Expert Commentary
By Kala Shipley, Executive Director,
Health Promotion – Division of Health
Connecting Care Inside and
Outside the Doctor’s Office in Iowa
Promotion and Chronic Disease
Prevention, Iowa Department of Health
Right now, 30.4 percent of adults and 13.6 percent of
children in Iowa are obese. According to the 2012 F
as in Fat report, if things continue on their current
course, the state’s obesity rates could climb to 54.4
percent by 2030.
Currently, nearly 30 percent of Iowa
This is particularly important for
adults have hypertension and 9.7
obesity and related health conditions.
serious health and economic
percent have diabetes. If we don’t take
For instance, a doctor finds a patient
toll on the state.”
action, in the next 20 years, we could
has prediabetes. Unfortunately, there
see the number of new cases of type
is no special pill to prescribe as a cure,
2 diabetes, heart disease and stroke,
but, rather, the prescription is making
hypertension, arthritis, obesity-related
better decisions about nutrition and
cancer and other diseases continue
being more physically active. To
to rise, and obesity-related healthcare
make the connection between the
costs could grow by 3.7 percent.i
clinical setting and daily life, Iowa’s
“Obesity is already taking a
We’ve decided it’s time to do things
differently. One thing that has never
made sense is the disconnect between
the care patients receive in the
doctor’s office and the lack of support
there is in communities to be able to
follow the doctor’s advice in daily life.
local Community Transformation
Grant (CTG) projects are making it
easier for people who want to follow
the doctor’s orders to do so in their
community by creating environments
that support access to healthy foods
and physical activity.
To help connect individuals with community resources, we
launched the Iowa Community Referral Project so Iowans will
stay healthier longer and delay or avoid serious negative
health outcomes.
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fasinfat.org
We’ve partnered the Iowa Primary Care
of public health, community groups
community that can help them get
Association (IPCA) and Local Boards
and others to identify evidence-based
healthier and potentially avoid devel-
of Health so that doctors will now have
programs and efforts.
oping diabetes. The Community Re-
access and information about programs
in communities, and will be able to
refer and match their patients to those
resources. As part of our CTG, we are
bringing together partners, including
medical providers, local departments
Now, doctors in many counties will
have the information they need to
connect their patients with effective
programs. In essence, the prediabetic
patient will be able to receive a referral
from their doctor to programs in their
ferral Project connects individuals to
the entire spectrum of care — providing patients with better opportunities
to follow their doctor’s advice, whether
it be healthy eating, increased physical
activity or something else.
Examples of some types of programs include:
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The Black Hawk County Board of Health
Self-Management classes, exercise
high blood pressure or high cholesterol,
has built a referral system that connects
classes, farmer’s markets and disability
to health coaches at the hospital and
members of the community with healthy
resources.
wellness coaches at the YMCA who work
choices and better chronic disease selfmanagement. The evidence-based Stan-
l
improve their health.
medical record system in Decatur County,
ford Chronic Disease Self-Management
physicians can now give patients an “ex-
Program helps manage chronic conditions such as diabetes or prediabetes
by empowering individuals to set personalized goals for health improvement. At
the Aging and Disability Resource Center
serving Iowans in Black Hawk County
with individuals and hold workshops to
As part of the recently upgraded electronic
l
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In Dallas County, the county health de-
ercise prescription,” which can include
partment has built a referral system with
information about ways to increase physi-
county Mercy Medical clinics that par-
cal activity and connect people with fitness
ticipate in the Iowa Medicaid Enterprise
centers and exercise programs.
(IME) Health Home program. The clinics
In Polk County, medical clinics, the
and the Hawkeye Valley Area, counsel-
YMCA Health Living Center and the
ors help seniors find practical ways to
county health department are work-
self-manage their condition, starting with
ing together to connect patients with
understanding the health, mobility and
the Stanford Chronic Disease Self-
physical activity levels of individuals and
Management Program. Physicians at
making referrals to community programs
Mercy Medical Centers refer patients
such as the Stanford Chronic Disease
with chronic health conditions, such as
now regularly refer patients to a Health
Navigation program run by the county
health department, which connects them
with local services including housing assistance, food assistance, enrolling in
public programs, medication assistance,
behavioral health, wellness options and
other programs.
fasinfat.org
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One of the objectives of the CTG is to reduce obesity by
5 percent. We believe this project is one important piece
in helping to reach that goal. By creating more overt and
direct connections between care in the doctor’s office
with opportunities to be healthier in daily life, we can
achieve better results.
Last year’s F as in Fat report demon-
can prevent situations from getting
strated the impact these types of changes
worse — for instance, stopping
can have. If we reduce the average body
people with pre-diabetes from
mass index (BMI) of adults in the state,
developing type II diabetes — and
we could reduce healthcare spending
save lives and money.
by more than $2 billion in 10 years and
$5.7 billion in 20 years, while helping
thousands of Iowans from developing
preventable diseases.ii
By better coordinating care for those
It’s time we involve the whole
healthcare system in preventing
diseases and keeping us all healthier,
rather than just treating conditions
after they have already happened.
who have obesity-related illnesses, we
i Trust for America’s Health and Robert Wood Johnson Foundation. F as in Fat: How
Obesity Threatens America’s Future. Washington, D.C.: Trust for America’s Health, 2012.
http://healthyamericans.org/assets/files/TFAH2012FasInFatFnlRv.pdf
ii I bid
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fasinfat.org