NEW HAMPSHIRE Area Health Education Center

1

Area HealthEducation Center

N E W H A M P S H I R E

P R O G R A M P R O G R E S S R E P O R T1 9 9 7 - 2 0 0 3

A

2

1 Introduction3 Timeline5 Recruitment: Growing Your Own7 Placement: Placing Students in Rural and

Underserved Settings9 Education: The Lunch & Learn Model11 Special Topics: Health Literacy13 Special Topics: Cultural Competency15 Research: Investigating Barriers to Care17 Research: Improving the Oral Health of NH19 Resources: Moving Information from Source

to User20 Community Collaboration

Contact Information:

Rosemary A. Orgren, DirectorNH AHECDartmouth Medical School, HB 7016Hanover, NH 03755603-650-1817603-650-1331 (fax)[email protected]/~ahechome/

Martha McLeod, DirectorNorthern NH AHEC646 Union Street, Suite 400Littleton, NH [email protected]/

Paula Smith, DirectorSouthern NH AHEC128 State Route 27Raymond, NH [email protected]/

tableof contents

introduction

1

A D D R E S S I N G I S S U E S T H AT A F F E C T A C C E S S T O H E A LT H C A R E I N N E W H A M P S H I R E

The goal of the New Hampshire Area Health Education Center (NH AHEC) is tosupport and enhance the efforts of health professionals to care for underservedpopulations. Our issue is access to health care. Our audience is the health careworkforce. Our approach is educational outreach and support.

Workforce Shortages. While the country cycles through another severe nursingshortage, it is important to note that a growing number of other health profes-sions are similarly pressed to meet the demand for services. Dental hygienists,direct care workers, pharmacists, medical and laboratory technicians, to name afew, are all in short supply. These shortages mean reduced accessto health services, particularly for those who already face barriersto care, and longer working hours for existing professionals withfewer hours to stay current in their fields.

AHEC Programs. In partnership with other organizations around the state, NH AHEC provides services to the health care workforce in New Hampshire. We offer information, educational support, and technical assistance to the academic institutions that preparehealth care providers—and to the providers themselves. Whenever possible, we travel to practice sites or “piggyback” on other activities to minimize travel time of providers. We focus on issuesthat have direct impact on professional development and growth,including recruitment to health careers, retention in underservedcommunities, and the work environment. Through research, we’realso gathering data on the scope of the need in New Hampshireand documenting the impact of our programs.

Our Progress. In just six years, AHEC has grown to become a statewide networkwith administrative offices in three linked sites. Our basic programs haveexpanded to include research on community health indicators and workforcemapping, health literacy initiatives and coalition building in northern NewHampshire, cultural diversity and medical interpretation initiatives in southernNew Hampshire, and oral health education and training for providers across theGranite State. This progress report highlights our accomplishments since webegan operation in 1997.

What’s Next. AHEC and its community partners are addressing emerging issues such as emergency preparedness, looking at ways to better understand andaddress workforce issues statewide, and expanding our core activities, whichinclude professional education, curriculum development, and kids into healthcareers programs—school-based efforts to help prepare students for entry intohealth careers. We look forward to serving the State of New Hampshire foryears to come.

Rosemary Orgren, program directorRussell Jones, medical director

AHEC’s goal is tosupport and enhancethe efforts of healthprofessionals to carefor underserved populations.

Rosemary Orgren (center) with two AHEC students, Edna Markaddy (left) and CraigStrauss (right).

2

The Centers

NH AHEC consists of two community-based centers

and a central administrative unit. Each center—the

Northern New Hampshire AHEC in Littleton and the

Southern New Hampshire AHEC in Raymond—

develops and implements programs based on the

culture and environment of the communities they

serve.

Growing ethnic diversity in the southern tier is

reflected in programs such as cultural competency

workshops and simulated patients. The rural quality

of the North Country has led to a greater emphasis

on outreach library services and distance learning.

Both centers offer community-based student

placements, practice improvement, continuing

professional education, and programs that encourage

New Hampshire youth to enter careers in health care.

The program office, located in Hanover, supports the

work of the centers. We secure and administer federal

funds and pursue long-term sustainability of the

program statewide. We facilitate joint programming

and resource sharing with the home academic

institution, Dartmouth Medical School. We coordinate

efforts to educate state and federal legislators about

the importance and the impact of AHECs. And we

introduce the centers to new opportunities for

research, programming, collaboration, and leadership.

Belknap

Carroll

Cheshire

Coos

Grafton

Hillsborough

Merrimack

Rockingham

StraffordSullivan

Northern ew Hampshire AHEC

SoutNew

the centers

AHEC Administrative SitesNorthern NH AHEC: LittletonSouthern NH AHEC: RaymondProgram Office: Hanover

Northern New Hampshire AHEC

Southern New Hampshire AHEC

timelineS I X Y E A R S O F S U P P O R T A N D E D U C AT I O N

1997• Federal funding is secured.• The AHEC program office in Hanover is created.• The first center, Southern NH AHEC, is established.• 12% of medical students in New Hampshire receive training in

underserved communities.

1998• The second center, Northern NH AHEC, is launched. • AHEC begins a tradition of support for National Primary Care Day.• A statewide Multidisciplinary Steering Committee is established to

improve health professions training.

1999• AHEC coordinates the Preceptorship Program which supports

clinicians who teach students in community-based settings.• The Northern NH AHEC focuses its work on the unique

challenges faced by rural providers.• The Southern NH AHEC begins to develop capacity in

education about cultural diversity.• The first Lunch & Learn program is offered.• AHEC takes the lead to organize the second New England

Rural Health Round Table.

2000• A cultural competency grant funds training for simulated patients.• The first seminar using simulated patients is offered.• AHEC receives funding from the USDA to purchase interactive

videoconferencing equipment for nine sites in rural NH. • The NH Health Careers Catalog is printed and distributed.• AHEC is funded for three additional years.

2001• The AHEC staff participates in the Healthy People 2010

initiative, a prevention agenda for the nation. • AHEC institutes an annual “Champions in Health Care” event. • A Health Professional Volunteer Bureau is developed.• AHEC collaborates on the REACH (Racial and Ethnic Approaches

to Community Health) initiative.

2002• Chronic Disease Information Service (CDIS) is established.• The CDIS guide, “How to Get What You Need In New Hampshire,”

is published.• The Nursing Workforce Digest goes live on the AHEC Web site.• Vermont and New Hampshire AHECs collaborate on the Rural Health

Symposium.• AHEC develops placements for a new Master’s in Public Health

program at Dartmouth Medical School.• 36% of medical students in New Hampshire receive training in

underserved communities.

3

The NorthernNH AHECfocuses itswork on thechallengesfacing ruralproviders.

The Southern NH AHEC is developing capacity in cultural competencyeducation.

Surfing for Careers

Devon Littlefield, a sophomore at Littleton High School, wants to be an emergency

room doctor. Heather Thompson, a junior, is interested in physical therapy. Fortunately,

a recent AHEC presentation, “A Guided Internet Study of Health Careers,” helped

Littleton students find more information on their career choices. “It was cool to look

at career fields and find colleges with medical programs,” says Littlefield. Thompson

agrees: “It was very beneficial.”

The Internet study program is just beginning; the presentation in Littleton was a trial

run by Anne Conner, Northern NH AHEC’s outreach librarian, and Judy Day, Northern

NH AHEC’s health career coordinator. Students browsed online personality tests,

learned about different health careers from AHEC’s Health Careers Catalog, and

searched for colleges that offered degrees in the field of interest.

“The computer career research training is well put together, but what I think was even

more valuable was having professionals from AHEC conduct the training,” says Gail

Minor-Babin, allied health technologies teacher at Littleton High School, Gallen

Regional Vocational/Technical Center. “This interaction is important; if they can perceive

that the community cares about them and what they are interested in, this makes an

impression on them.”

surfingfor careers

• For many students, an interest in science emergesprior to completing highschool.

• Career advisors agree thatpromoting health careers inhigh schools is the mosteffective way to encouragestudents to enroll in healthcareer training programs.

4

5

recruitmentG R O W I N G O U R O W N

In communities that need health professionals, AHEC’s “Grow Our Own” programs start by generating awareness and interest. Whether it is an adultinterested in a career change, a nurse who hasn’t been in practice for a fewyears, or a teenager considering what to do after high school, AHEC offersinformation and guidance about careers in health care.

AHEC staff and a cadre of volunteers visit schools to promote health careers to students. The activity might be a puppet show for preschool children thatencourages good health behaviors or a classroom presentation to middleschool children about health career opportunities. High school students whowant more than just information can “job shadow” to observe health care professionals at work in area hospitals and medical practices. AHEC also provides resources—such as a health career lending library—and orientationtraining to teachers and guidance counselors.

On the horizon for AHEC’s Grow Our Own programs are refresher coursesfor EMTs and registered nurses, adult retraining courses, and new services tohelp high school students find scholarships and fill out college applications.

Tools to Grow Our OwnAHEC personnel who coordinate the “GrowOur Own” programs have developed twoimportant resources to support their work: a Health Careers Catalog and a video pres-entation titled “24 Hours in Healthcare.”

The New Hampshire Health CareersCatalog describes more than 80 careers inhealth care—typical job responsibilities andwork settings, potential annual earnings,and where to go for training in NH. It hasbeen distributed to thousands of highschool youth across the state, as well as toadults who want to explore health careers.

Videographers went on-site to interview six NH health professionals for AHEC’s 15-minute video, “24 Hours in Healthcare.”In their own words, a laboratory technologist,a nurse, a medical interpreter, an emergencymedical technician, a physical therapist, anda surgeon describe what they do, what theylike about their jobs, and personal successstories. The video is targeted to middleschool students to help increase awarenessand interest in health careers and stimulateclassroom conversation about the life of ahealth professional.

AHEC staff and volunteershave made 60 visits toschools and health fairsto distribute 6,000 HealthCareer Catalogs and talkwith 4,500 students and1,400 teachers, counselors,and parents in the last year alone.

6

Chronic Illness in Rural NH

How does a community view a child with a chronic illness? As Gary

Maslow learned during the summer after his first year of medical

school, there are many perspectives ranging from sympathetic

understanding to complete confusion.

“In all of New Hampshire, there are only about 50 children with cancer

and some 32,000 children with other chronic illnesses,” says Maslow.

“If kids are isolated or don’t have good access to care, the community

can really make a difference with their support. Medical providers can

also help mobilize resources and make the community strong.”

Maslow, as part of his student placement through AHEC, spent six

weeks in rural Littleton, NH, getting to know 10 children with chronic

health conditions like cancer, AIDS, asthma, muscular distrophy, autism,

Down’s syndrome, and spina bifida. He interviewed families about

caring for a child with a chronic illness, he talked to health care

providers and teachers, he stopped people on the street and asked

questions. It was a great exposure to rural medicine and an up-close

view of each family’s daily struggle with chronic illness.

“I have AHEC to thank for the place to stay—it really made a

difference to be able to live in the community,” says Maslow, a third-

year Dartmouth Medical School student. Although he’s not sure where

he’ll end up after graduation, his experiences in New Hampshire have

been good ones. “I would love to stay in NH and I would love to be a

rural doctor.”

lookingat the big picture

• The American HospitalAssociation documentedmore than 168,000 unfilledpositions including nurses,pharmacists, technologists,aides, and other health carerelated positions.

• According to the U.S.Department of Labor, Bureauof Labor Statistics, there will need to be 450,000 more registerered nurses and 136,000 more licensed practical nurses by the year2008.

• A recent survey of NH dentists in private practicerevealed that 48 percent indicated that inadequatedental hygiene staffingdecreased their ability to provide care.

• Retaining workers in directcare is extrememly difficult.National turnover rates are40 to 60 percent; many facili-ties report an annual turnoverof 100 percent.

placementP L A C I N G S T U D E N T S I N R U R A L A N D U N D E R S E R V E DS E T T I N G S

Historically, student placement in community-based learning sites has been acore mandate of the national AHEC program. “AHEC partners with academicinstitutions statewide to facilitate community-based placements,” says RosemaryOrgren, program director. “We’ve matched students and residents with community health centers, rural health clinics, health departments, private practices, schools, and health and human service agencies throughout NewHampshire, particularly in underserved areas.”

AHEC supports student placement in a number of ways, including offeringhousing options to students and assisting community sites with placement logistics to relieve some of the administrative tasks related to taking a student.There’s also preceptor training and student mentorship.

AHEC’s assistance makes each rotation a high-quality learning experience forboth students (who gain new exposures to diversity) and organizations (whobenefit from a focused community project). It has also led to more students completing their rotations in underserved and rural settings in New Hampshire.In 1996-97, just before AHEC was established, only 12 percent of medical studentswere going to such areas. By 2002, that number had increased to 36 percent.

Student placement will continue to be an important part of AHEC’s future. In2002, Dartmouth Medical School launched a degree program for a master’s ofpublic health (MPH). With its community connections, AHEC provided leadershipto link student field experiences to regional needs and developed guidelines,expectations, and roles for students, preceptors, and sites. In 2003, the first classof MPH students started their projects.

In 1996-97, just before AHEC was established, only 12 percentof medical students in NewHamspshire were going to ruraland underserved areas. By 2002,that number had increased to 36 percent.

7

8

Improving Care One Class at a Time

In March 1999, AHEC held its first Lunch & Learn on

diabetes management. Four years later, the topic is

still popular—and necessary. “It’s a growing epidemic,

nationally and right here in NH,” says Kathy Berman,

diabetes control program coordinator at the New

Hampshire Department of Health and Human Services.

The diabetes Lunch & Learn includes two, one-hour programs. Part one is a diabetes

management update which includes an overview of the NH guidelines for diabetes

care, information on new medications, and recommendations for early detection and

treatment of diabetes complications in adults. Part two includes a diabetes care

consultation. A diabetes educator leads a review of the current diabetes care process

and assists in the identification of strategies to enhance the practice. Additional one

hour programs on integrating new information into practice and a medications update

are now available as well.

Following a diabetes Lunch & Learn program, Coos County Family Health Services

instituted two quality improvements during primary care visits with diabetic patients:

a yearly microalbumin test to make sure the kidneys were functioning properly and a

foot exam every three months. These two practice changes have resulted in significant

quality improvement: microalbumin tests have increased from

55 to 83 percent and the foot exams have increased from 77 to

91 percent.

“Every little bit helps when it comes to preventing complications

from diabetes,” says Patty Couture, a registered nurse at Coos

County Family Health Services in Berlin.

improvingcare one class at a time

9

educationT H E L U N C H & L E A R N M O D E L

AHEC’s Lunch & Learn Series brings clinical education to provider offices.It’s a convenient, on-site way for physicians, nurse practitioners, physicianassistants, registered nurses, social workers, and other staff to stay up todate with medical advances and information.

Medical offices, hospitals, and community organizations can take advan-tage of programs on topics such as domestic violence, asthma, culturalcompetency, bioterrorism and its effects on the health care community,strategies for diabetes management, and breast cancer screening in theprimary care setting. All members of a medical practice team are invited.

The programs are offered on site, making them more accessible to healthcare providers. “If we have to go out of our area for training, a class withtravel time ends up being a full day,” says Adele Woods, CEO of CoosCounty Family Health Services in Berlin, NH. “Anything on site is a realbonus to us. It’s a huge savings when you add in the mileage and hoursinvolved—and it’s nice to be able to send everyone.”

By coordinating Lunch & Learns with provider schedules, more peopleare getting the information than ever before. “Instead of one doctorattending and sharing the information when he or she returns, it is nowpossible to take a practice-based approach to problem-based learning,”says Paula Smith, director of the Southern NH AHEC. “Everyone on theteam can be talking about diabetes, asthma, or cultural competency, anduse the dialogue to make things better in practice. It’s a whole teamapproach.”

AHEC has provided 244continuing educationprograms to 5,504 health-care providers from 600community-based sites inNew Hampshire in the lastyear alone.

• Diabetes is the sixth lead-ing cause of death in NH.

• About 5 percent of NHadults report having beendiagnosed with diabetes(50,000 people). This isprobably an underesti-mate, as one third ofAmericans who have diabetes do not know it.

• In 2000, there were

– 14,614 hospitalizationsamong NH diabetics

– 103 instances of kidney failure

– 272 lower extremityamputations

This information is from Diabetesin NH Issue Brief, January 2003

Simple Explanations

“Some of my clients have lived in Coos County all their

lives, but never finished grade school,” says Elaine

Belanger, care coordinator and LPN at North Country

Cares, a program in Berlin, NH, that helps North

Country residents access essential health care services.

Belanger has enlisted AHEC’s expertise with a number

of projects including the rewrite of a brochure that tells

patients how to access emergency care in the area.

“Being a nurse, I am always conscious of the area’s

population with a low literacy rate,” she says. “I try not

to speak in medical-ese, and use terms like stomach

ache instead of abdominal pain.”

Health literacy can be simplydefined as the ability to read,understand, and act on healthinformation. It is an emergingpublic health issue.

• Ninety million (nearly one out of three) Americans maybe at risk for poor healthoutcomes because of lowhealth literacy skills.

• One out of five Americanadults reads at the fifthgrade level or below, and the average American readsat the eighth to ninth gradelevel, yet most health carematerials are written abovethe 10th grade level.

• Annual health care costs forpersons with low literacyskills are four times higherthan those with higher litera-cy skills. Low health literacymay cost the U.S. health caresystem up to $73 billionannually.

• Only about 50 percent of allpatients take medications as directed. Problems withpatient compliance and medical errors may be basedon poor understanding ofhealth care information.

• Limited health literacyincreases the disparity inhealth care access amongexceptionally vulnerable populations.

simple10 explanations

special topics

11

People go togreat lengthsto try to hide the factthat theycan’t read.

H E A LT H L I T E R A C Y

Individuals with poor literacy skills have difficulty understanding thehealth care information they receive. They may have trouble reading consent forms; understanding written or oral information provided by physicians, nurses, or pharmacists; or acting upon medication directions.

“People go to great lengths to try to hide the fact that they can’t read,”says Anne Conner, Northern NH AHEC’s outreach librarian. “They mighttell the provider what they want to hear to avoid further questions—and discovery. Imagine how this changes their health outcomes.”

AHEC, in collaboration with community partners, has developed NorthCountry Care-Net, a Web site with easy-to-read health information. A grant provides funding for open Internet access and technical trainingto participating health providers. Before or after an appointment withtheir care provider, patients with low literacy skills can look up a wordin a medical dictionary (created by AHEC) and find a definition in simple language. “Novices are able to navigate this Web site and findhealth information they can easily understand,” says Conner.

North Country Care-Net is only one aspect of AHEC’s literacy program.With health education and promotion materials written at the 10thgrade level or above and the average reading level of adults is theeighth grade, AHEC also teams up with health providers to write orrewrite health information for the public. “It saves time, money, andlives,” says Conner.

Care across Cultures

“In Eastern Europe, people expect to walk out of the clinic with a diagnosis and

prescription. They don’t understand tests,” says Florentina Dinu. “People from the city

may ask questions about their care, but people living in rural areas are more humble,

saying yes to everything and deciding at home if they will follow treatment.”

Dinu is a simulated patient. She stands in front of a group of second-year Dartmouth

medical students while a student asks her medical history. In her role play, she is from

the Republic of Muldova. Her own Romanian background helps shape her answers,

providing students a first-hand view of how culture affects health care.

“Students don’t know the diagnosis, and have to guess. At the end, there’s time for all

the students in the class to ask questions,” says Dinu, the medical interpretation services

coordinator with Southern NH AHEC. “I hope that this helps two ways—establishing

a diagnosis and learning how to work with patients and interpreters from other ethnic

backgrounds.”

12careacross cultures

• Cultural and linguistic competence is aset of congruent behaviors, attitudes,and policies that come together in asystem to enable effective work incross-cultural situations.

• Across New Hampshire, there are nearly 100,000 individuals for whomEnglish is a second language.

• Lack of awareness about cultural differences can make it difficult forboth providers and patients to achievethe best, most appropriate care

• People of diverse racial, ethnic, and cultural heritage suffer disproportion-ately from cardiovascular disease, diabetes, HIV/AIDS, and every form of cancer. In addition, their infant mortality rates are generally higher,and their childhood immunization rates are lower.

special topics

13

C U LT U R A L C O M P E T E N C Y

There’s a growing number of people in New Hampshire for whom Englishis a new language. Manchester, a designated refugee resettlement area, has a diverse and growing minority population, which is reflected by the morethan 70 languages spoken in its schools. Across the state, there are almost100,000 individuals where a language other than English is spoken at home.

To provide awareness of how culture affects health, AHEC offers a series of cultural competency programs to health care providers. The first seminar,“Enhanced Cultural Competency Using Simulated Patients from DiverseCultures,” was offered in October 2000. Health professionals and medicalstudents engaged in cultural encounters with simulated patients fromdiverse communities, such as a 50-year-old longshoreman from St.Petersburg, Russia, with chest pain or a Latino female with asthma.

AHEC continues to add to the variety of its Lunch & Learns and eveningeducational programs. New cultural competency topics include health/mental health care from the gay and lesbian perspectives and a two-partprogram on diabetes and hypertension reviewed in context of the AfricanAmerican and Latino cultures. The Art of Medical Interpretation course isoffered twice a year and includes not only interpretation skills but also howto be a cultural broker between the patient and the provider.

“We look forward to partnering with AHEC in offereing medical interpretationand cultural competency training in the future,” said Jazmin Miranda-Smith,executive director of New Hampshire Minority Health Coalition, a non-profitorganization dedicated to improving the health of minority populations acrossNE. “The collaboration between the AHEC and the Coalition bridges therelationships between health care providers and patients from diverse communities, providing a wealth of cultural knowledge to both parties.”

In 2000, cultural competencygrant funded training for simulated patients. Duringthe current year, well over600 care providers willreceive such training.

One Size Doesn’t Fit All

The Bureau of Rural Health and Primary Care relies on data

to improve the health of NH communities. Eric Turer, a health

care consultant for the Bureau, finds that data is not typically

analyzed in geographic units that reflect the natural patterns

of local service areas. “We need a more rational basis to look

at access than town-by-town, and factors like economic barriers

have to be considered as part of the health care picture,”

he says.

Turer’s extensive use of geomapping tools led him to the New

Hampshire Access to Primary Care Indicator Project. “It is a

compelling project,” Turer says. “The idea of a standard set

of data combined with local information is great.”

State agencies, community leaders, local health officials, and

health care employers are already lining up for this type of

information. “NH will be able to use this data to identify

critical health issues, and then work with the community to

prioritize and address those issues,” says David Bott, a

research associate with AHEC, and principal investigator for

the project.

14one sizedoesn’t fit all

• The issues surrounding access to primary health care are interwovenwith issues of health resources and utilization as well as geography,economics, and socio-cultural barriers.

• The experiences and needs of local communities can differ greatly,even within a small and relatively homogeneous state such as NewHampshire.

Primary Care Service Areas (PCSAs)PCSAs are one way to represent primarycare markets. They are delineated here byrandomly colored blocks.

15

researchI N V E S T I G AT I N G B A R R I E R S T O C A R E

While data on primary care access exists, NH does not have the level of detail necessary to guide interventions, develop policy, or measureprogress.

In order to better understand one of the primary issues that AHEC addresses—barriers to health care access—research associate David Bott is headingup a research project, with support from the Endowment for Health, todescribe variation in access to primary care within the state. Researchers with the New Hampshire Access to Primary Care Indicator (APCI) Project are analyzing existing and newly available economic, socio-cultural, and geographic indicators and developing ways to assess primary care access.

“You don’t get an accurate picture by adapting national health care data to local communities. Primary care needs change in each part of the state,” says Bott who is working with researchers from AHEC, Dartmouth Medical School, the New Hampshire Bureau of Health Statistics and Data Management (BHSDM), and the Veterans Health Administration (VHA)White River Junction.

For example, federal data may show that there are enough primary careproviders in a service area—but if it is a 50-mile drive for an elderly man it would be considered a barrier to care. Bott and his research team will determine which indicators portray what is really happening with primary care in the state. The final analyses will provide citizens, policy makers, and researchers with information about the scope and nature of barriers to primary care access.

According to the U.S.Department of Healthand Human Services, about 20 percent of the U.S. population resides in primarycare health professionalshortage areas.

16

• New Hampshire is amongthose states with the lowest percentage of thepopulation (43 percent)benefiting from publicfluoridated water systems.

• At least 66 percent of thepediatric population doesnot receive fluoride sup-plements.

• The uneven distributionof dentists has createdbarriers to dental care inNew Hampshire’s morerural and inner city areas.

• Approximately 50 percentof New Hampshire’s prac-ticing dentists are overthe age of 50, and 20percent are over the ageof 60.

• There are no dentalschools or residency programs in the state,and there is only one dental hygienist training program.

• Approximately 25 percentof NH residents do nothave dental insurance.

• A survey of third gradersfound that 22 percent had untreated decay and52 percent had a historyof caries (treated oruntreated).

it startswith the mouth

It Starts with the Mouth

“Periodontal disease is a chronic, active infection that can ultimately

affect general health,” says Lindsay Josephs, program specialist with

the Endowment for Health. “By integrating oral health education and

assessment into pediatric and general medical practice, problems with

the mouth, teeth, and gums can be identified early. That’s why the

AHEC project was so appealing to us—it helps doctors recognize that

the mouth is a part of pediatric care. Good oral health plays into a

child’s total health and well being.”

Components of the Medical Provider Oral Health Education Project

include a questionnaire at the 4-month well child visit; a saliva test for

bacterial count at 12 months; and patient education materials tailored

to specific age ranges: 4 to 6 months, 6 to 12 months, 12 to 24 months,

and 36 months. “The eruption of the first tooth is a good time for

pediatricians and family physicians to talk to parents about oral

health—from not putting a child to bed with a bottle of apple juice

to the importance of fluoride supplements,” says Josephs.

researchI M P R O V I N G T H E O R A L H E A LT H O F N E W H A M P S H I R E

Tooth decay is one of the most common chronic childhood diseases—five times more common than asthma and seven times more commonthan hay fever. Although it is largely preventable, the poor state of oralhealth has become a critical issue for NH residents at all ages.

AHEC is trying to change the tide by piloting a practice improvementproject in seven communities: Littleton, Berlin, Laconia, Hillsboro/Henniker, Keene, Nashua, and Salem/Londonderry. Dr. Russell Jones,AHEC’s medical director, is working in cooperation with the NHAcademy of Family Physicians, the New Hampshire Pediatric Society,and the NH Dental Society to launch the Medical Provider Oral HealthEducation Project, a screening and education program for pediatriciansand family physicians.

The Medical Provider Oral Health Education Project is supported by theEndowment for Health, a tax-exempt foundation in Concord that fundsefforts to improve the health and well being of New Hampshire residents.The goals are threefold: educate medical providers about dental disease,increase opportunities for pediatricians and family physicians to usepreventive oral health interventions, and facilitate cooperation betweenmedical and dental practices in New Hampshire. Tracking the outcomesof this project will help AHEC and others plan future education andtraining activities around oral health.

The Endowment for Health anticipates that the AHEC oral health projectwill encourage system changes in the pilot communities. “Not onlydoes the project increase oral health screenings in medical practices, itwill establish a relationship between the pediatrician and the dentist,”says Lindsay Josephs, program specialist with the Endowment forHealth. “The project can potentially be replicated in other communities.We have great hope for this.”

17

Tooth decayis one of themost commonchronic child-hood diseases.

Information Is Power

While attending a workshop, Annie Ball heard about the NH Chronic Disease

Information Service (CDIS), a resource that includes a free Web site with current

information about services in the state. “Now I check the site regularly to learn

about new medications and their evaluations,” she says.

Ball, a registered nurse, uses the site in her role as a volunteer consumer advocate,

sharing both the Web site and hardcopy resource guide, “How to Get What You

Need in New Hampshire,” with friends, family members, and people living with

chronic or life threatening conditions.

“There is help available if you know where to go for it,” she says. “I receive a lot of

calls from people who are desperate or muddled, and it is wonderful to be able to

refer them to CDIS and the resource guide.”

18

CDIS offerings include:

• The CDIS News Digest: The Digest,distributed monthly via e-mail andarchived on the Web site, includesupdates on asthma and diabetes aswell as information on local and regional continuing education events.

• The CDIS Guide: How to Get WhatYou Need in New Hampshire; AResource Guide for People Living WithChronic or Life-threatening Conditionsprovides clear information and candidadvice to help patients and their caregivers find and make best use ofhealth care resources in NewHampshire.

• The CDIS Web Site:www.chronic-disease.net provideshealth care professionals and peopleliving with chronic conditions with easyaccess to current information aboutservices in the state. The site offerslinks to resources by type of service,region of the state, and for severalspecific chronic conditions.

informationis power

resourcesM O V I N G I N F O R M AT I O N F R O M S O U R C E T O U S E R

Staying current in any field is a challenge. The rate at which new information is generated continues to accelerate, and a growing array of information sourcesvies for our attention. One of the ways in which AHEC supports the health careworkforce is by locating, selecting, and providing timely information in easily accessible formats. The Nursing Workforce Digest and Chronic DiseaseInformation Service (CDIS) are two examples.

The Nursing Workforce DigestThe Nursing Workforce Digest is a searchable online database of informationculled from both traditional and unexpected sources. Beginning with a small set of citations of peer-reviewed articles primarily from health care journals, the Digest has grown to include references from the fields of law, economics,human resource development, and more. Government reports, professionalassociation white papers, popular media pieces, and Web sites are all assiduouslysearched for new and timely information.

“We are constantly being asked questions: numbers of licensed nurses, trends,differences in categories, and needs,” says Judith Evans, assistant director of theNew Hampshire Board of Nursing. “We maintain information about the numberof licensees but don’t keep any statistics about staff vacancies and needs, andhave to refer to other places. Once I knew the Nursing Workforce Digest wasthere, it became a great source of information, and will become more importantas the nursing shortage gets worse.”

Chronic Disease Information Service (CDIS)CDIS supports health care providers in the delivery of best practice care andempowers patients to participate more effectively in their own treatment.Physicians, nurses, chronic disease managers, and others have a direct link toadvances in asthma, diabetes, hepatitis, and HIV/AIDS. New Hampshire residentsliving with a chronic disease can access a directory of invaluable informationsuch as community support groups, legal resources, long-term or hospice care,finances, and new treatments or technologies related to their illness.

19

One of the ways in whichAHEC supports the healthcare workforce is by locating,selecting, and providing timely information in easily accessible formats.

C O M M U N I T Y C O L L A B O R AT I O N

Building a Statewide NetworkThe strength, focus, and ultimate success of AHEC rests on our ability torespond to community needs and strengths. That’s why nearly everythingwe do is collaborative. It is rewarding to promote connections betweenindividuals and organizations, academic institutions and communities—andsee these partnerships improve access to health care for NH citizens.

communitycollaboration20

Our PartnersAccess to Health Care CoalitionAccess to Mental HealthAccess to Oral Health CoalitionAmmonoosuc Community Health

ServicesAvis Goodwin Community Health

CenterBi-State Primary Care AssociationChild Health ServicesCity of Manchester, Planning &

Community DevelopmentColby Sawyer CollegeCommunity Health Access NetworkCommunity Health InstituteCommunity Mental Health CentersCommunity Technical InstituteCoos County Family Health ServicesDartmouth Family Practice Residency

Program, Concord HospitalDartmouth Medical SchoolDartmouth-Hitchcock ManchesterDartmouth-Hitchcock Medical CenterFamilies First of Greater SeacoastGranite State Distance Learning

NetworkGranite State FitKidsHealthFirst Family CareHealthy Manchester Leadership CouncilHome Care AgenciesHospitals throughout the stateLamprey Health CareManchester Center for Health SciencesManchester Community Health CenterManchester Community Resource

CenterManchester Health DepartmentMassachusetts College of Pharmacy and

Health SciencesMiddle and high schoolsMobile Community Health Team Project

Nashua Area Health CenterNashua Health DepartmentNew England Rural Health RoundtableNew Hampshire Board of NursingNew Hampshire Community Technical

College in ManchesterNew Hampshire Department of Health

and Human ServicesNew Hampshire Healthy KidsNew Hampshire Hospital AssociationNew Hampshire Minority Health

CoalitionNew Hampshire Nurses’ AssociationNew Hampshire Office of Minority

HealthNew Hampshire Office of Rural Health

and Primary CareNew Hampshire Public Health

AssociationNew Hampshire Technical College in

BerlinNew Hampshire Technical InstituteNorth Country Health ConsortiumRegional Alliance for Public HealthRivier CollegeRural Health CoalitionRural Transportation InitiativeUniversity of New Hampshire

GRANTS

AED Partner with State Office of RuralHealth and NH Bureau of EMS toprovide training on use of AutomaticExternal Defibrillators (AEDs).

Community Health AccessIndicatorsDescribe variation in access to primary care within the state by analyzing primary care services data.Funded by the Endowment forHealth.

Community Health Access Network TrainingDevelop and offer continuing educa-tion to community health center staffon a variety of topics.

Cultural Competency Offer educational series on improvingpatient/provider communicationthrough cultural competency.

Governor’s Commission GrantIncrease access to substance abuseprevention and treatment servicesand coalition building.

Legal InterpretationOffer 70-hour training for interpretersto work in a legal setting. Funded byCity of Manchester.

Medical InterpretationDevelop and implement comprehen-sive training program for medicalinterpreters, health professionals, and consumers. Funded by theEndowment for Health and the NHCommunity Grants Program in collab-oration with the NH Minority HealthCoalition.

Medical Provider Oral HealthEducation ProgramIncrease awareness and knowledge of the medical care community aboutdental disease and facilitate coopera-tion between the medical and dentalcommunities. Funded by theEndowment for Health.

Model CommunityWork with the Town of Littleton to increase access to people with disabilities and the elderly to enableindependence and inclusion in thecommunity.

National Library of Medicine-Care NetA Web site that provides people living in northern New Hampshirewith quick and easy access to understandable health informationand resources.

New England Rural HealthRoundTableCoordinate three-day regional conference on rural health issues.

Oral Health Strategic Planning Grant Develop a plan for increasing accessto oral health services for NorthCountry residents.

EMS Equipment Purchase life saving equipment forrural EMS units operating in NH StateParks and White Mountain area(AEDs and suction units). Funded bySamuel Hunt Foundation.

Simulated PatientsTrain health professionals and healthprofessions students on cultural competency using patients fromdiverse cultures.

Tobacco PreventionPrevent youth from starting the use of tobacco products, promote tobacco free environment, eliminateexposure to second hand smoke.

Turning PointBuild public health capacity anddevelop a comprehensive local public health improvement plan.

USDA Distance LearningProvide videoconferencing units tonine rural sites to improve access ofhealth professionals to continuingeducation programs.

CONTRACTS

March of Dimes, to coordinate FolicAcid project, marketing and outreachto high-risk women.

State of NH – Bioterrorism, to provide education and training tofirst responders, school nurses, primary care providers and business-es on Bioterrorism and emergencypreparedness.

State of NH – TobaccoPrevention/CHI, to provide educationand training to health professionalstreating women of reproductive ageon state-of-the-art tobacco treatment

State of NH – Breast and CervicalCancer ScreeningProgram/American Cancer Society,to develop and implement a Lunch &Learn program for primary carehealth professionals

State of NH – Office of Communityand Public Health, to develop andimplement Lunch & Learn programsin the areas of Osteoporosis andNutrition.

Granite State FitKids, to recruit facilitators, translate documents, anddesign training manual.

Manchester School System, to teacha faculty development workshop.

State of NH – Asthma Program, toconvene an Asthma Summit, developa web site, and administer a mini-grant program.

Community Health Access Network(CHAN), to provide diabetes education.

GRANTS AND CONTRACTS AWARDED TO THE NHAHEC

New Hampshire Area Health Education Center

AHEC Program OfficeDartmouth Medical SchoolHB 7016Hanover, NH 03755603.650.1817603.650.1331 (fax)www.dartmouth.edu/~ahechome/

Design Lynne Walker Design StudioWriting Howling Beagle CommunicationsPhotography Jon Gilbert Fox, Joseph Mehling, Mark Austin-Washburn