Public Health Detailing Program Speaker Kelly Larson, MPH Director, Public Health Detailing Program New York City Department of Health and Mental Hygiene Thanks to our Sponsors: School of Public Health, University at Albany NYS Department of Health NYS Community Health Partnership Special Thanks to: NYS Association of County Health Officials NYS Nurses Association Viewer Call-In Phone: 800-452-0662 Fax: 518-426-0696 Evaluations Please visit www.t2b2.org to fill out your evaluation and post test. Nursing Contact Hours, CME, CHES are available. Thank you! 1
Public Health Detailing Modeled after pharmaceutical sales approach Selling good health and promoting public health interventions Brief, one-on-one interactions with health care providers and staff Total office call Public Health Detailing Program Goals 1. Promote preventive health interventions to health care providers in the practice setting 2. Promote use of clinical systems to ensure that opportunities for care are not missed Target Neighborhoods 1 Team Leader 7 Health Department Representatives 2 Central Brooklyn 1 East & Central Harlem 4 South Bronx 3. Develop relationships and serve as a resource to practice staff Target Neighborhoods ~236 Primary Care Practices 80 Central Brooklyn 43 East & Central Harlem 113 South Bronx 0 Citywide & Neighborhood- Specific Campaigns Contracted Staff: 1-60 field staff 1-6 field supervisors Citywide: > 2,500 healthcare sites 2
Take Care New York: 10 Steps to Live Longer, Healthier Lives 1. Have a Regular Doctor or Other Health Care Provider 2. Be Tobacco Free 3. Keep Your Heart Healthy 4. Know Your HIV Status 5. Get Help for Depression 6. Live Free of Dependence on Alcohol and Drugs 7. Get Checked for Cancer 8. Get the Immunizations You Need 9. Make Your Home Safe and Healthy 10. Have a Healthy Baby Clinical Tools Providers Resources Patient Education Other Medications Health Bulletins Incentives (pens, post-it pads) Action Kits www.nyc/health/publichealthdetailing General Campaign Information Allow at least 4-6 months for campaign preparation Campaigns range from 8-14 weeks; typical campaign is 10 weeks Target all staff in the practice Staff visit same practices for each campaign; approximately 40 practices per rep 2 visits per contact per campaign allowing 4-5 weeks between visits Initial Follow-up www.nyc.gov/health/publichealthdetailing Campaign Framework 1. Develop key recommendations 2. Identify and develop clinical tools, provider resources and patient education materials that support the key recommendations 3. Develop assessment questions that help the health department representative understand current practice and tailor presentation 4. Train staff 5. Sell respective health intervention through one-on-one interactions 6. Monitor 7. Evaluate Key Recommendations No more than 3 Action-oriented Clear and concise 3
Assessment Questions Contraception Campaign 1. How often do you take your patients sexual history? 2. How is sexual history documented? 3. With which patients do you discuss contraception? 4a. To whom do you prescribe emergency contraception? 4b. Do you ever prescribe emergency contraception in advance? Topic Content Staff Training Program Initiatives Epidemiology Best Practices Challenges Barriers Staff Training Communication/Selling Skills Introductions Framing the Issue Active Listening Tailoring the Visit Materials Promotion Identifying and Overcoming Barriers Gaining a Commitment Role Playing Selling Health Interventions Through One-on-One Visits 1. Introductions 2. Framing the issue 3. Assessment questions 4. Tailoring message based on responses to assessment questions 5. Promoting materials in kit 6. Handling objections 7. Gaining a commitment 4
Public Health Detailing Program Evaluation Health Care Provider Self-Report Change in practice Implementation of clinical systems (ie. chart stickers, flow sheets) Community Health Survey Targeted Community vs. Non-Targeted Patient Claims data Evaluation Campaign Contraception Campaign June 29 September 23, 2005 Target Practices: Family Practice Internal Medicine Pediatrics Target Neighborhoods: East and Central Harlem South Bronx Brooklyn Bushwick and Bedford Stuyvesant Key Recommendations Contraception Campaign Clinical Tools Emergency Contraception, Chart Sticker, Referral Form Take a brief sexual history of all patients Encourage the appropriate use of contraception Offer emergency contraception in advance and as needed Provider Resources City Health Information and Journal Article Patient Education Fact Sheet, Easel and Palm Cards 5
Evaluation Health Care Provider Self-Report: Prescribes EC in Advance Contraception Campaign Site Reach 260 80.0% 70.0% 60.0% 67.0% 250 240 Sites Reached 248 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 17.1% 6.5% Initial 2005 Follow-up 2005 Evaluation Campaign 2007 N=235 N=235 N=154 Number of Sites 230 220 210 200 Total Sites 214 Number of Providers 190 800 700 600 500 400 300 200 100 0 Contraception Campaign Reach 417 235 Health Care Providers Initial Follow-up 702 Staff 378 Total Provider Contacts = 652 Total Staff Contacts = 1,080 Total Provider/Staff Contacts = 1,732 Nurse-Family Partnership Campaign January 18 March 14, 2008 Target Practices: OB/GYN Family Practice Target neighborhoods Northern Bronx Staten Island Queens Brooklyn Manhattan - Chinatown Key Recommendation Nurse-Family Partnership Campaign Clinical Tools Referral Form and Chart Stickers Refer all eligible patients to the Nurse-Family Partnership Campaign Eligibility No previous live births Less than 28 weeks pregnant Low-income Live in targeted area in NYC 6
Provider Resources NFP Service Map and Provider Brochure Patient Education Poster and Palm Cards Nurse-Family Partnership Campaign Site Reach Nurse-Family Partnership Campaign Contacts 800 736 250 225 200 Sites Reached 700 600 Initial 175 218 212 Total Sites 500 Follow-up Number of Sites 150 12 5 10 0 400 300 200 226 318 75 118 100 50 0 25 Health Care Providers Staff 0 Total Provider Contacts = 344 Total Staff Contacts = 1,054 Total All Contacts = 1,398 Challenges Challenges 1. Site Listing 2. Data Collection/Reporting 4. Materials Development Allowing enough time to prepare for each campaign 5. Consistently reaching staff in larger facilities 6. Site Access 3. Transportation 7. New Staff Training 7
Positive Outcomes Public Health Detailing Program Increase in health care provider/staff knowledge Implementation of clinical tools Widespread use of patient education materials - available in multiple languages; provides opportunity for patient engagement Comprehensive site listing of primary care practices in NYC Positive Outcomes Public Health Detailing Program DOHMH partnering with health care providers/staff throughout NYC Streamline agency/program messaging around specific health interventions Connecting practices to other DOHMH programs New strategy for DOHMH to sell public health messages Kelly Larson, MPH Director, Public Health Detailing Program klarson@health.nyc.gov www.nyc/health/publichealthdetailing 8