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New York
Medical Web Journal
of Health
Care
Supplement
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Papers
accepted for presentation at the Third Annual BWAFP Research Forum
2004.
Hosted by the DFM at AECOM.
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Paper
4001: Survey
of Practices Regarding Emergency Contraception
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Linda
Prine, Susan Rubin, Susan Hadley,
Nicole Tan Kirchen, Dena LaCara, Lia Bruner
Karen Roberts, Jason Fletcher
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Objective:
To
look at the prescribing practices of emergency
contraception (EC) before and after an educational
intervention.
Method:
Research
Design:
The research design is a before and after trial.
Setting:
Six family medicine residencies in the Northeast, which
include rural, suburban and urban locations.
Participants: Faculty and
residents (PGY1-3) as well as nurse practitioner providers in
the residencies.
Selection Procedure: All
eligible participants were encouraged to complete a survey.
The participation rate was 95%.
Intervention: One
hour of education on emergency contraception which included
slides that gave the audience feedback on how their residency
answered the survey in comparison to the other participating
residencies.
Measurement and Results: The surveys will be
re-administered after all of the educational interventions
have been completed. The
baseline surveys have been analyzed already.
In additional to tallying the results, we compared the
answers among the programs, looking for patterns depending
upon whether the sites were rural, urban or suburban.
We also looked at the amount of education each program
had done prior to the survey on emergency contraception.
The first round of the surveys found some interesting
results. For
example, the majority of practitioners for Urban sites (55.3%)
are more likely to prescribe EC during routine check-ups,
whereas the majority in Rural/Suburban settings (54.5%)
"rarely" or "never" prescribe EC during
these check ups. This difference is significant (p < .001).
The rest of the significant results will be presented in the
forum.
Conclusions: The
utilization of EC by all 6 of the residency programs has much
room for improvement. It
is our hypothesis that the educational intervention, as well
as filling out the survey twice, will improve the prescribing
practices of physicians. We are aware that there will be a tendency on the part of
providers filling out the surveys to over-report their
prescribing practices. However,
we believe that this tendency would have been true on both the
first and the second survey, so that some improvement due to
the intervention should be observable.
| | Paper
4002: Depression
Screening in Primary Care |
Katy
Topadze, M.D.
and Russell
Perry, M.D.
Department of Family Practice Bronx Lebanon
Hospital Center
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Background:
The US Preventive Services Task Force recently
recommended "screening adults for depression in
clinical practices that have systems in place to assure
accurate diagnosis, effective treatment, and
follow-up." In the year of 2001 in our Fulton clinic we
have implemented stamps for each adult visit asking two
questions about mood and anhedonia, as recommended by the
USPS Task Force. These two questions are: "During the
past 2 weeks, have you felt down, depressed, or hopeless?"
and "During the past 2 weeks, have you felt little
interest or pleasure in doing things?"
Objectives: In this study we looked at the effectiveness
of depression screening in our clinic. We tried to evaluate:
1 If the questions were asked. 2 If the cases with the
positive answers were followed by a formal diagnosis of
depression. 3 If ideas of suicide and homicide were explored.
Methods:
We reviewed 200 charts using exclusion criteria of:
patients age 18 or younger; prior psychiatric disease;
specialty visits such as podiatry, ENT dermatology; visits
prior to March, 2001.
Results: 134
charts and 402 visits included in the study: 27 patients
answered yes to
one or both questions; Only
4 patients were identified as depressed. 41
charts had empty stamps, questions not asked or not
documented; 4 patients were identified as depressed.
Conclusions:
Depression screening stamps should be used; Patients who
answered yes to one or both questions should be assessed. If
there is acute depressive state (such as pt is suicidal),
problem must be addressed.
In all other cases pt should be brought back for a separate
visit for further diagnosis and management.
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| Paper
4003: Assessing
Childhood Obesity in a Family Practice Center |
M
Son, MD, Y. Schlussel, PhD., and H Enubuzor, MD
Department of Family Practice and Community Medicine, St. Vincent's Catholic
Medical Center, Jamaica, NY
11432.
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INTRODUCTION:
The prevalence of childhood obesity has doubled in the past 30 years.
Obese children are likely to become obese adolescents and adults. Studies
have identified mother's obesity, low family income and lower cognitive
stimulation in the home as risk factors.
Adult obesity is associated with significant morbidity, including
hypertension, type II diabetes mellitus, hyperlipidemia, and colon cancer.
OBJECTIVES: 1)To determine the prevalence of childhood obesity among
children in an inner-city family practice center.
2) To design an intervention to prevent obesity and encourage weight loss
in this population.
DESIGN: Clinical chart review of 139 children at risk.
SETTING: A family practice center in Jamaica, NY serving low-income Black
and Hispanic children.
PARTICIPANTS: 139 children age 6-11 years old. 57% of the sample was
female. 32% had Medicaid.
RESULTS: The majority of parents of children attending this center were
unaware of the risk factors for obesity.
The average age of children screened was 12.
44% came from Jamaica, an area with higher rates of cardiovascular
disease than New York City as a whole.
The average BMI was 22.
55% of the sample was African American, while 22% were Hispanic.
CONCLUSIONS: While obesity is a multifactor problem, lower economic well
being and lack of access to safe, convenient recreational facilities among the
population served by the family practice center suggests a higher likelihood of
childhood obesity. Treatment of obesity in adults rarely meets with long term
success.
Prevention of childhood obesity is the best hope for decreasing the
prevalence of this condition later in life.
INTERVENTIONS:
Interventions will include patient counseling about a weight loss plan
involving parents and children during routine child well visits, and a follow-up
assessment of the impact of the intervention.
Obesity prevention will include discussions and handouts regarding
prevention and components of successful weight loss plans.
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| Paper 4004: Exercise
Awareness in the Urban Elderly. |
D.
Chintakayala,
MD, Y. Schlussel, PhD., H. Enubuzor, MD
Dept. of Family Practice, St. Vincent's Catholic Medical Center, Jamaica, NY,
New York Medical College.
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INTRODUCTION:
The benefits of physical exercise and fitness have long been understood.
Cardiac, pulmonary, musculoskeletal, and metabolic-endocrine changes
associated with age and/or disease slow in progression as a result of physical
activity.
The majority of elderly adults are unaware of the negative effects of
degenerative disease, and that regular exercise can improve their health status.
OBJECTIVES: 1)To increase the awareness and attitudes towards exercise
among the urban elderly. 2) To design an intervention for seniors based on
information obtained in a community survey.
DESIGN: Community-based cross-sectional survey.
SETTING: A senior center in Jamaica, NY serving low-income Black and
Hispanic adults.
PARTICIPANTS: 90 adults over 65 years old.
RESULTS: Over 50% of elderly attending this center were unaware of the
ill effects of degenerative diseases.
Greater than 50% noted that exercise had not been encouraged by their
physician.
Awareness of the positive benefits of exercise was higher among more
educated respondents. It was also observed that elderly individuals have greater
awareness about physical activity, but no realization that regular exercise will
positively affect their existing diseases.
CONCLUSIONS: The quality and life expectancy of this group will be
improved if the importance of exercise is stressed at each visit.
Self-consciousness and lack of self-discipline, social isolation, and
lack of knowledge have been found to be the predominant barriers to physical
activity in the elderly. The elderly are somewhat aware of the benefits of
exercise, such as improved self-esteem, mood, and health, but the beliefs about
the positive benefits of exercise may vary by ethnicity.
INTERVENTIONS:
The survey will be used to tailor an intervention program for the
center's elderly, stressing regular sustained exercise to promote health and
prevent progression of degenerative diseases.
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