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| New
York Academic
Minerva Web
Journal |
| January
2006 Volume 6,
Number 01 |
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Paper
0601:
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Determinants of Pneumonia/Flu Immunization
Among The Elderly In
Jamaica, NY
Peter Asafo-Adjei MD
Department of Family
Practice and
Community Medicine
St. Vincent’s
Catholic Medical
Center (BQ), New
York Medical
College, Jamaica, NY
Objectives:
To determine the
rate of Immunization
against Pneumonia
and Influenza among
the elderly at JSPOA
Senior Center
To assess Knowledge,
Attitudes and Past
experience with
Pneumonia/Flu
vaccination
To find out the
factors influencing
the Immunization
Rate
Introduction:
Each year influenza
and pneumonia
account for 50,000
to 80,000
deaths[1,2] and
about 400,000
hospitalizations in
the US[3,4].
The total economic
cost of treating
these
vaccine-preventable
diseases among
adults exceeds $10
billion each year,
excluding the value
of years lost[5].
Vaccination can
prevent about 50% of
deaths from
pneumococcal
diseases and 80% of
deaths from
influenza -related
complications in the
elderly [1].
Cost Effectiveness
of Vaccination
Vaccination is the
most cost-effective
method for
preventing influenza
and reducing
hospitalization for
influenza and
pneumonia for
community-dwelling
elderly individuals
in all risk
categories[6,7].
Vaccination Goals
for the US
Population
The federal
government, through
Healthy People 2010,
has set an influenza
and pneumonia
vaccination goal of
at least 90%
for adults
aged>_65yrs[8].
Evidence of Unmet
Needs
Although studies
have demonstrated
the value of
immunizations in
reducing deaths,
hospitalizations and
savings in health
care costs [9,10]:
the rates of
immunization
continue to be far
below the Healthy
People 2010 goal
nationally
[11]and even worse
in the Jamaica
community we studied
Mortality due to
Influenza
Influenza associated
deaths in the United
States have
increased
significantly over
the past two
decades, with 90%
occurring among the
elderly[12]
Ethnic disparities
in immunization
rates
According to CDC,
African Americans
and Hispanics are
less likely than
whites to be
vaccinated,
indicating that
there is a need to
target education
about vaccination
for African American
populations.
Rationale
Pneumonia/Flu is the
5th Leading cause of
death among the
community and 85% of
these are those
>_65yrs.[13]
It is also the 3rd
leading cause of
hospitalization
among the same
category of people
from 2000
survey[14].
From 2002, a New
York survey showed
Flu vaccination rate
varies significantly
by race with whites
having 67% vs.
African-Americans at
52% in NYC[15].
Exposure to
vaccinated staff
reduces flu rates in
institutions
Data showed that
patients in long
term care facilities
where more than 60%
of the staff has
been vaccinated
experience less flu
related illness and
death compared with
patients in
facilities where
fewer staff members
have been
vaccinated[16].
Geographic
Disparities in
Immunization Rates
From 2001-2002 self
reported survey the
average Flu
immunization rate in
NYC was about 63%
compared to below
50% among the
population in
Jamaica.
Pneumonia
Vaccination
Pneumococcal
polyssaccharide
vaccine (PPV)
reduces the risk of
bacterial
complications of
influenza
infection[16].
The increasing
prevalence of
penicillin-resistant
and multidrug-resistant
pneumococcal strains
underscores the
importance of
primary prevention
through vaccination
of high risk
populations [16] .
In 2002 the overall
prevalence of
penicillin
resistance among
s.pneumoniae
isolates in New York
city was 26.7%[16].
Risks of Pneumonia
in NYC and Jamaica
In 2001 NYC survey
50% of persons
>_65yrs of age
have had PPV,
racial and ethnic
disparities remain a
problem with only
40% coverage among
African-American and
45% among
Hispanics[16].
In Jamaica,
mortality statistics
shows more people
>65yrs are dying
each year from
Pneumonia/Flu with
rate of 125,131,158
per 100000 in
1997,1998,and 1999
respectively.
Method
A questionnaire was
designed and
distributed to
seniors 65 yrs and
over attending JSPOA
Senior Center.
The questionnaire
evaluated:
Age,sex,race/Ethnicity,level
of education, Income
,insurance,
accessibility to
health care
facility, PCP, side
effects of vaccines,
employment,
comorbidities/Chronic
dx, and knowledge,
attitudes and past
experience with
vaccination
Jamaica Elderly Pop.
In % cf with NYC
Increase in the
Elderly Population
at Greatest Risk of
Flu
Complications(75-84)
Access to medical
care in Jamaica vs.
NYC
Percent of adults
receiving flu shots,
2001
Leading Causes of
Hospitalization in
Adults in Jamaica
vs. NY, 2001
Conclusion:
The 1994 NVAC report
on adult
immunization
concluded that
`Better public
understanding of the
seriousness of
vaccine-preventable
diseases and the
benefits of
vaccination will be
essential if there
are to be
improvements in
immunization`[18]
Educating public and
health care
providers is the
cornerstone of an
effective
vaccination
strategy.[19]
What can FP’s do:
Importance of
Education in
Increasing
Immunization Rate
Many studies have
shown that
education improves
immunization rate
We will use this
fact and any others
that may be revealed
in the survey in
designing the
intervention.
References:
1 Pneumococcal
Polysaccharide
Vaccine. MMWR
1988;37:64-8,73-6
2.Prevention and
Control of
Influenza:
Recommendations of
the Advisory
Committee on
Immunization
Practices (ACIP)
MMWR-1996;45(RR-5):1-24
3.Prevention and
Control of Influenza:
Recommendations of
ACIP;MMWR:1997;46(RR-8):1-24
NYAMWJ
2006, 6:Abstract
0601
Presented to the
Fifth BWAFP Research
Forum
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| Paper
0602: |
Patient
Attitudes
Towards Smoking
Cessation in a
Family Practice
Teaching Clinic
Loulou M, MD,
Schlussel YR,
PhD, Enubuzor H,
MD, Xu X, MD.
Department of
Family Practice
and Community
Medicine, St.
Vincent’s
Catholic Medical
Center, Jamaica,
NY
The
Problem
Smoking is the
largest single
preventable
cause of death
and disease in
the US
OBJECTIVES:
Why do
screening?
To determine the
factors that
influence
smoking
cessation
To emphasize the
role of primary
care physician
in helping
smokers to quit
To examine the
degree of
awareness of
smoking risks
Design of the
Study
a survey of 36
patients
presenting to an
urban family
practice clinic
attended by
minorities
patients
screened in each
family
practice clinic
by Resident
Physician
Setting
An urban family
practice clinic
serving a large
African-American
and Hispanic
community in
Jamaica, New
York
36 Patients were
given a survey
containing 44
questions
regarding their
knowledge of and
experience with
smoking
cessation.
Demographic
Characteristics
of Patients
Surveyed
36 patients aged
18-73 completed
the survey.
Main Outcome
Measures
Proportion of
patients who are
motivated or
willing to quit
smoking
by length of
time smoking and
amount
controlling for
demographics
Controlling for
number of times
quit in past
RESULTS:
Of the 86% who
are willing to
quit smoking,
69% don’t know
enough about
cessation
methods to try
it
Therefore, there
is an unmet need
for more
knowledge about
smoking
cessation in
primary care
Discussion:
Why
is it important
to assess
willingness to
quit in FP
Patients?
Nicotine is one
of the strongest
addictions
Smokers hold
various beliefs
about smoking
Doctors need to
consider how to
communicate risk
without
confrontation
Smoking
cessation may
control referral
costs for
specialized
care, reduce
visits for
comorbid
conditions in
primary care
How can MD’s
change attitudes
about smoking
cessation?
Family
physicians can
educate
themselves and
their patients
about smoking
cessation
In recent
surveys, the
majority of
primary
care physicians
were moderately
interested in
using
alternative
therapies with
patients
Limitations of
the study
Although this
study was
limited in
sample size and
practice
variation, it
demonstrates
that knowledge
and practice of
smoking
cessation in an
urban primary
care sample of
patients is:
not widespread
dependent on
educational
attainment
may increase if
patient
willingness is
high
Conclusions:
There is an
unmet need for
increasing
knowledge and
use of smoking
cessation
counseling in
the family
practice
setting.
While the
willingness to
attend smoking
cessation
classes is high,
current practice
is considerably
lower
Only by
educating both
patients and
family
physicians, can
we address how
this gap may be
bridged.
The
implementation
of smoking
cessation by FPs
can be
significantly
improved by:
Brief, repeated
nonjudgmental
advice by a FP
the adoption of
a systematic
(whole practice)
approach to
smoking
cessation,
a more strategic
approach to
counseling
Motivational
interviewing
techniques to
provide brief,
behavioral
counseling to
patients who
smoke
more effective
use of practice
nurses for
follow-up
NYAMWJ
2006, 6:Abstract
0602
Presented to the
Fifth BWAFP
Research Forum |
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| Paper 0603:
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Secondary
Prevention Of Heart Disease In Ethnically Diverse Women
O. Karantoni, Md, T. Reid, Md, Y. Schlussel, Phd, and M. Rodriguez, Md
Saint Vincent Catholic Medical Centers, Brooklyn And Queens Service Division,
New York Medical College, Jamaica, NY
BACKGROUND:
Coronary heart disease is the leading cause of death in adults in the
US, accounting for 1/3 of all deaths in people > 35 years old. Contributory
modifiable risk factors for heart disease include HTN, lipid disorders,
diabetes, smoking, obesity and physical activity.
Heart disease mortality in all women is 401/100,000.
The highest mortality rates are seen in African American women
(553/100,000), white women (388/100,000) and Hispanic women (265/100,000).
OBJECTIVE:
To determine the factors that affect adherence to medication therapy
and life-style modification in women greater than age 40 with identifiable
risk factors for heart disease such as diabetes, HTN, hypercholesterolemia and
obesity.
An intervention will then be implemented to improve adherence.
STUDY DESIGN:
Site:
St. Dominic’s Family Practice Center in Jamaica, New York.
Surveys with question on demographics, SES, health (including knowledge
of their disease condition, medication and risk factors for heart disease),
dietary behaviors and compliance to medication, office visit and life-style
modification were administered to 40 participants.
Consent was obtained for all participants.
Survey conducted via face to face interview by 2 FP residents.
Data Analysis:
Data was analyzed using SAS v. 8.2.
Results:
Problems with compliance: 1. Majority needed to be told to take meds at
same time.
2.
Many needed to be reminded to take meds.
3.
Some needed to be told to take meds every day.
CONCLUSIONS:
Extended families may be a source of stress to women who have chronic
disease, and many responsibilities:
58% had 1-2 children age 29-32 who lived at home, 40% took care of
their young children.
Patients will be educated on their health condition (Diabetes mellitus, HTN,
high cholesterol and obesity), and the importance of adhering to medication
regimen and life-style modification.
All the patients will then be given paper diaries to record
modification in the behavior they are trying to improve and half of the study
population will be randomly assigned to be given electronic organizers that
remind them of their appointment and when to take their medication.
Patients will be re-evaluated in three months and data analyze to
assess improvement in compliance and risk factors.
NYAMWJ
2006, 6:Abstract 0603
Presented to the Fifth BWAFP Research Forum
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Paper 0604:
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Breastfeeding and Attitudes of Residents
Elizabeth
Natal, PGY2 Resident, Family
Medicin
Montefiore FMRP, Bronx, NY.
Background:
Many organizations have documented the benefits of breastfeeding both for the
mother and the infant. Among these
are nutritional, immunologic, economic, environmental and psychological
benefits. Due to this the American
Academy of Pediatrics, the World Health Organization, UNICEF and other leading
organizations recommend at least six months of exclusive breastfeeding, with
continued breastfeeding to at least one years old or after.
Despite these recommendations, the Healthy People 2010 report states that
the breastfeeding rate at 6 months continues to fall below the recommended
level. In 1998 64% of postpartum
mothers were breastfeeding, but by the 6th month only 29% had
continued. The Healthy People 2010
goal is to have 75% of early postpartum mothers breastfeeding and 50%
continuation at 6 months. The CDC guide to Breastfeeding Intervention stated a
Cochrane review found that institutional changes in maternity care practices
effectively increased breastfeeding initiation and duration rates.
It also stated that educating hospital staff with a training program
enhanced compliance with maternity practices and increased rates of
breastfeeding. This information
stands to reason that an educational intervention to train family medicine
residents should also assist in increasing the knowledge, attitudes and clinic
behavioral practice of residents, as well as increase the rates of
breastfeeding.
The question this study is trying to address is what level of intervention is
required to improve residents’ knowledge, attitudes and clinical practice.
A new form of intervention will be compared with a prior instituted one
day a week four-session breastfeeding curriculum held onsite during the
obstetric rotation of first year family medicine residents at Weiler Hospital.
The study is being designed to evaluate if there is any difference in the
knowledge, attitudes and practices of residents, as well as the breastfeeding
rates of patients whose residents receive a two session off-site intervention
versus the formal four session breastfeeding curriculum.
The educational intervention will include a one-hour didactic lecture and
an additional workshop that will involve role-playing activities, practice in
the mechanics of breastfeeding and the presentation of video clips on
breastfeeding.
Objective: To determine what impact a new two-session educational
intervention would have on the knowledge, attitudes and clinical practices of
residents, when compared to the prior formally administered four-session
breastfeeding curriculum implemented to Montefiore Medical Residents undergoing
their obstetrical rotation at Weiler Hospital.
This study will also try to assess if there is any difference in the
breastfeeding rates of the two groups. The
idea is to try to determine if one intervention is better at improving overall
breastfeeding rates.
Setting: The site for
the study is the Montefiore Family Medicine Residency Program in Social Medicine
located in the Bronx, New York. The
residents are from two local family health centers. The Montefiore Medical Group Fordham Family Health Center
being one and the Williamsbridge Family Health Center being the other.
The Fordham site consists of a predominantly underserved area.
It serves a large Latino population, a large African American population
and a growing Asian community. Medicaid
insures a good majority of the patients in this community.
Participants: The participants of the study will be first year
residents of an urban family medicine residency. All residents under study come from the Montefiore Family
Medicine Residency Program in Social Medicine.
The current PGY2 class of 2007 will be the initial comparison group who
received the prior implemented formal breastfeeding training.
The current PGY1 class of 2008 will be the experimental group and will
receive the new two session educational intervention.
Chart reviews will be done to evaluate the breastfeeding rates of
patients under the care of residents from both groups.
All residents of the current PGY1 class will be included as long as they
participate in the pre-survey, educational interventions and post-survey.
The only patients whose data will be excluded from the study will be
patients who have contraindications for breastfeeding (HIV, active illicit drug
users, active/untreated T.B, certain prescribed drugs, etc… )
Method: This will be a partially quantitative prospective and
partially quantitative retrospective cohort study.
The study will involve administering a pre-intervention survey, an
educational intervention and a post- intervention survey to an experimental
group. The results of these surveys
will then be compared to those of a group that received a different
intervention, a more formal breastfeeding education. The experimental group will complete the pre-intervention
surveys prior to the intervention. Then
this group will receive an educational intervention in the form of a didactic
breastfeeding lecture and/or workshop, followed by a post-intervention survey.
The purpose of the surveys is to evaluate two different interventional
styles to determine if either style has a greater impact on residents’
knowledge, attitudes and practice. Furthermore,
chart review will also be performed to look for any differences in breastfeeding
rates between the two interventional groups.
A chart review will be conducted to evaluate the quantity of breastfeeding
discussion during the 3rd trimester visits of the two groups.
The chart review will also evaluate the breastfeeding rate for all
postpartum patients at one week to one month, two months and four months.
The goal is to identify any differences in breastfeeding rates between
the patients of the two groups. The
information collected will be used to assess if one form of breastfeeding
intervention versus another would be more helpful in improving physicians’
knowledge, attitudes and practices’, as well as improve the breastfeeding
rates of their patients.
NYAMWJ
2006, 6:Abstract
0604
Presented to the Fifth BWAFP Research Forum
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Paper 0605:
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Prevalence of certain infectious diseases in an inner city pregnant population.
Z. Shi, MD, A. Hamaoui, MD, and R. Mercado, DO
Lincoln Medical and Mental Health Center
NYAMWJ 2006, 6:Abstract
0605
Presented to the Fifth BWAFP Research Forum
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