallgarth

Family Medicine Clerkship Student Projects

Dietary recall by patients is time consuming & inefficient. This project aims to develop a screening tool to accurately and efficiently track patient's diets over the course of multiple healthcare visits.

Improving Identification Of Ldct Lung Cancer Screening Eligible Patients, Mckenna L. Schimmel

Family Medicine Clerkship Student Projects

USPSTF updated lung cancer screening guidelines this year to include all patients 50-80 years old who have 20+ pack years of smoking history and are active smokers or who have quit within the last 15 years. While providers and patients both support lung cancer screening efforts, only a small fraction of eligible patients end up getting screened annually. One way we can improve this metric is by making sure we are correctly identifying which patients meet screening criteria.

Assessing Patient Perceptions Of Pre-Visit Methods To Reduce Wait Time And Provider Burden, Vinh H. Le

Family Medicine Clerkship Student Projects

Due to multiple factors, patients at ambulatory settings tend to experience long appointment wait times, negatively impacting patient satisfaction and overall well-being. One proposed solution is to use pre-visit data collection to simplify check-in and screening processes at the office. This project surveyed patients at Brookfield Primary Care & Pediatrics regarding quantitative wait time data and qualitative perceptions on the proposed solution. It was found that a majority of patients are open to using pre-visit online forms to reduce wait times.

Psa Screening - Patient Decision Aid, Michael Brown

Family Medicine Clerkship Student Projects

PSA screening decision aid

Screening For Disordered Eating Among High-Risk Groups, Julia B. Purks

Family Medicine Clerkship Student Projects

Many patients with disordered eating will not present with objective manifestations such as low BMI, physical exam findings, or electrolyte abnormalities. Among patients that meet DSM-V criteria for an eating disorder, the majority do not fit criteria for anorexia nervosa or bulimia nervosa, but instead fall into a category known as "Otherwise specified feeding and eating disorders." As such, it can be difficult to identify these patients. This project proposes adding 2 validated screening questions to outpatient intake forms, or incorporating them into patient visits, to identify disordered eating among high-risk groups.

Exercise Prescriptions In Primary Care, Caitlyn Haines, Pgy-2

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives:

●Review the health benefits of physical activity.

●Recognize barriers on the part of the provider that limit our discussion of exercise with our patients.

●Understand the current recommendations for physical activity including: time per week, exercise intensity, and recommendations for pregnant patients and those with chronic disease.

●Understand the current recommendations for screening prior to exercise in patients with chronic medical conditions.

●Help patients devise strategies to introduce physical activity into their routine.

●Become familiar with resources to connect our patients with for exercise in their area.