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(continued from last page) breath or unusual fatigue. The nurse contacts the patient when the data points to a possible adverse change in his or her condition, and the physician is contacted when the patient's condi- tion is deteriorating. Communica- tion with the physician also includes a weekly summary of biometric readings by fax and is also available to provid- ers in a web-based application. This conveniently allows trending of blood pressure or glucose readings that pro- vides valuable data for making medical management decisions. Reminders for the patient to take medications or go to a doctor's ap- pointment can be set to pop up on the telemonitor for patient conve- nience. Short video programs about chronic conditions are also available via the telemonitor to help the patient and their family members learn more about the member's conditions, in- cluding symptoms that may require urgent medical attention. Educa- tional articles to read about medi- cations and disease specific infor- mation can be accessed through the touch screen monitor by the patient and caregivers. As members become more knowledgeable about their con- dition, their self management skills and health habits often improve, and they are better able to make decisions which promote their health. Ongoing RCM of chronically ill individuals promotes quality care through early recognition and treat- ment of exacerbations and compli- cations, thereby keeping patients in their homes and reducing the cost of care. As this technology becomes more readily available, patients with chronic conditions are more likely to receive the right care, at the right time, in the right place. RCM services may be the best solution to costly and avoid- able care for certain populations of chronically ill patients. Engaging pa- tients in their own healthcare through telemonitoring can help them be more compliant with their plan of care by reaching the ultimate goal of an RCM program, which is improved self man- agement skills. Third-Hand Smoke H BY Linda Grosser, RN, CNP ave you ever wondered why cigarette smoke tends to linger, long after you think it should be gone? It's because nicotine vapor has a stickiness quality which makes it cling to people's hair, skin, clothing and all of your home furnishings, even the walls. Long after secondhand smoke has cleared the air, this third-hand smoke hangs around, penetrating and being absorbed by surfaces everywhere, and it is a health threat, especially to infants and chil- dren. While smoking outdoors is defi- nitely an improvement from smoking indoors, nicotine clings to the smok- er's body and when carried indoors, it literally goes everywhere. Over time, third-hand smoke be- comes more toxic, according to Hugo Destaillats, a chemist with Berkeley's National Laboratory for Indoor En- vironmental Technologies. Tobacco smoke contamination which lingers on furniture, clothes and other sur- faces, may react with common indoor chemicals in the air, to form potential cancer-causing substances according to Gundel, a staff scientist at Berkeley National Laboratory. "People can be exposed to toxins in tobacco smoke in a way that's never been recognized before." The residue left behind from smok- ing indoors includes heavy metals, carcinogens and even radioactive ma- terials that young children can get on their hands, inhale in dust particles or ingest, especially if they're playing on the floor. Most people just don't real- ize that breathing air in a room today, where people smoked yesterday can be especially harmful to infants and children whose skin is thin and more readily absorbs contaminants. The carcinogens in third-hand smoke rep- resent an unappreciated cancer risk to anyone else who comes in contact with third-hand smoke according to Dr. Philip Landrigan, a pediatrician who heads the Children's Environmental Health Center at Mount Sinai School of Medicine in New York. Smoke residue includes heavy metals, carcinogens and radioactive materials. The best way to protect ourselves from third-hand smoke is to create environments where smoking is never allowed, especially in our homes and cars, and also in public areas. Nic- otine is not an easy habit to kick. If you are a health care professional, re- member to ask your patients not only if they smoke, but also if they would like some help in quitting tobacco. Health plans are rated by the Na- tional Committee on Quality Assur- ance (NCQA) on smoking cessation efforts, including providers asking about tobacco use, and offering sup- port to quit tobacco with medications or tobacco cessation programs. What we know about third-hand smoke makes it even more compelling to provide education about the haz- ards of smoking, and encourage our youth to never start using tobacco. A resource for quitting tobacco in our state is the Indiana Tobacco Preven- tion and Cessation (ITPC) Pro- gram, that helps participants through educational programs and personal coaches to help them through the tough times. Additional informa- tion about this service can be found at http://www.in.gov/isdh/tpc/. CMCS connections 6 2nd qu arter 2012 photo © 2010 dean mccoy, made available under cc Attribution 2.0 license