PA cAARds! An integrated intervention for diabetes and

1
PA cAARds!An integrated intervention for
diabetes and tobacco control professionals and
paraprofessionals

• Marlin L. Williams, MBA
• Diabetes Symposium
• November, 17 2010

2
Training Objectives

• Improve understanding of statewide and local
  resources for diabetes education and management
  and tobacco cessation services
• Improve understanding of integrated strategies
  and identify where organizations fit into the
  organizational integration continuum
• Encourage you to attend PA cAARds! Training
• Increase the use of the Ask Advise Refer brief
  intervention in diabetes and tobacco programs
• Increase the use of PA cAARds among community
  based health care organizations

3
PA cAARds!

• PA cAARds! is the first integrated initiative of
  its kind in Pennsylvania and a unique
  collaborative effort between the Pennsylvania
  Department of Healths Diabetes and Tobacco
  Prevention and Control Programs
• PA cAARds! Is funded by the Pennsylvania
  Department of Health

4
Problem

• 133 million people, or almost half of all
  Americans live with a chronic condition. That
  number is projected to increase by more than one
  percent per year by 2030, resulting in an
  estimated chronically ill population of 171
  million
• Tobacco Use is one of the single most modifiable
  risk factors of ALL chronic diseases
• Data from www.improvingchroniccare.org. 2008

5
Problem

• In 2007, it was estimated that 26.3 million
  individuals or 7.8 of the US population were
  diabetic. Of those, 5.7 million were undiagnosed.
  (CDC, 2008)
• A study published in the December issue of
  Diabetes Care suggests that the number of
  Americans with diabetes is expected to nearly
  double by 2034 (Diabetes Care, 2009)
• Smoking represents the leading cause of
  preventable death in the Unites States
  Responsible for 1 in 5 deaths (CDC, 2009)
• In Pennsylvania, there are more than 764,000
  adults diagnosed with diabetes and approximately
  17 of them smoke. (CDC 2005, BRFSS 2006)

6
Smoking Diabetes

• A dangerous combination
• Smoking increases the harmful effects of diabetes
  by making diabetes more difficult to control
  (JRSPH, 1998)
• Smoking increases diabetes-related complications
  that include blindness, kidney disease, heart
  disease, and neuropathy (JRSPH, 1998)

7
Tobacco Use Diabetes

• Tobacco use..
• narrows blood vessels contributing to high blood
  pressure, heart disease and poor circulation in
  those with diabetes(CDC, 2004).
• increases insulin resistance and deteriorating
  diabetes control (Diabetes Care, 1999)
• increases the risk for Peripheral Arterial
  Disease, multiplying the likelihood of
  amputations by 5. (of people with diabetes who
  need amputations, 95 are smokers)(Diabetes Care,
  2001)
• is suggested in studies to be an independent
  risk factor for type 2 diabetes (JAMA, 2007)
• doubles the risk of heart disease in people with
  diabetes (approximately 65 of people with
  diabetes die from heart disease and stroke (CDC,
  2005)

8

• For nonsmokers
• Approximately 60 of non-smokers have biological
  evidence of TSP exposure
• The combination of diabetes and secondhand smoke.
• raises the risk of developing glucose
  intolerance
• decreases the ability of the pancreas to make
  insulin
• reduces the insulin sensitivity in people with
  type -2 diabetes

9

• Smokeless tobacco products
• Spit, oral, chew, snuff and dip are not safe
  alternatives to smoking.
• People who dip or chew get comparable amounts of
  nicotine to regular cigarettes.
• Chew tobacco is high in sugar.

10
Economic Toll

• In 2004, cost for diabetes hospitalization in PA
  reached 673 million and accounted for more than
  131,000 hospital days. (PADOH, 2007)
• Over the past five years, total costs in PA
  reached 2.6 billion and accounted for more than
  649,000 hospital days. (PADOH, 2007)
• Direct health care and lost productivity costs
  due to smoking related illness are estimated for
  PA to be over 8.5 billion annually. (PADOH, 2008)

11

• Due to the complex and overwhelming
  relationship between diabetes and tobacco
  use/exposure, addressing the harmful impact
  requires an integrated approach that emphasizes
  communication across disciplines.

12
Solution

• The goal of PA cAARds! is to proactively address
  the dual risks of unmanaged diabetes and tobacco
  use by maximizing utilization of regional and
  statewide resources.
• educate health care and other CBOs providing
  diabetes and/or tobacco cessation in an
  integrated brief intervention and referral
  process
• work with these organizations to sustain
  integrated tobacco, diabetes, and other chronic
  disease efforts.

13
PA cAARds!

• Integrated brief intervention and referral
  process where diabetes and tobacco professionals
  are trained to use the Ask, Advise, Refer
  intervention with their patients/clients
• The Ask, Advise, Refer model integrates the 5
  As
• (Ask, Advise, Assess, Assist, Arrange)
• Ask/Advise/Refer based on ADHAs/SCLCs
• adaptation of 5As

14
PA cAARds!

• Adapted from Californias Do you cAARd? Program
• Adapted to Pennsylvania
• Bidirectional between diabetes and tobacco

15
Development Process

• Literature review and environmental scan
• Recruited diabetes and tobacco control key
  stakeholders
• Facilitated a planning summit
• Solicited regional review and feedback
• Solicited DOH Feedback
• Pilot the initiative
• Implementation

16
(No Transcript)
17
Intervention

• Primary tool in addressing the dual risks of
  unmanaged diabetes and tobacco use/exposure
• Facilitate cross referral
• Do not need to be cross-disciplinary experts
• Brief Intervention
• Group Individual Settings

18
Intervention

• Motivational Interviewing
• a directive, client-centered counseling style for
  eliciting behavior change by helping clients to
  explore and resolve ambivalence.
• The art of getting people to do what you want
  them to do because they want to do it.
• (Dwight Eisenhower)

19
Referral

• Goal Facilitate cross referral to get
  patients/clients into appropriate services.
• Option of choosing between local or statewide
  services
• Provide referral tool (available on website and
  in your packets)
• Complete referral tracking form

20
Referral

• Local Resources
• Referral Lists and Regional Prescription
• Community diabetes management/education programs
• Community tobacco cessation programs
• Statewide Resources ( Take Charge Card ordered
  thru the website)
• PA Free Quitline
• Community based health care organizations use Fax
  referral form along with the Take Charge Card)
• American Diabetes Association

21

• Quitline (Diabetes Providers) (1-800-Quit Now)
• Free evidence-based, individualized phone
  cessation counseling
• Multiple counseling sessions to callers committed
  to quit
• Work with clients to set a quit date
• Offer information about medications
• Recommend tactics for dealing with urges
• Provide suggestions for reducing triggers to
  smoke
• Provide referrals to local cessation providers

22

• National Diabetes Help Line (1-800-Diabetes)
• (1-888-Diabetes regional office)
• Center for Information Community Support
• Provides information on managing diabetes and
  nutrition
• Local educations classes
• Support groups

23
Referral Tools

• Take Charge Card (statewide diabetes
  management/education and tobacco cessation)
• Fax Referral provided in tandem with the Take
  Charge Card (Diabetes professionals/paraprofession
  als)
• Regional Prescription Pad (local referrals)

24
Fax Referral

• PA DOH tobacco prevention and control program is
  partnering with PA cAARds! to pilot the fax
  referral process with community based health care
  providers
• Fax referral will serve as a tool to facilitate
  referral to the PA Quitline which is the
  statewide resource for PA cAARds!

25
Fax Referral

• Links the services of the Quitline directly to
  your patients with your help.
• Tobacco users no longer have to take the first
  step in calling the quitline.
• Quit coach pro-actively contacts your patients to
  provide an intervention after receiving a fax
  referral from you.

26
Technical Assistance

• Provide technical assistance related to
  integration readiness and implementation outreach
  and strategies to build organizational capacity
• Providing training to utilize an evidence-based
  curriculum alone does not guarantee that a
  program will be successfully adopted within an
  organization
• HPC will also provide ongoing comprehensive
  technical assistance (TA) for organizations
  participating in the training workshops to
  implement and sustain PA cAARds

27
Technical Assistance

• Programmatic T/A
• help address and resolve any issues or questions
  regarding curriculum, tools , state and/or local
  resources and referrals (website)
• Intensive T/A
• Increase organizational capacity to sustain
  integrated diabetes, tobacco and other chronic
  disease efforts (Leadership buy-in, Policy
  Development, Systems Change)

28
Integration Continuum
Not Linked
Fully Linked or INTEGRATED
Communication
Cooperation
Coordination
Partnership
Collaboration
Not Linked -We dont work together at all and
have separate program goals. Communication We
share information only when it is advantageous
Cooperation We share information and work
together when any opportunity arises Coordination
- We work side-by-side (independently) to achieve
common program goals Collaboration We work
side-by-side and actively pursue opportunities to
work together Partnership We work together with
specified responsibilities to achieve common
program goals Fully Linked or Integrated We
mutually plan, share staff and/or funding
resources and evaluate activities to accomplish
our common goals.
Integration Model adapted from NACDD Tobacco
Program Integration Report 2004
29
Website

• PA cAARds web portal is a trainee-specific tool
  that allows you to
• Download curriculum, tools and materials
• Receive technical assistance
• Communicate with the project staff and other
  trainees (message board and blog)
• Report referrals and success stories
• Access national and local resources (i.e.
  articles, toolkits, data reports etc.)

30
Continuing Education Credits

• UPMC
• Dietician, Social Work, Nursing, General Health
  Care Professional
• 5.5 credit hours
• Credit Designation
• Course Evaluation

31
North East Training

• December 1, 2010 10am 4pm
• Monroe County Public Safety Center
• 100 Gypsum Road, Suite 2
• Stroudsburg, Pa 18360
• To register please visit www.pacaards.org

32
THANK YOU

• on behalf of..
• Pennsylvania Department of Health
• Diabetes Prevention Control
• Tobacco Prevention Control
• Health Promotion Council

33
Acknowledgements

• BE A BRIDGE Partnership
• California Diabetes Program
• California Smokers Helpline
• Regional Advisory Council Members and Other Key
  Stakeholders

34
Marlin Williams215-731-6109marlin_at_phmc.org