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.


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


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%


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.


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.


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


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


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


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.


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.


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.


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


Database PeekDatabase Peek


One more peekOne more peek


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%


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


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


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


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


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


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


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


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)


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


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

North Country Healthy Heart Network, Inc. Administrative Office Saranac Lake, New York.

Documents

incidence of heart disease

county profileu

public health service

tobacco use

program featuresevidence

program designaccess

health behavior change

tobacco coalitions