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San Juan County Health Project


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Here is a draft of the San Juan County Rural Health Project.
Chiyoung & Kristi

Published in: Health & Medicine, Education
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San Juan County Health Project

  1. 1. San Juan County Rural HealthProjectSmoking Cessation in the Elderly<br />Chiyoung Cha PhC MN RN <br />Kristi Vaughn DNPC ARNP MN RN <br />UCONJ 501B<br />School of Nursing<br />University of Washington<br />
  2. 2. Table of Contents<br />Introduction<br />Demographics<br />Rural designation<br />Health issues<br />Elderly population<br />Access<br />Geographical<br />HCPs<br />Adult Health Behaviors<br />Tobacco abuse<br />Binge Drinking<br />Dental<br />Environmental<br />Woman’s Health<br />HCP communication<br />Access<br />Insurance<br />Tobacco use in SJ CO<br />Intervention Challenges<br />The Chronic Care Model<br />Evidence-based Interventions<br />NRT/ HCP counseling<br />Follow up telephone contact<br />Evidence base research<br />Mental Health services<br />Conclusion<br />References<br />
  3. 3. San Juan County, WA<br />
  4. 4.
  5. 5. Demographics<br />Population (2008)<br />15,294 (8.6% increase from 2000)<br />Predominately live: Orcas, Lopez, Shaw & San Juan Island<br />Characteristics<br />Well-educated<br />Caucasian (95.7%)<br />Median household income:$52,118 (State,$55,628) <br />Median age 50 years <br />Persons poverty level (9.9%)<br />Occupations<br />Government (23.5%)<br />Construction (16.2%)<br />Wholesale/retail trade (13%)<br />Accommodation/food services (12.9%) <br />Travel time to work 15.8”<br />
  6. 6. RUCA<br />Score10<br />Isolated rural area<br />HCP (2005)<br />8-13 primary care MDs/100,000 (2005) <br />13 dentists/100,000 (1998)<br />6 MUAs: Score 0<br />Rural Designation<br />
  7. 7. Health Care Access<br />Natural Barriers<br />Water<br />Weather <br />Travel<br />Ferry 60”<br />Helicopter 7-20”<br />Hospitals<br />Island Hospital-Anacortes<br />St Joes-Bellingham<br />Harborview MC-Seattle<br />Children&apos;s-Seattle<br />Clinics<br />Lopez- 1<br />Orcas- 2<br />San Juan-2<br />Inter Island MC; Level 5 TC<br />Future- Peace Health<br />
  8. 8. Health issues<br />Elderly population<br />&gt; 65 years 21.4% (State,11.7%)<br />Increased life expectancy; 80 years<br />Fixed income<br />Chronic illness<br />Cancer<br />Lung CA 18.2 % increase<br />85% tobacco related<br />CV disease<br />Suicide;18 % (firearms) (State, 12%)<br />Falls; 66% unintentional injuries<br />Access <br />Health insurance (2006)<br />Adults30 % uninsured (State, 17%)<br />Children 13%<br />Unmet medical needs 15% (State,13%)<br />No HCP 26 % (State, 22%)<br />Adult health behaviors <br />tobacco abuse 20 % (State, 18%)<br />binge drinking 17% (State, 14%)<br />
  9. 9. Health issues<br />Dental <br />33 % no dental visits (State, 28%)<br />Environmental<br />Increased waste facilities<br />Sewage 100% failure correction rate<br />Women’s health <br />low rate prenatal care 77% (State, 80%)<br />Breast CA screening rate 74% (State, 79%)<br />
  10. 10. Health Issues identified by SJ CO HCPs<br />(Personal communication)<br />Access<br />Geographical barrier<br />Limited HCPs<br />Aging work force<br />Low/slow pay<br />Rural HC overhead costs<br />No critical access hospital<br />Insurance<br />Poor reimbursement<br />Uninsured/ under insured<br />HCPs overworked/ no relief from locum tenums<br />Economic<br />Unemployment<br />Fixed income<br />Increased cost prescription drugs<br />SJ CO Health Care Providers<br />
  11. 11. Tobacco & Cancer Stats<br />514 deaths/100,000 <br /> population <br />(State, 724/100,000)<br />36 cancer related <br /> deaths 145/100,000<br />(State, 179 deaths/100,000)<br />7 deaths lung CA 2007<br />18% increase <br />compared to 2003-2005<br />1,900 adult smokers<br />200 smokeless tobacco<br />
  12. 12. Tobacco<br />Increasing # users <br />15% (State,17%)<br />1.7% increase past 5 yrs<br />SJ CO Tobacco use<br />5.0% (State: 17%) <br />Adult smokeless tobacco use<br />1.8% (State: 3.0%)<br />Male 3.3% (State: 5.8%)<br />
  13. 13. Tobacco-con’t<br />*FPL: Federal Poverty Level<br />*Data from 2003 WA Needs Assessment Household Survey <br />
  14. 14. Lack of:<br />Awareness<br />Perceived effectiveness<br />Participation<br />Intervention Challenges<br />
  15. 15.
  16. 16. NRT & HCP counseling<br />Rationale: Effective for elderly<br />Community Resources: <br />Partnerships w/community agencies<br />Free or Low cost NRT; reduce out of pocket $ for<br />cessation therapies<br />Health systems:<br />Self-management support: emphasis patient’s central role, 5A’s<br />Decision Support:multi-component interventions, <br />evidence-based guidelines, proven HCP education <br />Delivery system design: all HCPs & community involved, intense follow up<br />Clinical information system: provider reminder <br />systems w/education, ID individual smokers<br />
  17. 17. Rationale: Limited access to care, geographically isolated area, low cost<br />Telephone cessation support<br />Community<br />Resources: Private physicians, Free cessation counseling, Telepsychiatry service which was proven to be effective (funded through April, 2010)<br />Policies: Encourage smoke free restaurants<br />Health systems<br />Self-management support: Telephone cessation program<br />Decision Support: Health & Community Services <br />Delivery system design: County’s effort to build new cell phone towers<br />Clinical information system: Participants<br />
  18. 18. Evidence-based research<br />Hung & Shelley, 2009; CCM<br />Adherence 5As (ask, advise, assess, assist, & arrange)<br />500 (PCP’s)/60 community clinics NYC <br />low-income, minority populations<br />84% of HCPs asked Hx smoking<br />Clinics 3 CCM elements<br />enhanced delivery system design<br />clinical information systems<br />patient self-management support<br />6 CCM elements<br />Protocols tobacco use<br />ID & Rx<br />Decision support/clinical guidelines<br />Referral community. <br />CCM integration (5 and 6 elements) <br />20.4 to 30.9 x&gt; deliver full spectrum 5A services<br />
  19. 19.
  20. 20. NRT & Counseling<br />Tait, Hulse, Waterreus, et al. (2007)  <br />ID success predictors<br />Effectiveness aged &gt;or =75 years<br />165 intervention subjects vs. 50 smokers<br />intervention group younger<br />smoked fewer years<br />&gt;nicotine dependence scores<br />&gt;previous quit attempts. <br />6 months 20 % abstinent<br />NRT use<br />Male<br />higher anxiety scores<br />quit due to more frequent colds & coughs<br /> &gt;=75 years matched cessation criteria.<br />Conclusion: older smokers brief HCP <br /> counseling & NRT can quit smoking.  <br />
  21. 21. NRT Access & Cost<br />Miller, Frieden, Liu, S. et al. (2005) <br />New York State HD & Roswell Park Cancer Institute <br />Effectiveness large-scaled distribution program <br />free nicotine patches<br />Stop rate 20% NRT recipients<br />6038 successful quits attributable NRT<br />Cost $464/quit<br />Conclusion:<br />easy access cessation medication diverse populations may help smokers quit<br />Free or low cost access NRT & counseling by a HCP can <br /> promote smoking cessation in the elderly<br />Lightwood & Glantz (1997) <br />new nonsmoker reduces medical costs associated AMI & CVA<br />$47 1st yr<br />$853 next 7 years <br />Primary prevention adult smoking pays immediate dividends<br />Health improvement & cost savings<br />
  22. 22. Conclusion<br />Elderly population<br />Increased life expectancy<br />Increased # adult smokers<br />Increased prevalence lung CA & other tobacco related illness<br />Access<br />Geographical barriers<br />decreased # HCPs<br />limited Insurance; Medicare, uninsured<br />fixed income<br />Chronic Care Model<br />Utilizes all members HC team <br />Solutions<br />NRT<br />Counseling<br />Telephone contact<br />Community participation<br />
  23. 23. Questions to our colleagues<br />A. Are there other formats available at a low <br />cost to provide NRT? <br />B. Who else would benefit from this information? <br />Q & A<br />
  24. 24.
  25. 25. References<br />A Draft Summary of San Juan County Public Health Indicators (2008). Personal communication. <br />Brandeis University (2002). Treating Tobacco Use and Dependence as a Chronic Disease: A Planning Guide for Practice Sites in Developing an Office-Based System of Care. Retrieved on 8/1/2009 from<br />Bureau, U. S. C. (2009). State & County Quick Facts: San Juan County, Washington Retrieved 6/30/09, from<br />CDC & Surgeon General (2008). Treating Tobacco Use and Dependence: 2008 update retrieved on 7/30/09 from  <br />CDC. (ND). Smoking and Tobacco: Fast Facts. Retrieved 7/10/2009, from<br />CityData. (2009). San Juan County, Washington (WA). Retrieved 07/08, 2009, from<br />CommunityGuide. (2009). Tobacco use. Retrieved 7/10/2009 from<br />Hung D. Y., & Shelly, D.R. (2009). Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care clinics. HSR: Health Services Research, 44(1), 103-127.<br />
  26. 26. Manning, J. T., & James, F. (2009). The health of San Juan County. Friday Harbor, WA: Health and Community Serviceso. Document Number)<br />Miller,N., Frieden, T.R., Liu, S. et al.(2005).Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation Lancet,365, 1849-54. <br />OFM. (2008). San Juan County Profile. from<br />SJCWMC. (Date unknown). San Juan County characterization report. Retrieved 07/08/09, from<br />Tait, R.J., Hulse, G.KL., & Waterreus,A. et al. (2007)Effectiveness of a smoking cessation intervention in older adults Addiction, 102,148-55 <br />Wikipedia. (2009). San Juan County, Washington. Retrieved 6/30/09, from,_Washington<br />WSDH. (2007). Tobacco and health in Washington State- County profiles of tobacco use. Retrieved 7/10/2009, from<br />WSDH. (2009a). Guidelines For Using Rural-Urban Classification Systems for Public Health Assessment. Retrieved 06/26/09, from<br />WSDH. (2009b). San Juan County Tobacco use statistics. Retrieved 7/10/2009, <br />