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From the Director...
One of the Rhode Island Department of Health’s (RIDOH) three overarching goals is to address the social and environmental determinants of health, with the anticipated outcome of eliminating disparities and promoting health equity. One initiative helping us to reach this goal is the creation of Health Equity Zones (HEZ) in Rhode Island.
Since the spring of 2015, RIDOH has funded and collaborated with community organizations to create, implement, and sustain 10 HEZs, or geographic areas, that use innovative approaches to help prevent chronic diseases and improve the social and environmental conditions of neighborhoods throughout the state. HEZs are based on the philosophy that health is not just defined by healthcare. Healthcare, as important as it is, is only responsible for about 10% of our health outcomes. The other 90% of health outcomes are influenced by other elements - social and environmental factors, behaviors, and a little bit of genetics. Health begins where we live, learn, work, and play. It begins with the services available in our neighborhoods, the quality of our housing, the safety of our communities, the nutritional value of the food we can access, the jobs we can get, the equitable experience of educational excellence among our communities, our level of health literacy, and the support we get from our community.
In all five counties, HEZs are putting the spotlight on access to healthcare, healthy and affordable foods,transportation, housing and homelessness, youth and elderly engagement, healthcare, education, jobs and income. They are the foundation of an overall strategy to ensure a better quality of life and healthy living for all Rhode Islanders.
In the coming months, you will see more and more evidence of HEZs doing what they do best. You will start to see “pop-up†farmer’s markets and community gardens. For people who are interested in professional development, there will be linkages to job training opportunities, promotion of trauma-informed practice, and community kitchen incubator facilities. To help neighborhoods offer more safe and healthy opportunities for the people who live there, look for welcoming outdoor green spaces, Wellness Hubs, built environment partnerships to promote physical activity, and diabetes self-management programs. For people who may be struggling with addiction, there will be neighborhood substance recovery centers and community services with certified peer recovery specialists. These are only a few examples of the amazing and innovative projects that HEZs have planned for year two of their grants.
I want to acknowledge and thank each and every one of the HEZs for the work they have already completed that many times goes unnoticed. Each HEZ lead agency first met with community leaders, agencies, and residents to learn gather information about their health concerns, to recognize the assets and resources that already exist in their communities, and to identify potential solutions together.
All Rhode Islanders need to have an equal opportunity to take advantage of resources that will help them live the healthiest life they can, regardless of their address, income, education, or ethnicity. We must continue to work toward making a difference in the health of all Rhode Islanders, and that change begins in the community. With an expanded understanding of all of the factors that determine our health outcomes, the HEZs that represent their communities are leaders in Rhode Island and for the nation - transforming health right along with you. To learn more about each of the HEZs and how you can get involved, visit http://www.health.ri.gov/projects/healthequityzones/
Nicole Alexander-Scott, MD, MPH
Director of Health
New Forms For Protection From Utility Shutoff
As of May 2, 2016, National Grid customers who want to request protection from utility shutoff, must have providers complete and return a Serious Illness Protection Form-RI and/or a Handicapped Protection Form-RI. Both of these forms are available on National Grid’s website at https://www.nationalgridus.com/media/pdfs/billing-payments/cm6346ri_handicap_serious_illness.pdf National Grid offers the following reminders to healthcare providers who are completing the forms:
- A physician must attest to the patient’s health condition, the duration of the condition, and whether the patient’s condition meets National Grid’s definitions for serious illness or handicapped.
- A physician does not need to evaluate the medical necessity of the patient having utility service.
- It is essential to document the duration of the health condition(s). Indefinite, permanent, or ongoing are all appropriate terms to use.
- For any patient who has life-sustaining medical equipment that requires power, a patient should also submit a Notice of Life-Sustaining Equipment to National Grid. This form can be downloaded from https://www.nationalgridus.com/media/pdfs/storms-outage/ri/cm6239_lifesupport_ma_ri_01_16.pdf
Providers who have questions about completing the forms or about protecting patients from utility shutoff can call the Rhode Island Center for Justice at 401-491-1101, ext. 802.
CDC: Do Not Use Flumist In 2016-2017 Flu Season
The CDC’s Advisory Committee on Immunization Practices (ACIP) recently announced an interim recommendation that live attenuated influenza vaccine (LAIV), also known as nasal spray flu vaccine (Flumist), should not be used during the 2016-2017 flu season due to ineffectiveness. Any provider who has already reserved a quantity of Flumist through OSMOSSIS, that reservation will be replaced with injectable vaccine. The CDC expects sufficient injectable vaccine supply for the upcoming season. For more information, read the June 28 advisory that was sent to all state-supplied vaccine providers.
A Message From State Epidemiologist Dr. Utpala Bandy
While it is RIDOH’s expectation that all healthcare providers, especially those in emergency departments, are regularly screening travelers for a variety of infectious diseases, emerging to endemic, questions about the risk for Ebola continue to arise. RIDOH discontinued active and direct-active monitoring of travelers from impacted countries on December 29, 2015; however, because Ebola can remain in survivors’ bodies for lengthy periods of time, small outbreaks continued to occur in impacted countries. On June 9, 2016, the World Health Organization (WHO) declared Liberia, the country with the most recent outbreak, Ebola-free for the fourth time (it had been 42 days since the last patient tested negative for Ebola in two consecutive tests).
The CDC has stated that since transmission of Ebola has been greatly reduced, clinicians no longer need to screen patients specifically for Ebola, as was done in the past. For those of you who still have them up, you should remove the posters in your waiting rooms. We refer you to CDC’s Frequently Asked Questions on Screening for Ebola Virus Disease for Providers, Healthcare Facilities, and Health Departments for additional guidance on screening: http://www.cdc.gov/vhf/ebola/healthcare-us/evaluating-patients/faqs-screening-ebola-providers-hc-facilities-health-departments.html
In addition, we encourage you to build the CDC’s Traveler’s Health webpage into your policies and procedures, if you haven’t done so already: http://wwwnc.cdc.gov/travel/destinations/list. This page will provide you with the most up-to-date information about outbreaks happening around the globe, which are ever-changing.
As always, should you encounter a patient who has traveled and you are considering a reportable disease, please contact the Center for Acute Infectious Disease at 222-2577 during the day or 272-5952 after hours or on weekends.
What Can The PDMP Do For Me?
RIDOH’s Prescription Drug Overdose Prevention Program is offering a monthly training about the basics of using the Prescription Drug Monitoring Program (PDMP). The training is designed for prescribers who have an active Controlled Substance Registration (CSR) or for individuals to whom prescribers delegate PDMP access. Participants will learn how to:
- Navigate the PDMP database
- Use the delegate feature
- Run patient reports
- Run an individualized prescription report
The trainings all take place from 3:30 p.m. – 5 p.m. in the Department of Administration’s (1 Capitol Hill, Providence) computer lab on the basement level and are scheduled for July 13, August 10, September 14, October 12, November 9, and December 14. To register for one of the trainings, email PDMP Education Coordinator Monica Tavares.
What Is One Key Question?
While there are many approaches to initiating a discussion about pregnancy intention with a patient, it may, in fact, be as simple as asking one question. The One Key Question® initiative was developed by the Oregon Foundation for Reproductive Health (OFRH) and they recommend providers ask a patient if “You (or your partner) would like to become pregnant in the next year?†This one question is designed to facilitate a proactive conversation about pregnancy intention, help identify reproductive health needs, and reduce bias and assumptions about patients’ intentions and need for reproductive health services. RIDOH is partnering with Title X Family Planning agencies to pilot One Key Question® for all patients who seek family planning services. RIDOH plans to share lessons learned from this initiative in a future issue of Health Connections. Learn more about One Key Question® on their website.
Success for Chronic Disease Self-Management Programs
Chronic disease is a growing problem in Rhode Island. Currently, 58% of Rhode Island adults have at least one chronic condition. Arthritis, diabetes, and heart disease prevalence rates are rising:
- 27% of Rhode Island adults have been diagnosed with arthritis.
- 9% of Rhode Island adults have been diagnosed with diabetes.
- 8% of Rhode Island adults have been diagnosed with heart disease.
RIDOH offers evidence-based self-management programs across the state. In these programs, participants learn to eat healthy, manage medications, and exercise appropriately. The programs include the Chronic Disease Self-Management Program, the Diabetes Prevention Program, and Walk with Ease. Completion of these programs has resulted in fewer hospitalizations, fewer outpatient visits, weight loss, increased physical activity, and improved self-confidence. For information on the programs and opportunities for patient referrals call RIDOH’s Information Line at 222-5960.
Transition of Care Requirements When Prescribing Opioids
A message from James McDonald, MD, MPH; Chief Administrative Officer for the Board of Medical Licensure and Discipline
If you prescribe long-term opioids, there are several regulations you must incorporate into your practice. One important concept is how critical it is for you to make sure there is a safe transition of care if you decide to stop prescribing long-term opioids to your patient.
A physician can generally end a physician-patient relationship for almost any reason; however, there is a specific and higher duty when you discharge a patient who has become opioid dependent while under your care. Discharging an opioid-dependent patient without a safe transition of care violates regulation 3.10. Opioid-dependent patients must have continuity of care for pain management or, if appropriate, addiction management.
Your patient may not agree with the need for a new provider; however, you can find a new provider by using the Find a Doctor tool at health.ri.gov. In addition, you can find a list of treatment programs on Prevent Overdose RI's website that might be appropriate. Leave an opioid-dependent patient without appropriate transition-of-care may put them at risk for withdrawal or for seeking illicit means to address their dependence.
If you suspect a patient is diverting controlled substances, referring that patient to treatment might be appropriate. Generally prescribing additional controlled substances is not appropriate. If a patient violates a pain agreement or if you see a Prescription Monitoring Report that concerns you, check these documents on RIDOH’s website for some helpful suggestions: http://www.health.ri.gov/publications/guidelines/provider/PatientViolatesPainAgreement.pdf or http://www.health.ri.gov/publications/guidelines/provider/PositivePrescriptionMonitoringReport.pdf.
If you have questions about interpreting regulations, please contact your risk manager or feel free to contact me at james.mcdonald@health.ri.gov.
Upcoming Training: Equal Access to Care: Transgender, Gay, Lesbian, and Bisexual Patients
The Massachusetts Office of the Attorney General, the Massachusetts Hospital Association, and the National LGBT Health Education Center at the Fenway Institute is offering a training on best practices for hospital personnel to improve access to medical care for LGBT patients with a special focus on transgender individuals. This training will provide information about the unique challenges and barriers faced by LGBT patients generally, and transgender patients in particular, in accessing healthcare. The training is July 19, from 10 a.m. – noon at Cooley Dickinson Hospital. The goal of this training is to ensure that hospital staff and other healthcare providers have the knowledge necessary to develop internal intake and admission procedures, data collection policies, and clinical care principles that support culturally competent care for this population. The training is intended for hospital administrators, providers, and front-line staff. Healthcare facilities are also encouraged to send senior leadership, diversity and quality officers, legal counsel, and directors of emergency and other clinical services. All attendees will receive training materials that may be used for staff-specific training at their home institutions. To register, visit the Fenway Institute’s website.
FOR ORAL HEALTH PROFESSIONALS
Fifth Annual Mission of Mercy A Success
The annual Rhode Island Mission of Mercy free dental clinic provided free dental health services to more than 720 Rhode Islanders on June 4 and 5 at the Dental Hygiene Clinic at CCRI’s Flanagan Campus in Lincoln. The two-day clinic was organized by the Rhode Island Oral Health Foundation, RIDOH, and other community partners. The entire event was run by volunteers and provided more than $483,000 in free dental services to adults and children who cannot afford dental care. Licensed, volunteer oral health professionals offered a variety of services, including cleanings, fluoride treatments, dental sealants, X-rays, oral health education, fillings, tooth extractions, root canal treatments, interim partial and complete dentures, and minor denture repairs. In total, more than 250 community and 400 health professional volunteers, including dentists, dental hygienists, dental assistants, physicians, nurses, pharmacists, and health educators came together to make the event a tremendous success that Rhode Islanders are proud of.
FOR NURSES
Can Registered Nurses Give Anesthetics?
The Board of Nursing has had several requests about the Registered Nurse’s scope of practice regarding the use of anesthetics, such as Propofol, Ketamine, and Lidocaine. The Board has determined that it is not within the scope of practice of a registered nurse who is not also a Certified Registered Nurse Anesthetist (CRNA) to administer agents used primarily as anesthetics for moderate or deep sedation. This decision is consistent with the Board’s previous determination that anesthetic agents are not in the scope of practice of the registered nurse and should be given by a physician, anesthesiologist or Certified Registered Nurse Anesthetist (CRNA).
FOR PHARMACISTS
FDA: Guidance Related to Transactions With First Responders
The Food and Drug Administration (FDA) issued a new guidance indicating that the agency does not intend to take action against a dispenser who transfers ownership of a product directly to a first responder without providing product tracing information to the first responder, as required by sections 582(c)(1)(A)(ii)-(iv) and (d)(1)(A)(ii) of the Federal Food, Drug, and Cosmetic Act. FDA does not intend to take action provided that certain conditions are met, as outlined in the Requirements for Transactions with First Responders under Section 582 of the Federal Food, Drug, and Cosmetic Act — Compliance Policy Guidance for Industry. The compliance policy guidance indicates that requirements for transactions with first responders include:
- Dispenser captures and maintains the product tracing information for such transactions for not less than six years after the transaction
- Dispenser provides such product tracing information to the first responder or secretary, if requested, not less than two business days after receiving the request or in such other reasonable time as determined by the secretary, based on the circumstances of the request.
FOR EMERGENCY MEDICAL SERVICES PROFESSIONALS
EMS Week 2016 Honors Pre-Hospital Care Providers
In honor of National EMS Week, RIDOH’s Center for Emergency Medical Services honored those who choose the vocation of EMS and highlighted the critical work of pre-hospital care providers in Rhode Island and in the country. Whether EMS professionals respond to emergency as a career or in voluntary service to their neighbors and community, today’s world of EMS is challenging and unique compared to 50 years ago. Five Emergency Medical Technicians (EMTs) were honored for their professional duty and service to their communities. The honorees were:
- Volunteer EMTs of the Year: Amanda Gingell, Harrisville Fire Department; Lawrence DiSandro, Ashaway Ambulance
- Career EMTs of the Year: Kyle Newman, Pascoag Fire Department; Domenic Lautieri, Portsmouth Fire Department
- EMS Coordinator of the Year: Jonathan Polak, Smithfield Fire Department.
EMT-C Program Migrates To Advanced EMT-C
As of June 15, RIDOH’s Center for Emergency Medical Services has completed the shift from EMT-Cardiac (EMT-C) licensing category to the Advanced EMT-C (AEMT) licensing category. This change in the licensing structure equips EMS professionals with a highly-modernized program of learning. Significant changes include:
- Candidates must pass testing by the National Registry of EMTs
- A new curriculum that is based on national standards and best practices
- Candidates must complete more clinical hours before being licensed
- A recommendation that of maintaining certification with the National Registry of EMTs
The shift to the AEMT program has been completed with the support of RIDOH, the Rhode Island Ambulance Service Advisory Board, and other professional partners.
Coming Soon: Revised EMS Protocols
The Rhode Island Ambulance Service Advisory Board’s Rules and Regulations subcommittee presented revised Rhode Island EMS Prehospital Care Protocols and Standing Orders to the full Board at its June meeting. One goal of the subcommittee was to have Rhode Island’s protocols in closer alignment with other New England states. The Center for EMS staff is working to incorporate the proposed changes into the existing protocols. Final protocols will be presented to the EMS community and will be included in a future issue of Health Connections.
In Case You Missed It...
Efforts in R.I. to curb painkillers are working
Providence Journal, July 8
Vape shops fear effects of excessive regulation
Providence Business News, July 8
West Nile virus detected in mosquitoes in Worcester
Boston Globe, July 8
Brown Med Student Organizes 'Citizen Physicians' To Vote
RIPR.org, July 7
Is Your Child Getting Enough Physical Activity at School?
Newport Daily News, July 7
R.I. groups join in program to reduce costs for improved elder care
Providence Journal, July 7
R.I. groups fight cancer with free 'Skin Check' at beaches
Providence Journal
The Pulse: Overhauling The Way Rhode Islanders Access State Benefits
RIPR.org, July 7
R.I. groups join in program to reduce costs for improved elder care
Providence Journal, July 7
Police: Confusion over mink led store employees to be bit; animal was set free
Westerly Sun, July 6
Feds Pave Way For More Suboxone Patients
RIPR.org, July 6
No West Nile found in latest mosquito tests in Rhode Island
Providence Journal, July 6
HUD awards $2M to support R.I. HIV/AIDS housing programs
Providence Business News, July 6
State issues rabies warning after animal bites pair at Walmart
Providence Journal, July 6
Providence St. Joseph Health celebrates first day as a new organization by committing to be a catalyst for improving mental health
Channel 6, July 6
Dept. of Health: 3 bitten by animal at Westerly Walmart
Channel 12, July 5
Possible Rabies Exposure at Westerly Store
Channel 6, July 5
Unidentified animal bites Westerly Walmart patrons; rabies feared
Westerly Sun, July 5
RI Dept. of Health warns of possible rabies exposure at Westerly store
Channel 12, July 5
10 Cares: The Newport Health Equity Zone
Channel 10
Temperature expected to reach 90 in Providence; air quality alert issued
Providence Journal
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July 2016
