Archive for the ‘General’ category

Preventive Services Widget for Clinicians

August 28th, 2014

SONY DSCThe Agency for Healthcare Research and Quality recently announced the release of the “ePSS widget” – which provides primary care clinicians and health care teams with timely decision support regarding appropriate screening, counseling, and preventive services for their patients.

The tool is based on the current, evidence-based recommendations of the US Preventive Services Task Force and can be searched by specific patient characteristics, such as age, gender, and selected behavioral risk factors.  The tool brings information on clinical preventive services that clinicians need – recommendations, clinical considerations, and selected practice tools – to the point of care.

It uses an Electronic Preventive Service Selector (ePSS) application platform on existing websites.  You can access the web application, download mobile app’s and download the ePSS Widget on-line.  Let your Stakeholders know about these easy to use tools.

Public Health & the Panama Canal

August 25th, 2014

mosquito sucking blood from human handThe Panama Canal celebrates its 100th anniversary this week.  Hailed as both a Wonder of the Modern World and a Monument of the Millennium, the Panama Canal has public health, engineering, and laborers to thank for its completion.  You may remember from history class that the construction of the Canal took decades longer than anticipated.  One reason for the delay was the debilitating illness caused by malaria and yellow fever.  French workers were said to be fleeing Panama out of fear of death and no wonder – 80% of their coworkers were being hospitalized.

When the US acquired the Panama Canal Zone in 1904, Colonel William Gorgas was assigned as the Chief Sanitation Officer.  He came up with a new concept - that mosquitoes were spreading malaria and yellow fever.  His team implemented a multilayered approach to mosquito control in Panama.  They drained pooled water within 100 meters of houses, killed mosquito larva with chemicals, put screens on windows to prevent mosquito entry, and more.  By 1906, the Zone was free of yellow fever, and eradication of malaria soon followed.  Within the next decade, the Panama Canal was finally able to be completed.

Infectious diseases weren’t the only public health challenges faced by workers.  Work on the Panama Canal could be treacherous - and occupational health and safety was a real problem.  In fact, the death rate for Canal laborers in the early years was between 4-5% per year.  Perhaps the most dangerous job was dynamiting - because the explosives were sometimes in poor condition and unstable - or would remain unignited until exploding later by accident.  Landslides were another serious occupational hazard.  In all, more than 5,000 people perished building the Canal.

There’s a good PBS Special American Experience: Panama Canal.  You can watch on-line, buy the DVD, or get it through iTunes.

Healthy Aging Brief

August 21st, 2014

women_iconThe Association of State and Territorial Health Officials recently investigated ways in which public health can support healthy aging. The results are now available in an issue brief that outlines key recommendations to help state health agencies support healthy aging, identify collaborative opportunities, and integrate public health and healthy aging.

The 5th “Vital Sign” & the Painkiller Epidemic (Part IV of V)

August 20th, 2014

feetIn Parts I, II, and III of this series we established the acute and growing effects that the opiate painkiller epidemic is having in America, and how it has been driven (in part) by aggressive pain management strategies that were implemented since Pain was identified as the 5th Vital Sign.  Since then, public health and other sectors have been responding by developing and implementing strategies to break the cycle of opiate misuse and abuse.

The CDC recently recommended a number of strategies states can employ including: 1) electronic Prescription Drug Monitoring (which AZ has through the Arizona Board of Pharmacy); 2) patient review and restriction programs within state Medicaid programs to monitor prescription claims data for inappropriate use of controlled prescription drugs (AHCCCS does this); 3) implementation of health care provider accountability programs to ensure providers are following evidence-based prescription guidelines (we have Guidelines); 4) enacting state laws to prevent doctor shopping and the rogue operation of “pill mills” (some AZ laws exist); and 5) providing affordable, comprehensive, and meaningful substance abuse treatment programs (we do this through our behavioral health services division).

The Arizona Substance Abuse Partnership endorsed a Prescription Drug Reduction Initiative, known as the Arizona Prescription Drug Misuse and Abuse Initiative. Using the strategies proposed by the Office of Drug Control Policy as a starting point the partnership developed a set of data-and-research-driven strategies to be used in a multi-systemic, multi-agency collaborative approach to reduce prescription drug misuse in Arizona.  Initiative participants have also developed Arizona Guidelines for Dispensing Controlled Substances and the Arizona Guidelines for Emergency Department Controlled Substance Prescribing as well as draft new Arizona Opioid Prescribing Guidelines for all healthcare providers.

At the national level, the Joint Commission issued a new Sentinel Event Alert recommending that health care organizations take defined steps to improve their response to and reporting of prescription drug misuse and abuse including: 1) monitoring patients who are receiving opioids on an ongoing basis; 2) using pain management specialists or pharmacists to review pain management plans; 3) providing education and training for clinicians, staff and patients about the safe use of opioids; and 4) using standardized tools to screen patients for risk factors such as over-sedation and respiratory depression.

At the state health department level, the Association of State and Territorial Health Officials’ 2014 President’s Challenge is to “reduce the rate of nonmedical use and the number of unintentional overdose deaths involving controlled prescription drugs 15% by 2015”.  The President’s Challenge includes a strategic plan to implementing evidence-based Prevention Strategies, Monitoring and Surveillance, Control and Enforcement, and Treatment and Recovery to reach this important goal.

Now that we’ve discussed responses to the prescription drug abuse and misuse…the next question to ask is whether these collective intervention efforts are enough to turn the tide.  We’ll tackle that in Part V.

Association v. Causation

August 18th, 2014

Matt TattooOne of the key objectives of public health is to assess the cause of disease or bad outcomes so we can design interventions.  In order to do that, we need to be able to tell the difference between when something is actually “causing” an outcome and when the exposure or condition is simply “associated” or “correlated” with an outcome.  Whether something causes or is simply associated with a bad outcome is a key factor when we design interventions.  The following examples may shed some light on the relationship between risk factors, outcomes, and the difference between association and causation.

A study in the American Journal of Clinical Pathology that found that “…persons with tattoos appear to die earlier than those without”.   The study found that people in the study group with a tattoo died 14 years earlier than people without a tattoo (p = .0001).  This study doesn’t conclude that having a tattoo actually causes people to die earlier.  Rather, it suggests that having a tattoo may be associated or correlated with other independent factors that might lead to an earlier death (e.g. people with tattoos may be more likely to have risk-taking behaviors).

In order to conclude that an exposure or condition actually causes an outcome, researchers randomly divide study participants into groups by assigning them to the exposure or condition they’re studying (experimental group) while making sure that another group doesn’t have the exposure or condition (control group).  If the expected outcome is observed within an experimental group and not in the control group it’s likely that exposure actually caused the outcome.

For example, if researchers were to expose one randomly-selected group of people to poison ivy via direct contact with poison ivy leaves – while not exposing the control group to poison ivy – they would most likely be able to establish that poison ivy actually caused the rash.  It’s this random assignment to conditions that make experiments sophisticated enough to detect actual causation.

Judging the causal significance of an association or causation is both a science and an art.  The gold standard for determining what is an association and what is actual causation is described in a 1964 Surgeon General’s Report on this topic.

Most of the research you read about indicates a correlation or association between variables, not causation.  When you’re reading scientific studies, make sure you look for whether the study is talking about an “association or correlation” or whether they are talking about causation.

The 5th “Vital Sign” & the Painkiller Epidemic (Part III of V)

August 14th, 2014

prescriptionIn Part I and Part II of this series we’ve introduced the idea that contemporary pain management strategies have resulted in an epidemic of painkiller misuse and abuse that’s killing large numbers of people.  In fact, misuse and abuse of opiate prescription painkillers takes out more people every year than car crashes.  The run-up to the current epidemic appears to have its roots in including pain as the “5th Vital Sign” in national pain management strategies.  But, have contemporary pain management strategies (including pain as the 5th Vital Sign) been effective?

A 2006 study by Mularski et al. found that routinely measuring pain by the 5th Vital Sign failed to increase the overall quality of patient pain management.  A study authored by Karl Lorentz and his colleagues challenged the accuracy of pain as the 5th Vital Sign when used within an outpatient setting.  Another 2009 analysis conducted by Franck and Bruce found that in spite of efforts to increase the use of pain management strategies among practitioners, compliance with the use of standardized pain assessment tools in clinical practice has been poor.  And, a group of researchers has questioned the effectiveness of long-term opioid therapy for treating chronic non-cancer pain.

Collectively, these examples point to the idea the effectiveness of current strategies to manage pain are short of optimal…in other words including pain as the 5th Vital Sign may be causing more harm than good.  Some believe that introducing pain as a vital sign effectively monetized pain to the point where treating pain pharmaceutically, regardless of practitioners possessing the capacity to do so safely, turned pain management into a profit center rather than a cup of relief to aid suffering.

Given the less than optimistic view of the effectiveness of pain management strategies as reflected in the examples above you might think there isn’t much that can be done to reverse the downward spiral of prescription drug misuse and abuse that is plaguing our nation.  We’re trying.  Next week I’ll cover current efforts championed by public health that may hold the key to reversing the tide.

Stories to Make You Smile

August 13th, 2014

biscottiIn 2012 the Arizona Developmental Disabilities Planning Council (the DDPC works out of the 4th floor of our 1740 building) partnered with the Southwest Autism Research and Resource Center (SARRC) to develop new self-employment opportunities.  The Home Baked and Confectionary Goods law was used as the foundation for the project due to potential ease of implementation and access to hungry consumers with a love of baked goods.

Working with persons with autism spectrum disorders, the project put together and implemented a training program in baking, production and marketing and leveraged family support to help participants establish small businesses operated out of their home.  At the end of the project, a host of people with autism spectrum disorders completed the rigorous curriculum, got their food handler’s card and developed their product line.

For example, a company called SMILE Biscotti began with the efforts of Matt Resnik who developed biscotti using a traditional family recipe and sold them through friends, family and social media.  In his first months of operation, Matt delivered more than 25,000 biscotti and now maintains a website that includes a video of how his biscotti’s are prepared.

Another successful enterprise is the Stuttering King Bakery, a home-based business operated by Matt Cottle and his mom, Peggy.  The bakery offers an impressive array of delicious items including muffins, scones, brownies, whoopie pies (2 cookies with a filling) and cookies.  Eventually Matt hopes to expand his business enough to move his business to a brick and mortar bakery, where he’ll employ and teach the art of baking to others with autism.

Suicide & Depression: A Critical Arizona Winnable Battle

August 12th, 2014

iStock_000041434018_blogDepression strikes more people than you might think.  Some 300,000 people in Arizona live with major depression.  It may take years from when symptoms first emerge and to when people finally get help.  Less than one-third of adults with a diagnosed mental illness receive treatment.  Often, it’s the friends and family of a person living with depression who first recognize symptoms and encourage the person to seek treatment.

Robin Williams had received treatment for substance abuse and was reportedly experiencing serious depression.  He is one of many who will commit suicide this year; suicide is preventable, and it starts with removing stigma concerning depression.

There are a host of evidence based and effective treatment strategies available these days.  What can you do?

Learn about the signs and symptoms of mental illness including depression in a mental health first aid class.  Since 2011, more than 5,000 people in Arizona have learned to identify signs and symptoms of mental illness and how to help or refer folks for professional help using our Mental Health First Aid initiative.  Anyone interested in becoming a MHFA-ider can take this course for free.  The schedule of classes statewide is available online at www.mentalhealthfirstaidaz.com.

You can also join ADHS staff, community members and other stakeholders at a series of conversations statewide concerning the 2014 State Plan for Suicide Prevention.

August 29th: Coconino Conference room, 1300 S. Yale Street, Flagstaff

September 3: CPSA Training Center, 2502 N Dodge Blvd., Tucson

September 5: Mercy Maricopa, 4350 E. Cotton Center Blvd., Phoenix

For more information, contact Kelli M. Donley at 602-364-4651, Kelli.donley@azdhs.gov

Employment First Initiative

August 12th, 2014

PArizona Developmental Disabilities Planning Council is sponsoring a series of six Employment First Community Forums to develop a comprehensive strategic plan designed to promote employment for individuals with developmental and intellectual disabilities.  A broad coalition of self-advocates, family members, service providers, educators, state agencies, advocates and employers are sharing ideas and strategies to raise public awareness, promote an attitudinal shift, build capacity, aimed at bringing about systems change.  It’s all about integrated and competitive employment, or real jobs earning minimum wage, for all working age Arizona residents with disabilities.

There’s still time to join the discussion.  Participate in one of the final Community Forums in Tucson (August 12) or Yuma (August 14).  Become involved in a movement that’s helping Arizona improve its economy by supporting businesses to find talent and meet their needs by hiring individuals with disabilities.

To learn more about Arizona’s Employment First Initiative, or to register for a Community Forum, please contact Michael Leyva, Arizona Developmental Disabilities Planning Council mleyva@azdes.gov.

Successful Infectious Disease Prevention Conference

August 1st, 2014

386 (2)Last week we wrapped up our 5th annual Arizona Infectious Disease Training and Exercise. This event kicked off with a full day pandemic influenza tabletop exercise followed by two days of training on a variety of infectious disease topics. The 400 registrants – public health folks, infection preventionists, healthcare providers, academic partners, and others – learned about things like healthcare associated infections, foodborne illness, vaccine-preventable diseases, vectorborne and zoonotic diseases, HIV, STD, and tuberculosis from experts in Arizona and across the country.

Coordinating trainings like these helps to enhance infectious disease capacity across the state, which allows us to promote health and wellness for all Arizonans. It also strengthens and expands partnerships to promote health in Arizona by allowing opportunities for networking and sharing of best practices and lessons learned.

A big thanks goes out to Joli Weiss and the entire Steering Team as well as all the support staff who helped pull of the event without a hitch. Slide presentations from the training will be available shortly on the training website.