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WISEWOMANAbout the WISEWOMAN ProgramWell-Integrated Screening and Evaluation for Women Across the NationWISEWOMAN is a CDC-funded programthat helps women without insurance gainaccess to screening and lifestyle interventionsthat can reduce their risk for heart diseaseand other chronic diseases. WISEWOMANdemonstration projects across the nation helpwomen become more physically active, adopthealthy eating habits, lead smoke-free lives,and target high blood pressure and highcholesterol.In 1993, Congress authorized the CDCto establish the WISEWOMAN program.Congresswoman Rosa L. Delauro sponsoredthe WISEWOMAN legislation, which expandsthe services offered within the National Breastand Cervical Cancer Early Detection Program(NBCCEDP). As a result, women who qualifyfor NBCCEDP services are also eligible to receive WISEWOMAN services. Women who qualifyfor WISEWOMAN are 40–64 years old and have little or no health insurance coverage. Manywomen are from ethnic or minority populations and have risk factors for heart disease andstroke. WISEWOMAN adds value to the NBCCEDP by Screening women for high blood pressure and cholesterol. Assessing women’s knowledge, attitudes, and behaviors regarding lifestyle risk factorssuch as sedentary behavior, unhealthy eating habits, and tobacco use. Conducting lifestyle interventions that promote healthy nutrition, physical activity, andsmoking cessation. Providing appropriate medical follow-ups and referrals, as needed. Conducting research to determine which lifestyle interventions are most effective.WISEWOMAN projects allow us to measure how such services are helping low-income anduninsured women. The first three WISEWOMAN projects, launched in 1995, were evaluated,and the findings were promising: Offering screening tests for chronic disease risk factors to women in the NBCCEDP wasfeasible and well accepted by providers and participants. Participants reported reducing the fat in their diets and becoming more physically active.WISEWOMAN Works 7

WISEWOMANBy 2002, more than 12,000 medicallyunderserved women participating inthe NBCCEDP had received preventiveservices through WISEWOMAN’s 12demonstration projects (see U.S. mapon the inside back cover). WISEWOMANhas bridged the gap to give theseunderserved women access to servicesthey normally would not receive. In thesuccess stories that follow, you will seeexamples of four strategies that buildstrong WISEWOMAN projects: Expanding access. Reaching culturally diverse women. Women helping women. Developing partnerships.8 WISEWOMAN Works

WISEWOMANExpanding Access

WISEWOMANSuccess Story 1South Dakota Women Learn About Diabetes, Thanksto WISEWOMAN’s All Women Count! CollaborationDiabetes Education Reaches Women Where They LiveLocationFocusRural and frontier areas of South DakotaDiagnose diabetes early among low-income women living inrural or frontier areas and teach them about the disease so thatdevastating complications can be prevented.StrategyPartners in the community collaborate to give underserved womenaccess to high-quality diabetes education and screening.Levels of SuccessMany organizational changes have occurred. Partnerships withthe diabetes program, health department, and WISEWOMANprogram have been developed. Partnering with the DiabetesPrevention and Control Program to offer diabetes training fornurse/dietitian teams allows more providers to receive the trainingthey need to deliver high-quality diabetes care and receive fundingfor providing this care to WISEWOMAN participants.ResultsStory Developed ByOver 250 sites will receive training through this programto deliver high-quality diabetes education in 2003, and1,500 women are expected to be screened.Patty K. Lihs, BSPublic Education CoordinatorAll Women Count!South Dakota Department of HealthColette R. Beshara, RN, BSNDiabetes QA Nurse ConsultantSouth Dakota Department of HealthFor program contact information, see South Dakota in Appendix Cor visit http://www.cdc.gov/wisewoman.10 WISEWOMAN Works

South Dakota Women Learn About Diabetes, Thanksto WISEWOMAN’s All Women Count! CollaborationDiabetes Education Reaches Women Where They Liveeducation program. Diabetes education providers mustDiabetes is a major health problem in South Dakota, whereattend training in diabetes management and counselingmore than 6% of people have diabetes and many do not knowskills at a Department of Health sponsored 2-day trainingit. In addition, many women live in rural or frontier areas,session or submit proof that they attended 16 hours of studywhere access to quality diabetes education is limited. Thesein diabetes management, behavioral interventions, teachingcritical needs prompted South Dakota to add diabetesskills, and learning skills. Yearly continuing education forscreening and education to the cardiovascular risk factorproviders is also required. The facility must then use thescreening and education already provided by the WISE “Life with Diabetes” curriculum and standardized educationWOMAN program, known as All Women Count! Nearly 750forms to document continuing education.providers at 259 facilities participate inthe program. The goal is to diagnose dia South Dakota relies on partner In fall 2002, All Women Count! and thebetes early on and prevent devastating ships to provide high-qualitycare to women in remote areas.DPCP held a training session in Pierre,complications, particularly among womenand 120 professionals attended. This waswho have limited incomes or live in ruralthe first time the DPCP marketed itsor frontier areas.training to All Women Count! providers.The goal is access to high-quality dia During the pilot phase, All Women Count!betes education to women screened at allparticipants who had diabetes diagnoses259 All Women Count! sites.or problems controlling their blood sugarwere offered diabetes education at the 21Importance of Successsites recognized by the South DakotaDepartment of Health or the AmericanThe expanded partnership between AllDiabetes Association as providing highWomen Count! and the state DPCP pro quality education. When the pilot phasevides underserved women with greaterwas initiated, All Women Count! staffaccess to diabetes screening and highknew that these 21 sites could not possi The woman is at the center of aquality diabetes education. The partner wheel.Theclinicisthewheel’sbly provide geographic access to all of thehub, and the spokes are supportive ship also allows women with pre-diabetesmany women participating in the WISE partners.to be identified and referred to nutritionWOMAN program.and physical activity programs. In addi tion, women with problems controllingAll Women Count! staff wanted to eliminate this problemtheir blood sugar can get help managing this condition.and other barriers that were preventing women from access Women also benefit through better access to medication.ing diabetes health professionals. After speaking with healthMost importantly, at-risk women in rural and frontier areascare providers, diabetes educators, and other clinic staffnow have greater access to care.at pilot locations, they found some women were resistantto receiving education at a facility other than their normalTo date, All Women Count! has screened 776 women andclinic. Since most existing diabetes education programs areidentified 30 women as needing diabetes education. By thebased in hospitals, the change in environment was enough toend of 2003, All Women Count! expects to screen 1,500prevent some women from attending diabetes classes.women and provide comprehensive diabetes education forwomen who previously did not have access to this care.All Women Count! staff agreed they needed to offer unin sured women high-quality diabetes education in their ownLessons Learnedcommunities. So they collaborated with the state’s Diabetes Collaborate to expand your resources.Prevention and Control Program (DPCP) to develop the All Recognize that clinic staff members at existing facilitiesWomen Count! diabetes education program. This programoffers any of the 259 All Women Count! facilities the oppor know their patients best. A satellite location might nottunity to be reimbursed for high-quality diabetes education,be appropriate. Develop firm partnerships with your diabetes program,to get expert training, and to receive continuing education.Once a facility meets All Women Count! diabetes educationhealth department, and WISEWOMAN program. Addprogram requirements, it can deliver diabetes education topeer-review organizations as the quality improvementwomen with newly diagnosed diabetes or a history of dia arm if your program focuses on older women and you arebetes with problems controlling blood sugar. The facility canseeking Medicare reimbursement. Increase people’s awareness of the need for and value ofthen be reimbursed by All Women Count! To be part of thisprogram, facilities must have nurse/dietitian teams andcomprehensive diabetes education.complete a brief application detailing their existing diabetesSuccess Story 1, South Dakota 11

WISEWOMANSuccess Story 2WISEWOMAN Program Gives South Dakota Women Accessto Much-Needed Heart and Diabetes MedicationsBarriers Are Removed as Underserved Women Gain Accessto Low-Cost or Free MedicationsLocationFocusStrategyLevels of SuccessResultsStory Developed BySouth DakotaHelp low-income women get the medications they need forheart disease or diabetes.Partners in the community collaborate and use existing pharmacydatabases to help underserved women access free and low-costmedications for heart disease and diabetes.Many organizational accomplishments have been made. Byworking with partners, WISEWOMAN uses an established systemto provide low-cost or free medications to women who most needthem. Using a computer-based program gives clinic staff readyaccess to pharmaceutical programs. This way, women quicklyget the medications they need, without having to make anothervisit to their provider.Hundreds of women could receive access to low-cost or freemedications for heart disease and diabetes.Patty K. Lihs, BSPublic Education CoordinatorAll Women Count!South Dakota Department of HealthColette R. Beshara, RN, BSNDiabetes QA Nurse ConsultantSouth Dakota Department of HealthFor program contact information, see South Dakota in Appendix Cor visit http://www.cdc.gov/wisewoman.12 WISEWOMAN Works

WISEWOMAN Program Gives South DakotaWomen Access to Much-Needed Heart andDiabetes MedicationsBarriers Are Removed as Underserved Women Gain Access to Low-Cost or Free MedicationsWomen who have high blood pressure, cholesterol, or glu cose are at risk for serious health complications. In SouthDakota’s WISEWOMAN program, known as All WomenCount!, more than 700 women have been screened for car diovascular disease and high glucose levels. Most of thewomen who qualify for the program do not have insur ance, and many of the women who have been screenedneed prescription medications. WISEWOMAN funds can not be used to purchase medications. Therefore, the pro gram teamed up with two partners to help women get themedications they need at a low cost or for free.name, date, strength, and directions for use. Physicianssign the voucher, which the patient can take to any par ticipating pharmacy and receive the medication (current ly a vial of insulin) free of charge.Importance of SuccessMore at-risk women are getting potentially life-savingmedications—on an immediate and long-term basis—through these two programs. By using systems already inplace and building on partnerships, All Women Count!has eased a barrier for women unable to pay for medica tions. In addition, no moneywas spent to set up or maintainthese programs because theHaving a convenient system inprograms were already inplace that allows providers toplace. Some providers werealready using the programsgain access through a computerand most clinic sites had accessmakes it easy to ensure womento the programs. Thus, minimalget the medications they need.staff time was All WomenCount!’s only investment.About Rx AccessThe South Dakota Departmentof Social Services administersRx Access, a database of phar maceutical patient assistanceprograms that offer medicationsat no or low cost. The databaseincludes enrollment informationincluding income and agerequirements for each assistanceprogram. Some assistance programs even provide down loadable applications, making it easier to enroll a patientin the assistance program. After a woman submits infor mation including all medications she currently takes, apharmacist reviews the medications, makes appropriatesubstitutions, and generates appropriate applicationsthat are sent to the woman for completion and submissionto assistance programs. Once a woman has completed thisprocess, medications are sent to her health care providerfor her to pick up. Rx Access also knows when a prescrip tion needs to be renewed and generates applicationsbased on each patient assistance program’s process forrenewing existing prescriptions. Access to these servicesis provided at no cost to the women.About eMedSampleA second way All Women Count! ensures that women haveaccess to much-needed medications is through a programcalled eMedSample, which is administered by MedManage Systems, Inc. As soon as a woman is found to havehigh blood glucose, she can get immediate help. Currently,insulin produced by one drug company is the only productavailable. Within this program, physicians register withMedManage Systems, Inc., via www.emedsample.com.They can then print a voucher after filling in the patient’sStaff members with varied backgrounds working at differ ent facilities each offer a small contribution that, togeth er, makes a big difference for women in need. Case man agers help the women complete the application.Pharmacists with the South Dakota Department of SocialServices review medications and access pharmaceuticalprograms. Medical providers complete the vouchers.Pharmacists check medications and educate women abouteffective use. This network of providers makes accessinglow- or no-cost medications easier for at-risk women.Lessons Learned Use partnerships to create a safety net of providersand services. By partnering with existing programs,you can add valuable, life-saving services at a minimalcost. Consider computer-based programs to ensure clinicstaff members have easier access to pharmaceuticalprograms. Providers can get immediate help for womenin need during the same visit, reducing the possibilitythat these women will slip through the cracks. Realize the benefits of providing services at the clinicswhere women routinely receive their care. Thisensures their care is individualized and easy to access.Success Story 2, South Dakota 13

WISEWOMANSuccess Story 3More North Carolina Women Have Access to Care, Thanksto WISEWOMAN PartnershipPartners Reach Out to Working, Underserved WomenLocationFocusStrategyLevels of SuccessCabarrus Health Alliance in Kannapolis, North CarolinaReach underserved, working women who otherwise wouldnot have access to preventive care.Community partners collaborated to provide screenings forheart disease and cancer, health education, and medicationsto underserved, working women during hours convenientfor them.Many positive community benefits have occurred because ofthis partnership. More underserved, working women nowhave access to preventive care, and many health care providershave provided support for WISEWOMAN services.Organizational benefits also have resulted. Because thepartners are referring women to each other, demand forthese potentially life-saving services has increased. Moreimportantly, the organizations are providing health care tounderserved women who previously were hard to reach.ResultsStory Developed ByWISEWOMAN funds allow underserved and minority womenwho already receive breast and cervical cancer screenings toalso be screened for heart disease, to receive education, andto get free medications as needed. Through the WISEWOMANproject, the Cabarrus Health Alliance was able to provide vitalpreventive services to about 400 women in 3 years.Priscilla J. Wilson, RNBreast Health Program DirectorCabarrus Health AllianceFor program contact information, see North Carolina in Appendix Cor visit http://www.cdc.gov/wisewoman.14 WISEWOMAN Works

More North Carolina Women Have Access to Care,Thanks to WISEWOMAN PartnershipPartners Reach Out to Working, Underserved WomenIn Kannapolis and Concord, working women who are strug gling to make ends meet now have access to potentially life saving health services at a diverse number of clinics thathave hours convenient for them. A county health depart ment nurse brought together WISEWOMAN and otherpartners so they could offer these women screenings forheart disease and cancer, free medications, and healthadvice about healthy eating, fit ness, and other ways to improvehealth.Priscilla J. Wilson, RN, came upwith the idea and made it happen.She works with the CabarrusHealth Alliance (the countyhealth department), in both theWISEWOMAN Program and theNorth Carolina Breast andCervical Cancer Control Program(NCBCCCP). She also has volun teered at the Community FreeClinic, a facility in Concord thathas a small paid staff but is sup ported by grants, donations, andvolunteer health professionals.She wondered what would hap pen if the clinic, the WISE WOMAN program, and NCBCC CP teamed up to provide hardworking, underserved womenwith direly needed health servic es. When Priscilla shared herideas with the health depart ment’s administrative staff andthe clinic director, everyone wasenthusiastic about this newopportunity to help underserved,working women.high blood pressure, high cholesterol, and other seriousconditions also are available through the Community FreeClinic’s partnership with pharmacy programs.The Community Free Clinic also refers eligible women tothe county’s WISEWOMAN Program and NCBCCCP sothey can receive heart disease screening and education aswell as breast and cervical exams and mammograms. As aresult, participation in bothcounty programs has consistent ly increased, with a 64% increasein the number of women servedby WISEWOMAN. Over the past3 years, about 400 underservedand minority women in theselocations have received WISE WOMAN services. This is thefirst time many of these havereceived such services. Having areferral system in place andoffering WISEWOMAN servicesto all eligible NCBCCCP partici pants were key factors for gettingnew women enrolled.“Women screened at the countyhealth department used to bereferred to private providers, butthey had no access to medications.Now, with a partnership at theCommunity Free Clinic, eligiblewomen can get the medicationsthey need for free.”— Priscilla Wilson, RN,WISEWOMAN Service CoordinatorThe Cabarrus Health Alliance now provides WISEWOMANservices in their Kannapolis location and collaborates withpartners to provide these services at other locations duringhours that are convenient for working women. For example,the Community Free Clinic in Concord provides space for aclinic once each month and offers follow-up services towomen who have abnormal test results. A team of familynurse practitioners, nurses, a health educator, a lab techni cian, and a receptionist help run the clinic.Other partners providing services are the NorthEastMedical Center and its Mobile Mammography Unit as wellas Ask First, a community health line that refers women tosupportive services in the community. Fr

this book; Mindy C. Barringer and Michael J. Shagina, who offered graphic support; and Rebecca L. Payne, MPH, Lori A. Kuhlman, MPH, and Diane O. Dunet, MPA, who contributed . Participants reported reducing the fat in their diets and becoming more physically active. WISEWOMAN Works 7 . WISEWOMAN By 2002, more than 12,000 medically .