Community Medicine

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Now showing 1 - 3 of 3
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    Addressing Refugee's Barriers to Healthcare in the COVID Pandemic
    (2021) Jackson, Garrett; Bly, Cody; Weeks, Cassidy
    Purpose: The COVID-19 pandemic has restricted healthcare access for the refugee population in addition to the usual monetary, educational, language, and cultural barriers. The refugee population is significant as Texas is among the top states for refugee resettlement, accepting more than 57,000 refugees from 2010-19. Refugee Health Initiative (RHI), a student-run clinic at University of North Texas Health Science Center (UNTHSC), developed a COVID protocol to address these needs for this ever-growing population. Methods: To decrease the exposure risk, our protocol was divided into two categories: volunteer practices and clinic logistics. The COVID protocol focused on a decentralized system where each volunteer was educated and equipped with best practices as outlined by the CDC. The clinic setting itself was altered to enhance ventilation which included hosting the clinics outdoors. Results: With the changes to the clinic structure RHI has been able to host 8 clinics since October of 2020, administering 150 flu shots, 20 school physicals, and screening and referring 30 patients with chronic illnesses. This includes community outreach to 100+ individuals from these communities who continue to spread awareness of our clinical services. Conclusion: To continue filling the gap between the refugee population and the healthcare system, RHI created a COVID protocol that utilized educating our volunteers in COVID symptoms and best practices and performing the basic health services in environments conducive to limiting virus spread. Commitment to these simple measures resulted in our ability to prioritize preventive care for this vulnerable population.
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    Implementation of SOAP-R Screening Tool to Assess Adult Opioid Misuse in Rural Clinics
    (2021) Parry, Caleb; Weldon, Chad; Hadley, Lesca; Gibson, John
    Introduction: Opioid misuse is an epidemic in the United States with estimates of opioid overdose deaths increasing 156% between 2010 and 20151. Rural communities are disproportionately burdened. Barriers in the rural health systems include distance, cost, and lack of methadone treatment clinics. The aim of this project is to assess the effectiveness of an opioid screening questionnaire in a rural clinic. Methods: Implementation of the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R) was assessed over a 4-week period. Patients who were prescribed opioids twice over a two-week period and who were age 19-80 were included. Cancer patients on opioid therapy were excluded. Results: Out of the 15 patients who were eligible to take the questionnaire, 11 chose to participate (70%). Three patients refused and one patient was not offered the questionnaire. None of the patients who took the questionnaire tested at risk for opioid abuse. Conclusion: Implementation of the SOAPP-R screening tool may alert physicians to potential misuse of opioids leading to earlier intervention and treatment for such patients. The present study showed an increase of screening from 0% to 73%. Future Plan Do Act (PDSA) cycles should include larger sample sizes. To assess the impact and influence of SOAPP-R, researchers should measure whether screening leads to early intervention.
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    Reducing Utilization of Hospital Resources through Implementing Outpatient Follow-up in a Rural Setting
    (2021) Calcagno, Alexa; Johnson, Jeremy; Gibson, John; Hadley, Lesca
    Purpose: Will increased outpatient follow-up with patients having multiple chronic conditions lead to decreased utilization of hospital resources? About 15% of the U.S. population qualifies for Medicare, the majority of which have chronic conditions requiring regular management. One Medicare component, the Chronic Care Management (CCM) Program, allows for establishment of a comprehensive care plan in patients with two or more chronic conditions at risk of death or functional decline. Initiated at Graham Healthcare and Urgent Care in Graham, Texas in January 2020, the goal of CCM is to encourage outpatient management of chronic conditions and reduce utilization of emergency room (ER) or inpatient services. Methods: The target population was 24 clinic patients enrolled in CCM in January or February of 2020. The number of ER visits, hospital admissions, and clinic visits of each patient in the 7 months before enrollment were compared to the number in the 7 months after enrollment. Results: The number of ER visits and hospital admissions before enrollment compared to the number after enrollment decreased by 11.8%. However, the number of clinic visits did not change before and after enrollment. Conclusion: If a larger sample size of patients were tracked over a longer time frame, it is likely the number of clinic visits would increase, and the number of ER visits and hospitalizations would continue to decrease. Therefore, the goal is to continue growth of enrollment in CCM and to implement a follow-up protocol to enhance efficacy of CCM services and advanced-care planning.