Weitzman Weekly

Weitzman Weekly

Spotlight: Rewards to Quit (R2Q) w/ Carlee Clarino

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Carlee Clarino assisting patients with Rewards to Quit via telephone call.

Despite the grave health risks that come with smoking cigarettes, some smokers cannot seem to quit. In an attempt to help people quit, staff members in the various Community Health Center, Inc. (CHC) sites have been, and continue to, enrolling patients into a study called Rewards to Quit. The study, often referred to as R2Q, provides eligible participants with access to services (such as group therapy, Quit Hotline, nicotine replacement therapy, etc.) to help them quit smoking. For half of the participants, they are given an extra incentive to quit smoking by earning money for every service that they attend or participate in. This program has been widely spread among the patient population at CHC under the leadership of Carlee Clarino. Carlee started as an AmeriCorps member before joining the Weitzman Institute (WI) as a research assistant. This week, I talked to Carlee to learn more about her role and her vision for the R2Q at CHC.  

My Phuong Tong: How did Rewards to Quit start at CHC?

Carlee Clarino: Enrollment into R2Q actually started shortly after I finished my AmeriCorps year in 2013. We started enrolling patients into the study in October 2013 but my role in the program started early August of that year with all the preparatory work that would ensure the program’s sustainability at CHC.

MP.T: Can you tell me more about the prep work that you had to do?

C.C: Essentially, before CHC implemented R2Q, there was little federal aid for smokers who were interested in programs or medications that would help them quit smoking. A large part of my job early on involved implementing smoking counseling at the health center- in groups and individually. I organized trainings for all clinical staff so they could better prescribe meds, recommend nicotine replacement, offer motivational techniques to help patients quit, and run effective smoking groups.

In addition, before the program was implemented state-wide, the meds and nicotine replacement were not covered. I am proud to say that through R2Q, we are now able to provide eligible patients with smoking cessation counseling and medications, free of charge. By removing this monetary obstacle to smoking cessation, I think we have really given smokers who want to quit a much better chance at success.

MP.T: That’s great! Please expand on the monetary burden. How much do these services normally cost?

C.C: To give you an idea, the medication that we provide patients cost from $200-300 for a pack of 56 and nicotine replacement therapy – aka nicotine patches – can cost from $20-40 for a pack of only 14 patches. In addition, the behavioral therapy service provided to patients for free under R2Q can cost up to $335. These things add up and when your annual income is a little over $11,000 a year (poverty level) then it becomes a huge burden. That is why it is so beneficial for patients to enroll in this study even if they don’t get the extra monetary incentive.

MP.T: To date, how successful has CHC been at actually getting patients to enroll in the study and participate in the program?

C.C: We actually have done quite well in terms of enrolling patients. My most recent data shows that CHC has enrolled 830 patients of the 2,052 total patients enrolled in Connecticut. That is a respectable 40% of total patients enrolled in this study! I would attribute our success to the fact that staff members, other than medical care providers, are enrolling the patients. This allows patients to sign up for the program without having time taken out of their medical visit. I think this is a huge part of what makes the program successful here because WI staff and AmeriCorps run the research/program management side and clinical staff can focus on providing care!

A lot of patients were enrolled earlier on in study but recently, this year’s AmeriCorps members have started blitz weeks that have really helped increase the numbers of patients learning about and enrolling in the study.

MP.T: What are these blitz weeks that you mention?

C.C: Essentially, the AmeriCorps members have been encouraging clinical staff to refer patients who smoke to the AmeriCorps-run table that is stationed in the waiting room. At the table, patients learn more about the smoking cessation services and incentives. The referrals have worked wonderfully because they come from people whom patients trust and respect. For that reason, the AmeriCorps members have been able to enroll a large number of patients in the course of a week. The idea was created by some very engaged staff member in Fairfield County but the process is completely AmeriCorps driven and has given R2Q the rejuvenation that it needs.

MP.T: It seems like you have accomplished a lot through this program. How do you feel about the program today?

C.C: I am really proud to be part of this great project. It has been a rewarding experience for me getting to  work on research that can affect policy for our prominent Medicaid smokers, to help smokers quit smoking and to see people’s lives being improved as a result. I cannot tell you how many times I have been thanked by people for providing this service and helping them quit. I think it is easy to forget that smoking is an addiction that warrants medical assistance and attention. My involvement in R2Q has opened my eyes to the way that our healthcare system can help patients stop smoking and empower them to stay smoke-free.

MP.T: What would you say is the most memorable experience you’ve had while doing R2Q?

C.C: I remember one time when I was enrolling a mother into the study who was a heavy and chronic smoker. I asked her how many cigarettes she smoked a day and was shocked when she said three packs! For those who don’t know, that is 60 cigarettes a day. I couldn’t help but ask her why she chose today to try and quit smoking again. She smiled as her eyes started tearing up and she told me she wanted to see her children grow up and be there for them. In that moment, I was reminded of the fact that we are all involved in this program because the cost of smoking was not only affecting the patient’s wallet and health, but also the lives of their loved ones. It reaffirmed my early beliefs regarding the importance of having a program like R2Q at CHC.

In this interview, Carlee was able to give us a brief explanation of the Rewards to Quit program at CHC. This program is continuing to grow at CHC and there have been a few changes to the nature of the study. If you would like more information about the program, please contact Carlee (clarinc@chc1.com).

Cheers and enjoy this comic :)

R2Q comic

… Rewards to Quit is probably a more effective (and nicer) way of helping people quit smoking.

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Dr. Benjamin Sommers, Harvard School of Public Health

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Benjamin Sommers, Professor of Health Policy and Economics at the Harvard School of Public Health. Dr. Sommers is an expert on the impact of universal health coverage and Medicaid expansion as well as their influence on improved outcomes, reduced mortality rates and improved public health.

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Introducing a Third Nurse Practitioner Resident!

This week we are pleased to introduce a third Nurse Practitioner participating in our residency program, Ashley Fine. She has extensive experience in the health care setting both in the United States and abroad and is currently working with patients at our Middletown site. Learn more from her biography below:

I finished my Master of Science in Nursing this past Spring at Johns Hopkins School of Nursing. Before that I worked as nurse on the in-patient orthopedic/trauma unit at The Johns Hopkins Hospital.  In addition I worked per diem at the Greater Baltimore Medical Center in the outpatient wound care center.  It was my experience as a Peace Corps Volunteer in The Republic of Benin that inspired me to become a Family Nurse Practitioner. My best friend in town was the nurse and the only person with any medical training in the town. So she was always the doctor and the pharmacist.  I liked the model of the Nurse Practitioner so I decided to pursue it as my career.  When I came back to the United States I started volunteering at the local Planned Parenthood then got a job as a Medical Assistant while taking my prerequisites for nursing school. I have always enjoyed meeting and working with people from all over the world and from different walks of life.  I chose the Nurse Practitioner Residency program here in Connecticut because it was the first one and I wanted to build the best base of clinical care that I could for my patients.

In my free time I enjoy the outdoors. I love to go hiking and/or backpacking. I am learning to enjoy cold weather and look forward to trying different snow sports this winter.

Fine, Ashley

 

 

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November is Diabetes Awareness Month!

As many of you know November is Diabetes Awareness Month, and the number of people effected by this disease is ever increasing in the United States and around the world. This month is intended to shed light on the daily struggles and lifestyle choices people living with diabetes must make, both those with type 1 and type 2.

Here are just a few of the recent statistics on diabetes from the American Diabetes Association:

  • Nearly 30 million children and adults in the United States have diabetes.
  • Another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes.
  • The American Diabetes Association estimates that the total national cost of diagnosed diabetes in the United States is $245 billion.

A huge component of Type 2 Diabetes prevention, and management of complications once diagnosed, is education. It is imperative that people practice healthy habits such as eating nutritious foods and exercising regularly to control the progression of the disease.

On Friday November 14, which was official World Diabetes Day, CHC’s own certified diabetes educator Hilda Cardona hosted an educational diabetes event at the Meriden CHC as she does every year, photos below. The event provided patients with a healthy food demonstration along with a diabetes True and False quiz game, including prizes for correct answers. Examples from the game include ‘Should a diabetic test their blood sugar everyday?’ (True!) ‘What are some high carbohydrate foods?’ (potatoes, yams, white rice) After the game the patients were all pleased with the delicious yet healthy chicken and white bean soup. Hopefully they will take some of the new information they learned to help better manage their diabetes, or reduce their risk for developing diabetes.

She will also do a similar event for the patients in New Britain today, November 19.

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Posted in Diabetes, Fitness, Games, General, Living with Chronic Illness, News, Nutrition, Uncategorized, Wellness | Tagged | Leave a comment

Dr. Peter Basch, Medical Director of Ambulatory EHR and Health IT Policy, MedStar Health

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Peter Basch, Medical Director of EHR and Health IT Policy at MedStar Heath and Visiting Scholar at the Engelberg Center for Health Care Reform at the Brookings Institution. They discuss the challenges practices are facing adhering to ONC’s Meaningful Use requirements with health IT adoption.

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Introducing a Sixth AmeriCorps member!

This week we are pleased to introduce Eliza Hompe, a Community Health Corps Member serving with Access to Care in the Fairfield county sites. She has started her year of service off working on some great projects, with many more to come! Read her introduction below:

Hi CHC! My name is Eliza Hompe and I am serving in the Access to Care position at the Norwalk and Stamford sites for the upcoming year. I am from New Canaan, CT and recently graduated from Princeton University in June, receiving my A.B. in Chemistry with a certificate in Neuroscience.  While at Princeton, I worked in a biochemistry lab and investigated synthetic proteins, culminating in a senior thesis of independent research. I was also involved in club and intramural sports on campus, an academic mentoring program with a local middle school, peer tutoring, and social organizations such as my sorority and eating club. I am hoping to attend medical school next year, although I am currently undecided on what field of medicine I would like to pursue!

I am very excited to be serving as an Americorps member at CHC this year because it will enable me to be immersed in a public interest healthcare setting while working hands-on with an underserved patient population. It is a unique opportunity to broaden my knowledge of healthcare, explore a primary care setting, and strive to provide comprehensive care for our patients through my role as a community resource advocate.

In addition to serving for Americorps this year, I am also tutoring high school students for the SAT and academic subjects. In my spare time, I enjoy playing sports, running, doing crossword puzzles, and baking gluten-free desserts! Recently, I ran my first half-marathon, the Rock N’ Roll Half-Marathon in Philadelphia.

I am thrilled to be a new member of the CHC community and am looking forward to getting to know many of you over the next 10 months!

Eliza

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Weitzman Weekly

Spotlight: TEACH-BMT

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Buprenorphine ECHO Faculty Meeting

This week, we look at how frontline staff members at Community Health Center, Inc (CHC) and the Weitzman Institute have worked together to propagate change and improvement in the CHC clinics. In February 2013, Community Health Center, Inc. (CHC) initiated Project ECHO Buprenorphine, an innovative approach to educating health providers about how to treat patients with an opioid addiction. In August of that year, CHC began work on a 3-year project funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), to expand access to buprenorphine treatment to CHC patients by extending Project ECHO Buprenorphine to prescribers of buprenorphine and care teams at CHC. This is the story of Technology Enhanced Access to Comprehensive Healthcare and Buprenorphine Maintenance Therapy (TEACH- BMT).

One way of treating opioid addiction without causing extreme withdrawal is to administer buprenorphine (bup), an opioid medication that can be used in place of a stronger opioid like heroin or morphine. Buprenorphine enables the patient to discontinue the use of other opioid medications without experiencing withdrawal symptoms. The goal is to decrease opioid dependence and give the patients a better chance at getting rid of their opioid addiction all together. Although buprenorphine can be prescribed by any primary care provider who is a suboxone-licensed MD or DO, relatively few providers feel comfortable prescribing buprenorphine to their patients without a support system to provide experience and expertise.

CHC staff members, Marwan Haddad, MD, MPH, AAHIVS; Richard Feuer, MD, PhD; Cliff Briggie, PsyD., LADC, LCSW; Omar Perez and a professor at the University of Connecticut, Megan Ehret, PharmD, BCACP, serve as the faculty team for Buprenorphine ECHO. Bup ECHO is offered once per month to buprenorphine prescribers and care teams at CHC, and provides them a platform for asking questions about difficult patient cases and receiving feedback from a multidisciplinary team of providers who have experience treating addiction and prescribing buprenorphine for opioid addiction.

In order to extend Buprenorphine ECHO to more new bup prescribers and care teams at CHC, Dr. Haddad and Kasey Harding-Wheeler, Director of Integrated Care for Special Populations at CHC, applied to SAMHSA for a grant to cover the creation and maintenance of the TEACH-BMT program at CHC. The program relies on use of telehealth to educate buprenorphine prescribers and the care teams they work with on use and maintenance of buprenorphine treatment for eligible patients. Telemedicine is the use of information technologies or other electronic media to provide healthcare from a distance. It connects buprenorphine specialists with primary care doctors and allows for the transfer of knowledge and information on treatments that can benefit patients without forcing these patients to see a specialist.

The Weitzman Institute’s (WI) role in this project is to help launch this initiative and provide the technologies needed. Another one of WI’s roles is to help Dr. Haddad and Kasey Harding assess TEACH-BMT by conducting a study looking at whether provider participation in Project ECHO Buprenorphine and provision of buprenorphine therapy in primary care actually yields better patient outcomes and higher numbers of patients receiving buprenorphine therapy and being retained in care. This project is important to the agency because it helps an often-neglected population of patients have access to treatment for addiction in primary care. The results of the study will serve as a guide for improvements and help to expand this program if applicable. Together, WI and staff members within the agency are beginning to improve a medical process that affects such a major patient population at CHC.

I want to give a special thanks to Lauren Bifulco for helping me learn more about TEACH- BMT. Lauren is the Weitzman research associate most involved in TEACH-BMT. She plays a critical role in the project as the Buprenorphine ECHO coordinator and a research assistant. If you are interested in TEACH-BMT, doing research with Weitzman, or initiating a quality improvement study at your CHC site, please contact Lauren (BifulcL@chc1.com) or Ianita Zlateva (ZlatevI@chc1.com). 

Cheers and enjoy this comic! ☺

This is a real comic! [Click on the link to check it out.]

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Dr. Marci Neilsen, CEO of the Patient Centered Primary Care Collaborative

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Marci Neilsen, Chief Exectutive Officer of the Patient Centered Primary Care Collaborative, a consortium of over a thousand stakeholders across the health care industry dedicated to promoting the comprehensive care provided in Patient Centered Medical Homes to improve primary care delivery.

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The Fifth AmeriCorps Member Introduction!

Today we are continuing with our series of introductions with another AmeriCorps member. Elena is spending her year here working with School Based Health Centers on a variety of educational and outreach activities. Learn more about her here:

My name is Elena Villafana. I went to Amherst College in the Pioneer Valley Region of Massachusetts. I studied history and took pre-med classes.  After living in the Pioneer Valley for four years I have become slightly obsessed with cider donuts. Hopefully they have them here in Connecticut as well. I am also slightly obsessed with the TV show Orphan Black. It’s a totally awesome science fiction show. SPOILER ALERT: Clones.

During my time at Amherst I studied abroad in Copenhagen, Denmark. I studied their health care system and compared it to the health care system in the United States and other Scandinavian countries. One of my favorite parts of studying abroad was trying different types of Scandinavian food. Things like pickled herring, shawarma (similar to a gyro), and a myriad of different types of sausage hotdogs kept my stomach happy.

I’m excited about working for CHC through Americorps. I think the CHC does great work giving back to the community specifically Middletown but also all around Connecticut. I am interested in going into the health care field so this year of service with the CHC is perfect. It will give me great experience in a unique environment.

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Elena is pictured on the left with her Rugby game face on.

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Thank You Medical Service Professionals! It is National Medical Staff Services Awareness Week

In 1992, President George Bush signed Congressional House Joint Resolution #399 proclaiming the first week in November as National Medical Staff Services Awareness Week. Making this week, November 2 – 8 2014, National Medical Staff Services Awareness Week!

Medical staff professionals are experts in provider credentialing and privileging as well as accreditation and regulatory compliance.

We ask ourselves every time:

- what do we know about this provider?

- what should we have known about this provider?

- have we done enough to make sure that this provider is the right choice for our patients?

Medical staff professionals work tirelessly behind the scenes conducting accurate, detailed and thorough checks on all medical, dental and behavioral health providers. Our work helps in securing a strong clinical staff, enabling CHC to continue pursuing our mission of offering quality health care services to all, especially to those who cannot gain access to such services elsewhere.

Happy National Medical Staff Services Awareness Week and Thank You for all you do!!

For more information visit: www.namss.org

 

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