East Tennessee Arthritis Education Programs

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East Tennessee Arthritis Education Programs Powered By Docstoc
					Arthritis Education Partnership Reaching Rural Tennessee Audiences
Barbara (Bobbi) P. Clarke, PhD, RD Professor, Extension Health Specialist and Co-Director, UT Center for Community-Based Health Initiatives SERA 19 Rural Health Conference September 11, 2007

Purpose of Presentation
• Share with you
– A unique state partnership addressing arthritis self-management education – Strategies for success – Program impact at the state and county levels


Did You Know…
• One out of every three adult Tennesseans has arthritis • Tennessee ranks above the national average for arthritis prevalence • Arthritis is the major cause of chronic pain and disability, impacting medical expenses, lost wages and the ability to maintain independence

What Is Arthritis?
• Not an old person’s disease
– Half of seniors do not experience arthritis – Three out of five Tennesseans are younger than age 65

• Other causes besides aging
– Injury – Joint abuse – Overweight/obese

• Chronic condition without a cure
– Term covers over 100 diseases and conditions affecting the joints and connective tissue

Arthritis Control Challenges
• Self-management disease
– No treatment is right for everyone – Lack knowledge to self-manage disease to control the pain, depression and minimize further joint damage

• Lacking access to arthritis intervention and treatment
– Healthcare providers lack the time to teach self-management skills

The Solution: Tennessee Arthritis Education Partnership Since 2003
• Tennessee Department of Health’s Arthritis Control Program • Tennessee Chapter of the Arthritis Foundation • UT Extension statewide educational network of Family and Consumer Sciences educators


Three Evidence-based Educational Programs
Focus on self-care skills to reduce pain and discomfort of arthritis, decrease medications & decrease doctor visits: • Arthritis Self-Help Program • Arthritis Foundation Exercise Program • Tai Chi


Arthritis Self-Help Program
(6 2-hour Session)

• Teaches how to:
– Self-manage arthritis daily

medications, pain control, expressing feelings, weight control, relaxation techniques, pacing daily activities

– Communicate with healthcare provider

• Benefits: decreased pain, medication use, depression, improved daily activities of living and doctor visits

Arthritis Foundation Exercise Program
(8 Session)

• Low impact, joint safe exercises • Standing or sitting exercises • Benefits: decreased pain, joint stiffness, medication use, and increased energy, muscle strength, flexibility

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Tai Chi
(8 Session) • High stance Sun Style Tai Chi – gentle on joints • Range of motion exercises and agile steps • Pain control through breathing and relaxation techniques • Benefits: reduced pain, depression and stiffness, improved flexibility and balance, improved cardiovascular function

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County Demographics
• Rural counties in Tennessee geographically isolated, especially in the Appalachian Mountain chain • Services and educational resources are limited in this area

County Demographics (cont.)
• Arthritis cases increased 53% from 1990 to 2000 • 17 Rheumatologist locations in the state, mostly urban areas • While there are senior centers located within each county, there is a lack of educational providers for Arthritis education

TN Arthritis Education Partnership Goals
• Establish and maintain a network of UT Extension educators who are certified to teach AF programs. • Improve the understanding about arthritis as a chronic disease among rural Tennesseans. • Teach rural Tennesseans to be better selfmanagers of their disease by changing their behaviors that lead to better control of symptoms.

Building the UT Extension AF Certified Instructor Network
• Conducted series of AF certification
programs across the state from 2004 – 2007 • Training 54 UT Extension educators in various programs • Conducted an Arthritis Update professional development conference in 2005 at three regional sites
– Rheumatologist, pharmacist, physical therapist and AF staff – Requested by UT Extension educators – 2008 Arthritis Update


Role of Partners

TN Chapter of the Arthritis Foundation
• Tennessee Chapter of the AF
– Certification training – Evidence-based programs – Quality control of instructors and programs – Record keeping for national reporting


Tennessee Department of Health
Provide funding for
instructor training registrations ($100 ASHP & AFEP, $200 Tai Chi ► travel to and from the certification trainings, meals and hotel if necessary ► AF educational resources ► partner meetings and national meeting ► development of low literacy educational and promotional materials


University of Tennessee Extension
– Coordinate training sites – Promoted training opportunities – Develop low literacy educational and promotional materials – Funded the Tai Chi instructor trainings – Institutionalize the AF programs as part of the UT Extension Public Health Education Program. Must include in annual plans of work. – Provide web-based impact reporting system (SUPER) – Develop indicators and collecting program impact data – Develop and maintain individual Web sites for each program and the partnership

Partnership Impact
• CDC Grant revenue ($60,000) • Improving the quality of life for 5,737 Tennesseans in 2006 • Recipient of two national awards in 2006
– CDC Partnership Award – National Arthritis Foundation Public Health Innovation Award

• 2005 CDC Exemplary Program model for other states

Arthritis Self-Help Program
• 2,383 ASHP Graduates • 86% women, 12% men, 2% youth • End-of-Program Survey:
– 86% increased confidence in arthritis management

• 3-Month Follow-Up (n=1,987):
– 100% improved ability in coping with arthritis – 57% improved overall health


Demonstrating Results

Arthritis Self-Help
Exercise Program End-of-Course Evaluation 3-Month Follow-Up

Tai Chi

Self-Reporting through Pen and Paper Surveys

Arthritis Foundation Exercise Program
• 747 participant • 54% women,46% men, 15% youth • End-of-Program Survey:

• 3-Month Follow-Up (n=350):

– 81% reported exercises safe and enjoyable – 74% improved performance of daily activities – 74% decreased pain and stiffness – 75% increased range-of-motion – 63% decreased pain and stiffness – 88% continued the exercise routines

Tai Chi
• • • • 3,607 Tai Chi Graduates 77% women, 15% men, 8% youth End-of-Program Survey:
– 86% decreased stiffness – 82% improved balance – 71% improved in overall health

• 3-Month Follow-Up (n=1,200)
– 100% continued practicing Tai Chi – 77% improved in overall health

Outreach Strategies
• Extension educators collaborate, plan, promote, implement, evaluate/report • Partner with newspapers, health care providers, senior centers, county health councils, health departments • Offer program to community colleges and university

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Outreach Strategies
• Partner with newspapers, health care providers (physicians, pharmacists, physical therapist, worksites, senior centers, county health councils, health departments • Offer program community colleges and universities, senior centers, fitness centers, rec centers, churches, worksites • Work with media and community events to promote AF programs and educate public about arthritis

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User Fees
• All fee-based programs • ASHP - $35.00 • AFEP - $32.00 • Tai Chi - $48.00 • Fees Enhance:
– Course Materials – Agent Training – Travel

• Partnerships are vital • Must have strong coordination, trust, respect, follow-through and cooperation among partners • Outreach through Extension can expand the rural capacity of AF in creative and diverse ways • Funding from CDC is vital • Win-win partners at state and county levels • Real winners are the Tennesseans who participated in the programs and now reduced their suffering from arthritis. 27

Tennessee Arthritis Education Partnership