North Country Healthy Heart Network, Inc. Administrative Office Saranac Lake, New York.
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Transcript of North Country Healthy Heart Network, Inc. Administrative Office Saranac Lake, New York.
North Country Healthy North Country Healthy Heart Network, Inc.Heart Network, Inc.
Administrative OfficeAdministrative Office
Saranac Lake, New YorkSaranac Lake, New York
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Mission StatementMission Statement
To decrease the incidence of heart To decrease the incidence of heart disease and stroke in Franklin, Jefferson, disease and stroke in Franklin, Jefferson, Lewis and St. Lawrence County through Lewis and St. Lawrence County through education and the promotion of wellness.education and the promotion of wellness.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Heart Network Member Heart Network Member OrganizationsOrganizations
Four county public health departments Four county public health departments Nine HospitalsNine Hospitals
Adirondack Medical Center - Franklin CountyAdirondack Medical Center - Franklin County Alice Hyde Medical Center – Franklin CountyAlice Hyde Medical Center – Franklin County Canton Potsdam Hospital – St. Lawrence CountyCanton Potsdam Hospital – St. Lawrence County Carthage Area Hospital – Jefferson CountyCarthage Area Hospital – Jefferson County Claxton Hepburn Hospital – St. Lawrence CountyClaxton Hepburn Hospital – St. Lawrence County Clifton Fine Hospital - St. Lawrence CountyClifton Fine Hospital - St. Lawrence County Lewis County General Hospital – Lewis CountyLewis County General Hospital – Lewis County Massena Memorial Hospital – St. Lawrence CountyMassena Memorial Hospital – St. Lawrence County Mercy Health Care of NNY – Jefferson CountyMercy Health Care of NNY – Jefferson County
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
County ProfileCounty ProfileU.S. Census Bureau - State and County QuickFactsU.S. Census Bureau - State and County QuickFacts
CountyCounty Land AreaLand Area
Sq. MilesSq. Miles
PopulationPopulation
20002000
PopulationPopulation
Per Sq MiPer Sq Mi
Per CapitaPer Capita
Income ‘99Income ‘99
Poverty Poverty Rate ‘99Rate ‘99
FranklinFranklin 1,6321,632 51,13451,134 31.331.3 $15,888$15,888 14.6%14.6%
JeffersonJefferson 1,2721,272 111,738111,738 87.887.8 $16,202$16,202 13.3%13.3%
LewisLewis 1,2761,276 26,94426,944 21.121.1 $14,971$14,971 13.2%13.2%
St. St. LawrenceLawrence
2,6862,686 111,931111,931 41.741.7 $15,728$15,728 16.9%16.9%
TotalTotal 6,8666,866 301,747301,747 45.5 45.5 averageaverage
$15,697 $15,697 averageaverage
14.5% 14.5% averageaverage
NYSNYS 47,21447,214 18,976,45718,976,457 401.9401.9 $23,389$23,389 14.6%14.6%
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
TargetTarget PopulationPopulation
Low-income people that use tobacco and Low-income people that use tobacco and have at least one other risk factor for heart have at least one other risk factor for heart disease. disease.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
ChallengesChallenges
How to make access easy.How to make access easy. How to let people know about our How to let people know about our
services.services. We wouldn’t even talk about the weather.We wouldn’t even talk about the weather.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Program DesignProgram DesignAccessAccess
One-on-OneOne-on-One Mobile Mobile Unlimited number of meetingsUnlimited number of meetings Face-to-Face; Telephone, E-Mail Face-to-Face; Telephone, E-Mail FreeFree Flexible meeting sites and hoursFlexible meeting sites and hours Track for one year on a quarterly basisTrack for one year on a quarterly basis
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Program FeaturesProgram FeaturesEvidence Based InterventionsEvidence Based Interventions
CounselingCounseling MedicationMedication Support within the helping relationshipSupport within the helping relationship Support development within the participant’s Support development within the participant’s
primary networkprimary network Clinical Practice Guideline – Treating Tobacco Use and Dependence, Clinical Practice Guideline – Treating Tobacco Use and Dependence,
Public Health Service, June 2000Public Health Service, June 2000
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Helping ModelHelping ModelIntegrated Strategies to Meet the Needs of Each IndividualIntegrated Strategies to Meet the Needs of Each Individual Services tailored to the individual’s stage of readinessServices tailored to the individual’s stage of readiness
Transtheoretical Model/Stages of Changes, Prochaska & Transtheoretical Model/Stages of Changes, Prochaska & DiClementeDiClemente
Motivational Interviewing- Motivational Interviewing- • Increase importance & confidence will see movement Increase importance & confidence will see movement
towards action.towards action.• Stephen Rollnick, Stephen Rollnick, Health Behavior Change, Health Behavior Change,
• Miller & Rollnick,Miller & Rollnick, Motivational Interviewing Motivational Interviewing
Basic Counseling, Basic Counseling, Gerard Egan, Gerard Egan, The Skilled HelperThe Skilled Helper
Strength BasedStrength Based Problem Solving ModelProblem Solving Model
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
The Helping ProcessThe Helping Process Program Participants screened at each meeting.Program Participants screened at each meeting. 0-5 Importance0-5 Importance 0-5 Confidence0-5 Confidence How soon do you want to quit?How soon do you want to quit?
Interventions are then tailored to increase self Interventions are then tailored to increase self efficacy & importance.efficacy & importance.
When ready quit plans are developed: physical, When ready quit plans are developed: physical, psychological & activities of daily living.psychological & activities of daily living.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
OutreachOutreachHow to make program visibleHow to make program visible
Clinicians OfficesClinicians Offices Human Service Organizations that serve Human Service Organizations that serve
low-income peoplelow-income people Program material placed at locations Program material placed at locations
frequented by target groupfrequented by target group Minimal paid advertisingMinimal paid advertising Partnership with Tobacco Coalitions in Partnership with Tobacco Coalitions in
region.region.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
New ChallengesNew Challenges
Uninsured participants cannot afford Uninsured participants cannot afford medication.medication.
Lack of discrete start and stop times Lack of discrete start and stop times makes program monitoring and evaluation makes program monitoring and evaluation difficult.difficult.
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Heart Network’s ResponseHeart Network’s Response
Pharmacotherapy FundPharmacotherapy Fund Two week voucherTwo week voucher Active participationActive participation Prescription requiredPrescription required One vendor well positioned in regionOne vendor well positioned in region
Database developed – Holmes & AssociatesDatabase developed – Holmes & Associates Data Analysis – State University of New York at Data Analysis – State University of New York at
Albany- School of Public Health – Graduate Albany- School of Public Health – Graduate Student InternStudent Intern
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Database PeekDatabase Peek
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
One more peekOne more peek
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
EvaluationEvaluationJuly 1, 2002 – June 30, 2003July 1, 2002 – June 30, 2003
ParticipantsParticipants 310 people - 62% female – average age 45.5310 people - 62% female – average age 45.5 Low IncomeLow Income
• 34.2% below $10,00034.2% below $10,000• 57.1% below $20,00057.1% below $20,000
InsuranceInsurance• 28.7% Medicaid28.7% Medicaid• 8.7% Medicare8.7% Medicare• 15.5% Not insured15.5% Not insured
One other risk factor for heart diseaseOne other risk factor for heart disease• 86.5%86.5%
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Evaluation ContinuedEvaluation ContinuedTobacco HistoryTobacco History
Tobacco Use - Range from 3 to 66 yearsTobacco Use - Range from 3 to 66 years Tried to Quit before: 90% Tried to Quit before: 90%
Average attempts – 4.5Average attempts – 4.5 Talked to their doctor about quitting: Talked to their doctor about quitting:
81.2% - 98.4% were told to quit by doctor.81.2% - 98.4% were told to quit by doctor. 36.3% live with a smoker36.3% live with a smoker
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
EvaluationEvaluationSessions with SpecialistsSessions with Specialists
2,156 sessions2,156 sessions 71.2% face to face71.2% face to face 27.2% telephone27.2% telephone 1.6% group1.6% group .1% email.1% email
Average 5.7 sessions per participantAverage 5.7 sessions per participant
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
OutcomeOutcomeMovement towards ActionMovement towards Action
Importance, confidence and readiness increase with Importance, confidence and readiness increase with number of sessions.number of sessions.
Figure3.2 Changes of confidence of participants with the increasing of session times
2.5
3
3.5
4
4.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Session times
Con
fiden
ce le
vel
Figure3.1 Changes of importance of participants with the increasing of session times
4.64.654.7
4.754.8
4.854.9
4.955
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Session times
Impo
rtan
ce le
vel
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
Movement towards ActionMovement towards Action
Figure6.4 Percentage of Readinesson Stages Between Intake and Last Session
0.3
21.0
68.4
10.3
0.0 0.01.3
18.5
36.4 36.8
2.3 4.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Readiness Stages
Perc
en
tag
e
Intake
Last Sesstion
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
OutcomeOutcomeAction - MaintenanceAction - Maintenance
162 (52.3%) Quit for at least one day.162 (52.3%) Quit for at least one day. June 30, 2003 - 126 still quit (41%)June 30, 2003 - 126 still quit (41%)
• 25.76 % 25.76 % 0-1 month0-1 month• 28.03%28.03% 1-3 months1-3 months• 27.27%27.27% 3-6 months3-6 months• 7.58%7.58% 6-9 months6-9 months• 6.82%6.82% 9-12 months9-12 months
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
OutcomeOutcomeProfilesProfiles
Quit minimum of 1 monthQuit minimum of 1 month Doctor recommendedDoctor recommended Have tried to quit beforeHave tried to quit before Relatively higher educationRelatively higher education Relatively more confidentRelatively more confident
Relatively higher incomeRelatively higher income Several risk factors Several risk factors
• COPD, High COPD, High cholesterol, diabetescholesterol, diabetes
Quit less than 1 monthQuit less than 1 month Doctor recommendedDoctor recommended Relatively higher educationRelatively higher education Relatively higher incomeRelatively higher income History of clinical History of clinical
depressiondepression Relatively larger household Relatively larger household
sizesize High blood pressureHigh blood pressure Family history of heart Family history of heart
diseasedisease Cholesterol not highCholesterol not high
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
ProfileProfile
Quit minimum of 1 month Quit minimum of 1 month versus quit for less than 1 versus quit for less than 1 month.month.
Do not have a history of Do not have a history of depressiondepression
Are not overweightAre not overweight High cholesterolHigh cholesterol COPDCOPD AsthmaAsthma No family history of heart No family history of heart
diseasedisease Not on other medicationNot on other medication
People who did not make People who did not make a quit attempta quit attempt
Do not have insuranceDo not have insurance Doctor did not recommendDoctor did not recommend First quit attemptFirst quit attempt Live with a smokerLive with a smoker Not confident Not confident Relatively lower education Relatively lower education Relatively lower incomeRelatively lower income Do not have high blood Do not have high blood
pressurepressure
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
CostCost
Per Participant (310)Per Participant (310) $ 635.00$ 635.00 Per Session (2,156)Per Session (2,156) $ 91.00$ 91.00 Per Quit/day (162)Per Quit/day (162) $1,215.00$1,215.00 Per Quit -6/30/03Per Quit -6/30/03 $1,563.00$1,563.00
(126)(126)
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
ClosingClosing MobilityMobility FlexibilityFlexibility Evidence Based ServicesEvidence Based Services Helping relationship-participant controls the Helping relationship-participant controls the
process & outcome, respectful, supportive, process & outcome, respectful, supportive, genuine interactionsgenuine interactions
Follow upFollow up Data entry-retrieval system & analysisData entry-retrieval system & analysis Integration into health/human service systemIntegration into health/human service system
North Country Healthy Heart NetNorth Country Healthy Heart Network, Inc.work, Inc.
We Are So Grateful !We Are So Grateful !
To the New York State Department of To the New York State Department of Health Tobacco Control ProgramHealth Tobacco Control Program
• Freedom to develop a program that focuses on the Freedom to develop a program that focuses on the needs of rural tobacco users in NNYneeds of rural tobacco users in NNY
• Support to create a database and data analysisSupport to create a database and data analysis• Encouragement to be here todayEncouragement to be here today