Audrain City-County Health Unit

ANNUAL REPORT

2014

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PROGRAM SUMMARIES FOR 2014:

A)Administrative ReportKevin W. LowranceL) Grief Support GroupArlinda Wilson, RN

B)Audrain County MedicalM) Human Services CouncilEmily Stotler

Assistance Program (ACMAP)

(United Way sponsored)Linda SpurlingN) ImmunizationsBrandi Meyer, LPN

C)Blood Pressure ScreeningKerry Patton, LPNO) Maternal Child HealthKerry Patton, LPN

D)Communicable Disease P) Pregnancy TestingBecky Wieberg, RN

Surveillance & InvestigationBecky Wieberg, RN

E)Disaster Preparedness/Q) STD/STIBecky Wieberg, RN

Emergency ResponseJodi Elliott

F)Environmental PublicR) StudentsKevin W. Lowrance/Arlinda

Health ServicesRandy SenorWilson, RN

G)Family PlanningBecky Wieberg, RNS) TBBecky Wieberg, RN

H)Foot ClinicArlinda Wilson, RN/T) Vital RecordsLinda Spurling/Dorothy Schafer

Brandi Crow, LPN

I)Health Education/HealthU) Walk-in Patients/

Promotion/MediaCarol Stuart/ArlindaOffice VisitsArlinda Wilson, RN

Wilson, RN

J)Home HealthArlinda Wilson, RN/V) WebsiteEmily Stotler

Brandi Crow, LPN

K)HospiceArlinda Wilson, RN/W) WICBecky Wieberg, RN

Brandi Crow, LPN

**A special thanks to ALL the ACHD staff who make these programs possible and effective**

A} / Administrative Report

Overview:

The Audrain County Health Department (ACHD) proudly and diligently serves the Audrain County community, and is committed to addressing the public health needs of all individuals.

Public Health in Audrain County has a long and important history. In April 1961, the citizens of Audrain County formed the Audrain City-County Health Unit (ACCHU). The ACCHU existed as a result of a cooperative agreement consisting of support provided by the Audrain County Commission, Audrain Medical Center, the City of Mexico, and the City of Vandalia under Sections 70.210 to 70.320 of the Revised Statutes of the State of Missouri (RSMo).

The Compact Agreement allowed for the establishment of the City-County Health Unit of Audrain County (dba) the Audrain City-County Health Unit. ACCHU began operations with a public health nurse, an environmental sanitarian and a part-time clerk typist. The local book, “The Friend of Audrain – A History of Medicine in Audrain County”, by Leta Hodge, ©1985 has some interesting information, not only of medicine, but of public health in Audrain County going back to the mid-1800’s.

In November 2011, the citizens of Audrain County voted and passed a ballot measure establishing a new form of governance for Public Health. This measure allowed for the formation of the Audrain County Health Center (dba) the Audrain County Health Department (ACHD) under sections 205.010 to 205.115 of the Revised Statutes of the State of Missouri (RSMo). The Audrain County Health Department officially began operations 1 January 2013 and exists under an elected Board of Health.

In August 2013, the Audrain County Health Department moved into the facility located at 1130 South Elmwood in Mexico, Missouri.

ACHD constantly and consistently assesses the health status, health resources, and the unmet health needs of Audrain County residents.

In addition to the public health services of communicable disease identification and follow-up, environmental public health programs related to food safety and sanitation, lodging, daycare inspections, and on-site sewage system permitting; ACHD staff assesses the need for identified resources for funding and implemented programs addressing:

Blood Pressure Screening
Immunizations
Environmental Public Health
Home Health and Hospice Services
Women, Infants and Children (WIC) supplemental food program
Communicable Disease
Family Planning Services
Maternal Child Health
Foot Care Clinics
Allergy Shots
Breast Feeding Peer Counseling
Audrain Community Health Planning
Community Action Groups
Disaster and Emergency Preparedness
Many others…

The Audrain County Health Department is here for you. By taking a proactive approach, rather than a reactive one, we can hope to positively affect and influence the lives of each and every one of us. Public Health really does affect and belong to each of us…most people just never think about how.

Take a minute and look at the information provided within this document; and we sincerely hope that you will understand and appreciate the diverse nature of public health and what the Audrain County Health Department does daily for the citizens of Audrain County.

B}Audrain County Medical Assistance Program (ACMAP)

This program provides limited financial assistance for some common, medically-related needs that otherwise may not be fulfilled due to being under-insured, lack of insurance or personal funds. Funding for this program is partially provided by the United Way of Audrain County. Provision of this service is primarily to assist with prescription drugs; however other medically-related services may be included.

Calendar Year 2014
# of times utilized / 256
Average per month / 21.33
# individuals assistance provided to / 128
Average per month / 10.67
# of prescriptions / 531
Average per month / 44.25
C} / Blood Pressure Screening

Blood pressure screenings are available at ACHD during normal business hours; and are also held at other locations within Audrain County. You can contact the ACHD at (573) 581-1332 for details. Of the total screened in 2014; 53 individuals were referred to their primary healthcare provider or the AMC Emergency Department for further medical evaluation and/or treatment.

Number Screened
ACHD Facility / 602
Mexico Area YMCA / 190
Harbison-Walker / 42
Mexico Senior Center / 77
Mexico Senior Apartments / 55
Mexico Help Center / 85
Vandalia Lange Building / 12
Vandalia Country Cupboard / 83
Special Clinics / 353
TOTAL (avg. 125 screenings per month) / 1,499
D} / Communicable Disease Surveillance & Investigation

This service provides epidemiological surveillance, investigation, and follow-up for all reportable communicable diseases. Reports regarding specific reportable communicable diseases are provided to local healthcare providers on a quarterly basis. There are over 200 different reportable communicable diseases, with many of these having separate variants that are also reportable.

2014
Totals for Various Reportable Diseases (not all inclusive)
VACCINE PREVENTABLE
MEASLES / 0
MUMPS / 0
HEPATITIS A / 0
INFLUENZA A AND B / 204
PERTUSSIS (WHOOPING COUGH) / 1
VARICELLA (CHICKEN POX) / 0
NEISSERIA MENINGITIDIS / 0
STREP PNEUMONIA MENINGITIS / 0
INFLUENZA H1N1 / 0
DIRECT CONTACT
MAMMAL BITE / 23
EHRLICOSIS (TICK) / 1
WEST NILE VIRUS / 0
LYME DISEASE / 0
TB DISEASE / 0
TB INFECTION / 2
ROCKY MOUNTAIN SPOTTED FEVER (RMSF) / 2
TULAREMIA / 0
BLOOD BODY FLUIDS
HEPATITIS B / 2
HEPATITIS C / 5
HEPATITIS D/E / 0
FOOD/WATER BORNE
CAMPYLOBACTER / 1
GIARDIA (PARASITE) / 6
SALMONELLA / 1
NORWALK VIRUS / 0
YERSINIA ENTERCOLITICA / 0
LEGIONELLA / 0
SHIGELLA / 1
SHIGA TOXIN / 0
SEXUALLY TRANSMITTED
CHLAMYDIA / 26
GONORRHEA / 2
SYPHILIS / 0
TOTAL (avg. 15 per month) / 277
E} / Disaster Preparedness/Emergency Response

ACHD works with community members, local governments, and other agencies to address many diverse issues such as, but not limited to Pandemic Influenza, Bio-Terrorism, Shelter Operations, and Man-Made or Natural Disasters.

Number of
Occurrences
# of exercises conducted or participated in / 3
# of actual disasters / 0
TOTAL (avg. 0.4 per month) / 3
F} / Environmental Public Health Services

Environmental Public Health provides a variety of services that includeinspections offoodestablishments,residential on-site sewage systems/sewage permits through the Audrain County On-Site Sewage Ordinance, lodging establishment inspections, daycare licensure and inspection, and environmental issues/complaints. Consultation is also provided for general environmental health and/or sanitation concerns.

Food Service Inspections Total: 144
* City of Mexico / 110
* City of Vandalia / 17
* Audrain County / 17
Food Service Consultations / 75
Daycare Inspections (State of Missouri Licensed) / 33
Lodging Inspections (State of Missouri Licensed) / 13
Sewage Inspections / 57
Sewage Permits Total: 36
* Construction / 26
* Operating / 10
Sewage Consultations / 74
Grease Trap Inspections (City of Mexico only) / 127
Rabies-Related Issues / 4
Complaints (Various and non-specific) / 21
Misc. Requests / 49
Recalls (food related) / 75
Private Water Consultations / 5
Educational Presentations / 6
Training Attended by EPHS / 22
Misc. Environmental (Fire response) / 0
Truck or other transportation wrecks involving food product / 0
G} / Family Planning

Family planning services are no longer available at Audrain County Health Department, clients can now access those services at the local FQHC (Federally Qualified Health Center).

2014 / Clients / Annual Exam / Initial Exam / Intermediate / Brief / Referral
TOTAL / 34 / 18 / 14 / 2 / 0 / 6

NOTE: Referred relates to those individuals sent to other healthcare professionals.

H} / Foot Clinic

ACHD started offering foot clinic in January 2014. There are two clinics in Audrain and two clinics in Vandalia. Blood pressure checks and flu shots are offered during applicable months at these clinics. Home visits are also offered to patients.

Foot Clinic 2014
Mexico / 334
Vandalia / 124
Walk-ins/home / 7
TOTAL / 465
Average per month / 39
I} / Health Education/Health Promotion/Media

Health education is integrated within all programs and clinics at ACHD. Health education pamphlets are available for the general public upon request. Displays of available services and public health information are located at the ACHD, Audrain County Courthouse, Vandalia City Hall, & Mexico City Hall; or via the ACHD website ( The ACHD staff works one-on-one with individuals and provides presentations to groups, community organizations, etc. upon request. A comprehensive brochure of ACHD services is available. A quarterly ACHD newsletter is produced and distributed. If you would like to be included in the ACHD newsletter distribution, please contact the ACHD at (573) 581-1332.

Number of Occurrences
Press Releases issued by ACHD / 34
Interviews conducted by local or regional media / 30
Speeches, presentations made by ACHD to local, regional, or national groups / 34
Newspaper Advertising / 143
TOTAL (avg. 20 per month) / 241
J} / Home Health and Hospice

This service was provided by professional medical staff to qualifying patients to provide top quality award-winning care. As of September 31, 2014, this asset was sold to SSM Health at Home, so that residents could have the best access to home care.

ACHD Patient Load – Avg/Wk* / Patient Referrals received by ACHD for HH or H services – Avg/Wk* / ACHD Patients per locale – Avg/Wk*
Home Health / Hospice / Public Health-related- Weekly / Total – Weekly / AMC Referrals – Weekly / Referrals – Total Weekly / Mexico Area Patients - Weekly / Vandalia Area Patients - Weekly / Audrain County Patients - Weekly / Other Patient Locales - Weekly
5 / 1 / 2 / 8 / 2 / 7 / 4 / 1 / 1 / 1
K} / Human Services Council

The Audrain County Human Services Council is made up of community, social services, support and civic groups, and other individuals serving residents of Audrain County. The purpose of the Human Services Council is to share information and activities ongoing in our agencies in order to help others serving our county to be aware of available resources for their clients, and to improve the living conditions and way of life for Audrain County residents.

The Human Services Council meetings are held the last Wednesday of the month beginning at 12:00 P.M. at the Community Center located at 828 Garfield, Mexico MO.

2014
Average Number of Attendees per Meeting / 26
L} / Immunizations

Immunizations are provided for children and adults needing specific immunizations. In addition, the ACHD Immunization Program provides immunizations to Audrain County Mennonite (Vandalia) and Amish (Western Audrain County) communities.

Immunizations
(as provided by ACHD) / Number Vaccinated
DTaP / 92
Pediarix (DTaP, Hep B, Polio) / 38
Polio / 82
Hepatitis A / 13
Hepatitis B / 39
Hib / 57
HPV (VFC) / 18
Menactra / 71
MMR / 99
Prevnar 13 / 58
Rotavirus / 7
Tdap / 145
Varicella / 57
MMR/Varicella / 0
VFC Flu <3 / 6
Adult Hep A / 31
Adult Hep B / 60
Adult Menactra / 0
Adult TD / 0
Adult Varicella / 0
Adult Tdap / 66
Shingles / 15
Seasonal Flu Vaccine / 359
TOTAL (avg. 109 immunizations per month) / 1,313
M} / Maternal Child Health (MCH)

This program addresses the needs of pregnant women, mothers, infants, children and adolescents in order to protect, promote, and improve their health. With support from the Missouri Department of Health and Senior Services, ACHD is identifying and developing intervention strategies to establish a comprehensive plan to prevent and reduce adverse birth outcomesand its negative effects within our community. Love & Logic classes are offered throughout the year and are designed to encourage healthier parental relationships as well as healthier bodies and minds. A nutrition component has been added to the Love & Logic parenting classes offered by ACHD. The ‘Audrain County Directory of Health & Social Services’isavailable and can be found on the ACHD website ( or a hard copy can be requested by calling the ACHD office.

Love & Logic Parenting and Nutritional Education Classes

Date - 2014 / Location / Number in Attendance
February / ACHD Facility, Mexico, Missouri / 15
April / ACHD Facility; Mexico, Missouri / 12
September / ACHD Facility; Mexico, Missouri / 15
TOTAL / 42
N} / Pregnancy Testing

Provided for all females requesting a test.

2014 / Number of Pregnancy Tests Provided
TOTAL (avg. 7 tests per month) / 81
O} / STD/STI

ACHD provides services related to sexually transmitted diseases and/or sexually transmitted infections, and accomplishes HIV, RPR (Syphilis), GC/CT (Gonorrhea/Chlamydia) testing per Missouri Infertility Prevention Project (MIPP) through a contract with the Missouri Department of Health and Senior Services; and other testing through a private lab.

2014
# of clients / 96
Average # of clients per month / 8
# of tests / 290
Average # of tests per month / 24
# follow-up for positive tests results / 16
P} / Students

ACHD cooperates with schools of higher education in order to help ensure the proficiency and quality of students as they prepare for entering the workplace. The University of Missouri School of Medicine, the University of Missouri Sinclair School of Nursing, the University of Missouri School of Veterinary Medicine, and Truman University are just a few that have sent students to ACHD for internships and field study.

It’s important to note that ACHD is the only local public health agency officially on the syllabus at the University of Missouri School of Medicine.

Nursing Students: One (1) from Lincoln University; two (2) from University of Missouri; two (2) from Truman University

Medical Physician Students: None were scheduled during 2014

Other Students: None were scheduled during 2014

Q} / TB

Tuberculosis Skin Testing (TST) is available by the One-Step or the Two-Step test procedure.

2014 / Number Tested
TOTAL (avg. 16 tests per month) / 192
R} / Vital Records

Birth certificates are available for people born in the State of Missouri from 1920 to present. Death certificates are available for people who have died in the State of Missouri from 1980 to present. Some birth and death certificates have to be obtained directly from the State, but our staff can assist you. Additionally, information is also available regarding obtaining birth certificates for people born outside the State of Missouri.Everyone requesting a birth or death certificate must show a form of identification, such as a picture ID, two documents showing signature, check book, insurance card, or old birth certificate. Persons who can request a record include the individual on the certificate, wife, husband, mother, father, son, daughter, brother, sister, grandparents, grandchildren, aunt, uncle, niece, or nephew. Those who cannot request a record include cousins and a father whose name is not on the official record (or any of his family members). Most records are available for adopted individuals if that person was born in the State of Missouri. If the adopted person was not born in the State of Missouri, then the Department of Health and Senior Services should be contacted.

Certified copies of birth and death certificates issued by ACHD for 2014:

Death Certificates / 1,349
Average per month / 112
Birth Certificates / 1,009
Average per month / 84

Certificates filed at the State of Missouri for events occurring in Audrain County for 2014, as required by law:

Fetal Death / 0
Death / 25
Average per month / 2*
Birth / 0**
Average per month / 0**

* State started filing directly by Funeral Homes in August 2012.

**Beginning May 2010, birth certificates were filed directly with the State of Missouri Department of Health and Senior Services and not by local public health agencies.

S} / Walk-In Patients/Office Visits

Limited services are provided daily to walk-in patients for TB testing, blood sugars, pre-filling medication packs, etc. Various injections may be done with a Physician’s order.

NOTE: These visits are not direct services and are conducted outside of the regularly scheduled clinic timeframes for the associated program. For details on program specific visits see the applicable program.

Number of
Clients
Public Health-related, including Blood Pressure Screening / 441
Communicable Disease-related / 527
Family Planning-related / 118
WIC-related / 11
MCH-related / 1
Immunization-related / 470
TOTAL (avg. 131 per month) / 1,568
T} / Web Site

Emily Stotler serves as the webmaster.

2014
# of website hits / 8,150
Average per month / 679
Average per day / 22
U} / Women, Infants, & Children (WIC)

WIC is a supplemental food program for women (pregnant, breastfeeding, and postpartum), infants and children (through 4 years of age). Participants have to meet financial guidelines and have a nutritional risk to qualify for WIC. Participants receive food vouchers that may be redeemed at participating stores for milk, cheese, juice, eggs, beans, peanut butter, cereal, whole grain foods, fruits, and vegetables, and upon request infant formula.

Number of
Clients
ACHD Facility / 6,839
Vandalia Facility / 780
TOTAL (avg. 635 per month) / 7,619

Breastfeeding Support Group is offered monthly for any prenatal or postpartum breastfeeding woman and family. There were a total of 54participants in calendar year 2014.

Breastfeeding Peer Counseling provided valuable peer counseling to 275 prenatal contacts and 540 post-partum/breastfeeding mothers in calendar year 2014.

Thank You