Resident-run Clinic Research Articles

Increasing Diabetic Retinopathy Screening in Resident-Run Clinic Through Partnership With Ophthalmology Clinic: A Pilot Study.

Despite the importance of early detection of diabetic retinopathy, many diabetic patients fail to receive the recommended screening. The objective of this quality-improvement initiative was to increase diabetic retinopathy screening through a partnership between primary care and ophthalmology, where primary care clinic staff may schedule patients directly for screening appointments at point of referral. To our knowledge, this intervention is the first described to use an interspecialty partnership to increase screening. We implemented the intervention at a resident-run primary care clinic with a medically underserved patient population. The pilot intervention took place over a 6-month time frame. The completion rate of diabetic retinopathy screening examinations was compared before and after intervention and was found to increase in a statistically significant manner from 34.7% to 40.5% (p = .01). The no-show rate did improve from 66.7% preintervention to 46.0% postintervention; however, this change was not statistically significant (p = .44). During this pilot, the intervention was able to increase diabetic retinopathy screening completion rate; however, further efforts should be aimed at addressing no-shows. Overall, this initiative was a positive step toward the goal of every diabetic patient undergoing the appropriate screening examinations.

Underprescribing of cardioprotective novel antidiabetic drugs in marginalized patients with type II diabetes mellitus

Abstract Background Cardiovascular disease is the most common cause of increased mortality in patients with type 2 diabetes mellitus (T2DM). Novel antidiabetic agents such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists were shown to reduce this risk. SGLT-2 inhibitors are considered a secondary treatment option in patients with heart failure with reduced ejection fraction (HFrEF) in patients with or without T2DM. In patients with T2DM, these medications not only reduce hyperglycemia but also reduce the progression of chronic kidney disease (CKD). GLP-1 agonists are indicated for treatment of not only T2DM, but also obesity, and were shown to improve left ventricular ejection fraction, myocardial contractility, and endothelial function. The literature suggests that there may be disparities in prescribing patterns in marginalized populations. Objective The purpose of this study was to conduct a retrospective chart review to assess the adherence to the new guidelines regarding the use of SGLT2 inhibitors and GLP-1 agonists in marginalized patients with T2DM. Methods The study was conducted at a resident-run clinic that serves a large number of under-resourced individuals. Inclusion criteria included patients between the ages of 18 and 75 with T2DM seen in the clinic within 18 months prior to the start of the study with an A1c greater than 9.0. Exclusion criteria included patients with type 1 diabetes mellitus and patients with T2DM under care of endocrinology. We performed retrospective chart review to determine providers’ prescription practices. We created electronic patient database for this study. Results The data showed that 26.87% (n= 381) of the clinic’s population had an A1c greater than 9.0, of those 343 patients met the inclusion criteria. About 7.87% (27/343) of patients were identified with HFrEF. Of those, only 40.74% (11/27) were found to be on an SGLT2 inhibitor. Patients with CKD constituted 17.49% (60/343) of patients, and only 16.67% (10/60) of those were on an SGLT2 inhibitor. We identified 27.70% (95/343) of patients with a BMI between 30-35, and 30.32% (104/343) with a BMI greater than 35, but only 56.84% and 64.42% of those, respectively, were on a GLP-1 agonist. The patients that were not on the cardioprotective agents were 50.19% (135/269), 11.15% (9/269), and 12.64% (34/269) African American, Hispanic, and Asian American, respectively. Conclusions This study demonstrates that SGLT2 inhibitors and GLP-1 agonists are underprescribed in marginalized patients diagnosed with T2DM, even in those with the additional indication of heart failure and CKD. Most of those patients are of racial minorities. There are a number of barriers that could be contributing to the poor adherence to the guidelines in this population. Our next step is to analyze those barriers and develop a quality improvement project that would improve guideline-directed therapy for this under-resourced population.

Abstract 12070: An Implementation Study to Improve Statin Optimization in Primary Prevention Patients at a Resident Run Clinic in Rural US

Introduction: Despite the benefit of statin in primary prevention of atherosclerotic cardiovascular disease (ASCVD), guideline-concordant statin use (statin optimization) remains low. Methods: We previously showed that among 325 consecutive 40-75 years old patients at baseline 35.4% did not have lipids ordered and 49.2% had lipid results unavailable over 3 years in electronic medical record (EMR). Using mixed-methods design, we previously identified provider and patient-related barriers; lack of automated ASCVD risk score reporting in EMR, insufficient clinic time and follow up visits. We identified and used several implementation strategies: 1) designed and disseminated a simplified process map and a guideline directed algorithm, 2) developed an automated ASCVD risk score reporting in EMR, 3) conducted telemedicine follow up, and 4) provided several refresher trainings/reminders. Now, we report two-year results among 354 consecutive patients with hypertension following the program adoption. Results: Mean age was 59.2 (61.9% male) and 50.6% were White patients and mean BMI was 30.2 (7.1). Compared with baseline, percentage of lipid labs ordering (64.6% vs 95.5%), lipid lab orders completion (78.6% vs 95.3%), ASCVD risk score assessment (3% vs 91%) and primary prevention statin optimization (34.6% vs 90.1%), all increased at 2 years (Table). Conclusions: Contextually appropriate implementation strategies can be helpful to address provider- and system-level barriers in cholesterol management and using statin for primary prevention.

The Resident-Run Clinic in Podiatric Medical Foot and Ankle Surgery Residency Training: A Study of Resident-Perceived Benefit.

Resident-run clinics provide autonomy and skill development for resident physicians. Many residency programs have such a clinic. No study has been performed investigating the effectiveness of these clinics in podiatric medical residency training. The purpose of this study was to gauge the resident physician-perceived benefit of such a clinic. A survey examining aspects of a resident-run clinic and resident clinical performance was distributed to all Doctor of Podiatric Medicine residency programs recognized by the Council on Podiatric Medical Education. To be included, a program must have had a contact e-mail listed in the Central Application Service for Podiatric Residencies residency contact directory; 208 residency programs met the criteria. Statistical analysis was performed using independent-samples t tests or Mann-Whitney U tests and χ2 tests. Significance was set a priori at P < .05. Of 97 residents included, 58 (59.79%) had a resident-run clinic. Of those, 89.66% of residents stated they liked having such a clinic, and 53.85% of those without a resident-run clinic stated they would like to have one. No statistically significant differences were noted between groups in how many patients each resident felt they could manage per hour or regarding their level of confidence in the following clinical scenarios: billing, coding, writing a note, placing orders, conversing with a patient, working with staff, diagnosing and treating basic pathology, and diagnosing and treating unique pathology. Resident-run clinics provide autonomy and skill development for podiatric medical residents. This preliminary study found there was no difference in resident-perceived benefit of such a clinic. Further research is needed to understand the utility of a resident-run clinic in podiatric medical residency training.

Preparing for a Crowded Cosmetic Market: A Resident Training Model for Minimally Invasive Cosmetic Treatments.

Patient demand for nonsurgical and minimally invasive cosmetic treatments has increased in recent years, resulting in a growing market that is particularly vulnerable to specialty creep. Despite this growing demand, nonsurgical cosmetic training for plastic surgery residents is often inconsistent and challenging. To ensure the continued safe and effective delivery of nonsurgical cosmetic care by board-certified plastic surgeons, it is critical to implement standardized training models for plastic surgery residents. In this Special Topic article, the authors describe their experience with a resident-run clinic training model that incorporates graduated autonomy, volunteer patient recruitment, and grant-based industry support that has been successfully implemented at their institution for the past 6 years. The article provides a framework for a resident educational model and addresses common obstacles in resident cosmetic training. The authors also provide recommendations for patient recruitment, optimizing clinic workflow, and the management of patient complications.

Abstract 16: Addressing Gaps In Cholesterol Management In Primary Cardiovascular Prevention In A Resident Run Internal Medicine Clinic: A Mixed Method Approach

Background: Provider and system level barriers can delay timely initiation of statin therapy in primary atherosclerotic cardiovascular disease (ASCVD) prevention. A simple, pragmatic and scalable quality improvement (QI) approach is needed to address these gaps. Methods: We describe methods and preliminary results of a QI initiative in a resident run internal medicine clinic in Cayuga Medical Center (total 19 residents, 5 attendings, ~200 patients seen/month with 10% no shows). First, we assessed rates of lipids tested and statin use in 40-75 years old patients without ASCVD. Second, we performed a focus group discussion (FGD) among residents, attendings and clinic leadership to understand barriers for statin use. Third, we outlined key actionable items informed by FGD. Finally, we will assess the impact of the intervention. Findings: We report baseline data in 325 consecutive patients (Table). Mean age was 55.2 years (50.2% women), 50.6% did not have lipids checked and only 17.5% were on statin therapy in the preceding 3 years. Three major themes from FGD were: lack of automated ASCVD score reporting in electronic medical record (EMR), insufficient clinic time and follow up visits. Subsequently, we adopted automated ASCVD risk reporting in EMR and telemedicine follow up to address identified gaps and associated downstream impact, which is currently ongoing. Conclusion: Using mixed-method approach, we describe an implementation strategy to address gaps in cholesterol management in primary prevention patients in a resident run clinic. If effective, this strategy can be a model for other clinics.

S3249 Identifying Colorectal Cancer Screening Barriers in a Resident Run Clinic

S3249 Identifying Colorectal Cancer Screening Barriers in a Resident Run Clinic

Prevalence of advance care planning in a resident run clinic in an underserved community.

e24067 Background: Advance Care Planning (ACP) ensures that patients receive care that is in line with their values and preferences. ACP is best done in the outpatient setting. Despite recognizing the importance of ACP, the rates of ACP completion continue to be low. We conducted a retrospective study to determine the rates of ACP in a resident run primary care clinic in Hartford, Connecticut, which serves the underserved community. We looked at patient characteristics to find correlation with ACP completion. We also aimed to determine the reasons which could decrease the completion of ACP. Methods: This was a retrospective chart review. Patients who met any of the inclusion criteria [i) Age&gt;65 ii) End stage renal disease on dialysis iii) Metastatic/Recurrent cancer iv) End stage heart failure v) COPD Gold stage D] and were seen in the primary care clinic from September 1, 2019 to December 31, 2019 were selected. Their charts were reviewed to see if ACP was documented during primary care visits over the past two years. The demographics of the patients were noted. Subsequently, a survey was distributed to residents to determine the possible causes of low rates of ACP discussion. Results: The characteristics of the 373 patients included in the study are shown in Table 1. Only 14 (3.8%) of the 373 had documentation of ACP during their primary care visits. The characteristics of the 14 patients in whom ACP was done are as follows: Sex- Female 9/14 (64%); Ethnicity- Hispanic 10/14 (71%), African American 4/14 (29%); Religious Affiliation- Christian 13/14 (93%), None 1/14 (7%); Married/Partner 2/14 (14%). Patient demographics including sex (p 0.6), religious beliefs (p 0.8), and marital status (p 0.6) did not show any correlation with the likelihood of ACP completion. Of the 31 residents who answered the survey, the most commonly listed barriers to ACP completion were the following: lack of time to conduct these discussions (94%), forgetting to conduct ACP discussions (48%), and lack of training (19%). All the residents believed that ACP discussion was beneficial to patients and medical providers. Conclusions: The rates of ACP planning in our clinic are much lower than the national average. African American and Hispanics, who make up the majority of our clinic population, traditionally have had low rates of ACP completion. This is an important issue that needs to be addressed. Advance care planning training should be also be strengthened during residency. [Table: see text]

Descriptive cross-sectional analysis of lung cancer screening in inner city resident run clinic.

e18668 Background: Lung cancer is one of the leading causes of cancer-related morbidity and mortality. The 5-year survival rate is 19% but goes up to 57% if diagnosed at early stage. The recommendation for lung cancer screening is low-dose computed tomography (LDCT) for adults of age 55 to 80 years who have a 30 pack-year smoking history and are currently smoking or have quit in the past 15 years. Unfortunately, less than 5% of eligible patients undergo LDCT. Methods: A retrospective chart review was done for patients with any smoking history, who had internal medicine residents as their primary care provider. The data collected included baseline characteristics and the rates of LDCT scan being ordered and completed. Results: 706 medical charts were reviewed. 178 patients (25.2%) qualified for LDCT screening. The average age of patients included was 64.41 years and average BMI was 28.8 kg/m2. 48.3% were female and 51.6% were male. 54% were current smokers and 46% were former smokers. The ethnic/racial distribution was as follows: 19% African American, 36.5% Hispanic,16.2% Caucasian and 27.5% belonging to other groups. The primary insurance was as follows: 48.8% Medicaid, 19.6% Medicare, 25.8% private insurance and 5% were uninsured. 95 patients (53.3%) had a LDCT scan ordered and 73/95 (76.8%) completed the LDCT scan. The rate of compliance among patients based on their race/ethnicity and primary insurance is detailed in the table. Only 30% of the patients initially screened had a follow up LDCT ordered in one year. Conclusions: Low screening rate LDCT may be due to new residents not prioritizing preventative care. Patients at this clinic belong to a lower socioeconomic class with limited resources. There may be barriers to completion of the ordered test, like poor health literacy, scheduling issues, transportation, fear of being diagnosed with cancer and poor understanding of preventative health. Residents need to be educated about the importance of lung cancer screening as early detection translates into better outcomes and lower mortality. Patients need to be informed of the benefit of screening to improve compliance rate. Assessing the barriers these patients face to completing the screening test should also be carefully evaluated to better identify areas of improvement.[Table: see text]

Postpartum Note Template Implementation Demonstrates Adherence to Recommended Counseling Guidelines.

Postpartum visits may provide patients with an inadequate amount of counseling on postpartum depression, birth spacing, healthy eating, exercise, or changes in sexual response and emotions. We created a template in our electronic health record (EHR) with the aid of our clinical informatics department to increased adherence with recommended counseling guidelines. We retrospectively reviewed the postpartum visits of 200 patients who had a delivery and received postpartum care. Patients were seen in a resident-run clinic: 100 visits occurred prior to implementation of the template, while 100 visits occurred post-implementation with use of the template. We observed for documentation of counseling on Pap smear, birth spacing, breastfeeding, contraception, depression, gestational diabetes mellitus, pre-eclampsia, and sleep/fatigue. Descriptive statistics of mean and standard deviation were used to describe the continuous variables. Frequency and percentage were used to describe the continuous variables. Analysis of variance compared the continuous variables. The Pearson chi-square test compared the categorical variables. In visits that occurred without use of the template, counseling was charted as low as 1.0% for birth spacing to as high as 86.0% for contraception. With use of the template, counseling was charted as 100% in all visits for each of the recommended counseling guidelines (all p < 0.001). In conclusion, an EHR template for documentation of postpartum visits is associated with resident adherence with recommended postpartum counseling guidelines. Managers in hospitals and clinical practices should consider incorporating OBGYN-specific EHR note templates to improve quality and increase adherence with recommended guidelines during postpartum visits.

Digging deep into diabetes: achieving better glycemic control in diabetic patients in a resident-run clinic

ABSTRACTBackground: Diabetes mellitus (DM) affects over 30 million Americans with an estimated annual cost of $327 billion in 2017. Patients with diabetes, especially with financial and/or social hardships, pose challenges in achieving target hemoglobin A1c (HbA1c) values. Understanding patient-specific barriers offer opportunities to improve outcomes in patient care.Objective: We aimed to improve a patient’s glycemic control by reducing barriers to care. Furthermore, we evaluated the impact that a resident quality improvement effort had on providing high value diabetic care.Methods: We performed a retrospective cohort study of patients with HbA1c >9.0% in an underserved, resident-run clinic. Patients were surveyed on their knowledge of diabetes and reported obstacles to achieve diabetic control. We then implemented a 12 -month customized, patient-directed, multi-modal, multidisciplinary intervention.Results: Ninety-four patients with HbA1c >9.0% were identified, 65 surveyed, and 51 included in the intervention phase. After the intervention phase, re-evaluation of HbA1c in a paired sample comparison showed that the average HbA1c had decreased by 1.41% (11.28% vs. 9.87%, p < 0.01). Among the patients included in the intervention group, approximately 8% had their HbA1c reduced by ≥50% from their baseline, 23% had their HbA1c reduced by ≥25% from their baseline and 49% had their HbA1c reduced by ≥10% from their baseline.Conclusions: A strategically designed, a patient-centered customized intervention can have a positive impact on a patient’s diabetic control.

Implementing genetic risk assessment in a community free clinic

1585Background: Assessment of hereditary cancer risk plays an integral role in reproductive healthcare. ACOG and NCCN recommend that OB/GYNs assess hereditary cancer risk annually. The Saban Community Clinic is a Resident-run clinic in Los Angeles, California, serving a predominantly non-white, uninsured patient population of low socioeconomic status (SES) with no access to genetic counseling. Prior to this study, no formal cancer family history was elicited. Methods: We adapted a bilingual screening tool developed at the UCSF Cancer Risk Program that is compliant with NCCN and ACOG guidelines. It relies on fact recall that patients can complete independently assuming low health literacy. Clinic providers were briefed on the project and distribution commenced in April of 2017. The questionnaires were scored and entered into a secured database. Results: Between April 2017-January 2018, a total of 98 questionnaires were collected. Ages ranged from 19-67. Thirty-two percent (32%) of the patients identified a...

Rapid Intervention Through Telephone Encounters for Blood Pressure Control by Residents in an Outpatient Resident Clinic.

IntroductionSixty-seven million Americans have hypertensionthat costs the nation $47.5 billion each year. The aim of this study was to determine if regular phone calls by residents helped achieve better blood pressure control.MethodsThe study was a randomized open-labeled study in a resident-run outpatient clinic in Rochester, New York. A total of 57 poorly controlled hypertensives in the clinic were divided into two groups. All the patients received scheduled phone calls once every two weeks for a total of 24 weeks. In one group, the medications were adjusted over the phone and the other group was referred to be seen in the clinic for elevated blood pressures. Both the groups were compared to the usual standard of care group.ResultsFifty-eight patients were recruited for the trial out of which 53 were used for the final data analysis. Eleven patients completed the trial and had a mean drop of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 28 and 11 mmHg with p < 0.01 and p < 0.03, respectively. Among the patients who did not complete the trial but answered at least one phone call, the mean drop of SBP and DBP was 29 and 8 mmHg with a p < 0.001 and p < 0.008, respectively. When these were compared to the usual standard of care group, the mean drop in SBP was 28.36 (12.36-48.36), 29.85 (11.85-47.85), and 0.76 (8.04-9.56) with a p < 0.02.ConclusionsPatients enrolled in the trial had much better blood pressure control compared to the usual standard of care. Residents can take greater ownership of patients to help achieve better blood pressure control. To our knowledge this is the first such study done exclusively by residents in a resident-run clinic.

Digging Deep into Diabetes—Barriers to Achieving Glycemic Control in Diabetic Patients in a Resident-Run Clinic

Introduction: Diabetes mellitus (DM) affects over 29 million Americans with an estimated annual cost of $245 billion. Diabetes in patients with multiple comorbidities, financial, and/or social hardships pose challenges to achieve target hemoglobin A1c (HbA1c). We investigated the barriers to achieve the HbA1c goal in patients in a federally funded resident-run clinic. Methods: Among diabetic patients in our clinic, 29% had a HbA1c &amp;gt;9.0 in 2016. We reviewed these patients’ medical records, and interviewed them to identify the barriers in achieving HbA1c ≤9.0. Interviews were used to assess their knowledge about diabetes, perceived self-efficacy of disease management, confidence level regarding treatment plan, and the patient’s declaration of barriers of diabetic management. Then, we conducted an intervention to include regular telephone follow-up and clinic visits to ensure adequate supplies, medication refills, and diet and medication compliance. We have also engaged social service workers to address issues with transportation, medication costs and insurance coverage. Results: A total of 87 patients with HbA1C &amp;gt;9.0 qualified for the study, 94% were African American with female predominance (55%). Average age was 52.2 years and average BMI was 33.32 kg/m2. Average HbA1c was 11.5%. We were able to reach 59 patients to interview. Of those reached, 98% knew they had DM, 83% knew about HbA1c, but only 32% knew their last HbA1c. Major obstacles to achieve HbA1C goal are noncompliance with diabetic diet (29%), inability to afford medications (22%), inadequate medication refills (25%) and forgetting to take medication (20%). After 3 months of intervention, average hemoglobin A1c dropped to 9.7% from 11.5%, and 34 (58%) patients had an absolute decrease in their HbA1c from pre-intervention period. HbA1C dropped below 9% in 12 patients (20%). The intervention is currently ongoing. Disclosure S. Hawatmeh: None. M. Meier: None. O. Qaiyum: None. M. Asghar: None. A. Talebian: None. H. Kaur: None. R. Haque: None. R. Shailly: None. H. Kawsar: None.

The Use of Resident-Run Clinics as an Educational Tool in Orthopaedic Surgery Residency

This article was migrated. The article was not marked as recommended. BackgroundThe use of resident-run clinics to provide operative and clinical training is utilized in orthopaedic surgery, and other specialties (Neaman, Hill, Ebner, &amp; Ford, 2010; Pyle, Angobaldo, Bryant, Marks, &amp; David, 2010). Many orthopaedic residency programs promote resident-run clinics on their websites, but the structure and number of clinics remains unknown.ObjectiveThe purpose of this study was to provide insight into the current utilization of resident-run clinics in orthopaedic surgery residency programs and to assess program structure. Additionally, in programs that do not utilize a resident-run clinic, this study sought to assess program consideration and perceived barriers for instituting a resident-run clinic.Accreditation Council for Graduate Medical Education (ACGME) accredited orthopaedic surgery residency programs in the United States were asked to complete an anonymous on-line survey. In 2016, an e-mail was sent to the 150 ACGME accredited orthopaedic surgery residency Program coordinators. The email was unable to be delivered to 4 programs, making the total number of programs 146.ResultsOf the 28 orthopaedic residency PCs that responded to the survey, 18 indicated their programs had resident-run clinics (64%). At 78% of resident-run clinics, residents spent one half-day per week in clinic. At 56% of programs, residents participated in resident-run clinics 4-5 times per month. Residents saw 11+ patients in an individual clinic setting (61%) and scheduled on average 6+ surgical cases per month out of clinic (72%).ConclusionsThis study demonstrates that resident-run clinics in orthopaedic surgery residency may provide a valuable learning environment by exposing residents to a reasonable volume and variety of patients with appropriate supervision.

Implementing genetic risk assessment in a community free clinic.

1585Background: Assessment of hereditary cancer risk plays an integral role in reproductive healthcare. ACOG and NCCN recommend that OB/GYNs assess hereditary cancer risk annually. The Saban Community Clinic is a Resident-run clinic in Los Angeles, California, serving a predominantly non-white, uninsured patient population of low socioeconomic status (SES) with no access to genetic counseling. Prior to this study, no formal cancer family history was elicited. Methods: We adapted a bilingual screening tool developed at the UCSF Cancer Risk Program that is compliant with NCCN and ACOG guidelines. It relies on fact recall that patients can complete independently assuming low health literacy. Clinic providers were briefed on the project and distribution commenced in April of 2017. The questionnaires were scored and entered into a secured database. Results: Between April 2017-January 2018, a total of 98 questionnaires were collected. Ages ranged from 19-67. Thirty-two percent (32%) of the patients identified a...

Impact of an HPV Education and Vaccination Campaign among Canadian University Students.

Uptake of HPV vaccination among university students remains low despite risky sexual practices and increased prevalence of high-risk HPV genotypes. The study objective was to determine the level of knowledge related to HPV and cervical cancer among university students and to subsequently develop a targeted education and vaccination campaign to increase uptake. Phase I was a pilot project in which participants were recruited as part of Cervical Cancer Awareness Week 2015 at two universities, one site immediately offering vaccination and the other not. A self-administered questionnaire was used to collect demographic information from participants and evaluate their baseline knowledge related to HPV and the risks of cervical cancer, in addition to determining barriers to vaccination and future willingness to be vaccinated. Data was compiled and analyzed using descriptive statistics of means and percentages. In phase II, which followed 1 year after, a targeted education and vaccination campaign was designed based on lessons learned from phase I, and vaccination uptake was reevaluated after 1 year. In phase I, 56 participants responded to a questionnaire related to HPV knowledge and cervical cancer. Among these, 29 students were vaccinated in a 2-day resident-run clinic. Overall, 63% felt they were not at risk of cervical cancer, though 88% knew HPV was the cause of cervical cancer. The three barriers identified to previous vaccination were lack of access to a doctor or a nurse (25%), financial reasons (25%), and low self-perceived risk (7%). There was a 50% three-dose completion rate in phase I. Based on this information, the education campaign in phase II was expanded in the subsequent year through social media, email communication, information booths, and individual solicitation. A total of 151 students were approached for individual solicitation and education. Among these, 64 students were vaccinated on site, including five men. Most importantly, there were 18 walk-ins resulting directly from the education initiatives and person-to-person solicitation. Subsequently, in 2016, 502 students were vaccinated at the McGill student health clinic and 455 at Concordia University. HPV vaccination rates in university students are readily increased through educational campaigns, of which person-to-person solicitation proved to be the most fruitful in this study. Identifying barriers to vaccination can guide future initiatives to maximize impact.

An educational intervention to increase awareness reduces unnecessary laboratory testing in an internal medicine resident-run clinic

ABSTRACTAt our resident-run clinic in an underserved community, laboratory test costs in 2013 exceeded the government subsidy by $400 000. To optimize limited resources and improve patient care, an education program to reduce testing was implemented.Between November 2014 and January 2015, residents attended lectures on utilization of laboratory testing, focusing on standard practice guidelines, and analyses of unnecessary tests. Multivariate nonparametric statistical methods and subgroup analysis were used to evaluate cost reduction.There were 453 clinic visits during the intervention period and 471 visits during the control period. Lectures were independently associated with a significant laboratory cost reduction. Median laboratory cost per visit decreased from $106.00 to $74.00. Total cost in the study period decreased from $79 403 to $51 463. There were similar reductions of laboratory costs in two subgroups: age groups of <50 years and ≥50 years, new encounters, and follow-up visits . In the analysis of individual tests, the cost of TSH and Vitamin D tests had the greatest reduction ($8176 and $5088 respectively).An appropriate physician education program can reduce laboratory tests and costs. Screening tests with inadequate evidence support were reduced most, whereas those with proven benefits did not decrease significantly.

Rural, Resident Fertility Clinic Patients Have Little Insight Into Their BMI or Implications of Obesity on Fertility [27P

INTRODUCTION: Abnormal weight and its effects on health and fertility are poorly understood by patients. We aimed to evaluate differences in knowledge of abnormal weight and its effect on fertility between patients seen for infertility and general gynecology (GYN) at a rural, resident-run clinic. METHODS: Participation in this 12-question survey-based analysis of weight/fertility knowledge was offered to patients seen in our rural, resident-run clinic. Survey assessed knowledge of abnormal weight and its effect on fertility, yielding a “Fertility Knowledge Score” and “Physician Education Score.” Visit number, age, visit type, and body mass index (BMI) were collected via chart review. The mean correct scores of both groups of patients (infertility and GYN) were compared using 2 sample T-test and Chi-squared test. RESULTS: Surveys for 44 infertility patients and 51 GYN patients were included. Infertility patients had higher mean BMI (37.5) than gynecology patients (32.9), (p=0.0263); 91% of fertility patients and 80% of GYN patients were overweight/obese. Infertility patients (p=0.0239) and patients with higher BMI (p=0.0112) reported discussing weight/BMI with a physician more often. There was no difference in survey scores between new and established patients overall or when these scores were analyzed by patient weight. CONCLUSION: Both infertility and GYN patients have little insight into their own BMI, with no change over visits. BMI is higher among infertility patients. Though, infertility patients have high general knowledge of effects of abnormal weight on fertility. This suggests we are not effectively discussing individual implications of weight/BMI despite large numbers of overweight/obese patients under our care.

Understanding Patient Perceptions of Communication About Gestational Weight Gain

INTRODUCTION: The prevalence of obesity among women of reproductive age is increasing. Excess gestational weight gain is associated with increased short- and long-term maternal and neonatal morbidity and mortality. We sought to examine associations between pre-pregnancy body mass index (BMI) and self-suggested gestational weight gain and to identify barriers to achieving an appropriate weight gain in an inner-city population receiving care at a resident-run clinic. METHODS: From July 2012 to March 2013, 451 surveys were completed by patients at their first prenatal visit before meeting with a provider. Patients reported height and weight, and BMI was calculated. RESULTS: Sixty-nine percent were African American and 53% stated they received food assistance. Forty percent of women were obese (BMI greater than or equal to 30 kg/m2) with an average BMI of 27.4±7.6 standard deviation kg/m2. Seventy-one percent of women did not know their appropriate gestational weight gain, and the higher the BMI, the greater prevalence of overcalling suggested gestational weight gain. Fifty-six percent stated that excessive gestational weight gain was not a problem (Table 1). Regardless of level of parity, 63% said that their obstetric provider had never spoken to them about gestational weight gain in prior visits (Table 2); of those, 40% instead heard about gestational weight gain from friends and family. When stratified by BMI category (Table 3), only 46% of obese patients and 48% of patients with BMI greater than or equal to 40 kg/m2 responded that their health care providers ever discussed gestational weight gain.CONCLUSION: Despite the Institute of Medicine's updated gestational weight gain guidelines (2009), pregnant patients are still unaware of the appropriate amount of weight to gain during pregnancy. One significant modifiable factor reported by patients is the lack of information provided to them by their resident physician. Further resident education is required to bridge the gap between physician knowledge of maternal obesity and patient understanding.