AMIGAS Cervical Cancer Prevention Program Learning Collaborative
The AMIGAS “Ayudando a Las Mujeres con Información, Guía y Amor para su Salud” or “Helping Women with Information, Guidance, and Love for Their Health” is an evidence-based, bilingual health education intervention program designed to train community health workers (CHW) or “promotoras” to increase cervical cancer screening rates among Hispanic women. According to the Centers for Disease Control and Prevention (CDC), the incidence rate of cervical cancer is highest among Hispanic women in the United States with over 2,000 new diagnoses reported each year. The first module of this learning collaborative will provide an overview of the AMIGAS program to guide CHWs on how to promote cervical cancer screening resources and education in English and Spanish to Hispanic women who may be at high risk of cervical cancer in their community to improve health outcomes.
Building an Effective Collaborative Care Team to Address Diabetes in Special and Vulnerable Populations: Tailoring Care for Social Context
This session focused on the necessary elements to develop a high functioning patient-centered team for diabetes prevention, management, and treatment in primary care. The session addressed the roles of all members of the team including the critical role of leadership and clinical champions to building an effective collaborative team. This session laid the groundwork for the full series by engaging participants in a discussion of how to tailor diabetes care for social context. The conversation focused on the key elements needed for treating diabetes in the primary care and community setting with an emphasis on team-based approaches to wellness.
Current and Emerging Issues in Public Housing Primary Care
Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing diseases, reducing disabilities, and achieving health equity. On this call, Public Housing Primary Care Health Centers (PHPCs) and NCHPH discuss current and emerging issues in PHPC settings, including the two HUD’s most recent initiatives: Envision Center Demonstration and Smoke-Free Public Housing.
Developing the Role of Community Health Workers and other Support Staff in Diabetes Prevention, Treatment, and Follow-Up
Community Health Workers (CHW) have been shown to be especially successful reaching hard to access populations such as agricultural workers and their families as well as the homeless and residents of public housing. In this session, participants and faculty explored the role of CHWs in the diabetes care team. Case studies and real-world discussion provided examples of both effective and ineffective integration of CHWs into the clinical care team. Participants discussed the scope of practice and most effective roles for CHWs within the diabetes care team as well as the role of clinical champions and leaders in effectively mobilizing the skills of CHWs and other team members.
Diabetes Continuum of Care: Using Behavioral Health and Substance Use Disorder Integration to Address Older Adults with Cognitive Impairments and Diabetes
This is the second webinar in the continuation of our Diabetes in Special & Vulnerable Populations: A National Learning Series. Diabetes affects more than 30 million people in the United States. Multi-tiered efforts to prevent, treat and manage diabetes are critical in reducing the burden of diabetes, particularly for medically underserved racial and ethnic minority populations. In addition to higher prevalence, ethnic and racial minority patients with diabetes have higher mortality and higher rates of diabetic complications.
FQHCs and PHAs – Opportunities for Collaboration to Improve Resident Health
During this presentation, NCHPH provided an insight on the background of health centers and public housing residents. NCHPH also discussed the impact of public housing and health along with opportunities for collaboration between health centers and public housing authorities. Case examples of resident health improvement were presented related to health insurance coverage, senior health programs and community safety.
Health in Public Housing Advisory Group Call October 2019
In this call, NCHPH and the Advisory Group discussed HRSA priorities, increasing access to care and other important topics for Public Housing Primary Care.
Identifying and Treating People with Prediabetes
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. According to the Center for Disease Control and Prevention (CDC), approximately 84 million American adults—more than 1 out of 3—have prediabetes. Of those with prediabetes, 90% don’t know they have it. In this session participants discussed statistics of prediabetes and conversion rates from prediabetes to diabetes, identify patients at risk for diabetes, resources to screen and test for prediabetes and the use of EHRs to identify people with prediabetes.
Patient Engagement Strategies for the Collaborative Care Team: Group-Visits
Pre-visit planning includes scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits and spending a few minutes to huddle and handoff patients. This can be particularly challenging for vulnerable populations such as agricultural workers, the homeless and residents of public housing. This session will explored strategies and tools for diabetes pre-visit planning that can be successful for vulnerable populations. Participants and faculty brought case studies and real life scenarios to the discussion in order to facilitate problem-solving conversations about how to address challenging scenarios. The session also addressed how to best incorporate pre-visit planning into a team-based setting that includes CHWs.
Phases of Diabetes Care
Diabetes care can be organized into three phases: pre-visit, intra-visit, and post-visit. Opportunities exist during each phase to introduce practice changes that can help engage and support patients in their diabetes care and management. Health care teams can optimize diabetes encounters by taking a planned, continuous improvement approach to visits, which includes pre-visit preparation (by both patients and practices), intra-visit coordination (among practice team members), and post-visit follow-up (among the practice team and with patients).
Patient Intervention Strategies for the Collaborative Care Team: Pre-Visit Planning
Group visits have been shown to be an effective strategy to address diabetes management in a number of health settings. During group visits, participants have a greater opportunity to ask questions, run the discussion and provide one another with peer support. CHWs can be particularly effective in setting up and helping run group visits at health centers. During this session, participants discussed different models for group visit and explored best practices used in health centers. The session relied on case studies and real-life scenarios to discuss challenges and successes using group visits with vulnerable populations.
Transformation of Public Housing
During this conference call, NCHPH lead a discussion with PHPC advisory group members on the Moving to Work Demonstration program and Rental Assistance Demonstration program. An overview of the most recent National Health Center Needs Assessment results were highlighted in addition to discussing chronic medical conditions affecting PHPC patients.
Using Information Systems and Technology to Enhance Diabetes Care
Patients and physicians require new tools to manage the growing burden of chronic illness. For providers responsible for the care of diabetic patients, developments in information management, real-time health education and feedback, and new approaches to self-monitoring and insulin delivery hold great promise to improve the quality and safety of diabetes care. In this call, NCHPH and Health Centers participants shared some of the major developments in the field, and the ways these technologies can be integrated into a typical practice.