Pelham - Windham News

April 9, 2010 - 11

submitted by Monique Mazejka, GOAL/QPC

Over the past four decades, chronic illness has increased to the point where it is the cause of 75 percent of the deaths in the US and consumes 75 percent of the healthcare resources. Over 50 percent of healthcare costs are related to four chronic illnesses: diabetes, asthma, cardio-vascular disease (hypertension), and depression. More than 85 percent of these costs are avoidable with patient self- care. Among some of the most important self-care practices a patient can do to avoid unnecessary medical costs from sickness related to chronic illness include taking meds, checking blood pressure and blood sugar, managing diet, and setting (and keeping) simple goals.

Chronic Illness has increased over the last 40 years, but the American health system has not been changed to deal with these ongoing illnesses. Only about 15-20 percent of Americans with these illnesses practice self-care.

In the past decade, several programs

have been developed to help reduce chronic illness and the negative effects on health due to these illnesses. One such program is the Asheville, NC, Chronic Illness Project, in which city and hospital employees were provided with coaching by a pharmacist who checked their use of meds, informed them about their disease, checked their skill in taking blood pressure and blood sugar, helped them set goals, and

Well Care Well Care

measured progress on goals. Those who agreed to take coaching received free meds and medical supplies (no co-pay) for their chronic illness as long as they continued to take the coaching. This program resulted in huge success for those involved—medical costs declined for diabetics by 43 percent the first year and as much as 75 percent by the fifth year. Similar results were obtained for those with asthma, cardio-vascular disease, and depression. Why pharmacists? Patients see pharmacists more than any other healthcare provider. Research has found that the primary reason for lack of self-care is often related to problems with medications, wrong dosage, ineffective meds, wrong combinations of meds, etc. Pharmacists are the best-equipped healthcare provider to identify and reconcile those problems. This approach has been implemented

over the last 10 years with similar results. Health & Human Services Secretary Leavitt endorsed the program as one of 10 successful, community-based healthcare programs in November 2008. Medication therapy management programs have also helped pharmacists integrate brand name, generic naturopathic, and other supplements by facilitating the appropriate use of medications and ensuring efficacy, safety, and adherence. Medication therapy management means

providing the following services: 1. Performing or obtaining necessary assessments of the patient’s health status;

2. Formulating a medication treatment plan; 3. Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness;

How Well Do You Fit Your Vehicle?

submitted by Sarah Riley, Occupational Therapist, Northeast Rehabilitation Hospital

As humans age, there are certain changes that may occur in the body. Most often, there is diminished vision, flexibility, strength, range of motion, and even height. Some of these changes are inevitable. These physiological changes may make driving less comfortable and more difficult. There are a few things that individuals may do to assist with these changes, such as exercise, practice good nutrition, and get regular eye exams and medical check-ups. However, the one sure thing that the mature driver can do to adapt to the body’s physical changes is to make modifications to their vehicle and secure the perfect fit. There are certain adjustments that will help the driver feel more comfortable and in better control. An optimal fit means that there is: • A clear line of sight over the steering wheel, seeing at least three inches above the wheel.

• Plenty of room between the breastbone and the front airbag and steering wheel. Ideally, at least 10 inches.

• A seat that fits comfortably and safely. The seat should adjust for good visibility and access to controls.

• A properly adjusted head restraint, as this can help prevent neck injury. The center of the head restraint should be against the center of the back of the head, not the neck.

• Easy access to gas and brake pedals. One should be able to reach both pedals without stretching too far, be able to completely depress the brake pedal, and be able to move the foot easily from the gas to the brake.

• A seat belt that holds the driver in the proper position and remains comfortable while driving. The lap belt goes across the hips and the shoulder belt across the rib cage, not under the arm. Drivers should also be able to:

• Reach the shoulder belt to buckle and unbuckle with ease.

• Get into and out of the vehicle easily.

• Turn the head to look over the shoulder when changing lanes and backing up.

• Sit comfortably without knee, back, hip, neck, or shoulder pain. For situations in which making

changes to the vehicle are unsuccessful in obtaining the optimal fit, there are adaptive devices that may be able to help. For example, for difficulty managing the seat belt due to hand or shoulder problems, there are seat belt extenders. For difficulty with light or glare, there are visor extenders, and for arthritic hands, there are steering wheel covers. These items would not require any special training to use. Other devices that may require training include larger, panoramic mirrors to enhance the field of vision; pedal extenders for people that are not able to manage the gas and brake pedals easily; and steering devices for people that have difficulty grasping the wheel.

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Before purchasing any adaptive devices, there should be an evaluation completed by a driver rehabilitation specialist who will be able to recommend which equipment will work best and most appropriately for the individual. CarFit is a program that was developed by the American Society on Aging in collaboration with AARP, American Occupational Therapy Association, and AAA. It is a program designed to give a quick, but comprehensive check of how well the individual and the vehicle work together. A trained professional will ask simple questions and complete a 12- point CarFit checklist. The entire process takes about 20 minutes to complete, and one leaves with recommended car adjustments and adaptations. There will be an upcoming CarFit check at Northeast Rehabilitation Hospital in Salem. This will be held in conjunction with their “Seniors-On-The-Go” fair, designed specifically to keep seniors going, driving, and mobile for as long as safely possible. This event will be hosted at the hospital in collaboration with AAA, Merrimack Valley on May 8, from 9 a.m. to 1 p.m. If you would like more information, or would like to set up an appointment to complete the CarFit checklist, call Sarah Riley at 893-2900, ext. 3212.

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Self-Care is the Best Medicine for Chronic Illnesses

4. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events;

5. Documenting the care delivered and communicating essential information to the patient’s other primary care providers;

6. Providing verbal education and training designed to enhance patient understanding and appropriate use of the patient’s medications;

7. Providing information, support services, and resources designed to enhance patient adherence with the patient’s therapeutic regimens;

8. Coordinating and integrating medication therapy management services within the broader healthcare management services being provided to the patient. Patient self-care is the best way to help

those with chronic illness avoid unnecessary health issues and a possible hospitalization, as well as control healthcare costs. For those who require additional assistance with self-care, pharmacist coaching and medication therapy management are the most effective ways to ensure the best self- care. GOAL/QPC in Salem has started a pilot project called the Chronic Illness Apollo Project with a goal of reducing chronic illness by 50 percent in this decade. This project is stemming from the successful Asheville, NC, chronic illness program. For more information regarding the Apollo Project, call 890-8800, ext. 120.

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