Transcript Hanover Area Coalition for Lung Health

Hanover Area
Coalition for Lung Health
A Program Description And How To…
For Your Community
Michael Ader, MD
[email protected]
Vicky Shrader, RRT
Hanover Hospital
Hanover, PA
November 30, 2001
Coalition for Lung Health
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The Problem
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What we did in Hanover - Get some ideas

How to start an NLHEP type program in your community
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Media material examples
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health CD
1.
Billboard one
BMP
2.
Billboard two
BMP
3.
Coalition Brochure
JPEG
4.
Thank you letter to Pharmaceutical Company
MS WORD
5.
Dear Doctor: educational poster #2
6.
Dear Office Manager: spirometry training
7.
Dear Businessmen: educational poster
8.
Dear Colleagues: educational poster #4
9.
Dear Doctor: Coalition brochure
10.
Dear Doctor: educational poster #1
11.
Dear Doctor: Intro to Coalition
12.
Dear Pharmacist: educational poster
13.
Funding request letter: #1
14.
Funding request letter: #2
15.
Funding request letter: #3
16.
Hanover Coalition NLHEP intro letter
17.
Letter to major companies in community
18.
Please post letter to neighboring hospital
19.
Poster #1
JPEG
20.
Poster #2
JPEG
21.
Poster #3
JPEG
22.
Poster #4
JPEG
Hanover Coalition for Lung Health
Where?
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health
Hanover Hospital
Hanover Coalition for Lung Health
The Problem – The Frustrations

Treating “End-Stage” COPD

Limited use of spirometry by physicians to detect COPD or
measure its severity.
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Lack of public awareness of COPD and lung cancer compared
to Breast Cancer, Heart Disease, AIDS, etc..
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Patients often don’t get STRONG recommendations to stop
smoking. Often don’t get any of the recommended treatments
to help stop.
Hanover Coalition for Lung Health
1994 – The Lung Health Study
– 5887 middle aged smokers
– Mild asymptomatic COPD – Based on spirometry
– “usual care” or “special care” to help stop smoking
– More in the special care group quit smoking
– Continued smokers lost lung function more rapidly
– Quitters gained lung function initially then declined at a
“normal” rate
– Over 5 years, more people died from lung cancer than
cardiovascular disease
Hanover Coalition for Lung Health
National Lung Health Education Program
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1996 --Creation of the NLHEP
– National campaign to promote early COPD detection with
spirometry – NHLBI
– UNFUNDED !!
1997-1999 – No local effect from NLHEP
Spring 1999 – Decision to try and create a local lung health program
April 1999 – First Coalition meeting
June 1999 – First Coalition advertisement
October 2001 – Most recent Coalition Billboard
Hanover Coalition for Lung Health
Volunteers (working group 5-8)
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Respiratory Therapy Manager - Vicky Shrader
Pulmonary Physician Staff Nurse – Sandy Lawrence
Hospital Community Relations (marketing) – Pat Lilly
Pulmonary Rehabilitation Therapist
Hospital Community Wellness Nurse
Lung Association Representative
Pulmonary Physician – Michael Ader, MD
Hanover Coalition for Lung Health
Goals
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Educate Primary Care Physicians and Public
– COPD -Emphysema
– Early COPD Detection
– Spirometry
Promote greater use of spirometry for early COPD detection
Promote office spirometry: easy, inexpensive, reimbursable
Screen as many people as possible (case finding and educational)
Hanover Coalition for Lung Health
Baseline Survey 1999
Hospital Employees
– 100
Multiphasic Participants -- 167
76
73
80
70
60
50
40
30
27
24
20
10
0
male
female
smoker or
ex
Hanover Coalition for Lung Health
never
smoked
Baseline Survey 1999
79
80
70
60
52
61
50
40
30
14
20
10
0
know
cholesterol
Had PSA
Had
Mammogram
Hanover Coalition for Lung Health
Know Lung
Numbers
Leading Cancer Killer
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Men:
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Women: LUNG CANCER
LUNG CANCER
Lung Cancer has been the leading cancer killer in
both men and women for many years
Hanover Coalition for Lung Health
Question: What is the Leading Cancer Killer
in Men? - 1999
56
60
50
40
33
30
20
11
10
0
Colon
Prostate
LUNG
Hanover Coalition for Lung Health
Question: What is the Leading Cancer Killer
in Women? - 1999
90
80
82
70
60
50
40
30
20
10
0
15
3
colon
breast
LUNG
Hanover Coalition for Lung Health
1999 Physician Office Spirometry Survey
80
70
60
50
40
30
20
10
0
73
38
13
13
3
own
spirometer
staff trained PFT at risk pts PFT on pts
with lung
disease
Hanover Coalition for Lung Health
consider
purchase
Borrow a Logo -- “F.A.Q.” Book
Hanover Coalition for Lung Health
Communications
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Regular Primary Care Physician Contact
– Frequent letters
– Bulletins
– Education material
– Publicity material
– Advanced notice of materials going to public
Hanover Coalition for Lung Health
Promotion Campaign
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Educational Posters Created
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Sent to physicians, pharmacies, businesses
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Personal letter sent with poster describing the “Coalition
for Lung Health” goals. Asked if the poster could be
placed in view of employees or public
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health
Promotion Campaign
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Series of 4 posters: one sent every 3-4 months
– Early lung disease may be silent
– Lung cancer is a major health problem for women
– Screening Spirometry is simple, easy and the only way
to detect early emphysema (COPD)
– National Emphysema Prevention Program
– The “At Risk” population needs spirometry
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All with “Test Your Lungs-Know Your Numbers”
Hanover Coalition for Lung Health
Promotion cont’d
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“On Hold” message on hospital telephones
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“Did you know that you could have emphysema and not know
it…….”
Regular messages in monthly hospital calendar of events
published in the newspaper and distributed to physicians
and the public…..
Hanover Coalition for Lung Health
Promotion Cont’d
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If you are over 45 and smoke, you may already have emphysema. A simple
breathing test is the only way to tell.
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Chronic Obstructive Lung Disease (COPD) may be present even if your chest
x-ray is normal and you have no shortness of breath. A simple breathing test
can detect early COPD. If you’re at risk, call your doctor
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Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of
death. If you ever smoked, you are at risk.
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More men and women die of lung cancer than any other form of cancer.
Emphysema increases your risk, even when it is mild.
Hanover Coalition for Lung Health
Promotion Cont’d
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Articles in hospital newsletters
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Distributed to hospital employees
Second newsletter distributed to the entire community
Promotion at hospital screening functions
Hospital Web Site
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Coalition news and information on “Test Your Lungs – Know
Your Numbers” campaign. Linked to NLHEP
Hanover Coalition for Lung Health
Promotions Cont’d
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Grand Rounds to hospital staff
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Physician discussed COPD Treatment and tied it into early
detection
Articles at Journal Club for physicians
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–
–
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Early COPD detection
Early Lung Cancer detection
Spirometry recommendations for Office Practice
Reliability of office spirometry
Hanover Coalition for Lung Health
Promotion cont’d
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Promotion material created and distributed to physicians
and community
– Stickers
– Pads
– Magnets
– Buttons
– “Lung Number” cards for spirometry results
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All material with Logo, Coalition for Lung Health and a
number to call for information
Hanover Coalition for Lung Health
Promotion Cont’d
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Public Service Announcements on Radio
WSBA/WARM - Local AM and FM stations
30 sec PSA from local businesses in return for ad time
PSA’s ran 30 to 60 times over several weeks on two
stations
Hanover Coalition for Lung Health
Public Service Announcements
“Only one of the four leading causes of death claimed more victims this
year than last. It’s not Cancer, its COPD.
I’m Denise P____, Marketing Director for Auto Glass Technology.
Chronic Obstructive Pulmonary Disease or COPD will claim the lives
of more than 110,000 people this year. If you’re over 45 and ever
smoked or if you get out of breath easily, the Hanover Area Coalition
for Lung Health wants you to get your lungs tested.
Test Your Lungs and Know Your Numbers. For further information,
contact your physician”
Hanover Coalition for Lung Health
Billboards – Oct 2001
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health
The Message to Physicians
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15-20% of smokers develop COPD – find them early!
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Early COPD with minimal airflow obstruction can only be detected by
spirometry! NOT by physical exam and NOT by Chest X Ray
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Lung Function drops rapidly in those smokers with COPD who continue to
smoke.
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Identify those 20% of smokers with COPD at an early stage before there is
enough irreversible airflow obstruction to lead to symptoms and disability
Hanover Coalition for Lung Health
The Message
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Do not assume primary care physicians know the message
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What we take for granted in the understanding of COPD and
emphysema is not as widespread as you would expect.
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What we take for granted in the use of spirometry for monitoring or
testing for lung disease is not taken for granted by physicians
Hanover Coalition for Lung Health
The Message:
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Ask about smoking at every office visit
Spirometry if in high risk group
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Over 45
Smoked more than 20 years
Chronic symptoms of cough, sputum or dyspnea
FEV1/FVC < 70% and FEV1 < 80% means airflow
obstruction. If it persists after bronchodilator then COPD
is probably present unless there is an asthma history
Hanover Coalition for Lung Health
Office Spirometry
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Easy to Perform by office staff once trained
Equipment is easy to use
Equipment is not expensive
Basic interpretation is straightforward
Reimbursable if there are any symptoms like cough,
mucous or dyspnea
Hanover Coalition for Lung Health
Office Spirometry CPT Codes
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94010 – basic spirometry with printed
report. At least FVC, FEV1 and
FEV1/FVC
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94060 - basic spirometry before and after
bronchodilator
Hanover Coalition for Lung Health
What if Spirometry is Abnormal?
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Your patient has a chronic disease that could be
progressive
Aggressive measures for this group:
– Education about COPD and its progressive nature
– Education about higher risk of lung cancer, CAD, CVA and death in
COPD group
– Aggressive smoking cessation
– Regular follow-up as with any other chronic disease
Hanover Coalition for Lung Health
Smoking Cessation:
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ASK:
Identify all tobacco users at every visit.
 ADVISE:
Strongly urge all tobacco users to quit.
 ASSESS:
Determine willingness to make a quit
attempt within the next 30 days
 ASSIST:
Aid the patient in quitting
 ARRANGE: Schedule follow-up contact
Hanover Coalition for Lung Health
Smoking Cessation
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The Five A’s of smoking cessation
Nicotine replacement therapy
Buproprion
Nortriptyline
Follow-up
Hanover Coalition for Lung Health
The 3-minute intervention (AHCPR)
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Strongly advise all smokers to quit.
Provide social support and offer simple advice.
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Set a quit date
Stress the need for total abstinence
Review past attempts to quit
Anticipate challenges
Avoid alcohol
Provide culturally and age-appropriate education material.
Schedule a telephone or in-person follow-up.
Hanover Coalition for Lung Health
What Should the Physician’s Goals Be?
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Identify COPD/Emphysema Patients Sooner
Reduce risk factors (tobacco, workplace fumes)
If young, alpha-1-antitrypsin level
Target this group for aggressive smoking cessation
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Medications i.e. bupropion, nicotine replacement therapy
Screen for other conditions at greater risk with low FEV1
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Lung Cancer (CXR? CT scan? Sputum?)
Coronary Artery Disease (check cholesterol)
Hanover Coalition for Lung Health
Physician Goals
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Mild COPD – Medications if symptomatic
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Moderate COPD:
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Bronchodilators if symptomatic
Pulmonary rehabilitation
Inhaled steroids to reduce exacerbations?
Severe COPD
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prn short acting bronchodilators (ipatropium, beta-agonists)
Long acting bronchodilators (beta-agonists, theophyllines)
Oxygen therapy if needed based on O2 assessment
Flu Vaccine, Pneuomovax
Follow regularly since there is a chronic disease
Hanover Coalition for Lung Health
Physician Coalition Survey - July 2001
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100% recall receiving information on early COPD
detection and spirometry
90% recall seeing Coalition signs
50% placed Coalition signs in office
90% recall Coalition logo and “Test Your Lungs –
Know Your Numbers”
15% Heard Radio P.S.A.
Hanover Coalition for Lung Health
Physician Coalition Survey – July 2001
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Obstacles to doing more frequent office spirometry on patients at risk?
– 50%
– 55%
– 20%
– 50%
– 25%
– 30%
– 45%
– 40%
– 25%
Time
Staff expertise
Cost
Easier to send to hospital for PFT’s
Reimbursement issues
Patient reluctance
Spirometry Interpretation
Quality of test results
Explaining normal spirometry results
Hanover Coalition for Lung Health
Primary Care Spirometry Survey
1999 – 2000 - 2001
100
80
60
40
20
0
own
spirometer
staff trained PFT at risk pts PFT on pts
with lung
disease
1999 (n=40)
2000 (n=31)
Hanover Coalition for Lung Health
considering
purchase
2001 (25)
Leading Cancer Killer in Men
70
60
50
40
30
20
10
0
colon
prostate
1999
2000
LUNG
2001
Hanover Coalition for Lung Health
Leading Cancer Killer in Women
90
80
70
60
50
40
30
20
10
0
colon
breast
1999
2000
LUNG
2001
Hanover Coalition for Lung Health
Respiratory Care Practitioner
Their Role in the Coalition for Lung
Health
Vicky Shrader, RRT
Director Respiratory Care
Hanover Hospital
Respiratory Therapy Involvement
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Coalition for Lung Health member from the beginning
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Met regularly with the Coalition during the planning phase
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Participated in decisions about promotion campaign
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Helped create promotional material
Hanover Coalition for Lung Health
RCP Role - Spirometry
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The resource group for Spirometry
– Equipment experts
– Experts in performance of test
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Liaison to Primary Care Physician’s office in matters
concerning new or old spirometers
Hanover Coalition for Lung Health
RCP Role - Spirometry
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Letter to Office Managers about spirometry
 Respiratory Therapists offered to troubleshoot and calibrate office
equipment
 Respiratory Therapists held luncheon workshop for office staff
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Equipment
Basics of Spirometry
Performance of Tests
Coding and Billing
Hanover Coalition for Lung Health
RCP Role - Spirometry
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Information sent to Physician’s Offices
 “Simple Spirometry for Frontline Practitioners”
 NLHEP consensus statement on spirometry
 Information on interpretation
 Information about FEV6
 Reimbursement Information
Hanover Coalition for Lung Health
RCP Role - Spirometry
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Information on several brands of office spirometers
provided to physicians
Demonstrations of use of several different spirometers
loaned by suppliers
Pricing information supplied to physicians
Hanover Coalition for Lung Health
RCP Role – Screening
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Spirometry added to Hospital Screening Tests
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Every other month
2000 people screened since June 2000
Age 11-84 (average 50)
32% had FEV1 below 80%
Screening offered to major area employers
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Screening for early emphysema in those at risk
Not looking for occupational lung disease !!
Hanover Coalition for Lung Health
RCP Role - Screening
 Provide participants with their “lung numbers”
 Created a “Lung Health Card”
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FEV1
FVC
FEV/FVC
 Told to contact their physician if abnormal
 Provide smoking cessation and Coalition information
about early COPD detection
Hanover Coalition for Lung Health
RCP Role – Smoking Cessation
 Smoking cessation
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5 Respiratory Therapists trained in the American Lung Assoc
“Freedom from Smoking” program as facilitators
Regular Smoking Cessation Programs throughout the year
 Smoking cessation support groups
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A.S.H.E.S. Active Support Helps End Smoking
Hanover Coalition for Lung Health
RCP Role – Smoking Cessation
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Inpatient smoking cessation information
 Inpatient COPD teaching
 COPD case management – planning stage
 Hospital wide risk assessment
 Consider all patients in the hospital (inpatient, SDS, ED)
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All smokers – provide smoking cessation information
Smoked over 20 pack years and over 45 yrs old (at risk for COPD)
 Spirometry screen if possible or tell patient and PCP about
recommendations for screening spirometry
 Patient teaching (COPD risk)
Hanover Coalition for Lung Health
How You Can Do It?
How can you start your own NLHEP
“Coalition for Lung Health”
In your community?
Step by step instructions……………..
Hanover Coalition for Lung Health
FIRST!
You must have one person who says….
“This is something I think we should do”
Hanover Coalition for Lung Health
Step 1
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Establish Your Goals
– Public education about COPD
– Physician education about COPD
– COPD early detection
– Spirometry for early detection
– Education about associated diseases (lung cancer)
Hanover Coalition for Lung Health
Step 2
Form your working group
– Respiratory Therapy Leader
– Physician interested in community education
– Community Relations or marketing person
– Wellness Nurse
– Pulmonary Rehabilitation Therapist or Nurse
– Hospital Administration Liaison
– Any other interested support staff - secretarial
Hanover Coalition for Lung Health
Step 3
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Name your group
Announce yourself – letter of introduction to hospital, docs, etc
– Who’s in your group
– The connection (in spirit) with the National group (NLHEP)
– What your message is
– What your plans are
– Who your target population is
– Who to contact if questions or need more information
Hanover Coalition for Lung Health
Step 4
Determine clear recommendations
to physicians
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Know what you are going to tell them – make it brief
Know what you are going to ask them – make it easy
Hanover Coalition for Lung Health
Step 5
Establish Your Target Population?
– Geographic?
Area “captured” by your hospital
 Area of your primary referring physicians
– Which Physicians?
 Referring base of Primary Care Physicians
 Which specialties?
– The public served by your hospital
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Hanover Coalition for Lung Health
Target
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Physicians
– Suggest those primary care physicians who refer to your hospital
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Public
– Suggest the geographic area served by your target physicians
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Hospital can supply you with their:
– Primary market area
– Secondary market area
Hanover Coalition for Lung Health
Step 6
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Physician Mailing List
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Community Mailing List
– Businesses (Chamber of Commerce list)
– Pharmacies
– Other allied health providers e.g. dentists, chiropractors etc….
Hanover Coalition for Lung Health
How to? Step ……
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Get Hospital “blessing” or support
– As a needed community health project
– Good “fit” with Respiratory or Wellness Department
– Connection with National educational program (NLHEP)
– Hospital may have a “Quality Council” to present to
– Support of hospital may allow:
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Meetings during working hours by hospital emloyees
“In kind” support; meeting rooms, copying, postage ?
Use of hospital marketing person
Use of hospital media such as bulletins, newsletters, web site…
Hanover Coalition for Lung Health
How to? Step ……
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Find a resource person for “graphics” – computer savvy
Create or borrow a slogan:
–
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“Test Your Lungs – Know Your Numbers”
Create or borrow a logo
Combine it with your hospital logo if desired
Hanover Coalition for Lung Health
How to? Step ……
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Frequently Asked Question Brochure
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Design your own or customize the FAQ brochure from the
National Lung Health Education Program (NLHEP)
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Distribute widely: hospital, public, physicians,
pharmacies etc..
Hanover Coalition for Lung Health
How to? Step ……
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Determine educational messages
– Or borrow pre-made ones from NLHEP site
Communicate with physicians regularly
– What’s planned, what’s coming, literature support
for what’s being done.
Hanover Coalition for Lung Health
Hanover Coalition for Lung Health
How To? - Funding
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Within the budget of the Respiratory Care
Department or Wellness Department
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Don’t need to seek outside funding
Need to prepare and request a budget and FTE’s
Fund separately from the hospital
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Allows significant independence
Don’t need to get hospital “approval” for everything done
Spend “energy” seeking monetary support
Hanover Coalition for Lung Health
How To? - Funding
– Hospital donation
– Donations from pharmaceutical industry
– Donations from local Medical Supply Co’s
– Charitable Organizations
– State “Tobacco” Funds
Hanover Coalition for Lung Health
How To? - Funding

Funding Request Letters
– Review project
– Review its connection with national program (NLHEP)
– Explain lack of government funding
– Provide sample educational material
– Ask for a specific amount
– Explain what funds are used for e.g. printing, mailings,
advertisements etc…
Hanover Coalition for Lung Health
How To? - Funding

Pharmaceutical Companies
– Source of funding through sales reps
– Have funds to give to physicians for meetings or journal clubs.
– Can supply educational materials
– Can sometimes help with graphic design
– Can sometimes help with printing
– Sales force which visits physicians regularly can be an effective
way to disseminate educational material
Hanover Coalition for Lung Health
How To?
Spirometry Equipment Suppliers
– Vested Interest in promoting spirometry
– May be willing to donate funds
– May be willing to provide spirometers for demonstration
– Sales force can help promote your campaign
Hanover Coalition for Lung Health
How To?
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Donated funds
– Manage funds accurately
– Hospital can set up a “development fund” account
– Provides place to store funds safely with limited disbursement
ability
– Provides “not for profit” account for donations
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Within a Department Budget
– Budget proposals to administration
Hanover Coalition for Lung Health
How To?
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Regular meetings –keep minutes
– How to obtain funds
– How to spend funds
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Plan campaign for the next 2-3 months
Design marketing material
Printing
Dissemination
Hanover Coalition for Lung Health
How To?
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Designate someone to communicate regularly with
physicians – regular letters
Determine material to be sent to physicians with each
letter. Promotional material as it is designed and
ideally before it goes to pubic
Utilize any resources you can to get help with a “publicity
campaign”
Hanover Coalition for Lung Health
How To?

Contact local radio and TV stations
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Interviews with coalition members
Call in Radio shows
Contact Health Reporters of local TV stations
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National PSA available with Loni Anderson
Contact Newspapers – health topics for the community
 Hospital Wellness publications
 Hospital Web site and calendar of events

Hanover Coalition for Lung Health
How to? - Screening Spirometry
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Design Screening Spirometry Programs
During frequent Blood Pressure, glucose and multiphasic
lab screenings by the hospital Wellness Department
Contact major employers and offer to provide free
spirometry screening for employees
Provide people at screening with appropriate information
on lung function and COPD/Emphysema
Hanover Coalition for Lung Health
How To? - Spirometry

Determine baseline office spirometry use
 Questionnaire to primary care physicians or office managers
– Do you have a spirometer?
– Do you have someone trained to use it?
– Do you perform spirometry in your office on patients with known lung
disease?
– Do you perform spirometry in your office on patients at risk for lung
disease (smokers over 45)
– Do you routinely send patients with known lung disease for spirometry at
another facility (hospital etc…)?
– Do you routinely send patients who are at risk of getting COPD for
spirometry at another facility?
Hanover Coalition for Lung Health
How to? - Spirometry for Physicians
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Hands on demonstration of new small office spirometers
Provide information supporting the use of spirometry
– GOLD and NLHEP Consensus recommendations
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Provide lots of information on the ease of use of spirometry
Provide information about the reimbursement of spirometry
– As long as there are any symptoms reported
– Cough, dyspnea, wheeze, chest discomfort, abnormal CXR
Hanover Coalition for Lung Health
How to? - Spirometry for Physicians

Information on SIMPLE INTERPRETATION !!
Airflow Obstruction =
FEV1 / FVC < 70%
FEV1 < 80%
( below .70)
For COPD screening, forget the other numbers !
Hanover Coalition for Lung Health
How to? - Spirometry

Office staff teaching opportunities
– Hands on demonstrations
– Teaching classes on performance of spirometry
 Lunch and learns
– Information on office billing
– Offer regular “competencies” for office staff on spirometry
– Maybe offer hospital certificate of competency for office
spirometry
Hanover Coalition for Lung Health
How to? - Spirometry

Teach the “ESSENCE” of simple screening spirometry
– Explain that you are measuring how much and how fast
– Demonstrate the maneuver
– Full deep breath
– BLAST the air out
– Exhale for at least six seconds - encourage
Hanover Coalition for Lung Health
How To?

Grand Rounds:
– Well known speakers to talk about COPD, spirometry and early
detection

Journal Club
–
Presentations by physicians on your committee. Articles about
early COPD detection
Hanover Coalition for Lung Health
How To?

Baseline and follow-up data is helpful
– Pubic and physician questionnaire
– Survey offices about spirometry
Hanover Coalition for Lung Health
Be Persistent
Constant reminders to the pubic about “silent emphysema”
 Constant reminders to the pubic about spirometry as the
only way to detect early lung disease


Constant reminders to physicians about the need to look for
early COPD with spirometry and focus on this group with
smoking cessation. Don’t just wait for those with “end stage”
COPD to present to the emergency room
Hanover Coalition for Lung Health
Caution

Refer all people to their physician
– OK to provide an alternate information source

If Physician wants to send patients for spirometry rather
than do in his/her office, that’s fine

Don’t give impression that you’re just trying to “drum up
business” for your hospital or Respiratory Care
Department.
Hanover Coalition for Lung Health
Thank You
Any Questions…….
Hanover Coalition for Lung Health