hanover area coalition for lung health a program description and how to… for your community...

Hanover AreaHanover AreaCoalition for Lung HealthCoalition 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

Hanover Coalition for Lung

Health

Coalition for Lung HealthCoalition for Lung Health

The Problem

What we did in Hanover - Get some ideas

How to start an NLHEP type program in your community

Media material examples


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



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


Health

Where?Where?


Health


Health

Hanover HospitalHanover Hospital


Health

The Problem – The FrustrationsThe Problem – The Frustrations

Treating “End-Stage” COPD

Limited use of spirometry by physicians to detect COPD or measure its severity.

Lack of public awareness of COPD and lung cancer compared to Breast Cancer, Heart Disease, AIDS, etc..

Patients often don’t get STRONG recommendations to stop smoking. Often don’t get any of the recommended treatments to help stop.


Health

1994 – The Lung Health Study1994 – 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


Health

National Lung Health Education ProgramNational Lung Health Education Program

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


Health

Volunteers (working group 5-8)Volunteers (working group 5-8)

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


Health

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)

Goals

Hanover Coalition for Lung Health

Baseline Survey 1999Baseline Survey 1999Hospital Employees – 100 Hospital Employees – 100 Multiphasic Participants -- 167Multiphasic Participants -- 167

27

73

24

76

0

10

20

30

40

50

60

70

80

male female smoker orex

neversmoked


Baseline Survey 1999Baseline Survey 1999

5261

79

14

0

10

20

30

40

50

60

70

80

knowcholesterol

Had PSA HadMammogram

Know LungNumbers


Health

Leading Cancer KillerLeading Cancer Killer

Men: LUNG CANCER

Women: LUNG CANCER

Lung Cancer has been the leading cancer killer in both men and women for many years


Question: What is the Leading Cancer Question: What is the Leading Cancer Killer in Men? - 1999Killer in Men? - 1999

11

56

33

0

10

20

30

40

50

60

Colon Prostate LUNG


Question: What is the Leading Cancer Killer Question: What is the Leading Cancer Killer in Women? - 1999in Women? - 1999

3

82

15

0

10

20

30

40

50

60

70

80

90

colon breast LUNG


1999 Physician Office Spirometry Survey1999 Physician Office Spirometry Survey

38

73

13 133

01020304050607080

ownspirometer

staff trained PFT at risk pts PFT on ptswith lungdisease

considerpurchase


Health

Borrow a Logo -- “F.A.Q.” BookBorrow a Logo -- “F.A.Q.” Book


Health

CommunicationsCommunications

Regular Primary Care Physician Contact– Frequent letters– Bulletins– Education material– Publicity material– Advanced notice of materials going to public


Health

Promotion CampaignPromotion Campaign

Educational Posters Created

Sent to physicians, pharmacies, businesses

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


Health


Health

Promotion CampaignPromotion Campaign

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

All with “Test Your Lungs-Know Your Numbers”


Health

Promotion cont’dPromotion cont’d

“On Hold” message on hospital telephones “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…..


Health

Promotion Cont’dPromotion Cont’d If you are over 45 and smoke, you may already have emphysema. A simple

breathing test is the only way to tell.

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

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death. If you ever smoked, you are at risk.

More men and women die of lung cancer than any other form of cancer. Emphysema increases your risk, even when it is mild.


Health

Promotion Cont’dPromotion Cont’d

Articles in hospital newsletters Distributed to hospital employees Second newsletter distributed to the entire community

Promotion at hospital screening functions Hospital Web Site

Coalition news and information on “Test Your Lungs – Know Your Numbers” campaign. Linked to NLHEP


Health

Promotions Cont’dPromotions Cont’d

Grand Rounds to hospital staff Physician discussed COPD Treatment and tied it into early

detection

Articles at Journal Club for physicians– Early COPD detection

– Early Lung Cancer detection

– Spirometry recommendations for Office Practice

– Reliability of office spirometry


Health

Promotion cont’dPromotion cont’d

Promotion material created and distributed to physicians and community

– Stickers – Pads– Magnets– Buttons– “Lung Number” cards for spirometry results

All material with Logo, Coalition for Lung Health and a number to call for information


Health

Promotion Cont’dPromotion Cont’d

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


Health

Public Service AnnouncementsPublic 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”


Billboards – Oct 2001Billboards – Oct 2001


Health


Health

The Message to PhysiciansThe Message to Physicians 15-20% of smokers develop COPD – find them early!

Early COPD with minimal airflow obstruction can only be detected by spirometry! NOT by physical exam and NOT by Chest X Ray

Lung Function drops rapidly in those smokers with COPD who continue to smoke.

Identify those 20% of smokers with COPD at an early stage before there is enough irreversible airflow obstruction to lead to symptoms and disability


Health

The MessageThe Message

Do not assume primary care physicians know the message

What we take for granted in the understanding of COPD and emphysema is not as widespread as you would expect.

What we take for granted in the use of spirometry for monitoring or testing for lung disease is not taken for granted by physicians


Health

The Message:The Message:

Ask about smoking at every office visit Spirometry if in high risk group

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


Health

Office SpirometryOffice Spirometry

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


Health

Office Spirometry CPT CodesOffice Spirometry CPT Codes

94010 – basic spirometry with printed report. At least FVC, FEV1 and FEV1/FVC

94060 - basic spirometry before and after bronchodilator


Health

What if Spirometry is Abnormal?What if Spirometry is Abnormal?

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


Health

Smoking Cessation:Smoking Cessation:

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


Health

Smoking CessationSmoking Cessation

The Five A’s of smoking cessation Nicotine replacement therapy Buproprion Nortriptyline Follow-up


Health

The 3-minute intervention (AHCPR)The 3-minute intervention (AHCPR)

Strongly advise all smokers to quit. Provide social support and offer simple advice.

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.


Health

What Should the Physician’s Goals Be?What Should the Physician’s Goals Be?

Identify COPD/Emphysema Patients Sooner Reduce risk factors (tobacco, workplace fumes) If young, alpha-1-antitrypsin level Target this group for aggressive smoking cessation

Medications i.e. bupropion, nicotine replacement therapy

Screen for other conditions at greater risk with low FEV1 Lung Cancer (CXR? CT scan? Sputum?) Coronary Artery Disease (check cholesterol)


Health

Physician GoalsPhysician Goals

Mild COPD – Medications if symptomatic prn short acting bronchodilators (ipatropium, beta-agonists) Long acting bronchodilators (beta-agonists, theophyllines)

Moderate COPD: Bronchodilators if symptomatic Pulmonary rehabilitation Inhaled steroids to reduce exacerbations?

Severe COPD Oxygen therapy if needed based on O2 assessment

Flu Vaccine, Pneuomovax Follow regularly since there is a chronic disease


Health

Physician Coalition Survey - July 2001Physician Coalition Survey - July 2001

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.


Health

Physician Coalition Survey – July 2001Physician Coalition Survey – July 2001

Obstacles to doing more frequent office spirometry on patients at risk? – 50% Time– 55% Staff expertise– 20% Cost– 50% Easier to send to hospital for PFT’s– 25% Reimbursement issues– 30% Patient reluctance– 45% Spirometry Interpretation– 40% Quality of test results– 25% Explaining normal spirometry results


Primary Care Spirometry SurveyPrimary Care Spirometry Survey1999 – 2000 - 20011999 – 2000 - 2001

0

20

40

60

80

100

ownspirometer

staff trained PFT at risk pts PFT on ptswith lungdisease

consideringpurchase

1999 (n=40) 2000 (n=31) 2001 (25)


0

10

20

30

40

50

60

70

colon prostate LUNG

1999 2000 2001

Leading Cancer Killer in MenLeading Cancer Killer in Men


Leading Cancer Killer in WomenLeading Cancer Killer in Women

0102030405060708090

colon breast LUNG

1999 2000 2001

Respiratory Care PractitionerRespiratory Care Practitioner

Their Role in the Coalition for Lung Health

Vicky Shrader, RRT

Director Respiratory Care

Hanover Hospital


Health

Respiratory Therapy InvolvementRespiratory Therapy Involvement

Coalition for Lung Health member from the beginning

Met regularly with the Coalition during the planning phase

Participated in decisions about promotion campaign

Helped create promotional material


Health

RCP Role - SpirometryRCP Role - Spirometry

The resource group for Spirometry– Equipment experts– Experts in performance of test

Liaison to Primary Care Physician’s office in matters concerning new or old spirometers


Health


Letter to Office Managers about spirometry Respiratory Therapists offered to troubleshoot and calibrate office

equipment Respiratory Therapists held luncheon workshop for office staff

Equipment Basics of Spirometry Performance of Tests Coding and Billing


Health


Information sent to Physician’s Offices

“Simple Spirometry for Frontline Practitioners” NLHEP consensus statement on spirometry Information on interpretation Information about FEV6 Reimbursement Information


Health


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


Health

RCP Role – ScreeningRCP Role – Screening

Spirometry added to Hospital Screening Tests 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 Screening for early emphysema in those at risk Not looking for occupational lung disease !!


Health

RCP Role - ScreeningRCP Role - Screening

Provide participants with their “lung numbers” Created a “Lung Health Card”

FEV1 FVC FEV/FVC

Told to contact their physician if abnormal Provide smoking cessation and Coalition information

about early COPD detection


Health

RCP Role – Smoking CessationRCP Role – Smoking Cessation

Smoking cessation 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 A.S.H.E.S. Active Support Helps End Smoking


Health

RCP Role – Smoking CessationRCP Role – Smoking Cessation

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) 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)


Health

How You Can Do It?How You Can Do It?

How can you start your own NLHEP

“Coalition for Lung Health”

In your community?

Step by step instructions……………..


Health

FIRST!FIRST!

You must have one person who says….

“This is something I think we should do”


Health

Step 1Step 1

Establish Your Goals– Public education about COPD– Physician education about COPD– COPD early detection– Spirometry for early detection– Education about associated diseases (lung cancer)


Health

Step 2Step 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


Health

Step 3Step 3

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


Health

Step 4 Step 4

Determine clear recommendations to physicians

Know what you are going to tell them – make it brief Know what you are going to ask them – make it easy


Health

Step 5Step 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


Health

TargetTarget Physicians

– Suggest those primary care physicians who refer to your hospital

Public– Suggest the geographic area served by your target physicians

Hospital can supply you with their:– Primary market area– Secondary market area


Health

Step 6Step 6

Physician Mailing List

Community Mailing List– Businesses (Chamber of Commerce list)– Pharmacies– Other allied health providers e.g. dentists, chiropractors etc….


Health

How to? Step ……How to? Step ……

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:

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…


Health

How to? Step ……How to? Step …… Find a resource person for “graphics” – computer savvy Create or borrow a slogan:

– “Test Your Lungs – Know Your Numbers”

Create or borrow a logo Combine it with your hospital logo if desired


Health


Frequently Asked Question Brochure

Design your own or customize the FAQ brochure from the National Lung Health Education Program

(NLHEP)

Distribute widely: hospital, public, physicians, pharmacies etc..


Health


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.


Health


Health

How To? - FundingHow To? - Funding

Within the budget of the Respiratory Care Department or Wellness Department

Don’t need to seek outside funding Need to prepare and request a budget and FTE’s

Fund separately from the hospital Allows significant independence Don’t need to get hospital “approval” for everything done Spend “energy” seeking monetary support


Health


– Hospital donation– Donations from pharmaceutical industry– Donations from local Medical Supply Co’s– Charitable Organizations– State “Tobacco” Funds


Health


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…


Health


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


Health

How To?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


Health

How To?How To?

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

Within a Department Budget– Budget proposals to administration


Health

How To?How To?

Regular meetings –keep minutes– How to obtain funds– How to spend funds

Plan campaign for the next 2-3 months Design marketing material Printing Dissemination


Health

How To?How To?

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”


Health

How To?How To?

Contact local radio and TV stations Interviews with coalition members Call in Radio shows

Contact Health Reporters of local TV stations National PSA available with Loni Anderson

Contact Newspapers – health topics for the community Hospital Wellness publications Hospital Web site and calendar of events


Health

How to? - Screening SpirometryHow to? - Screening Spirometry

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


Health

How To? - SpirometryHow 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?


Health

How to? - Spirometry for PhysiciansHow to? - Spirometry for Physicians

Hands on demonstration of new small office spirometers Provide information supporting the use of spirometry

– GOLD and NLHEP Consensus recommendations 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


Health

How to? - Spirometry for PhysiciansHow to? - Spirometry for Physicians

Information on SIMPLE INTERPRETATION !!

Airflow Obstruction =

FEV1 / FVC < 70% ( below .70)

FEV1 < 80%

For COPD screening, forget the other numbers !


Health

How to? - SpirometryHow 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


Health

How to? - Spirometry 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


Health

How To?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


Health

How To?How To?

Baseline and follow-up data is helpful– Pubic and physician questionnaire– Survey offices about spirometry


Health

Be PersistentBe 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


Health

CautionCaution

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.


Health

Thank YouThank You

Any Questions…….

hanover area coalition for lung health a program description and how to… for your community...

Documents

lung health coalition

lung health hanover

lung health study

lung health cd

lung health volunteers

hanover area coalition

lung cancer

hanover hospital slide