1. Presentation to: Presented by: Date: A State Public Health Approach to Prevent Chronic Disease and Improve Cardiac Care Georgia Academy of Family Physicians Brittany D. Taylor, MPH June 20, 2015

2. Leading* Causes of Premature Deaths (before age 75), Georgia Years of Potential Life Lost 2009-2013 Cause categories are the National Centers for Health Statistics (NCHS), rankable causes of deaths applied to Georgia. Source: Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP), OASIS Dashboard. http://oasis.state.ga.us/http://oasis.state.ga.us/

3. Colorectal Cancer Screening Recommendations Adults at average risk of developing colon cancer, beginning at age 50 and continuing until age 75, have to get a screening for colorectal cancer using high-sensitivity fecal occult blood testing (HSFOBT), fecal immunochemical test (FIT), sigmoidoscopy, or colonoscopy. Patients who have genetic risks or patients with Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease should get screening tests at earlier age. Patients with a family history of Colorectal Cancer, should begin colon cancer screening 10 years younger than the family member with colon cancer was, or age 40, whichever is younger. The Georgia Colorectal Cancer Program promotes two highly effective screening tests for average risk patients: 1) Fecal Immunochemical Test annually or; 2) Colonoscopy every ten years. – Goal: Increase colorectal cancer screening rates among Georgia residents ages 50 and older by two primary screening methods – FIT and Colonoscopy. – Georgia’s Screening Goal: By 2019, 85% of the population will be screened for colorectal cancer

4. Vaccination for Human Papilloma Virus (HPV) USPSTF Recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. ACIP Recommends screening for:  Females ages 11-26  Males ages 11-21 (MSM through age 26) How You Can Get Involved:  Make the offer of HPV vaccination to parents of boys and girls routine by promoting it with other required and recommended vaccinations.

5. Genetic Screening Guidelines vary by condition: http://www.cdc.gov/genomics/gtesting/guidelines.htmhttp://www.cdc.gov/genomics/gtesting/guidelines.htm A genetic counselor, doctor, or other health care professional trained in genetics can help an individual or family understand genetic test results. Attributes of family and personal history are the most significant indicators of an increased risk of cancer in the individual patient. Genetic testing can be used to further assess risk and guide strategies for cancer screening, prevention, and treatment. EVIDENCE-BASED GUIDELINES SPECIFIC TO HEREDITARY CANCER SYNDROMES

6. Hypertension Screening Disease Burden:  Prevalence rates increase with age, from 7.3% in persons ages 18 to 39 years, to 32.4% in those ages 40 to 59 years, to 65.0% in those age 60 years and older. Uncontrolled Hypertension:  Risk factors for uncontrolled hypertension include: heart attacks, stroke, and congestive heart failure.  Uncontrolled hypertension is a major contributing factor to cardiovascular and all- cause mortality in the United States.  In Georgia, there is an unknown number of undiagnosed persons with hypertension (est. 1M plus) The U. S. Preventive Services Task Force has concluded the benefits of screening for high blood pressure in adults to prevent cardiovascular morbidity and mortality are substantial, and the harms of screening are small. Controlling Hypertension Georgia Deaths, Major Cardiovascular Diseases, 2013 Total Number 21,831 Rate per 100,000 218.5

7. Georgia Tobacco Quit Line 1-877-270-STOP Georgia cAARds Program Ask. o Ask all patients about tobacco use during each visit. Advise. o Advise them about the benefits of tobacco use cessation Refer. o Refer your patient to an evidence-based resource (i.e. the Georgia Tobacco Quit Line to obtain a free “Quit Kit”, individualized plan and behavioral counseling support. 1-877-270-STOP Current GTQL Offerings Available to Georgia tobacco users aged 13 years and older Phone Counseling 5 call Program available to all 10 call program available in Pregnant and Postpartum Women Youth Support Program Integrated Web Coach Materials Only 4 weeks of Nicotine patches or gum, * While supplies last Referral to Community Resources

8. Guideline-based Care for Asthma Approximately 126,400 (9 out of 100) Georgia children aged 0-9 have asthma. 40% of Asthma episodes are caused by triggers in the home Based on a systematic review of the literature CDC and the Community Preventive Services Task Force recommends home- based multi-trigger, multicomponent interventions with an environmental focus for children with asthma aim to reduce exposure to multiple indoor asthma triggers. Guidelines- based Clinical Care Asthma Self- Management Education Healthy Homes Asthma Visit and Intervention Lower Costs and Better Outcomes (Reduced ED Use and Hospitalizations) Guidelines for the Diagnosis and Management of Asthma: http://www.nhlbi.nih.gov/health- pro/guidelines/current/asthma-guidelines/full- report

9. Why Teen Pregnancy Prevention? Teen pregnancy and birth rates are at historic lows: Georgia 12th in the nation for highest in teen pregnancies In 2013, 10,322 teen births occurred for girls ages 15-19 The Cost: Cost Georgia taxpayers $395 million in 2010 Nationally, teen childbearing costs taxpayers at least $9.4 billion each year Savings: Between 1991 and 2010 there have been, costing taxpayers a total of $10.3 billion over that period. Had it not been for significant declines in the teen birth rate in recent years, the costs to taxpayers would have been even higher. The teen birth rate in Georgia declined 45% between 1991 and 2010 saving taxpayers an estimated $492 million in 2010 alone compared to the costs they would have incurred had the rates not fallen. Progress: During 1998 to 2011, the birth rate among girls in Georgia 15-19 years old declined 41%, from 63.4 births per 1,000 females in 1998 to 37.9 in 2011. Decline continued in 2012 at 11% from 2011 and 47% from 1998. 1999 to 2012, the teen birth rate for non-Hispanic White adolescents declined 50%. Among non-Hispanic African-Americans the decline was 52% and 51% among Hispanic adolescents.

10. Diabetes Prevention and Control Focus: Prevention and Control Goals:  Increase awareness about the importance of Prediabetes screening, identification and treatment among healthcare professionals and “high risk” patients  Increase adoption of quality improvement processes related to reporting and monitoring of A1c, blood pressure and cholesterol measures  Increase access, referrals, participation and reimbursement for nationally accredited/recognized Diabetes Self-Management Education (DSME) Programs Age-Adjusted Diabetes Hospitalization Rate per 100,000 persons by Georgia Public Health District Source: 2013 Georgia Diabetes Self-Management Report at: https://dph.georgia.gov/diabetes-surveillancehttps://dph.georgia.gov/diabetes-surveillance Studies show people who receive diabetes education:

11. Nutrition and Physical Activity Poor nutrition and lack of physical activity 2nd leading cause of preventable death in Georgia Dietary Guidelines for Americans, 2010 Emphasize 3 major goals for Americans which include: Balance calories with physical activity to manage weight Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains The Physical Activity Guideline for Americans Recommendations in order to promote and maintain health: Adults 18 years and older 150 minutes or more each week of moderate-vigorous activity a Muscle- strengthening activities 2x week Adolescents and children Participate in 60 minutes or more of physical activity each day Dietary Guidelines for Americans, 2010 http://www.health.gov/dietaryguidelines/2010 Physical Activity Guidelines for Americans, 2008 http://www.health.gov/paguidelines

12. Tools for Chronic Disease Prevention

13. Quality Improvement QI Strategies: Delivery system design (who’s on the health care team and in what ways we interact with patients) Decision support (what is the best care and how do we make it happen every time) Clinical information systems (how do we capture and use critical information for clinical care) Self-management support (how we help patients live with their conditions and make behavioral changes to improve health)

14. Old Interaction vs. New Interaction Old Interaction Between individual provider and patient Face-to-face Problem-initiated and focused Topics are clinician's concerns and treatment Ends with a prescription New Interaction Between patient and care team supported by clinical information and decision support Multiple modalities Based on care plan: “Planned visit” Collaborative problem list, goals and plan Ends with a shared plan of care and follow-up

15. Outcomes Well-organized, efficient practices Satisfied patients on the right medication with excellent self-management and healthy behaviors Satisfied providers able to provide outstanding patient care without feeling overwhelmed.

16. Brittany D. Taylor, MPH Cardiovascular Health Program Manager Office of Tobacco, Policy, System and Environmental Change Brittany.Taylor@dph.ga.gov (404)657-6313