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| New
York Academic
Minerva Web
Journal |
| January
2004 Volume 4,
Number 01 |
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Paper
0401:
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Survey
of Practices Regarding Emergency Contraception
Linda
Prine, Susan Rubin, Susan Hadley,
Nicole Tan Kirchen, Dena LaCara, Lia Bruner,
Karen Roberts, and Jason Fletcher
Urban Institute,
NYC, NY
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.
NYAMWJ 2004,
4:Abstract 0401
Presented to the
Third BWAFP Research
Forum
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| Paper
0402: |
Depression
Screening in Primary Care
Katy
Topadze, M.D.
and Russell
Perry, M.D.
Department of Family Practice Bronx Lebanon
Hospital Center
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.
NYAMWJ
2004, 4:Abstract
0402
Presented to the
Third BWAFP
Research Forum
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| Paper 0403:
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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.
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.
NYAMWJ 2004,
4:Abstract 0403
Presented to the Third BWAFP Research Forum
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Paper 0404:
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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.
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.
NYAMWJ 2004,
4:Abstract 0404
Presented to the Third BWAFP Research Forum
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Paper 0405:
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Lifestyle
And Nutrition Related Cardiovascular Risk Factors In Elderly
Attending A Food And Nutritional Assistance Program
Lopez
W, MD, Enubuzor H, MD, and Schlussel Y, PhD
SVCMC, Jamaica, New York
Introduction:
Advances
in preventive medicine have significantly reduced the
morbidity and mortality associated with heart disease and
stroke. Despite
these improvements, cardiovascular disease remains the leading
cause of death for American over the age of 65. 20 million
persons over 65 have elevated LDL cholesterol, DM or HTN.
Cardiovascular disease is associated with a number of
modifiable risk factors, including elevated cholesterol,
hypertension, smoking, obesity and DM. Studies examining the
role of diet and lifestyle modification show benefits
including reduction in mortality, sudden death, cost of drugs
and coronary procedures. Dietary evaluation and counseling to
incorporate regular physical activity is recommended to
prevent coronary heart disease, hypertension, obesity and
diabetes.
Objective:
To determine the prevalence of cardiovascular disease
risk factors among urban elderly
for which nutritional therapy is recommended,
Setting
& Methods:
A cross-sectional survey of 64 low-income urban
residents over the age of 65 participating in a
federally-funded nutritional assistance program in Jamaica,
Queens NY. This program provides food supplementation to
participants monthly.
Participants: 72%
of respondents were female, 53% were married.14% were smokers.
Results: Risk
factors identified included: hypertension, diabetes, smoking,
hypercholesterolemia, coronary artery disease, sedentary
lifestyle and obesity. 67% had morbid conditions: 13% DM, 56%
HTN, 39% hypercholesterolemia, 14% CAD and 17% obese.
19% had more than one comorbid condition. While 81%
thought that diet helps control cholesterol, and 72% believed
it was important to have a balanced diet, only 22% had seen a
dietician. 70%
engaged in regular exercise, but only 38% on a daily basis.
Of those who exercise, 48% did so for at least 30
minutes.
Conclusion: The
urban elderly are at increased risk for cardiovascular
disease. Although patients are aware of their risk factors, they do
not actively seek nutritional intervention to help them reduce
their risk, and could do more to improve lifestyle
characteristics.
Interventions: From
the data gathered, we intend to develop an educational
intervention regarding the importance of nutritional
guidelines and physician follow up.
NYAMWJ 2004, 4:Abstract 0405
Presented to the Third BWAFP Research Forum
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Paper 0406:
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Alcohol
Exposure, Knowledge And Attitude Towards Alcohol In 6th
Graders
F
Magina, MD, Y Schlussel, Ph.D. and H Enubuzor, MD
St. Vincent’s Catholic Medical Center, Jamaica, NY.
Introduction:
Alcohol abuse and dependence are the most common
substance-related disorders and the second leading cause
of preventable death in the U.S. Driving accidents,
violence and suicide from alcohol are the leading causes
of death among American youth. Alcohol use is associated
with school failure and poor judgment, which may put teens
at risk for accidents, violence, unplanned and unsafe sex
and suicide. Half of all sexual assault and date rape
cases involve alcohol. 25% of children < 18 in the U.S.
are exposed to alcohol abuse or dependence in the family.
32.2% of students nationwide had first drunk alcohol
before age 13. Young people that use alcohol at an earlier
age are more likely to use alcohol heavily later in life,
have alcohol-related problems, abuse other drugs and to
get into trouble with the law.
Objective: 1)
to determine the level of alcohol exposure and to assess
knowledge and attitudes towards alcohol. 2) to design an
educational and interactive program to educate these
children on the negative impact of alcohol.
A post intervention survey will be administered.
Research Design:
a longitudinal survey of sixth grade students.
Established risk factors for alcohol awareness were
analyzed. Means, percentages and correlations are
presented.
Setting: an elementary school in the area of
highest poverty in Queens, New York.
Participants: 58 Students in the 6th
grade, whose average age was was 11.6(+.83).
58 students completed the survey; 41% were male.
Their average academic level was 2.8 (B-).
Results: Students
spend considerably more time on average watching TV (8
hrs/wk) than doing homework (1.8 hrs/wk)
or reading (2.6 hrs/wk).
33% of the students had tried alcohol, at the
average age of 9. While
only 4% had ever gotten drunk, 42% had family members that
drink. More
than 90% of students were aware of the dangers of drunk
driving, and health effects of alcohol on stomach, liver,
and cancer. Trying
alcohol at young age was related to reporting being in a
fistfight in the past (r=0.50; p<0.01).
Conclusion: Students
are aware about the dangers of alcohol.
Intervention:
Early exposure in the home, influence of media, and
the potential for aggressive behavior among students who
tried alcohol, will be taken into consideration when
designing an educational intervention program for
adolescents.
NYAMWJ 2004, 4:Abstract
0406
Presented to the Third BWAFP Research Forum
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Paper 0407:
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Exercise
Awareness In The Prevention And Treatment Of Diabetes In An Underserved
Elderly Population
Srinivas Nagabandi, MD; Harriet
Enubuzor,
MD, Yvette and R. Schlussel, Ph.D.
Dept. of Family Practice, St. Vincent’s Catholic Medical Center, Jamaica,
NY, New York Medical College
OBJECTIVE:
. To assess the prevalence of diabetes in this group, the incidence of
appropriate levels of exercise and the knowledge of the benefits of exercise
in diabetics attending a senior center.
RESEARCH DESIGN: Randomized
retrospective community survey.
SETTING: Elderly (>65
year old) adults attending a senior center located in Jamaica, Queens. The
center is a non-profit organization, serving more than 5000 senior adults
yearly and reaching 15,000 indirectly. This
community is very ethnically diverse with large numbers of ethnic and racial
minorities, mostly from lower socio-economic groups.
RESULTS: The prevalence of
diabetes in this population was 28%. 33%
have been diabetic for 5-10 years. Older
seniors(more than 70 yrs of age) were more likely to be diabetic.
Males were more likely to be diabetic. 79% exercise regularly, and 31%
have gained weight in the last 6 months.
Among diabetics, 50% exercised less than 3 times/week, for 20 minutes.
33% of seniors were aware that by exercising they could prevent
diabetes. Only 50% of diabetics
had this awareness.
CONCLUSION: Diabetes is
highly prevalent among urban elderly from low SES groups. Up to half of diabetic seniors are unaware of the benefits of
exercise to reduce morbidity from type II diabetes. Lifestyle modifications, including a regular exercise program
and weight loss are indicated in this population.
INTERVENTION:
Results of the survey will be used to design a prevention and education
program used to promote a healthier lifestyle and exercise awareness in this
elderly group. Physician
awareness regarding the benefits of exercise in this population also needs to
be increased.
NYAMWJ
2004, 4:Abstract 0407
Presented to the Third BWAFP Research Forum
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Paper 0408:
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Anemia
in an inner city population
G. Florez, MD and A. Hamaoui, MD
Wyckoff Medical Center, Brooklyn, NY
NYAMWJ
2004, 4:Abstract 0408
Presented to the Third BWAFP Research Forum
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Paper 0409:
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A
Qualitative Assessment of Existential Issues in a
Culturally-Diverse Cancer Patient Population in Israel
Craig
D Blinderman, MD, MA and Nathan I Cherny, MBBS, FRACP
Department of Family Medicine, Beth Israel Medical Center,
New York,
Director of Cancer Pain and Palliative Care Unit,
Department of Oncology, Shaare Zedek Medical Center,
Jerusalem, Israel
OBJECTIVE:
The
purpose of this study is to qualitatively assess the
existential distress in an ethnically, culturally, and
religiously heterogeneous oncology population in Israel.
We sought to determine the extent to which existential
concerns are present, how they are manifested and to what
degree they caused distress.
RESEARCH
DESIGN: Forty
culturally diverse patients with advanced cancer in
different phases of treatment were interviewed in Hebrew
or in English. The
interviewees were selected from patients with advanced and
incurable cancer currently undergoing care in the
integrated Oncology and Palliative Medicine Department at
Shaare Zedek Hospital, Jerusalem, Israel during the month
of August 2003. The methodology was essentially
qualitative. Patients were asked questions about the
following subjects: autonomy, dignity, body image, social
isolation, coping mechanisms, guilt, past disappointments,
spiritual health, meaning, hope, and death/dying.
SETTING:
Institution:
Shaare Zedek Hospital’s Oncology Treatment Center
SELECTION
PROCEDURE:
40 consecutive oncology patients were interviewed. Exclusion criteria were
patients
with organic brain syndrome, dementia, hospitalized
post-operative patients, or patients who were imminently
dying.
RESULTS:Overall,
the most striking finding of this survey was that despite
the prevalence of existential concerns, manifest
existential distress was relatively uncommon in this
patient group. Indeed, severe existential distress with
features of demoralization was noted in only four out of
the forty patients.
CONCLUSIONS:
Our
findings suggest that existential concerns in patients
with advanced cancer may be mitigated by a strong
framework of palliative measures, good family support,
effective coping strategies, and religious belief systems.
NYAMWJ
2004, 4:Abstract 0409
Presented to the Third BWAFP Research Forum
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Paper 0410:
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Health
in Refugees and Asylees
Gaurav
Mathur,
Beth Israel Residency in Urban Family Medicine.
NYAMWJ
2004, 4:Abstract 0410
Presented to the Third BWAFP Research Forum
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Paper 0411:
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The
Asthma Dialogues: Training Healthcare Providers
R.
W. Morrow MD
Albert Einstein College of Medicine
Introduction:
The author has participated in a project to improve
healthcare services for people with asthma. This
paper analyzes the process measures of an innovative
educational project designed to improve patient outcomes
by improving skills of healthcare providers in caring for
patients.
Methods
involved small group training in two one hour [or less]
sessions delivered to healthcare providers in several
sites in the NYC area. A total of more than 240 learners
were recruited. Learners completed a questionnaire
examining barriers and self-efficacy, and then viewed a
short doctor-patient dialogue. They then completed a
series of scaled questions as to the likelihood that they
would undertake certain actions at that time with the
simulated patient.
A similar simulation was then shown, and the group
discussed their thoughts on diagnosis and treatment for
about 45 minutes. They then viewed a ‘post sim’ and
responded to the same questions as posed for the ‘pre
sim.’ The three sims had comparable levels of severity,
and the responses pre and post were compared.
Results: The
sample of learners are predominantly physicians (MD/DO)
(53.4%), the next largest contingent are residents (19%).
The respondents surveyed were predominantly from Primary
Care fields. Participants specializing in Family Medicine
constitute 64.5% of the sample, and almost 25% are from
the field of Pediatrics.
The
t-test analyses indicate that the educational modules
impact the targeted clinical skills and domains of asthma
assessment, treatment and prevention.
Following completion of the case-based scenarios,
providers are significantly more likely to make use of
prescriptions, asthma equipment and training (peak flow
meter, nebulizer, observations) as well as indicated
medications (albuterol, steroids, anti-inflammatories).
Significant increases are also seen in terms of action
plan development, and contact availability (in the form of
office visits). Significant reductions were found for ED
referrals and Hospital admissions in the second module.
Perhaps most important is the impact on judgments of
asthma severity. Module 1 data show that of those who
assessed the patient's asthma as "intermittent"
at pre-test, 100% (18 of 18) rated the same patient as
“chronic” following the training. Similar improvement
was found for module 2, where 21 of the 22 providers who
initially assessed the case as "intermittent"
rated the patient's condition as "chronic" at
post-test.
Modules
1 & 4 contain items that tap learners’ perceptions
of efficacy in, and barriers to successful asthma
treatment. Upon completing administration of the four
module series, analysis of these items can define the
critical target domains impacted by the learning modules,
and also inform subsequent interventions.
Responses to efficacy items (for module 1) were recorded
on a 5-point scale representing a range of confidence,
ranging from “Not at all” to “Very” (confident).
Of the seven items tapping asthma treatment efficacy, the
three areas rated lowest by the sample of learners were:
1) Patients’ ability to use tools correctly (74% were
“Not sure” to “Not at all confident”), 2)
Patients’ ability to use steroids correctly (65% were
“Not sure” to “Not at all confident”), and 3)
Clinicians’ ability to accurately assess a patient’s
severity (51% were “Not sure” to “Not at all
confident”).
It is worth noting that 2 of these (lowest rated) items
focus on patients’ abilities, suggesting the
appropriateness of training patients to use treatment
tools and medications. The third (lowest rated) item
pertains to clinicians’ ability to evaluate a
patient’s severity, providing validation for a primary
directive of this educational effort.
Clinicians were most confident in their ability to 1)
Detect the appropriate components of asthma history (84%
were somewhat to very confident), and 2) Providing acute
in-office interventions (81% were somewhat to very
confident).
Barriers to asthma treatment were assessed in a similar
manner, with items scored on a 3-point scale (Not a
barrier at all- Somewhat a barrier-Definitely a barrier).
Issues that were rated as the greatest impediments to
treatment were 1) Patients’ denial of their chronic
disease (90% of clinicians rated this Somewhat to
Definitely a barrier), and 2) Patients’ personal
stressors (95% of clinicians rated this Somewhat to
Definitely a barrier).
The items that were least problematic to asthma treatment
were: 1) Comfort level talking with patients over the
phone (63% rated this “Not at all a barrier”), 2)
Reimbursement for time required to adequately treat
patients (63% rated this “Not at all a barrier”), and
3) Lack of training (in asthma treatment) (60% rated this
“Not at all a barrier”).
Conclusions:
Healthcare providers in primary care show a measurable
improvement in their intent to follow guidelines in an
appropriate way using this method of training. Patient
outcome data will be available in the near future to see
if such training improves asthma outcomes in daily
practice.
NYAMWJ
2004, 4:Abstract 0411
Presented to the Third BWAFP Research Forum
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Paper 0412:
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Are
we serious about cholesterol prevention?
Evelina
Tsarik, DO, Lilia Gehkman, DO, and Abraham Hamaoui,
MD
Wyckoff
Medical Center, Brooklyn, NY
Objective:
To
investigate the proportion of low income adults with
physician contacts aware of cholesterol as a risk factor
in heart disease.
Research Design: Observational cross-sectional
survey study and chart review.
Measurements
And Results: Low income patients who mostly spoke Spanish as
their native tongue and who were admitted to a community
hospital for acute events, mainly infection, uncontrolled
diabetes, and heart disease, and with an average age of
61.7 (males) and 65.3 (females) — and who consented (all
who were asked did) — were surveyed. Two thirds of
patients associated cholesterol (68.6%) and smoking (66.7%)
to heart disease. Most (64.4%) declared to have been
tested for cholesterol in the past. Slightly a lesser
number remember having received patient education by their
physician contacts on smoking cessation (44.2%),
cholesterol levels (61.5%), and about half remembered
recommendations as to exercise (63.5%) and diet (53.8%).
When we looked, at a similar population in an outpatient
center, we found that 25.4%
in one survey and 32.87% in another recalled
having received patient education on cholesterol. However,
when we checked the charts only 6.0% had been tested for
cholesterol as part of the in-hospital workup, while 42.0%
(32.97% in another review)
documented testing in the center.
As to other risk factors, patient education is less
likely to be missed in inpatients (54% vs. 11%,
p< 0.0001). However few remembered being checked
for homocysteine (5.8%), and only 9.6% were actually
tested for homocysteine during the hospital stay. None in
outpatients.
Conclusions:
The
survey indicates relatively good understanding of
cardiovascular risk factors by participants.
Patient education is fair though screening for cholesterol
by physicians may need to be incremented.
Primary and secondary prevention are still a challenge,
but may contribute definitely to ending the
Atherosclerosis epidemic.
NYAMWJ
2004, 4:Abstract 0412
Presented to the Third BWAFP Research Forum
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Paper 0413:
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Evaluation
of Prescription Competency for Family Practice Interns.
Regina
Ginzburg, Pharm.D., Andreas Cohrssen, MD and Stephen
Dahmer, MD
BIMC Family Medicine.
The paper describes
an innovative program and curriculum change that will
allow for earlier independent prescribing of
medication by interns. The reasons for the implementation
of the new program are discussed and
the details of the assessment forms, the 3 year curriculum
divided by
the ACGME competencies and a commentary by a PGY I
resident on their
experience in participating in this program are presented.
NYAMWJ
2004, 4:Abstract 0412
Presented to the Third BWAFP Research Forum |
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