Primary Care Commons^™

Identifying Sleep Disorders And Proper Sleep Hygiene In School-Aged Children, Kathryn Colelli

Family Medicine Clerkship Student Projects

Sleep is a daily struggle for many people. Children in particular often suffer from sleep restriction and poor sleep hygiene. Poor sleep can have a negative impact on their physical, social and emotional health. Children in our community are rarely educated about sleep disorders or sleep hygiene. The goal of this project was to create a learning tool to help facilitate sleep education in children.

Mental Health Awareness Among High School And College Students: Barriers To Knowledge, Accessibility, And Utilization Of Resources, Imelda Muller

Family Medicine Clerkship Student Projects

In 75% of individuals with mental health illness, age of onset is prior to 24. High School and College Students often face unique life stressors that increase their vulnerability to mental health challenges, including anxiety, depression, and suicide. Students facing mental health issues in Danbury often do not receive adequate support. This is partially attributable to lack of knowledge about mental health, stigma, and lack of available mental health resources specific for this age group. Students who do not receive these supports during times of vulnerability perform more poorly in school, have lower rates of completing high school and college, …

Managing Medications: Promoting Awareness Of The Importance Of Accurate Medication Lists, Christopher Meserve

Family Medicine Clerkship Student Projects

Extensive medication lists are a problem everywhere throughout the United States. As a rural state that has a rapidly aging population, these lists will continue to grow and the added aspect of lack of access to services (whether via the internet or transportation) makes managing these medication lists harder for Maine’s population. The perspectives of patients at the CMMC Family Medicine Clinic were obtained through an anonymous survey, and two interviews with community members were conducted to identify specific issues. The feedback and responses from both of these methods were incorporated into an informational pamphlet that was distributed within the …

Better Teeth, Better Health: Identifying Challenges With Dental Care In Lewiston, Me, Mary B. Ledoux

Family Medicine Clerkship Student Projects

My project aimed to elucidate barriers to dental health care in the Lewiston-Auburn community. Obstacles highlighted included cost of care, lack of education and guidance in preventative oral health, and paucity of resources available to aid patients in identifying affordable programs. The data generated can be used in the future to better direct oral health interventions at CMMC Family Practice Clinic. Additionally, the survey responses were used to assemble educational material to distribute to patients.

An Introduction To Alcohol Use Disorder And Motivational Interviewing At Henry Abbott Technical High School In Danbury, Ct, Laura D. Leonard, Dylan C. Hershkowitz

Family Medicine Clerkship Student Projects

We presented to high school students interested in careers in health about alcohol use and motivational interviewing. We demonstrated effective motivational interviewing skills including asking open ended questions, using non-judgmental language and eliciting change talk from patients. Finally we facilitated breakout sessions which allowed students to practice identifying at risk behaviors and to practice motivational interviewing.

Pre-Exposure Prophylaxis For Hiv Prevention: A Community-Based Approach To Increased Awareness Among Vermont Primary Care Providers, Nicholas Robert Bonenfant

Family Medicine Clerkship Student Projects

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 …

Bridging The Gap, Amy Wei-Hsin Yu

Family Medicine Clerkship Student Projects

Many elders must choose between paying bills, buying medication or buying food. Some elders are unaware that they qualify for food assistance, or would feel stigmatized using it. Only 1 in 3 eligible seniors (60+) participate in 3SquaresVT (SNAP), a federal nutrition program of the USDA administered by the Vermont Department for Children and Families. Over 14,000 (11%) of Vermont seniors face the threat of hunger and almost 7,000 (5%) are at-risk for hunger (food-insecure). Food insecurity can be screened for by using Hunger Free Vermont’s Two Question Screen.

Added Sugars: Educating The Public On New Guidelines, Michael A. Grant

Family Medicine Clerkship Student Projects

Added sugars are a non-nutritional source of calories found in many food products where people do not expect to find them. There is ongoing discussion of the healthy amount of added sugars to consume as well as new guidelines and labeling efforts. This project reviews the epidemiology of a small town in VT and considers ways to improve the awareness of added sugars and how to reduce the amount consumed by its residents.

Lewiston Community Health Improvement Project, Bryce M. Bludevich

Family Medicine Clerkship Student Projects

Community Health improvement project about low back pain and alternative treatment options. Particularly focuses on different treatment options in Lewiston, ME.

Exploring Attitudes Toward Physician-Nurse Collaboration Within A Team-Based Primary Care Environment, Tom Karagiannis Pharmd, C. Coschignano, Sarah E. Hegarty Mphil, L. Polenzani, E. Messina, R. Zoli, Mohammadreza Hojat Phd, Vittorio Maio Pharmd,Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Patient Experience Of Care In A Student-Faculty Collaborative Practice, Rebecca A. Berman, Scott Elman, Pratyaksh Kumar Srivastava, Janine Knudsen, Laura Huppert, Kyle Dempsey, Michael Barnett, Camille Powe, Karen Donelan

Patient Experience Journal

Student Run Clinics (SRCs) are a popular means of caring for the underserved while providing valuable medical education opportunities. Reports of patient experience surveys are rare in this setting. This is troublesome because it is possible that underserved patients, who are more likely to receive care at SRCs, are not receiving the same level of care as at more traditional medical practices. The purpose of this research was to measure patient experience in a student-led medical clinic. The method included the use of patient experience surveys, which were self-administered pre-visit and self- and interviewer administered post-visit. The key results, 100% …

Recurrent Aphthous Stomatitis: Diagnosis And Management In Primary Care, Jillian Hudson

Journal of Patient-Centered Research and Reviews

Recurrent aphthous stomatitis (canker sores) is a very common oral condition that remains incompletely understood. Presentation has been well-classified into minor, major or herpetiform subcategories based on clinical features, but exact etiology is unknown. Because etiology is unclear, treatments are primarily empiric and aimed at symptom reduction rather than prevention or cure. However, there are several methods, both topical and systemic, that can be easily and affordably utilized in the primary care setting.

Factors Associated With Ordering Laboratory Monitoring Of High-Risk Medications, Shira Fischer, Jennifer Tjia, George Reed, Daniel Peterson, Jerry Gurwitz, Terry Field

Jennifer Tjia

BACKGROUND: Knowledge about factors associated with provider ordering of appropriate testing is limited.

OBJECTIVE: To determine physician factors associated with ordering recommended laboratory monitoring tests for high-risk medications.

METHODS: Retrospective cohort study of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between 1 January 2008 and 31 December 2008. Analyses are based on administrative claims and electronic medical records. The outcome is a physician order for each recommended laboratory test for each prescribed medication. Key predictor variables are physician characteristics, including age, gender, specialty training, years since completing training, and prescribing volume. Additional variables …

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 …

An Electronic Health Record-Based Intervention To Increase Follow-Up Office Visits And Decrease Rehospitalization In Older Adults, Jerry Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, Sarah Cutrona, Leslie Harrold, Shawn Gagne, Peggy Preusse, Jennifer Donovan, Abir Kanaan, George Reed, Lawrence Garber

Jennifer Tjia

OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

DESIGN: Randomized controlled trial.

SETTING: Large multispecialty group practice.

PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home.

INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule …

Neglected Or Non-Compliant? Assessing The Difficulties Of Tuberculosis Patients In Salvador-Ba, Brazil, Erin Slatery

Independent Study Project (ISP) Collection

Objective: The aim of this study is to analyze how Instituto Brasileiro para Investigação da Tuberculose (IBIT), a philanthropic tuberculosis clinic in Salvador, Brazil, maintains treatment abandonment rates much lower than those of surrounding public clinics. This study also aims to evaluate how professionals conceptualize and address the difficulties faced by patients.

Methods: Interviews were conducted with 8 IBIT professionals and 16 patients in treatment for tuberculosis in the aforementioned institution via semi-structured and structured questionnaires, respectively. Participant observation guided the analysis of relationships between patients and professionals.

Results: Patients found varying aspects of treatment difficult depending on personal circumstances, …

Understanding The Role Of Promotora In A Latino Diabetes Education Program, Lynn Deitrick, Hannah Paxton, Alicia Rivera, Eric Gertner, Nyann Biery, Abby Letcher, Lissette Lahoz, Edgar Maldonado, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

The Capus Project-Innovative Solutions For Hiv/Aids Linkage To Care, Melanie Gwynn, Jamila Ealey, Kate Racoff Musgrove

9th Annual Rural HIV Research and Training Conference (2014-2019)

“The CAPUS Project-Innovative Solutions for HIV/AIDS Linkage to Care”

Objectives: 1) Expand knowledge of the current linkage to care landscape within Georgia; 2) Identify essential components of the Resource Hub to enhance linkage to care efforts throughout Georgia; and 3)Promote effective use of the Resource Hub to facilitate HIV/AIDS linkage to care within highly impacted communities

Mental Health Referral In Primary Care: Influence Of A Screening Instrument And A Brief Educational Intervention, Michael T. Miesner

Electronic Theses and Dissertations

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns …

Characterization Of Primary Care Clinicians’ Use Of Genomic And Pharmacogenomic Testing, Brian Stello Md, Heather Bittner-Fagan Md, Mph, Christopher V. Chambers Md, Melanie B. Johnson Mpa, Geoffrey Mills Md, Phd, Michael P. Rosenthal Md, Kyle Shaak Bs

Department of Family Medicine

No abstract provided.

Accessing Healthcare: The Experience Of Individuals With Autism Spectrum Disorders In Maine, Alan Kurtz, Angie Schickle, Margaret Carr, Marnie Bragdon-Morneault, Susan Russell, Debra Rainey, Jill Downs, Nancy Cronin

Health and Well-Being

Previous research has revealed that children and adults with autism spectrum disorders (ASD) are significantly more likely to have both unmet healthcare needs than those with other disabilities. In addition, they are more likely to have difficulty accessing primary or specialized medical care. Minority status, living in a rural location, and low income can exacerbate these disparities. Other obstacles to effective healthcare for individuals with ASD include the following: (1) severity of symptoms associated with ASD; (2) lack of knowledge or skill by medical practitioners; (3) lack of access to comprehensive healthcare supports or a medical home; and (4) lack …

Disparities In Patient-Reported Barriers To Attend Diabetes Group Visits, Beth Careyva Md, Melanie B. Johnson Mpa, Kyle Shaak Bs, Brian Stello Md

Department of Family Medicine

No abstract provided.

Primary Care Clinicians Use Of Genomics And Pharmacogenomic Testing, Heather Bittner-Fagan Md, Mph, Brian Stello Md, Christopher V. Chambers Md, Geoffrey Mills Md, Phd, Beth Careyva Md, Melanie B. Johnson Mpa, Dierdre B. Axell-House Ba, Michael P. Rosenthal Md

Department of Family Medicine

No abstract provided.

Perioperative Diabetes Management, Vasudev Magaji

Vasudev G Magaji MD, MS

No abstract provided.

Influenza And Asthma: Evaluation Of The Effectiveness Of An Evidenced-Based Intervention Bundle On The Influenza Vaccination Rates Among Asthmatic Children Age Six Months To 18 Years, Benjamin D. Malcolm

Master of Science in Nursing Theses

The American Academy of Pediatrics has begun an initiative called Accelerating Improved Care for Children with Asthma Program Chapter Quality Network Asthma Project, Phase 3 (CQN3). This project is a conscious effort to enhance the quality of life in asthmatics. One important initiative included in this project is to achieve 90% or greater influenza vaccination rates in children age six months and older with asthma. This is because children with asthma who contract influenza have increased morbidity and mortality rates than do their non-asthmatic counterparts. Studies have shown vaccination rates for these children are typically between 9 to 26%, and …

Patient Reported Barriers And Limitations To Attending Diabetes Group Visits (Poster), Beth Careyva Md, Melanie B. Johnson Mpa, Kyle Shaak Bs, Brian Stello Md

Department of Family Medicine

No abstract provided.

Rural Pediatric Primary Care Practice Patterns As A Result Of An On-Site Behavioral Health Consultant: A Retrospective Analysis, Kayla D. Mccarter

Undergraduate Honors Theses

Nationally, it has been estimated that 10 to 21% of children with psychosocial concerns are seen in primary care settings (Jellinek et al., 1999; McInerny, Szilagyi, Childs, Wasserman & Kelleher, 2000; Palermo et al., 2002). Often, however, children go undiagnosed with/treated for psychosocial concerns in pediatric primary care due to lack of physician time and poor referral rates to mental health providers. Evaluations of integrated care models, in which a behavioral health consultant is present in primary care practices, has shown to increase the availability of mental health services (Stancin, Perrin, & Ramirez, 2009). Using extant data from patient records …

Modified Cage As A Screening Tool For Mechanical Fall Risk Assessment: A Pilot Survey, Marna R. Greenberg Do, Mph, Facep, Michael Nguyen Md, Bernadette Gl-Porter Bs, Robert D. Barraco Md, Brian Stello Md, Arnold R. Goldberg Md, Clare M. Lenhart Phd, Mph, Anita Kurt Phd, Rn, Bryan G. Kane Md

Bryan G Kane MD

Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey Marna Rayl Greenberg DO, MPH, Michael C Nguyen MD, Bernadette G Porter BA,Robert DBarraco, MD MPH, Brian Stello MD, Arnold Goldberg MD, Clare M Lenhart, PhD MPH,Anita Kurt PhD, RN, Bryan G Kane, MD Background: Falls in the elderly cause serious injury. The literature does not hold answers to patient perceptions about their personal fall risk, their comfort level in discussing their fall history, or a home safety plan with their healthcare provider. Existing risk-assessing tools may be prohibitive in the Emergency Department due to their …

Hypertension Management In A Student-Run Free Clinic: Meeting National Standards?, Jason Zucker, Jennifer Gillen, Jason Ackrivo, Robin Schroeder, Steven Keller

Robin S. Schroeder MD

PURPOSE: Affecting one in three adults, hypertension is one of the most prevalent disorders in the United States. The purpose of this analysis was to evaluate, using national care guidelines and quality standards, the quality of care provided at the Student Family Health Care Center (SFHCC) of the University of Medicine and Dentistry of New Jersey (Newark).

METHOD: The authors performed a chart review of all patients seen from June 2008 to June 2009, collecting the following data: age, gender, ethnicity, body mass index, most recent blood pressure measurement, comorbid conditions, number of visits, free medications dispensed, and smoking status. …

Obesity: Practical Information For The Student Health Provider, Robin Schroeder

Robin S. Schroeder MD

No abstract provided.