February 15th, 2011 by admin
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Maricopa County Department of Public Health (and our Lab) confirmed a case of measles in an Arizona resident this week. Measles is one of the most communicable diseases there is (next to chicken pox). It’s a viral disease of the upper respiratory system that’s spread in the air via droplets. Measles starts with a fever and cough, eye irritation and a unique rash. The MMR vaccine introduced in the 1960s pretty much wiped out measles in the US. Around WW II the US had about 900,000 cases annually, but these days its usually less than 100 or so cases per year in the US.
When cases do show up, it’s usually among people that live overseas (in endemic areas) and visit the US or among US residents that travel overseas to areas with endemic measles (about 20 million people get measles globally every year).
The primary public health interventions are to identify contacts of cases and make sure that healthcare providers know exactly what to do when a patient presents with what could be measles, like implementing standard precautions and placing suspect cases in airborne precautions as soon as possible. If a patient calls a doctor and says that they’re sick and may have been exposed to measles we encourage the doctor to make sure that patients in the waiting room won’t be exposed and that all your staff are adequately vaccinated. Of course, the best intervention of all is to keep our vaccination rates up.
February 14th, 2011 by admin
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Last week I wrote about our Behavioral Health Outcomes Dashboard <http://directorsblog.health.azdhs.gov/?p=1117> – which highlights our efforts to shift our performance measures toward actual outcomes. In other words, we want to measure whether the services we provide actually help folks achieve their goals rather than whether someone’s paperwork is right.
The same is true for public health- our goal is to influence actual outcomes- meaning we need to measure whether the public health system is actually helping people to live healthier lives. That’s where our recent document written by Christopher Mrela comes in. The new report, called Differences in the Health Status, Arizona 2009 <http://www.azdhs.gov/plan/report/dhsag/index.htm> gives us a glimpse into Arizona public health outcomes.
The report looks at 70 measures of health in AZ over the last 10 years. In other words- it helps us measure how much progress we’ve made in public health outcome measures between 2000 and 2009. For example, the death rate for heart related diseases (the leading cause of death) fell by 32% over the last 10 years. Likewise, the cancer death rate (#2) fell by 14%. Death rates from stroke fell by a whopping 40% over the last 10 years. Other areas that showed improvement included teen pregnancy (which is associated with a whole host of bad outcomes), which dropped by 41%. Infant mortality improved by 12%. The death rate from influenza and pneumonia was 40% lower in 2009 than in 2000. Even mortality from diabetes improved by 17% in the same period.
Don’t get the idea that everything’s hunky-dory because not all the 70 measures improved. The death rate from falls increased by 37% and suicides went up by 10%.
Overall we see that Arizona as a whole has become more healthy and continues to improve. Be sure to look at the full report at the other measures that are compared to get a greater understanding of the health of our state- and make sure that you bookmark this new public health outcomes report <http://www.azdhs.gov/plan/report/dhsag/index.htm> . Well done Chris!
P.S.- For a whole host of AZ Public Health outcome measures be sure to visit http://www.arizonahealthmatters.org/
February 11th, 2011 by admin
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We’ve made a strong effort in the past couple years to make sure that we are doing our best to protect the health and safety of people in our licensed facilities. Whenever possible, we work to help those facilities come into compliance with our rules, but sometimes we have no choice but to drop the hammer of enforcement, which is what the Assisted Living team did at Fiesta Village.
Last summer ADHS closed the facility based on the conditions we found during our visits. The facility had been under scrutiny by the Division of Licensing for several months because of concern for the safety and welfare of the residents. While staff normally only goes into a facility once a year, ADHS staff had been in and out of Fiesta Village several times prior to the operator surrendering the license. ADHS worked closely with the city of Phoenix and other agencies to make sure the residents were transitioned into safe places and then after the facility closed to help with the criminal investigation.
You can check out licensed facilities for yourself any time of day at AZcarecheck.com.
February 11th, 2011 by admin
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We’ll be holding four public comment meetings for the Medical Marijuana Rules next week. Public comment meetings are the part of the Rulemaking process whereby “an agency shall afford persons the opportunity to submit in writing statements, arguments, data and views on the proposed rule, with or without the opportunity to present them orally”. We technically aren’t required to conduct these meetings because the Medical Marijuana Rulemaking is exempt from the normal process- but we’re doing it anyway because we think it’s a good practice that sometimes helps us make better decisions.
The objective is to listen to comments, concerns, and suggestions for improvements or solutions related to our draft rules. Public comment meetings don’t use a question and answer format- rather they provide a way for people to make suggestions in person. We take notes and record the sessions- but we don’t answer questions. Please note that the meetings next week aren’t intended to answer questions about how to open a dispensary. Here’s the format:
- Each meeting will consist of Department staff listening to comments, concerns, and suggestions for improvements or solutions related to the Medical Marijuana Program draft rules.
- Please limit oral comments to the substance and form of the draft rules. Don’t hesitate to express support or opposition to earlier comments but please try to avoid repetition.
- An individual may also submit written comments using the Comments Form that will be available at each meeting. There will be a marked container to put Comments Forms in at any time during each meeting or after each meeting concludes.
- Please submit all written comments by 5:00 pm, on Friday, February 18, 2011. All input will be considered when finalizing the Medical Marijuana Program rules.
Here are the schedule, logistics and the structure:
- Monday, February 14, 2011, at 10:00 am – 1:00 pm Flagstaff City Hall, Council Chambers, 211 W. Aspen Ave
- Tuesday, February 15, 2011, at 3:30 pm – 6:30 pm, ASU Sandra Day O’Connor College of Law, The Great Hall, 1100 S. McAllister Ave
- Wednesday, February, 16, 2011, at 3:00 pm – 6:00 pm, U of A James E. Rodgers College of Law, Ares Auditorium, 1201 E. Speedway
- Thursday, February 17, 2011, at 9:00 am – 12:00 pm, ASU Sandra Day O’Connor College of Law, The Great Hall, 1100 S. McAllister Ave.
February 10th, 2011 by admin
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Those of you that were working here in 2009 (or even if you weren’t) probably remember all of the angst and unrest that occurred when we increased our licensing fees for child care facilities (for the first time in over 20 years). The goal was to have licensing fee revenues cover the actual costs incurred by the State to ensure that childcare facilities are safe. The fee increases were sizable. For a facility with a capacity of more than 59 children, the fee for a three-year license increased from $150 to $7,800. However, as a result of the public comment, we introduced the Empower Pack which reduced the new fees by 50% as long as facilities agree to incorporate physical activity and nutrition activities that promote healthy lifestyles. Another result of the fee increase was the passage of SB 1315 last Session, which instructed us to conduct a cost study of our Child Care Licensing activities.
We published our study this week. There are a number of conclusions in the full report, including a finding that every category of licensed childcare facility is paying less in fees than it costs to license, inspect and regulate the facilities… because the Empower Pack Program (which uses Title V) pays for ½ of our licensing activity expenses in childcare. The cost study also examined the cost of the different types of activities of our team and found that inspections (34%) and licensure and certification process (30%) take the most time and effort.
One recommendation for improved efficiency was to adjust inspection frequency based on the risk profile of the facility. In other words, a place with a good compliance history could receive fewer comprehensive inspections than a facility that has a history of poor compliance. Another recommendation was that efficiency could be improved by adapting inspection schedules to inspect facilities near each other at the same time and to reduce the group home inspections from twice to once a year where warranted.
Cheers to Sandy Percival and her auditing team (they did the biggest chunk), Jim Humble, Tom Salow, Lynne Smith, Jennifer Tweedy, and of course Mary Wiley, Allan Oppenheim, Lourdes Ochoa, and of course the entire childcare licensing team for their work on this important project.
February 9th, 2011 by admin
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Reports from Washington today say the President hasn’t smoked in almost a year. He said last summer he’s spent his adult life trying to give up cigarettes. Research shows that quitting is easier if you have help – Arizona Smokers’ Helpline can help you. We have resources on the phone, online and even medication to help you achieve your goal. If you are ready, call the ASHLine at 1-800-55-66-222 or visit the website .
February 8th, 2011 by admin
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Although we know a lot about the role of proper nutrition, exercise and general health in having a healthy baby, occasionally a baby is born with a special health condition or a birth defect. Our Newborn Screening Program tests babies for 29 special health conditions including hearing loss. These conditions, like phenylketonuria (PKU), can be managed by medication, diet or therapies making it possible for children to grow up and live a full life. When these conditions aren’t discovered right away outcomes aren’t very good. A child with a special health condition has several resources available to them and their family.
The Arizona Early Intervention Program provides services to children from birth to age 3, who are at risk for a developmental delay. The Children’s Rehabilitative Services Program serves children with some of the most serious health conditions who are enrolled in AHCCCS. Arizona’s Long Term Care System provides care to children and adults with a physical or developmental disability who need the type of daily care a nurse might provide. Our Office for Children with Special Health Care Needs (OCSHCN) became part of the Bureau of Women’s & Children’s Health on January 1. OCSHCN continues working to improve systems of care, provide information and referral to families who would like assistance in finding the services available to their child, and supports telehealth to provide services and training to families and professionals in remote areas of the state. OCSHCN has many training resources for providers as well as families. You can find OCSHCN on our website, call 602.542.1860 or send an email to OCSHCN@adhs.gov<mailto:OCSHCN@adhs.gov> for more information.
February 8th, 2011 by admin
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A number of published studies have found that using marijuana (and other psychoactive substances) is associated with an earlier onset of psychotic illness (notice I said “is associated with” rather than “causes”). National mental health surveys have repeatedly found more substance use, especially cannabis use, among people with a diagnosis of a psychotic disorder.
A new study published today on-line in the Archives of General Psychiatry found “a relationship between cannabis use and earlier onset of psychotic illness… supporting the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients.” The authors go on to say that reducing marijuana use could delay or even prevent some cases of psychosis.
The earlier the onset of schizophrenia, the more challenging it is to manage. So reducing the use of marijuana could be one of the few strategies that could help delay the onset of symptoms. The article suggests that “… an extra 2 or 3 years of psychosis-free functioning could allow many patients to achieve the important developmental milestones of late adolescence and early adulthood that could lower the long-term disability arising from psychotic disorders.” The results of this study confirm the need for a renewed public health warning about the potential for cannabis use to bring on psychotic illness.
Anyway- there have been some public comments on our medical marijuana rules that have questioned the wisdom of requiring dispensaries to have access to a Medical Director. Hopefully this study and others that link marijuana use to bad outcomes will convince some folks that it makes sense to have some professional medical oversight at dispensaries to help protect the health status of the patients with debilitating medical conditions that will be using the dispensaries.
February 8th, 2011 by admin
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This month we also distributed to stakeholders (and posted on our website) a new resource called “An Introduction to Arizona’s Public Behavioral Health System.” It’s a high-level summary for people who wish to better understand who we are and what we do. The short document covers the service delivery structure and the continuum of care available, member enrollment and demographics, funding, utilization, and outcomes information. A big thanks goes out to Mike Sheldon and Melissa Thomas for helping put this together and for being patient with all of us “backseat drivers”.
We’re getting lots of great feedback and publicity on the flow chart and other helpful resources we posted to our website a couple of weeks ago. Our goal is to help individuals know what to do when they are concerned about their own or someone else’s mental health. We know that early detection and intervention can make a big difference, just like it does for high blood pressure, diabetes, and other medical illnesses. Our hope is that people will become much more aware of the many available resources and support that can be accessed when mental health problems are just surfacing. Here’s the video clip of Dr. Nelson on Horizon last week.
Dr. Salek, the Prevention Team and the Office of Individual and Family Affairs Team did a great job putting together this fabulous material together. We plan to add a resource on the civil commitment process as well in the coming days. As an FYI, there has been over 550 calls to the two support lines that were established for people who had questions or needed support following the tragedy in Tucson.
February 7th, 2011 by admin
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Our primary care and behavioral health folks put together a fabulous forum called the Arizona Integrated Models of Care in Behavioral Health and Primary Care Forum. Our team joined with the Milbank Memorial Fund to sponsor a forum on January 25 and 26 in Chandler, AZ, for policy makers in both the mental health and community health center fields. One author of the recent Milbank Foundation report (Evolving Models of Behavioral Health Integration in Primary Care) Denise Levis Hewson and Michael Lancaster, Director of Behavioral Health Care, Community Care of North Carolina were keynote speakers.
The forum also featured local models of integration, lessons learned and strategies for overcoming Arizona-specific challenges. The goal was to bring together leaders from the primary care and behavioral health community to facilitate stronger integration and the public health approach to overall health and wellness. The Milbank report and all of the wonderful presentations are posted on the ADHS website. A huge “thank you” goes to Jeanette Shea, Patricia Tarango and Jena Grady for all of the hard work that made this such a big success.