Local Suicide Prevention Day Event

September 4th, 2013 by Will Humble 1 comment »

We and Magellan Health Services of Arizona will host a webinar-based panel discussion on suicide prevention and intervention entitled “Closing the Gap to Zero Suicides” on World Suicide Prevention Day (Sept. 10).  The webinar will feature a panel of leaders from our team, Magellan, and the Veterans Administration.  The discussion will run from 10 – 11 a.m. AZ time… followed by audience questions. Each panelist will provide an overview of the most important aspects of this Winnable Battle and next steps to bring the behavioral health system closer to reaching our goal of zero suicides.  To register for this webinar click here.

What’s Community Paramedicine?

September 3rd, 2013 by Will Humble 1 comment »

Community paramedicine is a paradigm shift for the use of paramedics in the US.  It’s an emerging model in which paramedics function outside their usual emergency response & transport roles- delving into the world of primary care.  As the health care world increasingly shifts toward prevention and well care- the system will increasingly demand more folks that can function in a community health (primary care and prevention) role.  Community paramedicine is increasingly being recognized as a promising solution to efficiently increase access to care (especially for underserved populations). 

For example- paramedics could shift from a sole focus on emergency response to things like: 1) providing follow-up care for folks recently discharged from the hospital to prevent unnecessary readmissions; 2) providing community-based support for people with diabetes, asthma, congestive heart failure, or multiple chronic conditions; and/or 3) partnering with community health workers and primary care providers in underserved areas to provide preventive care. 

The UC Davis Institute for Population Health Improvement released a new report this week called ”Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care”.  The report is the one I know about that explores this new and evolving model of healthcare.  The report concludes that expanding the role of paramedics is a promising solution to efficiently increasing access to care, particularly for underserved populations…  and it recommends the development of pilot projects to further refine and evaluate the role of community paramedicine. 

One Valley fire department is exploring its own concept – the Mesa Fire and Medical Department is using a grant from the Centers for Medicare and Medicaid Services to staff mental health and nurse practitioners according to the Arizona Republic last weekend. 

I’ve asked Dr. Bobrow and Terry Mullins to open up dialogue about community paramedicine in Arizona and how it could improve outcomes in a measurable way- and to examine the current scope of practice for EMTs and Paramedics relative to the practice of community paramedicine.  We’ll be asking for interested volunteers from our EMS Council to lead a workgroup of individuals to begin answering the Who, What, Where, When and Why of community paramedicine in Arizona.  Stay tuned.

CDC Sortable Stats

September 2nd, 2013 by Will Humble No comments »

There’s a new CDC Sortable Stats web application that went live a couple of weeks ago that provides an interactive tool to analyze behavioral risk factors and health indicators compiled from various published CDC and federal sources.  You can search by state for things like death rates (e.g.  infant mortality, heart disease, motor vehicle death rates, etc.); health burden (e.g. obesity, Hepatitis B & C, diabetes, teen birth rate, etc.); risk factors (e.g. smoking, physical activity, seat belt use, etc.); and preventive services (colorectal cancer screening, flu vaccine, and child vaccination coverage).

A good place to start are the individual fact sheets for individual states or territories. Here’s a link to the Arizona report.

Marijuana v. Cannabis

August 30th, 2013 by Will Humble 70 comments »

Are Marijuana and Cannabis the same thing when it comes to Arizona Law?  The short answer is no- and the distinction may be  an important one for Qualified Patients. 

The Arizona Medical Marijuana Act provides registry identification card holders and dispensaries a number of legal protections for their medical use of Marijuana pursuant to the Act.  Interestingly, the Arizona Medical Marijuana Act definition of “Marijuana” in A.R.S. § 36-2801(8) differs from the Arizona Criminal Code’s (“Criminal Code”) definition of “Marijuana” in A.R.S. § 13-3401(19). In addition, the Arizona Medical Marijuana Act makes a distinction between “Marijuana” and “Usable Marijuana.” A.R.S. § 36-2801(8) and (15)

The definition of “Marijuana” in the Arizona Medical Marijuana Act is “… all parts of any plant of the genus cannabis whether growing or not, and the seeds of such plant.”  The definition of “Usable Marijuana” is  “…  the dried flowers of the marijuana plant, and any mixture or preparation thereof, but does not include the seeds, stalks and roots of the plant and does not include the weight of any non-marijuana ingredients combined with marijuana and prepared for consumption as food or drink.”  The “allowable amount of marijuana” for a qualifying patient and a designated caregiver includes “two-and-one half ounces of usable marijuana.”  A.R.S. § 36-2801(1)

The definition of “Marijuana” in the Criminal Code is “… all parts of any plant of the genus cannabis, from which the resin has not been extracted, whether growing or not, and the seeds of such plant.”   “Cannabis” (a narcotic drug under the Criminal Code) is defined as: “… the following substances under whatever names they may be designated: (a) The resin extracted from any part of a plant of the genus cannabis, and every compound, manufacture, salt, derivative, mixture or preparation of such plant, its seeds or its resin.  Cannabis does not include oil or cake made from the seeds of such plant, any fiber, compound, manufacture, salt, derivative, mixture or preparation of the mature stalks of such plant except the resin extracted from the stalks or any fiber, oil or cake or the sterilized seed of such plant which is incapable of germination; and (b) Every compound, manufacture, salt, derivative, mixture or preparation of such resin or tetrahydrocannabinol.A.R.S. § 13-3401(4) and (20)(w)

An issue the Department has been wrestling with for some time is how the definition of “Marijuana” and “Usable Marijuana” in the Arizona Medical Marijuana Act and the definition of “Cannabis” and “Marijuana” in the Criminal Code fit together.  This confusion, which appears to be shared by dispensaries and registered identification card holders alike, is not easy to clear up and has resulted in the Department receiving numerous questions regarding the interplay between the protections in A.R.S. § 36-2811 and the Criminal Code.  While we can’t provide legal advice as to whether a certain conduct is punishable under the Criminal Code (only an individual’s or entity’s legal counsel can do this), “Cannabis” is defined as the “resin extracted from any part of a plant of the genus cannabis” and “Cannabis” is listed as a narcotic drug according to the Criminal Code in A.R.S. § 13-3401(4) and (20)(w).   

In other words, registered identification card holders and dispensaries may be exposed to criminal prosecution under the Criminal Code for possessing a narcotic drug if the card holder or dispensary possesses resin extracted from any part of a plant of the genus Cannabis or an edible containing resin extracted from any part of a plant of the genus Cannabis.  If you’re concerned that your conduct may expose you to criminal prosecution, you may wish to consult an attorney.  We’ll be providing some specific guidance for dispensaries licensed by the ADHS next week.


Project Quit Kickoff

August 30th, 2013 by Will Humble No comments »

Tobacco is one of the most difficult addictions to break. A successful tobacco quitter can make on average 10 attempts before they’re able to finally kick the habit. This week we launched Project Quit, a new initiative developed in partnership with the Arizona Smokers Helpline a.k.a. ASHLine to showcase the tobacco quit process. 

Project Quit follows 4 tobacco users for 30 days and records their journeys to quit using tobacco.  The stories are compelling and emotional as they showcase the struggles and successes of quitting tobacco. Project Quit participants allowed a professional camera crew into their homes to film segments at the beginning, middle and end of the 30 days. They also recorded daily confessionals via web cams about the quitting process that included calls with ASHLine quit coaches. Also highlighted in the project are interviews with an addiction specialist who guides viewers through the quitting process.        

You can see each of their stories unfold on the Project Quit website and on our Facebook page. Click on each of the links to learn more about the project and to find resources that can help you or someone you know to quit using tobacco. We’re excited to launch Project Quit and applaud the participants for wanting to quit- and for sharing their experiences with AZ.  One of the successful participants is an ADHS employee- you’ll need to watch to find out who.

Primary Care Provider Loan Repayment

August 29th, 2013 by Will Humble No comments »

Building Arizona’s inventory of primary care providers has been a priority of ours for many years- and it’s increasingly important as we move toward Medicaid restoration.   As one of our many initiatives in our Bureau of Health Systems Development, our Workforce Program hosted a presentation to Physician Assistant students at the NAU Phoenix campus last week.  The presentation was geared to increase awareness about primary care physician loan repayment programs available in Arizona and will highlight the federally qualified community health centers as future practice sites for loan re-payers.  

The Arizona Alliance of Community Health Centers has been a strong partner in our efforts to increase access to comprehensive, quality and affordable primary care services for medically underserved Arizona communities.  Our collaborative partnership with  AACHC provides an opportunity to leverage agency resources to increase the number of health care professionals serving in those communities.

3 Medical Conditions Move to Hearing

August 28th, 2013 by Will Humble 11 comments »

Three of the petitions to add debilitating conditions to the medical marijuana program that we received last month will be moving forward to a public hearing, which will be on Tuesday, October 29 from 9 am to noon in our State Lab conference room.  We’ll also broadcast the hearing via Livestream. 

The petitions are for PTSD, Migraines, Depression.  All these conditions have already been through the review process in previous petitions- but we’ve asked the UA College of Public Health to look for any new literature that has been published on these topics since the previous review.  This will be the first set of hearings since the first round back in 2012.

Native American Trauma Report

August 27th, 2013 by Will Humble No comments »

One of the things you’ll see in our upcoming State Health Assessment is the fact that traumatic injury disproportionately impacts the American Indian population in Arizona.  To dive into the issue deeper and to help us design more effective interventions, our Bureau of Emergency Medical Services and Trauma System published our first Arizona American Indian Trauma Report last week.  

The report was prepared from data contained in the Arizona State Trauma Registry for 2011. American Indians in Arizona have a trauma injury rate of 871 per 100,000 which is almost double the rates of other race/ethnicity groups in AZ. American Indians in Arizona also have a lower rate for reaching a trauma center within one hour after injury, a lower proportion of safety restraint use, and suffer significantly more injuries from motor vehicle traffic, struck by or against, falls, cuts or puncture, and other transportation and a greater proportion of injuries involving drugs or alcohol. 

The Report was prepared in collaboration with a 21 member Work Group comprised of ADHS, Tribal, Tribal 638, ITCA, and IHS personnel. We’ll be using data from the report to assist in the development of trauma prevention programs that will reduce these health disparities statistics over time. A special thank you to the Work Group including Bureau staff Terry Mullins, Rogelio Martinez, Maureen Brophy, and Vatsal Chikani for preparing the report- along with Michael Allison, our Native American Liaison.

Licensing Collaborative Established as an Evidence-Based Best Practice

August 26th, 2013 by Will Humble No comments »

Our Licensing team routinely analyzes the most frequent and important deficiencies that we observe when we conduct inspections at our licensed facilities.  We use the data to help educate the folks that we license… and to identify topics for provider training and technical assistance (public health interventions). For example, our medical facilities licensing team has found that infection control had become increasingly troublesome among some dialysis providers.  

That info led our medical facilities licensing team to join with our Office of Infectious Disease Services and our Healthcare Associated Infections Advisory Committee to conduct a day-long collaboration for our licensed dialysis providers and public health professionals. We conducted the collaborative a few months ago- providing tools for dialysis providers to improve their infection control performance by building relationships with public health, renal associations, federal partners and other stakeholders.  The event was very well attended; participants spent the day sharing best practices, identifying new ways to promote infection control, and developing a strategic plan for future activities. Best of all- we’ve seen a decrease in deficient practices since the event.  

Our ADVICE Collaborative has been identified by the federal government as a Best Practice Pilot and will be featured at the upcoming Roadmap to Eliminate HAI: 2013 Action Plan Conference. Kathy McCanna, our branch chief of Healthcare Institution Licensing will be presenting at the conference about our collaborative.  You’ll find more about the collaborative by visiting our website. This is just one of our many examples of how we’re leveraging licensing to improve public health outcomes.

Coming Attraction: AZ’s 1st State Health Assessment

August 23rd, 2013 by Will Humble 1 comment »

Publication of Arizona’s very first State Health Assessment is just around the corner  The 2013 Arizona State Health Assessment will use AZ quantitative and qualitative data to assess the public health status of the state.  The end product will be a comprehensive summary of the 15 leading health issues that have the greatest impact in Arizona. 

Over 10,000 community members participated across the state in helping provide valuable input.  Our county health departments did the heavy lifting and engaged the public and their local partners to develop county level community health assessments. Primary data was collected through local community participation in surveys, focus groups and strategy meetings to establish local priorities and really capture the community’s concerns.  Secondary data from public data banks such as hospital discharge data, Behavioral Risk Factor Surveillance System, and the disease registries was also part of the analysis. 

The State Health Assessment uses a combination of the Community Health Status Indicator Project and the Healthy People 2020 Mobilize, Assess, Plan, Implement, Track Models. The 15 leading health issues identified in the Assessment were compiled from county and state priority rankings. Each indicator is summarized for its significance and scope, trending over the past few years, and comparative analysis against national data.  

The 15 priority health issues that’ll be identified in the Report are (in no particular order): obesity, tobacco use, substance abuse, healthcare associated infections, suicides, teen pregnancy, creating healthy communities, behavioral health services, diabetes, heart disease, other chronic diseases (cancer, respiratory disease, asthma), accidents and injuries, oral health, access to well care, and access to health insurance. 

The State Health Assessment will provide the starting point for our first ever State Health Improvement Plan in 2014… which will outline actionable and specific strategies, tactics and interventions for improving population health.  The Improvement Plan will provide a roadmap for Arizona policy makers at the state, county and local level as well as our partners in the private sector to take serious concrete steps to improve population health outcomes while reducing health care costs in AZ.