RESOURCES AVAILABLE ma THE REDUCEON C
0s: CORONARY HEART DlSEASE
m A RURAL COMMUNITY '

Scholarly-Project for-the degree Of
’ Masts? of Science in Nwsing
MICHIGAN STATE UNWERSSTY

MARY SEGER N033
1992

1.5.4.»: “‘13.

 

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Resources Avaiiebi

of Coronary Heart Di“

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in a Rurai Ccmmunity
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Mary Seger Nose

Submitted to
Michigan State University
in partiai fuifiiiment of the reQUirements
for the degree of
Master of Science in Nursing
Coiiege of Nursimg

19L)?

Resources Avaiiabie for tne neQUCCiQH c? Lcrorary heart ciseuse .h

a Rurai Community

By Mary Seger Moss

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The objective of this study Was to assess

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reduction resources. A teie
Memoriai Hospitai service area. a rurai cummuni
partiCipants were variOus heaith care organizations and schoois.
The intervention was to contact and assess variaus reaicn care

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organizations schoois in regards b0 coronary heart d1

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reduction programs and practices. The main Outcome measures ware

Choiesteroi Reduction programs. Sodium Reduction programs, Smokiog

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Cessation programs, and height Loss programs

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Choiesteroi Reduction program, one Sodium Reduction program, one

Smoking Cessation prograr, ans four Weight Loss programs in the
Otsego Memoriai Hospitai service area. Coronary Heart Disease is
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the number one kiiier in the d.S. Aimost one haif o? the dea;r
Otsegc>County were reiated to cardiovasCWTar disease. There are 'ew

resources avaiiabie in the Otsego Memoriai Hcssica: service area

to heip an individuai reduce his/her r‘si Fcr the oe‘eiccieit of
coronary heart disease. Lifestyie mrdifisat'chs cs reduce t e

risk of deveioping coronary heart disease. It is innerative that

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more resources for reducing coronary heart C1bdgce be JBVEfsbed i»

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itai serVice area.

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the Otsego Memoriai Hos'

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Tabie of Contents

Chapter 1 The Probiem ................................... i
Ctatement of the Protied ................................ 6
Purpose of the Prciect .................................. 9
Assumptions .......................... .... ............... TO
Conceptuai Framework ..................... . .............. 12
Figure 1- Access to Medicai Care Pram work ........... ...i5
Overview of Project ...................... .. ............. 19

Chapter 2 Review of the Literature..........................20
Characteristics of Popuiation~atwRisk...................22
Risk Factors.... ................ . ....................... 24
Risk Reduction Programs ....................... . ......... 30

Characteristics of the Heaith Care Delivery System......35

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Figure 1— Access to cardiovascuiar Ri

Reduction Programs. ............................. ........37
Overview of Project ..................................... 41

Chapter 3 Methodoiogy and Procedures . ...................... 42
Survey ..... . ............................................. A
Agency Seiection ........................................ 48
Procedures .............................................. 43
Evaiuation.... .......................................... 50

Chapter 4 Data Presentation, Interpretstion

and Recommendations. ................... . .................... 53

Tabie of Contents iCcnt.)

Resuits of Survey ........................... . ....... ....s4
Figure 1- Cardiovascuiar Risk Factor Reduction
Programs in the Ctsego Memoriai Hospitai service area...€2
Figure 2— Cardiovascu.ar Risk Reduction Programs... ..... 63
Impiications for Nurses ............................ . SC
Appendix A Survey Questions ................................ SB
Appendix B Resource Directory ............. . ................ 33

References. ............................................... ..84

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A Sincere thank you is esncerucd to a)» cliOiu.iJ DVUJBbt

chairperson, Barbara Given, Ph.D. and the memiers of my schoiariy

project committee Patty P

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United States. It. kiiis aimcst an; many individuais ans cancer,
accidents, pneumonia and ifiueiza aid uii itier .ausss a; dcutr
combined (American Heart Association, 10:1). In 1:98, aione, there
were 511,150 deaths From cu onary heart disease. This year
1,500,000 Americans Wiii have a myocardiai infarction, 5“0,00t at

them wiii die from the myocardial infarction. More than one in

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four Americans have some from of cardiovascuiar disease (Ame
Heart Association, 19:1).

Michigan is rated the tflmrti worst ctate ‘hi the nation in
regards to death from coronary heart disease. In 1988, there were
125.6 deaths from coronary heart d;sease per 10n,nr1 :ewc'e 1'
Michigan (American Heart Association 1932). The Michi

Department of Pubiir Heaith (1992i reocrts this as ‘0 ”TS deat‘s

due tx) coronary heart disease (Michigan Deoactaent of Pubii:
Heaith, 1992). Michigan’s age adjusted reart disease death rate

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has been above tne rat orai rate SSHCE tme dzc 1070 s (N 'n‘gai
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Department Of PuDiic Heaith, 733:). coronary heart C1“ use ‘0 a

serious probiem in Michigan.

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In 1990 chego county had 1:7 tsca. deaths, iith is caiths ate

to major cardiovascuiar diseases and 54 of the 83 deaths are due
to death from coronary heart disease. Forty seven oercert o? tn

deaths in 0tsego County (n283) were due to major cardiovascu:ar

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eases such as coronary heart dise

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CereDrOdeC'u 1a.? di::::-'loc:, dimmer-sot, :9: (31:18, ciiid Coat-Jr. {41.392.10'31“ 2-4" fh‘s‘

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arteries and cap “.ur es (ricr jzn ce"u**ment c‘ uti'c He. ti

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1990). Coronary heart di:cqoe was responsit.a tcr s1 of ti, t, a

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deaths in Otsego county in 1993. Primary new

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-?th care professiona'
shouid assess iwmeir patients ‘flar cardiovascuicr' risk factors.
IndiViduais need to be aware of the risk factors that can Tead to

the deveiopment wf coronery ieart disease. .he individua.s who are

of coronary heart d secse snou d

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at high risk for th;
then be referred to progress twat car he:o them reduce their risa

for the deveiopment of coronary heart disease.

There are a muititude of risk factors that can increase an

individuai’s chance of deveioping coronary heart disease. Risw
factors for coronary heart disease inriude being maie,

hypertension, eievated totai c oiesteroi, eievated LDL choiesteroi,

iow HDL choiesteroi, cigarette smoking, diabetes me‘iitur, a

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history of definite rerebrovascuiar or occiusive peripheral

vascuiar disease, severe obesity and a Famiiy history of prematare
coronary heart disease (US Deoartment of Hea th and Human Services,

939). Most of the risk Factors for coronary heart disease are

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under the individuai s controi. Individuais can reduce their risk

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of coronary heart disease, but oniy if they are made aware of

risk factors for coronary heart disease and are motivated to make

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individuai in mating rifestyie changes to reduce his/Per risi for

developing coronary heart disease.

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disease include a caHQFete coronary Mecrt unabace {Tan regaetTOfl

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program or indiVIcuca trcur .0 :cr each ris! fa.,or. Tn~ e ha»:
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been a number of comnanity based c:.d.oyrsralar 3.:ease tre.ention

programs deveioped Which have proven to be effective in reduc ng
rise factors for the deveiocment of coronary heart disease is ea
& Basch, 1990; Gold & Franks, 1993; a Van Camp,1990). Crnish
(1990) has deveioped a comprehensive program for tPe pcrooee of

reducing risk factors for tre deveio ment of coronary heart

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disease. The components {if Ornish’s {1930) program incio
smoking cessation, ewercise, weight reduction, stress reduction,
hypertension reduction, and serum cho2esterrT redortion. There are
also programs the have been deveioped to use in the schoo? syster

for chderen (Waiter & Wyhcer, 1999;

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Wynder, 1988). The prograr deveioped by Waiter et a1 ( 1383 &

1989) targets the risk f tors of cigarette smokino sedentary

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TifestyTe, obesity, and high serum choie“teroi TeveT. The program
targets chderen in the fourth through ei nth crades and is
deiivered by the teachers in the schooi.

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factor WOUid inciaoe.

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hypertension reduction programs (Working Group on Management of

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Patients with Hypertersicwi and Hion Biocd (Choinst.roi, i091)

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cholesteroi reduction programs (US Department of HeaTth and Human
Services, iSSe), s.oking cessation programs (US Department of

HeaTth and Human Services, 1990), diabetes education prograas and

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cardiova

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aluation,
care professionals will

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factors
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a directory of
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thsego hfifimorial Hosp .fl.. serricea.a*ea. h.e pr TKJ51 flea -ri care
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professionals may tnen ass the Llfeot©ry as a .escurue -c refer
indiViduais at rngn FMH? for tre development of coronary heart

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disease. Thls is the flret QoCD :H attelocsflg LU altv‘ Ceiavl F

to reduce individual’s rich for the development of coronary hear

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disease. The prima y sexiugi care professimials need re») w.

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assisting ENi indiVidual iri reducing the risk (of coronary heart

dise s . They need to know what resoor es are available so the;
can make referrals as needed, once the high risk indiVidual has

been identified. If‘ there are run resources lavailable hi *he
community, the primary health care professionals should work
together to develop variocs proorams for the redoction of roronary
heart disease.

Assumptions

The assumptions if this scholarly o oie t inc7ode:

1. Nurses and physTCia 5 view cardiovascular risk r

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important.

2. The primary health care professicnils must rave resource"

available in their community to refer the natients at high

risk for the development of coronary herrt disease.

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Patients need current knowledge of resources in tmeir
community to reduce the risk for developing cardiovascular
disease.

4. Patients must be notivated to mate the reoaired lif
modifications reouired to reduce the development cf coronary

heart disease.

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The ass"rntio‘s lists: atoms are all ii;_'t.nf factirs in
reducing the number of deaths cause“ by cardiovascular disease.
Nurses and phys cians view ?t is moortart for individuals to
reduce their rorl factors ffi"Uwe ievelo'mert :flir-;r nary heart
disease (Mann & Putman. iSSo; 3 Wilt, Hubbard, & Thomas, 199C}.
Unfortunately, nurse” and physicians .ind their knowledge apo't
available resources lackirg in regard" to referrino individuals
to reduce their risk factors for tne develccnent of poroniry reart
disease. This he not cnfly'.a problem 'fli t‘e =Dtsego Menorial
Hospital service .area, tum. also oi tre inmahe United States .as
demonstrated by carcioxasculzr disease being the number one killer
in the United States. Therefore a directory of resources for
reducing risk factors for the development of coronary heart disease
is imperative for tic primary realtn care profes“ioral. T*e first
step in reducing cardicvascular disease is making the dire tory of
resources at the .ocal level. If tre primary realtr care
professional cannot educate individuals hi regards to reducing
their risk for the development of coronary heart disease, ttey mist
know where to refer the individuals at risk for the develo“me"t of
coronary heart disease.

The scope of ‘this progect will be limited to tte ‘Ztsego
Memorial Hospital service area. The geogranhical area will be
limited to Otsego Memorial Hospital’s service area wh rh s Otsego
County and portions or Montmorehcy and Crawford Counties. Ctoego
Memorial Hospital is the small community hoso‘tcl ah'cr ser es this

area .

The researcher wil‘ ‘Wiyv be a-sessing the cow aun'tl for
resources available t3 reduce twe risk c. deveo~ no aidio escalar
disease. This lflF;rm;t’Q0 w ll then be developed into a resource
directory of 'escurres. This s orly a snall parc of the coal of
reducing deaths frtm cardiovascular disease. Primary health care
professionals mus assess for cardiovascular risk factors and refer
their patients to the appropriate resource to reduce their
cardiovascular risk factors. Individuals at risk for LEe
development of cardiovascular disease must make behavior rhanges
to reduce their risk fo the development of cardiovascular disease.
The resource directory is only the first, but important step in
beginning to reduce cardiovascular disease in the Ctsego Memirial
Hospital service area.

ConceptualrFramewcrk

This project will sous an ice characteristics of twe health
delivery system. The availability of the resources will be
determined by the volure, distribut on, and availabiliiy of
coronary heart disease risk reduction programs in the Otsego
Memorial Hospital service area. The organization vcriatle is
determined by what services are actually available in the Otsego
Memorial Hospital service area. The knowledge of the availability
of coronary heart disease risl reduction programs will be provided

to “the primary' healtn Care providers 'through the this of -.e
directory of resources. To educate the general ptblic shout
coronary heart disease risk reduction programs is bcyond the state

of the CFOjeCt.

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The LUT‘V‘JU’ Lid] F? l. ‘3va ‘ T, -17. W 1] 1-: Woe-.44 is: ULlQ L‘ ‘..1J;o_v l:
the Access to Hedi::l tare frzro.crw c:.e ;t;d nu A‘t>, C‘e“‘s.

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to resources ave-latle to t;e t;imary neanh care professionals Lu

refer indiViduals at risl f_r the LEVElCuJefit c; coronary Lear:

disease. Acce s mar be cefined as those dimensions which descr“be

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the potential and actual entry of a given popul:ti:n group to :re

health care delivery system. Tne probability of an indindual’s

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entry into the heae

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of the delivery system itsolf (the availatility and organicctIgd

of health care resourres) and the nature cf the wants, resources
and needs that potenttal consumers may bring to the care—seekino
process” (Aday et al, iu34, 3.13}.

Access can also be defined as “availability of hea in

facilities and personnel (i.e., physician to ptru:ation ratios)

(Anderson and Aday, 1973, p.534). Access is assumed to be eduitable

to sill people {xvi based :mi the ‘nmjividual’s needs. Access is
considered ineduitable when ”services are distributed co the basis

of personal characteristics such as race, family income or p‘ace
of residence rather than need'

Anderson (1984) analyzed the data from a national survey regarding

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access to medical care. They found that ”Rural peopi

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once the individual has entered the sy:
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policy. This study wil Focus on the organ
health delivery system. The organizatior
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care professional. This researcher wi

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the resources available in 'he Ctsego News.

area. This will include locatinn, tyoc c.

Figure 1-ACCESS TO MEDICAL CARE FRAMFWORK

 

 

 

V/

 

Health Policy:

«i...—

 

financing

 

organization

 

 

 

Characteristics of
health delivery

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availability:
volume

distribution

organization
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immutable

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convenience
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Characteristics

 

 

 

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the program "h rega as to resources ava.lau e t redure the
development of coronary heart disease

Health policy is determined 2V the f‘nancing orgin zat'cr.
Health policy cat ts defired as the rrgarization tPit is
responsible for financ-ng health care resources for the reiitiion
of cardiovascular disease. Hea.th policy affect“ theracterist cs
of the health delivery system.

Utilizatiin cf health serv tee is deterrined by type, sIte,
purpose, geographical location and time irterval of the progr~n
”Utilization rates are CCJEQt‘VE irdicators of i iividoaes site 7
entry to the health care system IAoay et al, l99a, p.6). The type
of program, location, ouroc:e cf the orogram and hours a.a lible
are all factors that irfluence itili::thmi of healfn servires
Characteristics of the health del ‘efy system ahd ctaracteristics
of the population~at~risf are the concetts that imtact utilization
of health services. Utilization of health services af.eti;
consumer satisfaction.

Consumer satisfaction is the sub;etti.e i dIcgt;r o" the
consumers opinion of the health care syste“. 'Ccrsuwer satisfacticn
is dependent on the conveniencr fifd avallaoility of tre healtr care
services. Consumer satisfaction is also derendsnt on the cost of
the program and the characteristics of the brov.der. E.ery cowcepp
hi this framework has EUl impact on consumer satisfact‘rn The
concepts include characteristics rif the hsaltl fisli er; sy rem
utilization of health SGFV‘CEE and characteristi,s of the
population—at-risf.

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of the develoooent or :orowary heart disease. Most of tre r:sv
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Memorial Hospita_ serVice area are uraware o‘ the resources ro"

individuals at risk for the develooment of coronary hgart disease

Resources will ircluJe smoking cessaticn programs, weigrt lcee
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reduction programs. TRe researcrer will assess the available

resources in tee rural commurtty.

A I “ ‘ " ' r’\r ’
QVBIYJGW,Qf tie Project

The Following cheoters will consist of: Chapter 2, Periew 0F

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Related Literature, Lhrfitel g“ Hetruuotcoi' age Proceeures an;

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3w3' reirt. d seas: lSE the ri,nter i il‘er 'vi tre isn‘t
, 37}’ rea't :J:;e;se is 'WM*'rej as ”:e? site er
nfarCZTCr 3r :fiei‘rite ryccarj‘al “schemia :aioh
{US Ceca *we~t. cf liealtn and riuman Service
year as :Wy as ‘.§DO.COO Americans will hive a rea
were team 500,009 an: them will die (fixer can «e—
1991). There are a hunter 1? r:sl factors tr
irdividual s chai;e o? d vclcpirg carorary tea
The risk Fact: 3 are: elevated serum total cholester
ol, male 56%, family n sterv o? oremature corcnl
ace, cigarette siouirg, hypertension, low H
diaeetes ncllitus, a histo y o? cefiwi
disease, and severe: obesity. Researchers ix.
reduCing the ncJ1Siatle r‘sh Factors the Cren-e
e=rt ciceaee can be reduCez.
reed to te assessed far t‘eir risk a;tors for L
corgn rv neart disease. Indivicuals a risk for t
of coronary ieart d‘rease inst fflwai as retsrrej
at can help them lover tneir risi factars. Sifia
to leef their ris~ .actors is not effecti.
need guidance and seaport wnew maiine nagcr lifesty
Cne cf the major problems in .hu Ctsefl: ”emuri
service area is lack cf availaple resources to redu
e 01 (marorary' nea t (jisecse. .ne :utrovea CF tn
be the cevelocmert of a rescurce directory oit wh
available in reg-r:c to researces tiat can assist

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et al (7905) :ddresse— ;ard a‘ascalar digs; : QWJUV the neai f ".
of the characteristics cf t e o’culatiwn-ac—r‘s‘. ”Pro'iderc rs'
document disease states thrccgr variaws alihita. tests awd
procedures” {Aday et al, 1035, p.5l.

Characteristics cf the copulat‘onnat-r‘sl trot slotlJ Le

affected by crovidind access to cardiovascular risk factors ar

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to change or alteration ( Morris, 19?6i.

include ”general health care beliefs and attitudes and knowledge

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of health care information” (Aday et al, p. 3, 1195). Th'
outcome should provide resource information to the primary health
care professionals iWM) than should eduzatc ‘Uwe general public
regarding cardiovascular risk factors.

The variable corcnary heart disease is definrd as a cefinits

5

prior myocardial infarction or definite myocardial ischemia, such
as angina pectoris" (US Department of Health and Human Servirss,
1989, p.23). A myocardial infarction is ”ischemic necrosis of tne

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myocardial tissue due to an abrupt derr

u‘na pectoris or myocardia

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myocardium” (Greene, 1987,
ischemia is defined as ”pain or discomfort described as
retrosternal, squeezing, gripping, strargling, burning or‘vise line
sensation that may or ma~ not radiate to the necl,

arms” (Greene, i987, o.365). The American Heart Association (1:31)

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reports 1,500,000 Americanr
year and 500,00J will die doe to the myocardial infarction.

I r-\ I) W / .‘n K In ‘ r' ‘- ’ A ‘ ‘ r V ‘ V ,... I / ‘ —‘
fiDpFOledtely s,c4t,oo0 Americans have angina pectaris.

Men are :tLFiigner risk i;¢“ijxa devefoonern::ar coronary
' -\ v“ v~ . -.~ ~ - ‘. “- r-—, f I“ l —v - '- -—. .— 5.- I -~ .-, >. «I
disease than woren. Levy ed al ( ‘30) reports from the Fran:

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, . ac rs.nmq».. 'nms.wt . A ._fi .fi, - ,i / g a,”
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from the Framingham study, men comprise ate c;

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amj women comprise 40%) cf eaél coronary events. Men
coronary heart disease at a yo'nger age and more freduently
women. This is a risk factor that can not be modified. Men
to be aware that they are at higher risi and therefore reduce

risk factors which are mod 'iaole.

Family history of premature coronary heart disease is arr

risk factor that can rmm; be modified. The National Choles

Education Program defihes family history a: i ”definite myoca

U)
Y1-

infarction or sudden death before age 55 in a parent of sio
(US Department of Health and Human Services, 1989, p.

Schildkraut et al (i989) in the Framirgham Study assessed

subjects for family history of death from corwnary artery dis'

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The researchers found trere was a o0% increase in the risk Tor the

development of coronary heart disease in those individuazs who rad

a

a parent die from coronary artery disease. This 30% increase in

risk for the development of roronary artery disease was true for

both males and females.

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Hopkins et 3H {ifiaw

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“eternflrvs if family history‘ :f :orcnary artery disease= is an
independent tljfi' factcr‘ frr i-se developmeLt {H7 Cirrhary ATLL”,
disease. The researchers found trst f3““ly h story of t ronnry
artery disease was n ghl' sign.ficart. for tte develo; ert. 35
coronary artery disease fan ly riotory is a risk factor that can
not be modified.

Smokin‘ Cigarettes is :3 risl factcr“fsr the deve'onnsnt cf‘
coronary heart disease. La Crcix et al (1991) assessed mortality
and smoking in older men and women in three different communities.

..j

The study consisted of 7778

aged 65 years and older w

had no history of myocardial infarction, strobe or cancer.
Mortality rates were two times greater in smokers than non—smokers
in males and females. Forner smo ers nad cardiovasctlar mortality
rates similar to those subiects who had never snoked.

In the Multiple Risk Factor Intervention Trial ’VQFIT).
researchers also found an increased risk of death from coronary
heart disease in smokers when conscred to nrn—smofe's. T3e
researchers studied 361,662 men over a ten year follow up period.
Results from smoking cessation are raoic in regards to radacing its
risk of develohing coronary heart disease. ”After or: year cf
smoking cessation, the relati/e risk of dyii; of corC‘=ry heart
disease 'flor the duitters r=s concered to twee non—cuitters was
significantly lower” (Ockene et al, iBQO, p.954). ~w3king
cigarettes increases an ino./idoal’s risk for tn; development 0i
coronary heart disease.

Hypertension is a ris‘ factor for the develictent a»d cortrcl

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Follow up Program Studl"d 10,94D hyoertensive patients over a 71‘
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rate in the treatment group. The follow up study found a CCHEEHU*

reduction in mortality even after the program had ended. ”It

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postulated that regression of hypertensive end organ crang=
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has hypertension, car
take appropriate action to reduce tre blood pressure.
Hypercholestero,emia is a risk factor for the development a
control of coronary heart disea“e. Hype orolesterolemia
determined by tota cholesterol and LDL cho'esterol levels. Hi
levels of HDL reduce an indiVidual’s risk for tte developnent
coronary heart disease. The He

1987) was a randomized doubze bl ind five year tria

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subjects wnc to: ”.Ler1rolesterslemia. Tie BXDQVlTEHle an
received oemf b.o;il. LL‘ sit.li;sric drug. -x’i tre cvitrt‘ C“
received 5i placebo. The researcrers foond g1 34% reduction
coronary heart Ulbsaié “w t“e e-cei‘meit;l u ;-o. Tie raj ;t

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of coronary heart C.o:1b6 in t.: e ceriue ta

after only two years of study.

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existing cardiovascolar disease in re:ation to their choleste

L.)

levels. Tie researchers assessed 2o41 white males aged Ao—é‘
old for an average of Tu,i years. The researchers found 3.45 ti
higher risk cf death from cardiovascalar disease in men with :4
existing coronary heart disease and increased sercm choleste

1 - (- ~ I’ 's‘ , . I" 5-‘ -I 1“ .- , - ~ ‘ 4“. '-‘ ~\ .- .- r F ' ‘-\ , ~ .v. ..
level when compared to men imm) had coroiarv hes t di ease

.m‘m «- Fm. 'l a..~ , '4.‘. K,. . ,_.._ p, .. “
normal leVels of serum cnoiesterol. Hrgh serum cmolesterol 'ex

'.,~~s;nrj rvaM-~ f stw- ia+u srs,i,~swm~swc in.
:‘wurtciifi'd wildcl' e C :||1lr ha. 914" I ‘l ‘11.): ‘gr‘uilt _/ 1"."

can lead to

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HDL serum cholesterol levels become a risk "tor whe-
level is ”below .35 dg/dl confirmed by repeat. measurement"

Department of Health and Human Services, 1983, p.23). Jacobs
al (1990) in a follow us of tre Linid Research Clinics Prevale.
Study studied 8,825 we: 'nd womcn. Jacobs et al (13903 found

inverse relationship between rfifl- cholestenol and cardiovascu

disease mortality in both men and women even after controlling

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age, LDL cholesterol, triglycerides, txmh' mass index, sy
blood 0 eosqre, and smoking.

Diabetes Mell’tus is a risk factor for the development

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Rancho Berna do sou v, oar euo cunno., can.

diabetes. Ma e stbgeccs wits diabetes ta
hazard of cardsovascular disease as
diabetes. This stddy was done over a 14

male diabetic su jects and 137 female die

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that caused females with diabetes to b
coronary heart diseasc, only that dicoet-s
increase 61 females risk cf" cevelccfng
(Barrett—Connor & Knaw, 1991}

Rosengren, Welin. isicceiahni, & mi
males vntfi diabetes add 'Ume effect inc
smoking had on the risk of coronary heart d
studied 232 smelf rebcrted diabetic wale

diabetic male sub*ects over a three year

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unable to find any significant interact”

factors, smoking, diabetes and hyoercnc

researchers did find that individuals wit

smoked and had hycercholesterolemia did a

risk for the dev lccment of coronary heart

factors an individual has for the develcr

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coronary heart : «ease. Li.tetes Vel‘itu: =c ;a serices r s
factor for the dexe‘come t f _, c ary heart d sease.

A history cf :e'eor .ae_uldr C‘se’se is a risk F371)“ for tn
develOLment and co‘trol :flr'Wsrciarv nea:t disease {Lfii Lecartmer
of Health and Humzn Ser ices. ’98s). 8 rna, Biller, Slorton,
Seabold, (ififiOl resort: ”In Lastienfs wit [gas/*otor tic ca*oti
stenosis, fIAs. an: “FCFET‘C stroie, the leading catse cf deato i
myocardial infarction. Clinical eviderce cf is"teri
cerebrovascular disease is a strand marier for unoerlvirg cwronar
artery disease" (p. 21}.

Harmsen, Qesergrer, Tsicog:anni, 3 Wilhelnsen, {iGGCl stcd e
7,495 men aged 47—55 in regards to cardiovascular disease ris
factors and stroke risa factcrs. Two hundred tn rty cf tre 743
men had strokes. Dis? factors for nonLeWmorrnagic strcle were big
blood pressure, smoking, and severe csychologiocl stres‘ as wel
as atrial fibrillat.on, nreviots transient ischenic attac%s, as
intermittent claudicatfdw. Hioh oiocd rreosu e W1: the inly rix
factor for intracerebral hemirrrage SCVLLBS. Risk factors that ca
lead to the development of coronary heart diééfiS“ can also lead t
the development o. a stroke.

Obesity is a risk factor for the develcorent 40d to trcl w
coronary heart disease. Manson, cold tz, Stampfer, w llett
Rosner, Monson, Soeizer, S he-weienn, iiOWJE, in the three;
Health Study, found fema.es wio were even Wildly t; noder tel
overweight were at increase; risi fcr the de;eldgre't cf ’3 -nar
heart disease. “an is ”t al (1990) stcdied i‘E,P : fe ales age

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30-35 years, cver an 3 year tire cericc. The women were divided
into five groups based on we git in kilograns divided by the square
of the heigrt l“ metE‘s Ti— suc3e1tc were free cf disease at the
cnset of t‘e SZqu. ~.certeds.cn, d acetes vellitas a'd

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Egan, Bogset, a Bloc , (19:1) studied 257 men ii rcnarcs '2
OCGSltY. carciovas uleu Flél faocqrs 1nd one. Toe research»rs
found that older men had more cardiovascular risk factors overall.
such as nycertension, hypercrolesterclsmia, and j 'CLop
intolerance. Cbesity in younger wen increased the ore ale oe cf

. i'. .—.—- .fl - —‘.--i —.. a .Hm h -. ~ ,. ,
Other caFOlC-vasuu Id? r to ., fa-uC‘C‘F‘s Susi: cc: .‘y’per teris' - .,

h" h"-]’.‘Q*':ar"1-Q‘i‘ ‘ —o i“ 1- ”in; For I’D‘t "’“ ‘1-( r... 1 ' 27 ' Ti ,2
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researchers dvd not prove that ooesity’ is a Fish factor ma
cardiovascular cisease, :xfly' that irt younger wen ”M; caused as
increase in other cardiovascular risk factors.

Researchers from the Nurses Health study were able to prove
that obesity 'hs an independent rhy< factor fcm‘ coronary heart
disease in women. Egan et al (1991) found that although obesity
is not an independent risk factor for the development of coronary
heart disease, it does increase tre prevalence of other
cardiovascular risk factrrs sucrias hyoertensicn. diabetes nell‘tus

and hypercholesterolemia.

Risk.Redgctign_Prerams

There are ea varietv of reasures and stia;;g.es a -r ion;
r R ~. ’~ . ,Fx '- q 3“ -,, r: c , ‘-. 7“ ‘~ + r , . . _-. .-- ~. ~ \ : ‘ I r A
health care profess anal oak use so ass at ai -r;‘.idaa i'i

lowering their Flil for tr» oexe 3LTEfit o soronary heart d weise.
Toese measures llC‘JCd snoii g cessation weight loss, a od-'~
restricted oiet. :no seram tholesternl reducti3n.

Sioking cessatioi oan te aol“EVed by a npmter of activities.
The primary healtl care professional can "resoripe a Nicotine hatch
which also includes a poor.eo on behaviirrl changes needed to do :
smoking. The primar. health care professiona' can also set up a
smoking cessation prdgrrn to use with a gross or individual“ that
smoke. The p.‘nary health care :mofessional cxmi also use tin
manual from the Maticwa. Cancer Institute entitled How to Help Y‘ur
Patients Stop_€noring (58 Department of Health and Human Services,
1990). This program m"Rides ilaoging all the cha ts of
individuals tkwm; smoke semi advising them an; eat?! visit C» the

importance of

stop smokino a

primary health

material includ

of this program
is done within

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profes.inial. There tut: also se f fe;a

'ed for the patient. One of the important aspects
is the follow up care. A post taro c. thone call
seven days in: the quit date for all indiViouals

king cessztion. a follow 'o vis*t is sc*~doled 1“

he du‘t date, with a secovo follow up Visit at 1—2

nal measure a primary health oare profes~ional can
refer the individual to £3 formal comwunity step

A smcling cessation gizur C’OVlCeS social support

ery effective for some individuals interested in

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bmplzlr:g udobdtlw'rl amt! m'dl'jTTt :Ccr \i:'c)l'.l~.i;':j u. sci},- oil I't..u-,~3L.:':.=;"'.c “r

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Patients \NTU: Hyperten

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PrTnldry health (ea-'3 UrL‘FBCQTpKJS; boll i'flCrLJ t. .:;r Lawlemoo \Vto-i'. .015}?

A 1-.ku r‘ '.‘. r4“,- ‘,'~-‘l,* ,<\~,,-\ - - - +1 - \
b1LOd Dre'bbdrt: [.1 L414)..-«-A':3:|' j “(.1er :3 l‘SJUCC‘ C'efir c-4.t lrlud’ ”:3. HE

' "~ ‘F‘r 1‘ " ." ’h‘.\l"‘ W7.“ “1 ’— r‘.t‘.;- ‘ I“ ‘~- ‘: f' v ‘ I n" - ‘ " I‘ .
Souibb Comuafly has de.elcuec a toun.et eitltled Living NEZH Ltbo

S-lt (So The booklet has a

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brief discussion of row to FEGuCe salt intake. The rest of the
book lists a variety of fooos with the amount of sodium in the

book. This booklet can be discussed with the patient, strategioe

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can be set up, an: the doublet can be sent home with th
The patient could also be referred to the local d;etirian if the
Drimary health care orofessional is not able to counsol the
individual on sodium restri;tion in the diet. A sodium restr'cted

diet can reduce an indivioual’s blood pressure thereby reducing

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his/her chance of developing or cortrolting eais
disease.

'. . 4 ' -. 7177 .‘_ _ ‘ \1 ' _' '_ _ ,_'_ ,W :_ 1-,“ ~;.,-..v.. .
Reducing hypertrolesteiczemia will decrease the QS‘B‘QPWC.L

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and increased severity of coronary heart disease (US Department o
Health and Human Services, 1939:. The three l fesiy e
modifications that the indiVidual must do to retune ris/ner seruh
cholesterol are: reduce cholesterol intake, reduce saturated fat
intake, and reouce calories in the diet (US department of Health
and Human Services. 1939).

There are two measures the primary hcalth care or;fess‘gnai

F - I ‘I I I II" " r— "- ‘4‘ / .— A ,—\/ ,‘\-'a. -I - ‘l \‘- +- 1’ ".n
Carl USB to l’l‘BHJ an lTlGlV Gual reduce lllb,‘l'l‘:‘? :3...”th o'fi.‘-€;.~..~;’Yt)l

:3

They are The Rational Choles1e cl Coucation Progrcvg and The
American Health Associations Step I an: Step II diet plan.

The National Cholesterol Education Program has specifit

guidelines for oifferewt total cholesterol awj LDL cholesterol

serum levels. The guioelines inc uoe the American Heart

borderlinewoigh

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cholesterol levels and in some cases high blood cholesterol. The
National Cholesterol Education Program reccpmends a minimum o. six
months of intensive diet theraov before beginning medica ions to

reduce their serum cholesterol (:8 Department of Health and Horas

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Services, 9). If dietary therapy is not effective there are a

variety of medications available to lower serum cho! sterol.

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The .American Heart AssOCiaticri has developed a booklet

entitled Dietarvareatment of Hypercholesterolemia; A Manual far

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Qatients (American Heart Association, 7938).

cholesterol and saturated fats and measures to lower crolesterol

and saturated fats in the diet. The Dietary Treatwent cf

Hypercholesterolemia: A ManHal for Patients discusses the Step I
and Step II Diet and gives sample menu plans for various calorie
intake. Finally the booklet lists ea variety of foods tum} the

amount of Cholesterol and sat“rated fat in the food.

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Weight Loss: There are a variety
employ to lose weight. The primary health care profesSional can
counsel the patient on behavior changes needed to lose weight and

have iflma patient weigh 'Hi at various time frames. :ner; are

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various individual weigmt loss clinics Such as the Diet Center an

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Nutra-Systeoiavailabie ior people wro preter individual ccunselin

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itere are eflema va-ious gitmai prograis for ifii inoiw duals wr:

prefer SOCial support as part of tre WElghu l

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A cornple te rardiovascular Tish reduction

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tne National Chole sterol Education Prografliwoul d consist of smoking

ight reduction. serum chclest rol reduction, and

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cessation, w

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sodium restriction in the diet. The above Urentioned progr ams can
Ema employed .as :1 package ix: reduce (or cootrol cardiovasrurar
disease in the individtiel. The two measures a p.imary re :lth care
professional could utilize as :1 complete cardiovascular risk

reduction program are: Heart RV and Dr. Dean Ornish’s Program for

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Reversing Heart Dis sees
A book entitled Dr. Dean_Drnish s Program for Rewersing Heart

Di se

e (Ornish, 1990) law; an e cellent proghwh for decreasing

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cardiovascular risk factors. The book provides measures to
decrease fat and cholesterol in the diet, stop smoking, start an
exercise program, decrease high blood pressure, and redute stress.
This book could be recommended to the patient or the primary health
care] professional could incorporate the measures ihto his/re:
practice.

Another' measu e the irimarx' health care professional can
/

employ as a way to reduce cardiovascuiar disease hos been develjped

a

by the American Heart Ass ociaticn ar

7- as n . i. ,— "‘ "~ — 4‘ r‘ —- ,r I ’x ‘ ‘. ~ 5 C' I ‘ — A i H

education Prcg ram (AweriCan Hes t A-soc1ateon, iDe.). T“ s l: a
N .1 ~‘. -\ a -- .” ." h - N It. \ rs ‘ "X ’ ‘ ' ’\ ( q -‘ | — '- y (

group .1? mudu;es used ta) address t~e ffilltrwi J r»: rai-. s

.~ ’ ' “ " ' ‘ I “ r‘ ' I a . I r": I ‘ v I- 4' "i —-. T ‘i 'I ~. 7* - r‘\ ‘ "i . "' 1 ' '
smoning, hype* ension, and diet mad fisat;on. .tis .rOgran a.so

includes educati;h regarding tie wc*ii g sigrs of hzart attar a“d
stroke. This brrgrar is ;es';ied s be used in a p h.r, rveili:
care setting and includes gt des and materials to .ats ”* the
individual in lowering their "is‘ for the :exelccreht and control
of coronary heart disease

Individuals W“d eryage in ri.h risk bena/iov mus he iirgeted
by the primary health care profess.onals. The primary health care
professionals must them either assist the individual in reduc ng
his/her high risk behavior or refer that individual to a resource
that. can assist tre individual in reduc rg .ii"her hiah risv
behavior. The goal of this researcher is to oevelcp a resourok
directory that primary hea.th ccre professionals :ai use to refer
their patients that are at risk for the development of coronary
heart disease.

The charaCterietics an? the copulation-ct~rick that xvill be
affected No this study ;JEi cardionascular risk 'factors. The
researcher 'Hi this study ivfll be assessing the Cisego rerorial
Hospital service area for programs that Will provide access to
individuals at risk for the develirment of carjiovascular disease.
Characteristics of the Health Care Del very System
Characteristics of tre healtr care iel‘verv system would wcltde
health care providers ard eXist“rg risb reduction prv-rs"“ in the
Otsego Memorial Hcspital service area. Health care nrov1jers are
the individuals that provice prng are for the reduction of
cardiovascular risk factors that ;an lead to the develdb'eht of
coronary heart disease. Male se: and family history of premature

' -\ ‘ ;-- .— ' - . < ,4. ’- l - »‘ n‘ I ,-\ - i ‘ v-x - -\ - — -— ’— 1 $ ' ,-4
be addressed in regards to snaract» lstlcs of the lsai.
system.

.- L . , _, ,. , , - ‘ , — j ,. - ,.‘ 4- -‘ — — - 1 ' I- _ r—. - , f- a .‘ ‘.

T k} e r e a r e U v.’ ‘- - 3 i 1 Li I?” J Ix.’ t ’4 r 1 \._-.l .1 I ‘sd- -_3 L, +- .J IL . IL I ll; -1 l t. i L; C: 1. I f: r )'

which are avaisaoility and craahizatior (See Figure
Availability is determined by the volume and distritu

n . r‘- . 4-» ;-~_ ,.. . n - ,~. .n -- "\ ,.., A ’- - r3 .— I 1 I 3‘ ’- —\ f ' .
primary health care ENCffibbl'flai: and facilities (Aday

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I ‘ I 'r ' ' . I" y ;" .". g “ I". N. -‘ ‘," 'I ‘ I" “ " - ': 5 'T‘ t i ' {"1 e -‘
1985). The organizatici component is determined oy the iunt_

{47

resources av ilable to the individual once sre/he has ehtere

system. The nrnanizatidri component is further broken down i

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entry component and the structure ccmprnent (Aday et al, 1
'Hwa entry component ’63 determined t»! the conveniehc

A n A .-~ ' s ems u . '1~,' '14 4: '—.4 p
regular souiCe c hedital care. Tre axaiiapiiicv c. tre s-

in evenings, we hands, or even in emergencies can make the

(l)

more convenient for some individuals. Convenient may
determined by the amount of time it takes to pet to the
source and the mode cf tr.rsportaticn required (Addy et al,
The structure of the organization component is deterh
location, type of provider, and tvnes of paramedica' cro»
Dost.is alsC>a part of the str'cture of tre crca

A F I "". ‘.‘. ".‘W :f‘ q.’ I 3" EHI- I ""- “F2" I+":r‘\§‘.
Paramedical providers wculd inc cue nurse practitic e

Dhysicians assistants (Asa, at al, 13:5).

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Access to Cardiovascular Risk Reduction Programs

 

Characteristics
of the
HeaTth Deiivery
s -System_-__
A. AvaiTabiTity
1. Primary HeaTth Care
Professionais
2. Faciiities
8. Organization
1. Entry (convenience)
2. Structure
a. Location
b. Type of Provider

c. Cost

 

 

Adapted from:

by Aday et a1

Cigure 1

Access to MedicaT

QConsumer Use —9

(1984)

 

 

Characteristics
Of tne

Pcpuiation—at-risK

A. Predisoosing Factors

1. General health care
beTiefs and attitudes

2. KnowTedge of heaTth

care information

8. Need

1. CardiovascuTar Disease

(Heaith Status)

 

Care Framework

 

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invoivaj irtcrrut“;n 333;: a rea‘try ““‘esty’e a": neas; es to
reduce the frjzvidtaT‘s ris- Fa;tsrs. T=is ti; a \ne Say 7. -v
and took about one “cur c‘ the injiwidgc"s tine. Mod f at“: rist
factors for the de.e‘;:~eit -‘ -Q’qu.y i«a : disease were TL-‘:

in 75% of the cart :icants. Tnere wig re Fez-cw up to determine

' . '~ " ‘v " o ‘ ." .. ". - r‘ . ‘ F" "’ 3". .‘ + 1‘. ‘7 ," r" " ,"i “ fl" ‘ i \ " V" . I“ r . "
what Tong tern benef.ts .t; j tats: ircn cm s c'qQTAW («in tarp,
n.
1994).
. .q‘ ._ ,.. ,_ i .-, . - - ,td. .e ‘ h ., ’ »~. _ ..-- .' . ‘ ,- .~ _ «. .
A worK~sice flea tr 3.33,: “a program ti reduc.”g risks th

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were required ix: particic;te 'wi three c‘asses vaufli addF?S‘

— ,5 m ~ 1 ,-. “H r‘n . ,, .2 4- .-" , . ~. , - ~~ L— ,-. ‘-\ - 1'» -‘ r .- ‘1‘ -. - a
hyperchOIestere.emia, nycerceusion. o es.ty, s ys ti. iact.¢ t»,

. - ’- -- .rw I. ~' F. "‘1 '— * ."‘- ' l-\ r l I i ,-. (N '— ' - I , . I .- 'I .P‘ ,—-_ '.
and Cigarette bflmriN~. A registered nurse and registered dieticiai
1 “ "‘ "- M __ I" ‘ ' I 5" .- ‘ '\ ‘ r' ." ~. * .“ "l I v‘. ‘ V‘». \ . ," "- ,— r" .
taught the c asses. screeni g tor tTooJ tressuze. cic.este:c7
l- “ ( - 1 . l“ ’\ . -_ ‘ T " '- l P "‘ ’- { N y "‘ '\ ‘\ ': y
Tevei, and xwe-ght. we e= attitmmai. Jiere Was a L3.6 HTCFbibtr in
I I- “V ‘ r‘ "‘\”’\."r- .1 .~ . -~-- ..—- .- *.-'~ r‘*‘ >~r r'\.. v\
knowiedge Twagarding ctrdzovascu.ar r”hfix factors 21s a raiica-us
session which occurred sir weeks after the program becan. There
was aiso an increase in exerCise treauersy and a decrease in fat,
I— 1.‘ N, y. i -1n‘\ Iv: ', . .1” f-\I ' ”-1 4 K ”‘3 ~

cnoiesteroi and sod.um i ta»e (Masai-Levy et at, .93t).

Schoois can aTsc chVide education regarding cardiovascuia

risk factors. The “Know itnu‘ 833‘” was deveioced 'Dd educate

chderen cm cardisvascuiar r“@§s factors. The tnmyy.xn incizj;j

dietary intske, obesity, bios: cnciester'i ieve

(

smoking. It is a ssnooT based. teacher deiivere.
' ‘ A f‘ I - 1 .4 r- -\ I ' 4- {a . , .- -. . r r“ r‘. . \ -; xx -. I“ "1 r- , ,w . r“
administrated to ch.iu~en in tie fOuttt thicbgn e gttn giace. ! is

program was fcund ta be effective in Toweri g theTes era” Te=e7s

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Pesearcre’s race .3t~, t.at :, '3“ n; ...escy.e a ce'asions an:
I . ~ . \ ‘ ; "i _ + " ’ "‘ T , . 1‘4 . ‘: .“ U" " " 1 I‘ ' "' ’ ,' '. I_ ' + .~“- ‘ I _-, :1
reduCing risr fastwrs, .ndi.iuua-s a,e at e {a reiuce treir r13"

~- ' ‘1 ‘ ‘ “ f ’ ‘V b V“ ' ‘ , ‘- f“ "\ ~“ I I V" .‘ F. " ,“~ ” 3" '_\ l ’ ' "\ I ' " I I I I ) 'F‘-
for the deye.opmeht CT CCrgfiari Feart disease. Measures to rejuce

identifyirg inCiVTGuais at risk fer tre Ce e seweht of c roha’y
heart disease; a :3 redutf:g High risk behavipr. PTiTgtfi teaitn
care professiona s mtst isentify individua%s. at r‘LR for the
deveiopment of coronary heart disease. Primary regith care
professionazs can tren wgrx with the indTViogaT to restce their
risk factors. If the primary reaésm care professions? eannct teib
the individuai to reduce ii s/ter risi fcm‘ the ceveigphert of

coronary heart :disease tiey s och refer the h dividcai to a

resource that can heip the ‘Acixisuai reduce “is/her ris f;' t~e
deveiopment of corsnary rea : dis::se.

The prcbieh is that Primary health CAVE pr‘teesic‘315 in 1*e
Otsego Memoriai Hospital servise area ma” te uruware cf resturtes
for‘ individuais at risk 11w“ tre ceue'tshent, of amarcnary hea~t
disease. The purpose of this :rcje’t “ ta *a.e‘cp a d'rectory ‘

tt> refer the "hmjividuai inn) is .at risk fix“ the ie.e’;ime”t (of
coronary heart disease. This resource directorv wiTT be
distributed to primary heaith care crofess:cha:s to ase'with theér
ciients. The outccte cf this pro

resources for the p imary Pea‘th care orofessiorai t; -2: ts refer

individuais at risk for the deve

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t h r‘ t: u g n

prevention

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6

Appendix

(See

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teTephone

‘OTAOH

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The

Titerature

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hypertension,
severe obes

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the individuai's
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Hypertension

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1988;

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advanced nursi:

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the Clinical Nurse S:ec*a'

the primary heaTth sare or

reduction in the primary

iack of kn wiedge. The r:

complete coronary heart dis

reduction program, a Tow

progranu There are no

m

reduction programs in t“

Besglts of Survey

A variety of hca?th'“

Hospitai service area were

reduction programs. 'Jtseg:

programs to reduce cardiov

three weight loss programs

area.

There is :3 serious

programs in the Otsego Memoriai

Department and the MSU Co—L.

reduction programs of any

Department and MSU Co—Oo
prevention of infant mort-

or YMCA organizations in t

program,

coronary

Vemoria?

m

\spi

Hospital service

T‘s I" ‘~~ /

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offered

two times

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aTso provide

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R K ‘1 m I“ "‘ A +' “ I‘ '\ r " ‘ " “ "k l “ F 1 ‘ "‘ ‘- " .~'1 /‘ k‘ ‘ r‘ ' " l “, ‘_. p“. 1 4‘ .1 T
bn‘lyba l lg C9 :2:- w ‘ v L y.- a? ‘_a 1- L. I ~_ 54 I ’1 lw-«f 1V Vbt‘: j \J |\ t: I a V" la ‘-.J\."—.4’ ' t»: o
. . . ‘ . 1 . I
P g “N ‘u‘ H I, a 7- ; .., 1 ". #— z‘\ 1 r" -:. > c'. A r‘ x'-_ x- :2" 5:; v‘~ L‘. r; :‘ r r_\_. : ‘ v'x , I x. 1
program is par eccu :n t.e .ooa. tau: . T.- e was c-;n no .1

up for this proéram in the [tsego Memo iaT service are: to moni
how successfuT tie crsgram ras Seen.

The dietician at Ctsego Menoria? Hcspitai pr; i
individuai counseii:g T1 resaCirg sadism in 1's gist.

' I . -\ f" - I ’- .H. - -.-. -\ r‘.‘ ." 9 ‘1 ". "- r ‘. \ I ,I v“. k v ,- . " -
dietiCian UbUai?) recompenus JOOQ mg. of sea um per day whitn
basicaTTy no added sait. Ere resorts tn*s Teve? of sodium is

-
a
l

Tcwest amount CT sodium intake individua

('
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7
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fi
7
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need to buy speCiaT foods. the
before the patient is p aced on an antinypertensive medicatw
patient Titerature to take home. The or3g.am Tenc*r is based
dietiCian reports she usta:1y mcats with the DRtTEWt onTy once

feeTs this is aded ace. The dietiCian {my a“ Per phone rwgw

avaiTabTe if the patient has any duestion in the future.

is certified as a Diacetes Educator. The dietician is svaii
Monday through Friday OTOO~iECO. The cost is $15.C; for the fi

session and a $5.00 cnarge for any fo Tow uo visits. The pati'

(I)

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(IT:

(A:

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m

l" I “« A u I,“ '-.,-‘~ I.“ '~ F Ivar“ \l .— "rwxn‘ I ' [a ‘— 1.‘ L ". “ —; .‘ "i I. '~ r\ a‘-
is given a receipt which re/sne wdy cut it to n.9, er ..surgm

t I . I“ A ‘r‘x I? '.‘y r‘ - ,~ . r N ’- 0 -,,’-\ - . m. , . ,a
company. Physician referra. and elf referra7 are totr a.7ov

. ' ' . ’r‘ + Fr~ F..- ..-.T i . ‘ a :sm... : .. r
Tne dietiCian a patients are usua..y from this .-ad {:23- m

This is the oniy program availabie in the Ctseoo Mem~ri T Hospi
serVice area that can assist an ird“wijua‘ in T;te*:‘g *‘e" --s

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pl/HO\\/1d

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e 5 t e e e t d . i- T . ... t C

IV. . Ind F.» (\ fill Inr‘ p .h fnv +Iv r b
.T .

t
u'
e program

9

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h
C

Li

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6’
$15.00 for

t
time.
he
f
intal
rob
nta
individu
s
dietician
visits.
his/her

i

IQFV'i—i

2.8

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hy"iciaaw

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I

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'31

should be

3
v ‘

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4 I

I_.II

attempt

is

...:
......
-...

.w...

<3 Tl“ if

9“. P"."\("1 V‘
. v3

Memorial

k.
8
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2...

e l" V l

S

- .— ..—__ V \ .—\
-.. P r: ’Y .‘W
. .. «.4

:") .' ‘1

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m.’ .4 f-

individ”al

include the

v

Group

Hospital.

Pounds

......
e

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+.

+ g
a

S

r!

e

i.
l
I \./

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4—]

iutr

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properly a:

minute

, 4. ‘\ 1 A
“J L10 {.1 l .; LA]

IV}

km f\ I

15

a
l
.:

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A:

8

menu .

his/her

individual

n.4,.

f“.

2..
+ u
.5
...3
m:
a

...]
.1.

behavioral Chan

.k’ '4'-»

w«

ges.

in meeting

\
I

i‘l'

diet which

EU

‘\ .‘

is

program

a

I

through

I l’;‘

,r :
u

0..
9)..
Qv

indixrhdcql ‘2: :n 1... ‘“ain:e -yiie 145$; t”3"3 1? no 'szrge ft” the
wecllv waigw l". 3; : '..*;r;e .J"-491es nil“ cover this i‘ Lie
indiv73ual l“ 33 p--”:s o.erwe :r: inc ‘3 referred by a 'h>s Clan
Anyone cad is i : e Di:. ;;i*3 . Tie suc;~ss rate if this L~gg'-n
has not been :3-.rente1.

The dietician at Dtaego mercrial W0-;ital wxll ccureel tte
individual in we‘grt lcss. Ste use: tke American Diabetic
Association ex-hange diet t) assist the ind./iiual ii l-3 ”j
weight. 7.. calcr“ le e“ is decerni‘ej by tne p‘ .7. an or c» t“*
dietician. Tre trcg'ax. is based a. tie Indixidaal’a heejs n

r‘ ' .1" F, I .4‘ -\ . I -. , ‘I , I Is . - 1 '-\ r g" .-x -‘_ I ~ ' ‘ 4°». . .F.
regards to It». .ften tre 1rd.uid.a. -ees the cueti-iad. Th:
I . ' , \ r‘. ." .~ ,. - I ~ .. r~ I.- ,\ H C" —» . — ”‘4 . _. .— ,—, r.- 1‘ , ‘ ‘3 9i - $- ~ -' -‘ ~‘ - . J A m.
dlechlafl has :1 Ba-n l-I .fl‘ .cIence deg.ee ir...t.r.tIcn ..x. is
+ ' i f" C" P bl "\ F - I :- ‘~ , " T r 4" . ‘ ‘~ \ I I. ‘ " f‘ , .
ceroified as a -ia-etic -ducator. .he d‘eti-*an is a illGQIB M “JG;

through Friday 0709-1300. the cost of tre 3 :gram :3 $13.30 For

ion With a $3..O Charts for any fOilow up Visits.

the first ses

U)

r ' " "‘ ‘ I I“ "I r l" " 1. . . I w" 4 t“. "‘ I'” I". " I"'. \ 4' i - ’\ “I i ‘I- ' I" . ‘ '1 "
The patient Is gzweh a receIpt wrioh -e/sme may acts . ta the.r

... .4 , -\ ,.,.‘ -. x , - ‘ 4. . .. '_. l.‘ .. . ,. ‘ -. - . ..- . ..

insurance c-mpah>. Anycne “a; enter in.3 the program. The*e s
' . .r‘ ‘ ' . .\ -. . Y ... ,. ... 1-. ,- .. .-. __. . g . - , .

no follow up, therefore it is rwt know” Row so-.essfal t..« di.5*.n

has been.

Weight Watchers is a group program, with the social support
received by tne group an important component of Weicn: Watchers.
Weight Watcher teaches ird v duals ix; eat cor ectlv and 3H5;

teaches portion contm:l. Tne diet is. nutrit ehasly sound and

l '4- - \ .«. I .“ _ v 'I "‘ P. .l‘ " y .“ a \ ,‘» 1 .+ I .'x
includes all the food riroups. SacIal ouuLS t l: _ ‘;re- a- _r:

meeting and also over the phone :s needed. The program is ef‘ered

’« -.‘ — - V - I‘: ~ 'r- ..I * "'1‘." .. P... w.v.--'—.. 2- 4"" -
tWO tlmes EVEI'V 'I‘J‘S':‘L’~.. P'JT‘IUJ‘)’ 3.- 1.)-.U mud ‘7‘-"‘1C.‘\jf|"QLJLZJ/ .H_ n .- 1.}. Mufti

is a weigt:‘:i 22:: : tre ree-‘ng s:er:~. n»e *eecl
lasts 30—40 nirutes. T‘s it. ”a 1; l;;at:: at tie I;
Crurcr l’l GL/lLWC. F‘I. Tr: leaders are tr: ned thr
latc ers. Tte ;;:t of tie :r“;.s: ~s ESE.ZD re stra
$8.00 weekly “strah:e :ces n;t cover he“; t Wstnns
Watchers r"Des outer fi-Aicial a': t) l”jl ‘daals mrc std

renuiremerts of 30*n‘ng w; gnt Watcners are That the

' 1 f". (M ."' " H] " "‘ ‘I «C | ,‘ -" . r". ' .‘ "‘ ~ - .-" “ 3“. ‘ (-‘. ‘4 ‘ +' , ‘ I.F~ ‘
mLJSt ha‘Vle to IL, '3 git a‘Z’Qi : . 1&5 [:ch L40 CRLJL.» JV .1 P.g 54".: $731!

(1)

criteria.

Take Pounds CT? Sersibly (T-PS‘ in ”hot“

J 1': (1.12.4 c ler 'ZIT”C;I.,.U

..J
U 1
Li)
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program. It

1+

- ‘\
1,;

VI
u

( i)

U

to indiViduals trying to lose we ght. The nrcuo is se:

9)

"l- - A- -. ..- —.— .7:=.\ “_.-.”;- — ,7 .~-.—
by the iOCdl c”3ct€? and brov.des ptbzt:ve reinter-

motivation to ‘the indiVidsal attemotinq to
individual must see his/ner physician to determine the

The indiVidual Must bring a signed slid frem tr;

r”

documenting tre gral weight. Tie l”dTVlC3a. may follow

per week “hi Gaylord. MI. The brogran meets at ire
Church on Tuesday at 1930 and at St. Andrew Eniscons
Wednesday at 0990. The brevider he a vclsntegr ele-
members cf” the chapter. There are vmwtshops the C“
attend. The cost is $15.0: for the First two years, wt
to the national headquarters. The loca

', . . .| ‘, ' “’va- .-~‘- 1'...” -‘ a .‘ ... A-
week. Anyone may Jnin TCro bu t-ey wast L»uw tre-i

(D

{r}

k,“

determined by a pri"; « nea :n Cu'é orti‘:sicn .

There CTEE igw >‘ss s :3; “'or tVe .:::-.t‘oh , C CQVd';.;gfm-1
risk factors in t-e Ctseg; Vs *"‘al s~r¢ics area {See Fig re 1
2). 'Theraa 3!“: no (”a ”’2: e indii:/asttil;‘ r lo; rwsiant‘QNi ;*r:grtvr
There is one (no e;fe ol red-“t’Ci pr gr“, one restricted sud’
diet. prooran. :oe s oping sssation "Worrat, aid tour 'qeig
reduction pr-g‘”vs ir toe Ttseg: W~nor'al Hospital service area

The American Heaht AssoCiation, the Anerioan Ca cer Scoiet
and he American tug; Associati‘n all have their local ntFices
Traverse City. Traverse City is located 75 miles frcm CaglCrd a:
is not easizy accessible.

The American Heart Association -as oevelcoed weart’?.. wee
Rx is aa cardiovascular riak redusticn education prograw th
primary health care professionals can use in tteir office to assi
their patients in reducing the‘” risé factors for the deve opne
of coronary heart disease. The merica* Yea t Assariat‘go also t
a catalogue .rom wlich tit ”eneral nublic and -rimary wealth
professionals can crcer literattre regarding heart 3 stise. T“
wil 1 mail tne l vterefixgre ts) the l*levlCflJEl. Tne Lahore ruwnter
1-800—998—2422. The American Heart Association does r;t ‘ave
local office in the otsego Menorial Hospital serV'ce area. (3
Appendix B).

The American Cancer Society (rs literature rega ding snck
cessation and low fat diet. This can be ordered by tallies t
office in Traverse City. The American Cancrr Sic.ety wil ';3l :
.hfnrmation to the iecividdal. The nrone nweter is i-ECC-TAC~037

rx . _

i ‘A'
V. '-
.) .L
.4 'y

i

I“ V’
5.; ...

Tre American San;:r S ..:1; 1'3; in; “a e a :oal
Ctsego Moncrial ~,__‘:;' car ‘ce u’B“. lies i-:s ii»
The Ffie”lcal _Hrg Asso-‘at'on has Jayelaped t~
SMOKirg progrsi “.3; "s cf‘e ei tkroagt Ctseg- Vc'
T're .Aoerican 'qr: Auscoiaticri has a:so dexe‘cper

1‘!-

Cardiovascular Risk Factor Reduction Program: in the

Memorial Hospital Service Area

l l w-

The Video "H3 called .31 Control' and ‘flua cost is

primary healUi care professional couhd also use

J.

individual pat.ents. The American Lung AssoCiation

I

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literature regarding smoking

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‘oation tlwx; can te

calling the Traverse City office. The American can:

will mail the informaticn to the individual. The p.
1-800-678-5864. The American Lung Association in
local office in tte Otsego Memorial Hospital servic"

Pr'

. l

‘1

mar health care professinnals may call the

“<

Figure 2

Cardiovascular Risk Reduction Programs

 

 

 

 

 

 

Freedom Serum SOGium
From Cholesterol ReStricted
Smoking Reduction ; Diet
sufiption Am. Lung Assoc. Ind. Counseling Ind. Counseling
Group Program AHA Step I & I Diet
Social Support
Weight Control
we Otsego Memorial 0tsego Memorial Otsego Memorial
Hospital Hospital Hospital
517-732-1731 517—732—1731 517—732-1731
Provider- R.N. Provider- R.D. Provider- R.D.
n Weekday Evening Mon-Fri 0700—1500 Mon—Fri 0700-1500
Jan. & Sept. by appoint. by appoint.
L $65.00 $15.00 initial visit $15.00 initial
$5.00 follow—up $5.00 follow-up
gipility No referral No referral No referral

reouired

required

reouired

 

urance

 

does not cover

 

does not cover

 

does not cover

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2 (Cont.l 64
Cardiovascular Risk Reduction Programs
The Weight TOPS lWeignt
Diet Watchers LOSS
Center r ‘Program
iuiption Wt. Loss Wt. Loss Wt. Loss Wt. Loss
Ind. Group Group Ind.
Use own food Exchange Diet Social Support ADA Evchange Diet
we Gaylord Gaylord Gaylord Qtsego Mem Hosp
517—732-8922 1~800—487—4777 517—732-1158 517—732-1731
Provider * Provider * Provider * Provider— R.D.
n Mon— Fri Mon 1200 Wed 0900 Mon—Fri 0700—1500
0800—1700 Wed 1730 St. Andrew by appoint.
Sat. 0800-1200 Congregational Tues 1930
Church Friendship Chur.
: $82.00 Reg. $25.00 Reg. $15.00 Annual $15.00 initial
$32.00/wk $8.00/wk > 2 years $5.00 follow-up
$1.00/wk
gibility No referral No referral Physician must No referral
necessary necessary set goal wt. necessary
urance 50 pound financial aid does not may cover
overweight for those who cover
JDr. referral qualify 1
"ovider is non-professional trained by company

65

:rms :Mic trws 1~8W0-wnfinber \Vlll

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be inrlid d a: tie h~.l of The resource booklet. (See Appendix D).

The Michigan State HJTVDFSlTy co—Lp Extension Home Economist

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focus is (Mi child development. Sre die: lfifl; haye literature
readily available regarding cholesterol reduction in the diet,

sodium reduction in the diet, weignt reduction, or smoking

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cessation. The Home Economist is not int;respbd in the role cf

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coronary heart Cisease

time constraints.

Thet3tsego County Commissicn on Ag ng provides Meals on whee s
and congregate merls in Gaylord, Johannesburg, and Elmira. The;
are unable to provide a low salt ”let. They d3 add very little

1 .

P" + I .- .--~ I -N .N L“. ‘ ' . ‘1 I:.'.\ T ..-‘ r“ \ , 3" “ “x {i ‘2
Salt but the foods tney cse a.e llgm lH sodiu». i»e» also QrchJt

I " " 'h '. I -‘ '0 l ' ‘ 9— > L ' I ' .7‘ r ' ‘\ I ‘ 1" TI 7' "(K ' 1‘ ' A ’x - u" ’
fish and chicuen alteriaoixes to Leaf. The otsego county

CommiSSion on Aging s mission is to proyice fccc for people unable
to provide food for themselves. The Ots‘go County Comm ssion tn

Aging does not provide any educational programs.

i
J

“‘ “ I ' "\ n 3 ' T + " ' I“ ' i ‘ r" 1 ‘ .’ i x‘ ‘ ""‘ + ‘ ‘ I f) v" r‘.r .“ I W
ego County District Hea.th Department as awos 1mm

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provide any cardiovascdlar risk reduction programs. 'te dieticiar
who works for the District #3 Health Department is responsible for
four counties. Her focus is on WIC. She does not provide specific
programs on decreasing serum cholesterol and decrecs2ng sodium in
the diet.

There are two home health care a'

1

Hospital area whicn are: Fealth wares and Ctsegc Manson home care.

(I!

Home iealtn care agencies a: PC». proxide preventative rei ti
promotion {Ni a regular Lasis. T ere must be CUl acute red cal
problem, such as open heart s; gory, pefcre trey ire able to enter
the home and recs-i e consenscticn Fran tn“ insu a:ce cczpan‘es
They do DFOVlSQ health promotion tsaching,sucn as smo»irg
cessation, cholesterol reduction, _cd um restrictiw‘, weight
reduction, ahd exerCise as tris time out their primary Focus is on
the physiological aspects .TE care secorccry to the 'fiflfil heart
surger Health promotion teaching would l"e focused mn tn;
individual’s r.sk Factors such as smoking cessat‘in, chclesterpl
reduction, hypertension reductior, and an eyercise program.

Community edpcction d“es not provide any cardiovascular risk
reduction progrcms. Crilorwn ih bcth school systems, tre Gaylord
Community Schoo.s and St Mary’s School, are provided Wlth
cardiovascular risk YECQLt‘CW education in tr “r healtn classes.
This education occurs in {tr grade in the Caylcrd CjTléfi‘T“ Schools
and in the 9th grade at St. ary‘s School.

The Otsegc County Linrary does have medical baits that present
information on cardiOvascular ris factors. The medical bocls can
not be circulated out the librarian will assis The individual in
copying portions of the book. The librarv has books about heart
disease and the risk factors that lead to the develotne‘t of h~art
disease. lime library also inns poets (Ni smoking CESS‘ClOfl and
cholesterol reduction.

The 4~H program provides a or gran entitled Era,t ; lealtFy.
This program teaches E“E- was“ old children how l1) ware nealthy

snacks. It is cffered in can 'ry and lasts frc“n sun weeks
nroup meets ore Clue oer wee, The Provider s a uol"rte3r ard
program is located in his/her home The cost cf the "rcgram
the amount of Money needed to c yer the cost of t‘e sracvs.
Time primary problem identified is that trere enws so
resources tc~ assist .fise iid'vidual Hi reducing their r“nu
developing coronary heart di ease. According to the Aday e
(1984) access model, the Otse o nemmrial Hospital serv'ue a'ea
a serious proplem with availability of resources. There are

few facilities

assist an indivi

heart disease. N:

follow up.

n

available are

heart disease.

Coronary r

(f)

tates. Researc

pr

Insurance
paying a much
When insuran

ce

paying for it,

.8:

companies

developing

and health care professionals w.c are affillabT
dual in reducing tneir risk for ”evelcpinc corc
Tne resources tlat are available have little f
is difficult to lit»; ff the rescurces t~at
fective in reducing the risk of develop‘rg ;-rc
irt disease 7 tne 'umber one killer in fire tn
hers have snown that lifestyle modificat ans
d'als FTSR for th develCiWent of _orora~;
oblem, siting lifesc~te modification to reduce
coronar/ heart diseases, in ni’icn
temd to pay ikw" the acnte problem, we
maller cost to prevent i“he probler frcm o carr
ompanies begin valuing realtn promcti n and the
resources 11) assist :mi indiv deal ri decr";
the develo-mert of coronary heart disea e

his/her risk for

increase.

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The (Juaracter st c- of the nea;t> :el very' systch‘ ale the
primary heali Tare prefers c.als that can proviJe Cd'fiicyuocul;F
risk reducti n progra.s T~ere are ery few nrimu y health tars
profeSSicnals that can provide cardic.as:u‘;r r‘s* rejecti_n
programs in the Ctsego Munor'el Hospital service area. Thorefcre
there are few programs a a latle fo consumers to access 'u help
them lower their rism for developini cardiovasCtlar o‘sease. There
can then be little change in the general health ca c pel'efs aid
attitudes of the Ctse30 “emcr‘al hosnital service area iopulation.
Resources to lower ”affilCVESCUlaF risk fartcrs are one of _vy'
factors heeded for "Rama“nv* the death rate iWIWi cardiovas;ular
disease. Hesources 't: lower cardirxcscular r‘sk factors .re
needed in the Ctsego Meccrial Hospital serVice area to help change
the health status of the pope‘stion oi thc “tse,n Memc.ial 'csp:ta‘
serVice area.

The service area cfiltseud V‘Norial Hospital is rural. Theie
is a serious lack of programs to reduce the development of coronary
heart disease. Cardicvrs=ular c‘sease was respinsitie for almost
half of the deaths ir Otsegc County in the year 1990. The citizens
in Otsego County can demand more re“ources but first tney rust be
educated about cardiovascular disease.

Implications for Nursing

A Clinical Nurse S“€Cla1';6 can inorcase awa“eness ‘i the
community by speating to the various service groups, churihes and
in the schools. The Clinical Nurse 8 ecialisc cou.d also :7 ~t a
grass roots group ivith the goal tushng to provide :gardioviscular

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(1987) res iccluded a weird: reduct‘on tie: in her book Hacdboob

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»SurveyngN‘ Programs for time Reduction (H: Cardiovascular_ RiS'

Factors

I have Questions about a cardiovascular risk reduction program or
programs for specific cardiovascuiar risk factors. This shouid
inciude education cw“ programs ‘Hi regards 11> smoking cessation,
hyperten81on reduction, serun1 choiestero] reduction aux: weight
reduction. Piease compiete the foiioWing Questionnaire. You wii]
find an attached biank sheet of paper for any additionai comments

you wish to make.

.‘5
«4.

Survey for Programs for the

Reduction of Cardiovascuiar Risk Factors

 

estions

Smoking

Cessation

Weight

Reduction

Chol.

Reduction.

Sodium

Reduction‘

CHD Risk

Reduction

 

to you have any of the

cove programs?

 

knat is the 1ength in weeks

cf the program?

 

that is the time length of

tne program?

 

Time of day offered?

 

 

Is it offered on weekends?

 

Is it offered in the

evenings?

 

What is the frequency of

the program per week?

 

hnat is the frequency of

the program per year?

 

¥

where is the program

offered?

 

 

 

 

 

 

-_.___

Survey for Programs for the

Reduction of Cardiovascular Risk Factors

 

wtions

Smoking

Cessation

Weight

Reduction

fChol.

Reduction

Sodium

Reduction

"'\ P‘
'tHu RiSk

Reduction

 

.Nhat 18 the level of the

provider responsible for

tne program?

 

Hill insurance cover all

or part of the program?

 

What is the cost of the

program to the individual?

 

 

Is the program for groups

or individuals?

 

What is the health status

required?

 

Are referrals required?

 

h;

Are self referrals

possible?

 

Are only geographic
residents (county only)

allowed?

 

 

Other (please speCify)

 

 

 

 

 

 

 

Cardiovascular Risk Reduction Programs

in the

Otsego Memorial Hospital SerVice Area
Prepared by Mary Seger Noss
December 6, 1992

517-732-28 3

Table of Contents

Cholesterol Reduction Program

Smoking Cessation Program

Sodium Reduction Program

Weight Loss Programs

Appendix A Order Forms for

AHA, ALA, & AC8

Page

Serum Cholesterol Reduction Program

Individual counseling using the American Heart Association Step I
and Step II Diet. Content cfi' program consists (sf education
regarding foods high in cholesterol and saturated fats. Discussion
occurs regarding foods high in unsaturated fat, monounsaturated
fats and complex carbohydrate used to replace foods high in
cholesterolzmnisaturated fats. Usually consistscfi one visit with
literature given to patient to use at home.

Where: Otsego Memorial Hospital

Contact person: Miriam Adelman, R.D. 517- 732-1731

When: by appointment Monday through Friday 0700-1500
Cost: $15.00 initial visit, $5.00 for follow up visits
Eligibility: anyone may enter program, no referral is required

Insurance: indiVidual responsible for submitting receipt to their

insurance company.

Smoking Cessation Program

”Freedom from Smoking“ from the American Lung AsSOCiation

The program is a group program and ophSists of social support,

weight control techniques, and assistance 'Hi making behavioral

changes needed to stop smoking.

Where: Otsego Memorial Hospital

Contact person: Delorus Burroughs, R.N. 517-732—1731

When: Offered two times per year (Jan. and Sept.), group meets one
time per week
for seven weeks, meeting lasts two hours

Cost: $65.00

Eligibility: anyone is eligible, referrals are not required
Insurance: individual responsible for submitting receipt to their
insurance company. Insurance companies typically

do not cover smoking cessation programs

Sodium Restricted Diet Program

Individual counseling regarding restricting sodium in the diet by
a registered dietician. Discussion occurs regarding foods high in
sodium, importance of reading labels, and not adding salt to food.

Usually consists of one visit with literature given to patient to

use at home.

Where: Otsego Memorial Hospital

Contact person: Miriam Adelman, R.D. 517—732-1731

When: by appointment Monday through Friday 0700-1500

Cost: $15.00 initial visit, $5.00 follow visits

Eligibility: Anyone may enter program. no referral is necessary

Insurance: Individual responsible for submitting receipt to their

insurance company.

_Weight Reduction Programs

-Individual Counseling regarding weight loss by a registered
dietician using‘Ume American Diabetic Association’s Exchange Diet.
The number of calories are determined by the primary health care
professional or the dietician. The number of visits are determined
on an individual basis. usually only one visit occurs with

literature sent home with the patent.

Where: Otsego Memorial Hospital

Contact person: Miriam Adelman, R.D. 732-1731

When: by appointment Monday through Friday 0700-1500

Cost: $15.00 initial visit, $5.00 follow visits

Eligibility: anyone may enter the program, no referral is
necessary.

Insurance: Individual responsible for submitting receipt to their

insurance company

-The Diet Center prov1des individual counseling regarding weal
planning and measures to reduce food intake. Individuals are given
lists of foods in the four food groups to choose from for eacn
meal.

Where: 1349 South Old 27, Gaylord 732—8922

Contact person: provider trained by company

When: by appointment Monday through Friday 0800—1700

Saturday 0800-1200

Cost: $82.00 registration fee and $32.00 per week. Some
insurance companies will cover the cost if the indiVidual
is 50 pounds overweight and referred by a physiCian
Eligibility: anyone may enter the program, no referral is
necessary,
unless the individual meets the criteria for insurance

coverage.

—Weight Watchers provides group counseling regarding a

nutritionally sound diet. The diet is an exchange diet and has been

developed tn! Weight Watchers Social support 'hs an important

component of the group intervention. Individuals may attend two

sessions per week but should only weigh in one time per week.

Where: Congregational Church Gaylord 1-800~487-4777

Contact person: provider trained by company

When: Monday 1200 and Wednesday 1730

Cost: $25.00 registration fee and $8.00 per week. Weight
Watchers does provide financial aid for those who qualify
There is no cost to the individual once they have met their
goal weight.

Eligibility: anyone may Join this program, no referrals are

necessary

-Take Pounds Off Sensibly (TOPS) provides social support through
group intervention to individuals attempting to lose weight.

5

Individuals may use the diet prOVided by their primary health care
professional or the TOPS’nutrition monograph which is an exchange
system for meal planning. The TOPS’ nutrition nonograph also
provides nutritional advice.
Where: Friendship Church Tuesday 1330
St. Andrew Episcopal Church Wednesday 090“
Contact person: Rose Hensen 732-1158 provider trained
by company
Cost: $16.00 annual dues for two years. $1.00 per week

Criteria: Physician must set goal weight

Index

American Cancer Society. Order Form, Appendix A

American Heart Assoc1ation, Order Form, Appendix A

American Lung Association, Order Form, Appendix A

Cholesterol Reduction Program, 1

Smoking Cessation Program, 2

Sodium Reduction Program, 3

Weight Loss Programs, 4-6

Appendix A

Cardiovascular Risk Reduction

Programs

 

 

 

 

 

 

Freedom Serum Sodium
From Cholesterol Restricted
Smoking Reduction Diet
mription Am. Lung Assoc. Ind. Counseling Ind. Counseling
Group Program AHA Step I & I Diet
Social Support
Weight Control
ye Otsego Memorial Otsego Memorial Otsego Memorial
Hospital Hospital Hospital
517-732-1731 517—732—1731 517-732-1731
Provider— R.N. Provider— R.D. Provider- R.D.
an Weekday Evening Mon—Fri 0700-1500 ion-Fri 0700—1500
Jan. & Sept. by appoint. by appoint.
st $65.00 $15.00 initial visit $15.00 initial
$5.00 follow—up $5.00 follow-up
gibility No referral No referral No referral

required

required

required

 

trance

 

does not cover

 

does not cover

 

does not cover

 

Cardiovascular Risk Reduction Programs

 

 

 

 

 

 

 

 

 

 

 

The Weight TOPS Weight
Diet Watchers Loss
Center Program
scription Wt. Loss Wt. Loss Wt. Loss Wt. Loss
Ind. Group Group Ind.
Use own food Exchange Diet Social Support ADA Exchange D:et
are Gaylord Gaylord Gaylord Ctsego Mem Hosp
517—732—8922 1-800-487-4777 517—732—1158 517-732-1731
Provider * Provider * Provider * Provider— R.D.
aw Mon— Fri Mon 1200 Wed 0900 Mon—Fri 0700—150w
0800-1700 Wed 1730 St. Andrew by appoint.
Sat. 0800—1200 Congregational Tues 1930
Church Friendship Chur.
a $82.00 Reg. $25.00 Reg. $16.00 Annual $15.00 initial
$32.00/wk $8.00/wk x 2 years $5.00 follow—up
$1.00/wk
gibility No referral No referral Physician must No referral
necessary necessary set goal wt. necessary
prance 50 pound financial aid does not may cover
overweight for those who cover
_¥7 Dr. referral qualify

 

Vovider is non-professional trained by company

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