WISEWOMAN Overview Training
Background 2
Mission Provide cardiovascular screenings and healthy lifestyle programs and resources to eligible women in Colorado in an effort to improve control of hypertension and other cardiovascular disease risk factors. 3
WISEWOMAN • W ell I ntegrated S creening and E valuation for WOM en A cross the N ation • CDC funded • Colorado WIS EWOMAN is administered through the Colorado Department of Public Health and Environment Tied to the Women’s Wellness Connection program • (serve the same population) • Colorado has been participating in WIS EWOMAN since 2013 4
Program Overview WIS EWOMAN provides eligible women with access to: • Cardiovascular screening services and health risk assessments • Risk reduction counseling • Case management Referrals to health care providers for medical o evaluation and management of condition(s) Follow up for uncontrolled hypertension o Link participants to free or low cost medication o resources • Referrals to health coaching and other healthy behavior support option 6
Eligibility and Enrollment 7
WISEWOMAN Eligibility • At least 30 years of age but less than 65 • Lawfully present in the United S tates • Low income o 250% or less of federal poverty guidelines • Uninsured or Underinsured o No insurance or unable to afford co-pays or deductibles Currently eligible for the Women’s Wellness • Connection (WWC) Program 8
Additional Eligibility Details • If a client’s eligibility details change within the same year of WIS EWOMAN participation, then the client is eligible for the entire year. o Age 64 at time of screening o Medicaid eligibility 9
Enrollment Enrollment is combined with the Women’s • Wellness Connection (WWC) • In order to enroll a client: Confirm client eligibility o Have client sign the combined consent form (only o once- do not need to every year) Confirm lawful presence for client; client signs o affidavit (template on agency letterhead) Client completes WWC client profile tool o 10
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Baseline Screening 1 3
Screening • WIS EWOMAN pays for cardiovascular screenings • Beneficial to offer cancer screening (WWC) at same time as cardiovascular (WIS EWOMAN), but not required Visit does not need to be integrated with WWC visit o • Health risk assessment o BMI o Blood pressure o Glucose o Cholesterol o Tobacco use assessment o Healthy behavior questionnaire (Patient Information form)
Health Risk Assessments • Agencies participating in WIS EWOMAN must comply with the following requirements: Conduct health risk assessment for each WIS EWOMAN o client during initial screening visit. Have all clients complete the Patient Information form o and review the form with each client. Complete health risk assessment for each client prior to o initiating risk reduction counseling. Assessments and results must be delivered in a cult urally o competent manner and in a language the client comprehends. 15
Patient Information Form 16
Tobacco Use Assessment • CDC requires all grantees to assess each enrolled client for tobacco use status and promote cessation services when needed. o Client records that lack a tobacco use assessment are not counted • Questions on tobacco use are included on Patient Information form • Referral status information is included on the Risk Reduction Counseling form • Policy details in WIS EWOMAN manual • Ask, Advise, Refer is the recommended assessment tool 17
Clinical Screening Requirements 1 8
Screening Lab Tests • The clinical screening component assesses the presence of chronic disease risk factors. The following assessment values are required: Body Mass Index (BMI) o Blood pressure o Laboratory tests: o Cholesterol Glucose or A1C 19
Blood Pressure Readings • WIS EWOMAN manual includes information on blood pressure reading procedures S eated with feet on floor, etc. o • WIS EWOMAN BP Requirements: Two readings are strongly recommended for all clients. o Two readings are required when first reading is greater o than or equal to 140 systolic or 90 diastolic. If first reading is less than 140/ 90, defer to agency o Medical Director to determine an internal policy for when a second reading must be taken. 20
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Disease-Level Values • Cholesterol ƚ o TC > 240 o LDL > 160 o TG > 200 • Glucose ƚ o A1C > 6.5% o FPG > 126 ƚ Refer for medical evaluation if not currently being treated 22
Uncontrolled Hypertension 140-180 S ystolic • 90-110 Diastolic • Must be referred for • medical evaluation within 30 days 23
Alert Values Blood Pressure • >180 S ystolic o >110 Diastolic o Glucose (fasting or non-fasting) • < 50 o > 250 o Requires Immediate Attention • Follow-up Required within 7 days 24
Medical Evaluation • All women in the uncontrolled hypertension or alert level range must be referred for further care. o Referral for medical evaluation/ Case management Uncontrolled Hypertension = within 30 days Alert levels = within 7 days Medical evaluation and case management should • include medication adherence/counseling 25
Medication Counseling Patient-centered focus • Motivational Interviewing • Ident ify barriers to access and adherence o May be delivered by: • Provider/ clinical staff o Non-clinical staff o Pharmacist o Can also be conducted/ revisited during health • coaching Details and tools provided in WIS EWOMAN manual • 26
Medical Evaluation & Workup 27
Risk Reduction Counseling 2 8
Risk Reduction Counseling • Overall point is to review and explain the client’s screening results o Help them understand their numbers and relative risk of developing heart disease • Must be started in person o Based on information available o Remaining topics can be finished over the phone • Provide screening results verbally and in writing • Patient focused o Active listening; talk with (rather than to) the client o Conversational, non-j udgmental attitude 29
Risk Reduction Counseling • Content: Review the Patient Information form to ensure o client understands questions o Discuss client’s health risk assessment and clinical values (BP, BMI, questionnaire and labs) and her CVD risk vs. other women her age Collaboratively identify priority areas o Assess Readiness to Change level o Facilitate access to Healthy Behavior S upport o Options 30
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Readiness to Change • Pre-contemplation o Not considering any healthy changes • Contemplation o Ambivalent about change • Preparation o S tarting to make plans or motions to change • Action Taking definitive change for healthy behaviors o • Maintenance o Ongoing lifestyle behaviors, striving to maintain 33
BP+ Overview 3 4
BP+ • BP+ is only used when a client becomes lost to follow-up. • Eligibility and enrollment are the same as a regular WIS EWOMAN client o S ee flow chart • Ideal is to eventually convert to full BP+ clients to full screenings whenever possible Bring them back in to finish labs, etc. o 35
BP+ • Requirements: BMI o Blood pressure o Two readings are recommended, especially if first is >140/ 90 S ame medical evaluation follow up requirements for clients in the alert and uncontrolled ranges Must complete Patient Information form o Risk reduction counseling must be started o Minimum- must review client’s relative risk of developing heart disease based on health risk assessment (BMI, questions, BP). 36
Healthy Behavior Support Options 3 7
Healthy Behavior Support Options • WIS EWOMAN Clients can be referred for additional healthy lifestyle resources once their initial screening is complete • WIS EWOMAN has three Healthy Behavior S upport Options categories: Lifestyle Programs (LS P) o Cooking Matters Diabetes Prevention Program (DPP) Health Coaching o Community-Based Referrals (non-reimbursable) o 38
Diabetes Prevention Program (DPP) • Diabetes Prevention Program (DPP) is an evidence- based lifestyle change program for preventing type 2 diabetes o Focuses on nutrition, stress and physical activity • DPP can be offered in-house or referred out to an established program • DPP course completion takes about a year o Includes 16 weekly sessions followed by six monthly sessions • S pecial eligibility criteria 39
Cooking Matters • Nutrition based health improvement program S hare Your S trengths Colorado o • Facilitated by Cooking Matters staff or Train- the-Trainer S ix total sessions o 4 sessions counts as complete for WIS EWOMAN o • Nutrition education: food labels, shopping on a budget Grocery store tour o • Each session includes an educational segment and in-class group cooking segment. 40
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