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Nutrition education
Did you know?

  • A serving of meat should be no larger than a deck of cards
  • The chemicals in certain plastics can leach into your foods
  • Many margarines contain high levels of trans fats, which are known to increase bad cholesterol It’s been said that you are what you eat, and most medical experts agree.

Through research and analysis, health professionals are learning more every day about the role of nutrition in preventing disease and maintaining good health. “As a dietitian for the FirstHealth Centers for Health & Fitness, one of my favorite responsibilities is helping educate the people who live and work in our community about healthy eating,” says Kathy Hefner, R.D. “Too often, people get needed information about nutrition after they have been diagnosed with a health problem. If we can reach those individuals earlier, we may be able to prevent or delay future issues.”

Each year, the Centers for Health & Fitness offer educational programs on a variety of nutrition topics. Most sessions are free and open to anyone who is interested. Staff members also speak at community organizations, churches and neighborhood associations on a regular basis.

FirstHealth Centers for Health & Fitness are located in located in Moore, Montgomery, Richmond, Hoke and Robeson counties. During Fiscal Year 2008, about 430 individuals attended 40 educational events at the Centers, and more than 2,300 people

participated in 21 outside programs. Some of the topics included:

  • Controlling Your Cholesterol
  • Plastics and Your Health
  • Metabolism Matters
  • Weight Loss 101
  • Learning About Whole Grains
  • The DASH Diet to Control Hypertension
  • Nutrition and an Irritable Bowel
  • Cooking with Fruits and Vegetables
  • Nutrition and Alzheimer’s Disease
  • Nutrition Over 50
  • Portion Distortion
  • Slow Cooker Recipe Demonstrations

Healthy Living in the Mid-Carolinas
Most of us are aware of the dangers of smoking and poor nutrition. We read about them in newspapers, hear about them on the radio and watch documentaries warning us to avoid the pitfalls on our TVs. Too often, words aren’t enough to convince us to change our lifestyles.

In the mid-Carolinas, however, concerned community members are developing walking clubs and trails on church grounds, scheduling educational programs to address health issues, requesting healthier options in vending machines and rethinking refreshment choices for workplace meetings. Their enthusiasm is contagious, and their efforts are spreading.

The driving force spearheading the changes is a new FirstHealth initiative called Healthy Living in the Mid-Carolinas. Sponsored by a seven-year grant from the Kate B. Reynolds Charitable Trust, Healthy Living promotes healthier lifestyles throughout the region—targeting the low-income and underserved.

The project kicked off in July 2007, and reached more than 1,000 people in Hoke, Montgomery, Moore and Richmond counties during its first year.

Healthy Living encourages physical activity, healthy eating and tobacco cessation through proven comprehensive education programs including Active Living Every Day (ALED), Healthy Eating Every Day (HEED) and FirstQuit.

Active Living Every Day uses step counters and written activity forms to help individuals get a clear picture of exactly how much they move. Participants complete special assessments to measure improvement over the course of the program.

During 2007-2008, 274 people attended ALED classes and 88 percent completed the course. Of that number, 58 percent showed improvement in the quality and quantity of their daily physical activity.

Healthy Eating Every Day: What does the nutrition information on a food label really mean? Is it possible to make good choices at a restaurant? Can you eat healthy foods on a limited income? HEED helps participants understand how food choices affect their health and well-being. During the class, individuals keep daily food diaries and set goals for healthier eating. This might include increasing fruits and vegetables, decreasing fats, and eating additional dairy products and whole grains.

During the first grant year, 443 people took part in HEED. Seventy-five percent completed the program, and 99 percent showed improvement in their food choices.

FirstQuit: A successful tobacco-cessation program, FirstQuit includes one-on-one counseling, support groups, nicotine replacement therapy (patches, gum and lozenges) and prescription medication to help people through the quitting process.

During one year, 285 tobacco users enrolled in the program and 66 percent completed a quit plan.

To measure the program’s success, staff members conduct follow-up calls at one-, three-, six- and 12-month intervals.

To reach those people who might not otherwise be able to participate, FirstHealth offers Healthy Living programs in central locations, recruiting participants through non-traditional settings such as churches, medical offices, worksites, schools, the Health Department and the Moore Free Care Clinic.

Expenses for Healthy Living during its first year totaled $693,840. Of that amount, $182,110 was funded by grants.

The effects of poor nutrition and tobacco use are well-documented. According to the Centers for Disease Control and Prevention, tobacco-use contributes to heart disease, many types of cancer, respiratory infections, chronic lung disease, stroke, miscarriage and low-birth-weight babies. Nearly 11 percent of North Carolina’s health care costs in 1999 were related to tobacco, and employers lose around $50 billion in production and earnings due to turnover and absenteeism related to health concerns resulting from smoking each year.

Inactivity and poor eating have a similar impact. People who are overweight or obese are more likely to suffer from high blood pressure, diabetes, osteoarthritis, heart disease and some cancers. In 2003, an estimated $2.1 billion of health costs in North Carolina were the result of obesity-related illnesses.

FirstReach in Montgomery County
Montgomery County is one of those unique places that many of us happen upon accidentally. Its rural setting attracts outdoor enthusiasts, and its people keep them coming back—people who are warm and welcoming and remember what it means to be a good neighbor.

Unfortunately, according to the North Carolina State Center for Health Statistics, these same people are 48 percent more likely to die of diabetes than other North Carolinians.

In fact, according to the North Carolina Division of Public Health, 5,400 Montgomery County residents have never been screened for diabetes and another 1,000 have pre-diabetes (blood glucose levels that are higher than normal but not yet high enough to be considered diabetic). Of those who have been diagnosed, at least 44 percent have never had any diabetes education.

In July 2008, FirstHealth introduced a special one-year initiative designed to improve the statistics and, more importantly, to make a difference for Montgomery County residents.

FirstReach is a community-based, grassroots effort to improve outcomes for people with diabetes. The goal is to screen, educate and follow up to ensure successful disease management. Patient navigators, some of them bilingual, assist with follow-up and education as well as locating screening sites and assuring attendance.

Since the program’s debut, members of the FirstReach staff have visited senior centers, worksites, churches, health fairs and medical offices to provide screening services and educational programs. During its first three months, FirstReach screened nearly 200 people. Sixty (31 percent) had abnormal results.

If a screening detects a high sugar reading, a diabetes educator will meet one on one with the patient to discuss the situation, needed care and available resources.

“Unfortunately, it is not uncommon for people with diabetes to miss appointments, run out of medication or blood glucose-testing supplies, or forget needed tests,” says Melissa Herman, FirstReach coordinator. “Our goal is to support them in making good decisions.

We help them with organizing their care, scheduling regular followup, accessing services like prescription assistance. We link them with health care providers in the community and help them avoid falling through the cracks. Hopefully, with the right information and needed tools, they will take the steps to maintain their health.”

The FirstHealth Montgomery Foundation has committed more than $40,000 to assist with FirstReach.

Healthy Carolinians support
North Carolina is made up of many unique communities. They differ geographically with environments ranging from sandy coastal plains to rugged mountain terrains. They are economically diverse with bustling urban centers and quiet farmlands. Likewise, their people hail from various backgrounds, education levels and cultures.

With such an eclectic mix of people, places and resources, a onesize- fits-all plan for improving health and safety is all but impossible to adopt. Therefore, the Governor’s Task Force on Healthy Carolinians encourages local partnerships to tackle such problems at the community level—creating plans that are as unique as the towns and counties they target.

Each partnership is made up of key community leaders, agencies and health care providers who join forces around a shared vision for health and safety. Together, these teams assess the strengths and weaknesses in their respective communities and develop plans to increase awareness and improve the health and well-being of all residents. Through a statewide network, the partnerships share their efforts and learn from one another.

FirstHealth is actively involved in Healthy Carolinians Partnerships throughout its service area. • MooreHealth (Moore County) was first certified as a Healthy Carolinians Partnership in 1995. Since its inception, the group has worked hard to improve health and quality of life for people in Moore County. Working together, its members have helped establish Habitat for Humanity in the community and assist those residents living in substandard conditions (no indoor plumbing, no heat, no running water).

The current focus areas include obesity, tobacco use and teen pregnancy prevention based on results from a 2005 Community Health Assessment. More recently, MooreHealth has secured grant funding to improve the availability of physical education equipment in the schools so that all children can be active. Another grant enabled the group to purchase an abstinence-based healthful-living curriculum for the schools.

In addition to being actively involved on the board with health initiatives, FirstHealth has provided administrative support and coordination, office supplies, grant-writing expertise and a meeting location to ensure the continued success of the partnership.

  • Healthy Hoke Task Force (Hoke County) is made up of two committees to help local residents adopt healthier lifestyles. The Chronic Disease Committee (CDC) emphasizes efforts targeting diabetes, obesity, smoking, lack of exercise and poor eating habits based on the results of a 2007 Community Action Plan. During the past year, the CDC introduced the Eat Smart Move More African-American Church Program and the Winner’s Circle Healthy Dining Program in addition to developing a system of community walking trails.

    The Adolescent Health Committee initiated two educational programs. Baby Think It Over reached 90 young people. This hands-on simulation provided teens with experiences that realistically portray the demands of parenting. Students cared for “babies” (dolls with computer simulators) that reacted like real infants. The committee also reached out to area middle schools through Abstinence Plus Education, reaching 253 students. FirstHealth employees serve in both communities and actively participate in all projects and programs.
  • Richmond Healthy Carolinians Partnership (Richmond County) organizes its projects according to age-specific categories (0-19, 20-49 and 50 plus). For the past two years, the group has emphasized health disparities, youth obesity/overweight, teen pregnancy prevention and health information for seniors.

    Over the years, FirstHealth has offered support in a variety of ways including managing minutes, organizing meeting agendas, compiling data and assisting with health assessments. FirstHealth also shares the responsibility for providing a meeting location and needed supplies.

Community Case Management
If you stopped the average man on the street and asked him whether he would prefer to be in a hospital or at home, his answer probably wouldn’t surprise you.

Most of us prefer the comfort and familiarity of our homes to a medical setting. Yet, for those struggling to manage a chronic illness such as congestive heart failure, COPD (chronic obstructive pulmonary disease), high blood pressure or diabetes, lengthy and costly hospitalizations are often a way of life.

In the fall of 2007, FirstHealth of the Carolinas started a program designed to help patients control their symptoms and reduce or eliminate the need for extended or repeat hospital stays. During its first six months, the Community Case Management Program enrolled 31 patients. For many, the results have been nothing short of astounding.

Take Jane Smith*, for example. Jane suffers from COPD and related complications, which make breathing difficult and painful. During the year before she was enrolled with Community Case Management, Jane’s average length of (hospitalization) stay or ALOS was 14.6 days. After she got help through the program, the number dropped to just three days, resulting in a cost-savings of $10,504.49 based on an average direct cost per day of $905.56. Even more importantly, however, Jane feels better and is more confident in managing the symptoms of her disease.

These decreased lengths of stay are attributed to patients’ increased compliance with self-management and early detection of disease warning signs and symptoms. Through Community Case Management, volunteers schedule phone calls to assess each patient’s health. Access to telehealth services, when appropriate, further improves outcomes.

Patients enrolled in Community Case Management benefit from services such as:

  • scheduled calls to assess disease management and to determine the need for referral for medical intervention
  • home-based assessment as necessary
  • medication management and assistance accessing needed medications for indigent or underinsured patients
  • referral to appropriate community resources such as the Department of Social Services, Meals on Wheels, Department of Aging and various FirstHealth programs
  • health education
  • coordination of transportation to medical appointments
  • telehealth services for the most at-risk patients

Community Case Management is available for those patients who:

  • have had three or more admissions to the hospital for the same diagnosis within six months
  • cannot afford essential medications
  • need help managing their medicines
  • have limited financial resources
  • have a clinical condition that could result in a high rate of relapse if care is not well managed

Patients are not eligible for the program if they have a current or past history of drug or alcohol abuse, current or recent primary psychiatric history, known criminal record, or reside in an unsafe environment as documented by a physician or discharge planner.

The Community Case Management Program serves patients who live within a 30-mile radius of FirstHealth Moore Regional Hospital. A registered nurse coordinator and highly trained volunteers staff the program, which can accommodate 130 active patients.

Physicians, nurses, case managers, ancillary staff, friends and family members can refer patients to the program by contacting the program coordinator. Patients can also self-refer.

(*Name has been changed.)

FirstHealth Cares
A patron standing in line at her local pharmacy during a recent flu season witnessed first-hand an exchange that is played out all too frequently in communities across the country. An elderly gentleman, obviously distressed, questioned the technician about each of the six medications he was picking up. He didn’t have the money to cover the cost.

One by one, he analyzed the bottles to determine which he needed most. He left the store with only one bottle of medication.

Although he promised to return when his monthly Social Security check arrived a few days later, the woman observing his predicament couldn’t help but wonder if he would.

Thanks to many years of research and advances in health information, we have access to medicines that treat chronic illnesses, manage the side effects of chemotherapy, reduce pain and improve how we rest at night. Taken as directed by our physicians, these medicines can keep us healthy and active. Unfortunately, if we don’t follow instructions, our health can decline, resulting in additional medical visits and sometimes even hospitalizations. Taking one pill every three or four days to “make the prescription last” or choosing between medications can result in a medical emergency.

What do you do when you have to choose between paying for your medicine and buying your groceries? It’s a question many people ask themselves every day.

Although many pharmaceutical companies provide certain prescription drugs at no cost for people who don’t have insurance and can’t afford to buy them, the very people who could benefit most usually don’t know that they exist or don’t know how to access them. If they do, they often need help filling out the applications and providing the necessary health and financial information.

FirstHealth Cares is a pharmaceutical assistance program designed especially to help such patients. The medications that are available at no cost through the program include those prescribed for chronic conditions including diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), emphysema, high blood pressure, high cholesterol and asthma.

FirstHealth Cares began as a two-year initiative funded by the North Carolina Health & Wellness Trust Fund. The fund’s ongoing support—as well as generous funding from the Kate B. Reynolds Charitable Trust, the FirstHealth Montgomery Foundation, the NC Office of Rural Health and the federal Health Resources and Services Administration—has allowed the program to continue to develop.

Some of the money donated by the FirstHealth Montgomery Foundation provides medications for people who are waiting for their free drugs to come from the pharmaceutical companies. (There is generally a three- to four-week waiting period.)

It also helps FirstHealth Cares purchase certain generic drugs, which most pharmaceutical companies don’t provide.

Since 2003, FirstHealth Cares has assisted more than 5,000 people in Moore, Montgomery and several other counties. About 1,800 people are in the program at any one time. Between April 2003 and August 2008, the FirstHealth Cares staff processed 25,450 requests for new prescriptions and refills—a cost savings to patients of more than $5.5 million.

Any patient who does not have prescription drug coverage and meets financial qualifications is eligible for assistance through FirstHealth Cares.

Initially, a prescription assistance coordinator will schedule an appointment. Financial qualifications will be assessed, and applications to secure needed medications will be signed. A pharmacist then reviews all prescribed medications to ensure that:

  • The medications can be taken together safely
  • The medications are right for the patient and his/her condition
  • The patient is not taking unnecessary or duplicate medications
  • The patient is informed about less-expensive alternative medications

All FirstHealth Cares services are free of charge.

Dealing with cancer’s unknowns
Beth Dietrich deals daily with the unknowns of cancer.

A licensed clinical social worker at Moore Regional Hospital, she works only with cancer patients and their families and caregivers. Her job has many facets, but a big part involves providing comfort and support and sharing information.

“I have a laptop, and I take it all over this campus,” she says. “It helps me get the job done and spend time with patients.”

Dietrich never limits the time she spends with patients. “I don’t wear a watch,” she says. “I give them the time for their individual case, because everybody is different.”

Much of Dietrich’s time is spent providing free counseling therapy to patients, couples and families who are dealing with cancer or the after-effects of the disease. She also maintains two cancer libraries—one in the Community Hospital Comprehensive Cancer Center in the main hospital and the other in the nearby Outpatient Cancer Center. Both are stocked with books, books on CD and other resources on cancer as well as materials to help patients and families pass the time during hospitalizations or treatments.

She facilitates two of the cancer support groups that FirstHealth sponsors—one for active patients and their loved ones and the other for people who have completed treatment and are trying to return to the routines of daily life. And she is a connection to CARE-Net, a program that links cancer patients with cancer survivors for support and information.

“CARE-Net is one of the best things that we offer,” she says. “It gives survivors the chance to give back and new patients the chance to hear from somebody who has been there. It’s wonderful.”

Many of the people who come to Dietrich for assistance are anxious and frightened, so it’s her job to help them figure out how to cope—usually by drawing from the strengths of previous life experiences.

“They all have strengths,” she says. “We just have to remind them what they are and how to use them.”

RMH Wellness Screening Day
A persistent nurse talks a middle-aged man into having his first-ever PSA screening. The results indicate that he has prostate cancer.

A high school football player has a blood test that reveals a platelet problem that could have caused internal bleeding if he had taken a hard blow to his body during a football game the night before.

These are true stories, taken directly from the archives of Richmond Memorial Hospital’s annual Wellness Screening Day. There are certainly hundreds of others like them after 26 years of a program that annually offers screenings to Richmond County residents who otherwise might not have them.

Many of the screenings are free; others are offered at a nominal charge. One year, in observation of the event’s 25th anniversary, the Richmond Memorial Hospital Foundation covered the entire expense.

“This is one way we can help improve the health of people in our community,” says then-Foundation chair Debbie Quick. “I know there are folks who can’t afford to have screenings if there is a cost attached, and some of them no doubt have health issues that they are not even aware of. Wellness Screening Day is an ideal opportunity to get those issues identified so they can be dealt with before they start causing serious health problems.”

Every year, dozens of FirstHealth employees and Richmond Memorial Hospital-affiliated physicians volunteer their time and service to Wellness Screening Day, an event that actually starts several weeks beforehand with pre-draw testing. Those who have their blood drawn for various tests or have an EKG (electrocardiogram), pulmonary function test or other screening can then pick up the results at the actual Screening Day event when local health care professionals are available to discuss the results with them.

“There is no telling how many lives we have touched in a positive way through Wellness Screening Day,” says RMH President John Jackson. “People really do take advantage of it, and that tells us that they see it as a very valuable, worthwhile service.” services

Total Hip and Knee Class
Every year, FirstHealth’s orthopaedic surgeons perform about 1,000 joint replacement surgeries. Every Wednesday, men and women who are about to get those artificial hips and knees attend a Total Hip and Knee class to learn about what lies before them.

The two-hour class, held on Moore Regional Hospital’s 2C nursing unit where patients recover after surgery, has been meeting for about 15 years. Prospective patients are invited to bring a family member who can also participate in the class, ask questions and meet members of the staff.

“The class is provided to allay the fears, concerns and questions that the patient or family member may have,” says Evelyn Dimps- Williams, R.N., the assistant director of 2C Orthopaedics/Urology. “It also allows them to meet the staff—nurses, therapists and discharge planner—that will be caring for them and to see the unit they will be on. Evaluations from the patients and family members are always positive and indicate that the class is a great help and gives them insight into what to expect.”