Hanover Area Coalition for Lung Health

1. Hanover AreaCoalition for Lung Health A Program Description And How To… For Your Community Michael Ader, MD mickeydoc@netrax.net Vicky Shrader, RRT Hanover Hospital Hanover, PA November 30, 2001

2. Coalition 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 Hanover Coalition for Lung Health

3. Hanover Coalition for Lung Health CD • Billboard one BMP • Billboard two BMP • Coalition Brochure JPEG • Thank you letter to Pharmaceutical Company MS WORD • Dear Doctor: educational poster #2 • Dear Office Manager: spirometry training • Dear Businessmen: educational poster • Dear Colleagues: educational poster #4 • Dear Doctor: Coalition brochure • Dear Doctor: educational poster #1 • Dear Doctor: Intro to Coalition • Dear Pharmacist: educational poster • Funding request letter: #1 • Funding request letter: #2 • Funding request letter: #3 • Hanover Coalition NLHEP intro letter • Letter to major companies in community • Please post letter to neighboring hospital • Poster #1 JPEG • Poster #2 JPEG • Poster #3 JPEG • Poster #4 JPEG Hanover Coalition for Lung Health

4. Where? Hanover Coalition for Lung Health

5. Hanover Coalition for Lung Health

6. Hanover Hospital Hanover Coalition for Lung Health

7. The 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. Hanover Coalition for Lung Health

8. 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

9. National 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 Hanover Coalition for Lung Health

10. 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 Hanover Coalition for Lung Health

11. Goals • 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

12. Baseline Survey 1999Hospital Employees – 100 Multiphasic Participants -- 167 Hanover Coalition for Lung Health

13. Baseline Survey 1999 Hanover Coalition for Lung Health

14. Leading Cancer Killer • Men: LUNG CANCER • Women: LUNG CANCER Lung Cancer has been the leading cancer killer in both men and women for many years Hanover Coalition for Lung Health

15. Question: What is the Leading Cancer Killer in Men? - 1999 Hanover Coalition for Lung Health

16. Question: What is the Leading Cancer Killer in Women? - 1999 Hanover Coalition for Lung Health

17. 1999 Physician Office Spirometry Survey Hanover Coalition for Lung Health

18. Borrow a Logo -- “F.A.Q.” Book Hanover Coalition for Lung Health

19. Communications • Regular Primary Care Physician Contact • Frequent letters • Bulletins • Education material • Publicity material • Advanced notice of materials going to public Hanover Coalition for Lung Health

20. Promotion 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 Hanover Coalition for Lung Health

21. Hanover Coalition for Lung Health

22. Promotion 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” Hanover Coalition for Lung Health

23. Promotion 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….. Hanover Coalition for Lung Health

24. Promotion 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. Hanover Coalition for Lung Health

25. Promotion 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 Hanover Coalition for Lung Health

26. Promotions 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 Hanover Coalition for Lung Health

27. Promotion 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 Hanover Coalition for Lung Health

28. Promotion 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 Hanover Coalition for Lung Health

29. 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

30. Billboards – Oct 2001 Hanover Coalition for Lung Health

31. Hanover Coalition for Lung Health

32. Hanover Coalition for Lung Health

33. The 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 Hanover Coalition for Lung Health

34. The 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 Hanover Coalition for Lung Health

35. 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 Hanover Coalition for Lung Health

36. Office 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 Hanover Coalition for Lung Health

37. Office Spirometry CPT Codes • 94010 – basic spirometry with printed report. At least FVC, FEV1 and FEV1/FVC • 94060 - basic spirometry before and after bronchodilator Hanover Coalition for Lung Health

38. 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 Hanover Coalition for Lung Health

39. 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 Hanover Coalition for Lung Health

40. Smoking Cessation • The Five A’s of smoking cessation • Nicotine replacement therapy • Buproprion • Nortriptyline • Follow-up Hanover Coalition for Lung Health

41. 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. Hanover Coalition for Lung Health

42. 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) Hanover Coalition for Lung Health

43. Physician 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 Hanover Coalition for Lung Health

44. Physician 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. Hanover Coalition for Lung Health

45. Physician 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 Hanover Coalition for Lung Health

46. Primary Care Spirometry Survey1999 – 2000 - 2001 Hanover Coalition for Lung Health

47. Leading Cancer Killer in Men Hanover Coalition for Lung Health

48. Leading Cancer Killer in Women Hanover Coalition for Lung Health

49. Respiratory Care Practitioner Their Role in the Coalition for Lung Health Vicky Shrader, RRT Director Respiratory Care Hanover Hospital

50. Respiratory 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 Hanover Coalition for Lung Health