Transcript Heart Health Project - Springer Static Content Server

Penn
Heart
Health
Heart Health Project
University of Pennsylvania School of
Medicine
American Heart Association
Pennsylvania State University
Funded by the Robert Wood Johnson Foundation
Finding Answers Program
Overview of Project Aims
Penn
Heart
Health
 Randomized controlled trial of a practice-based
team intervention that combines peer coach with
health educator support versus educational
brochures
 Evaluate effect on:
1) reduction of 4-year coronary artery disease (CAD)
or CAD death risk,
2) reduction in systolic blood pressure, and
3) cost-effectiveness from a societal perspective.
Increased Heart Risk in Blacks in
our Primary Care Practices
 Black patients more likely to have uncontrolled
hypertension than Whites in our practices
 Black patients and White women are less likely
to receive treatment for high cholesterol than
white men
 However, Black patients are more likely to have
medication increased when their blood pressure
is elevated than White patients
Why Peer Support
 Trained peer health educators significantly
improved adherence to cancer screening and
cancer care in largely minority study
populations Miller SM et al. J Natl Cancer Inst,
1997; Battaglia TA et al. Cancer, 2007, Turner BJ et
al. JGIM, 2008
 Peer role models offer support and strategies
to change behavior in regard to medication
adherence, diet, and exercise
Peer Coaches Help Keep
Colonoscopy Appointments
 Randomized controlled trial in our practices
 Trained peers called patients who were unlikely
to keep colonoscopy appointment
 Troubleshoot barriers to colonoscopy
 Patients who received peer calls were two times
more likely to attend the colonoscopy
 Patients were very satisfied with information they
received
 Successful!
Health Care Team to Help Reduce
Heart Disease Risk
 Health educator
 Meets with the client to review personal risk
factors for heart disease
 Calculates their risk of heart disease and death
from heart disease
 Reviews barriers, offer information, set goals
 Peer coach
 Serves as a role model of success from the same
community
 Offers practice tips to reduce barriers
 Changes attitudes by showing can succeed
www.acponline.org/hpp/pcmh07.pdf
Penn
Heart
Health
Study Design
250 patients with sustained
elevated blood pressure
125 Intervention
125 control
3 peer coach calls and
2 educator visits + brochures
Brochures from AHA
Endpoint at 6 months
(CAD risk, BP, LDL, weight)
Target Patient Population
Penn
Heart
Health
 Black patients aged >40 to 75 with hypertension
(2006), N=5,340
 Uncontrolled hypertension (sustained elevation
at two or more visits in one year) N=1,030)
 30% recent high LDL cholesterol
 16% current smokers in records
 35% diabetes
 26% known CAD or equivalent
 40% >200 lbs
Theory Underlying Our Study
Attitudes
Subjective norms
Perceived behavioral
control
Intention
to
Change
Desired
Behaviors
Peer Coach Support (n=10)
 Attitudes – emphasize heart health
 Beliefs and concerns about heart disease and risk
factors
 Why we care in black community
 How feels about personal CAD prevention plan
 Social Norms
 Personal successes and challenges
 Perceived Behavioral Control – barriers
 Adherence supports
 Diet tips
 Exercise benefits
Workplan
2008
5
6
7
PC
Penn
Heart
Health
8
9
10
11
12
2009
1
2
3
HE
endpoint data
CAB
CAB
2009
5
6
7
2010
8
9
10
11
12
1
2
Party
Anal
ysis
CAB
4
Peer Coach Phone Calls
calls
pts/mo
total pts
16
14
12
10
8
6
4
2
0
1
2
3
4
5
6
Months
7
8
9
10
11
12
13
14
7 PC x 20 patients = 140
Training Program
 Two sessions – 3.5 hours each
 Four conference calls – review materials and
practice talking with clients
 Two practice calls – with team and with each
other
 Update and troubleshoot conference calls every
other month
 Claire will touch base about problems monthly
 Meet twice a year for lunch at practice
 Party
Peer Coach Responsibilities
 Patient calls (up to four efforts to reach)
 Educate, support, role model desired outcome
 Record barriers, set goals, and leave barriersgoals for Lenette
 Receive updated barriers-goals from health
educator visit, review, update at call, and leave
message for Lenette
 Record each effort to reach client
 Record time spent on calls
Final Goals
 Patients have improved blood pressures
because of remembering medications and
working with physician
 Patients have healthier diets
 Patients have more active lifestyles
 Patients have lower cholesterol levels
 Patients and peer coaches and health educators
are pleased with the outcome of the project