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Slide 1
Thank You Janet
Slide 2
ABCS of Heart Disease and Stroke Prevention Our Challenge Our
Partners Jacquie Halladay MD MPH, UNC-CH Lindsay Beavers, CCME
Slide 3
ABCS of Heart Disease and Stroke Prevention Aspirin: Increase
low dose aspirin therapy according to recognized prevention
guidelines. Blood pressure: Prevent and control high blood
pressure; reduce sodium intake. Cholesterol: Prevent and control
high blood cholesterol. Smoking: Increase the number of smokers
counseled to quit and referred to State quit lines; increase
availability of no or low-cost cessation products.
National Heart Disease and Stroke Prevention (NHDSP) Program
Anchored in the Socio-ecological Model.
Slide 6
Use strategies that.. Are evidenced based. Have broad reach and
impact to general and priority populations. National Heart Disease
and Stroke Prevention Program - Strategies for States to Address
the ABCS
Slide 7
Linked to Policy and Systems Change outcome measures
Slide 8
Objectives: to understand. The components of the ABCS. Partners
in NC. How are we are addressing the ABCS at various levels of the
Socio-ecological Model in NC.
Slide 9
Plan Review ABCS Media materials and evaluation plans (CCME)
Next Steps Heart Healthy Lenoir Project Discuss coaching as a self
management support resource (State Health Plan and CCNC Medical
Home) Briefly discuss the Community Transformation Grant (CTG)
activities (NC DPH)
Slide 10
HDSP- CCME - Heart Lessons
Slide 11
The ABCS of Heart Disease and Stroke Prevention Janet Reaves
Memorial Conference February 3, 2012
Slide 12
Television Education Campaign Target audience: Adults, 45 years
of age and older, who have an annual household income below
$100,000 The commercial will focus on the ABCS, which is a national
CDC campaign. The new commercial will air for 4 weeks in February
2012 on cable and network television across the state, covering
media markets in Greenville, Raleigh, Greensboro, Charlotte, and
Asheville. Estimated potential impressions: 5,429,818 The media buy
was based on Nielsen Ratings.
Slide 13
Television Education Campaign, cont. Storyboard Focus Groups
Three focus groups tested three different concepts for the
commercial. The spot entitled Heart Lessons was chosen.
Participants: At least 12 participants per group Equal number of
ethnic majority and minority participants, male and female 45 years
or older Household incomes below $40,000 All were residents in
counties east of I-95, where the highest burden of heart disease
and stroke exists
Slide 14
2012 Television Education Campaign Evaluations Measurement 600
pre- and post-campaign surveys will be conducted. This process was
designed to specifically determine the impact of the TV advertising
campaign in the eastern counties of NC. Methodology Surveys will be
conducted through telephone interviews. Surveys will measure impact
of public awareness on ABCS, prevention measures, and
advertisement.
Slide 15
SWYH Banner Ads SWYH banner page on the SWYH website
www.startwithyourheart.com Home > Health Professionals > SWYH
Banners
Slide 16
Educational Material, cont. Other materials: 8,000 blood
pressure index cards 5,000 consumer ABCS flyers 7,500 stroke
magnets
Slide 17
Educational Material Brochures on stroke, blood pressure, and
cholesterol have been printed and provided to health
coordinators.
Slide 18
Media Outreach Sodium op-ed was published in the N&O on
December 23, 2011. http://www.newsobserver.com/2011/12/23/17285
02/cut-the-salt-and-help-your-health.html
http://www.newsobserver.com/2011/12/23/17285
02/cut-the-salt-and-help-your-health.html Circulation/distribution
total: 144,075 High blood pressure and Cholesterol op-eds in
progress SWYH promotional messages distributed via the CCME QP
Online newsletter, Facebook and Twitter pages, and the CCME
website.
Slide 19
Community Outreach Activities Conduct outreach activities in
2012, predominantly in eastern North Carolina February 2012 o
Provide ABCS flyers to be distributed at a Go Red Gala in
Greenville on Feb. 5 o Provide an ABCS insert for church bulletins
to 35 churches in eastern NC through Cornerstone Ministries May
2012 o Send ABCS flyers to 21 Wal-Mart pharmacies in eastern NC to
distribute to their patients
Heart-Healthy Lenoir Blood Pressure Control Project: ECU /
UNC-Chapel Hill PIs: Alice Ammerman, Darren DeWalt, Cam
Patterson
Slide 22
HTN office intervention team Darren A. DeWalt, MD, MPH - PI
Skip Cummings, PharmD Katrina Donahue, MD, MPH Beverly Garcia, MPH
Jacquie Halladay, MD, MPH Alan Hinderliter, MD Cassie Miller, MPH
Crystal Wiley-Cene, MD, MPH
Slide 23
Goals for the Hypertension Control Project Reduce blood
pressure levels among patients with poorly controlled hypertension.
Reduce disparities in blood pressure by race and by literacy.
Create systems that can sustain these improvements within current
primary care practice.
Slide 24
Stanford-USFC EBPC Performed a systematic reviews of
interventions aimed at reducing BPs among people with HTN.
Slide 25
Methods: Stanford-UCSF EBPC Search the literature from 1980 to
2003 regarding QI and BP reductions strategies Restrict to
interventions targeting provider behavior*/organizational change. *
separate review performed on patient only interventions
Slide 26
Classification of Interventions classificationsexamples
Provider EducationMaterials/instructions given to providers
regarding appropriate care Provider RemindersPrompts to providers
to perform specific care tasks Provider Audit and FeedbackClinical
performance reports Facilitated relay of clinical data to providers
Patient clinical data transmitted from home BP cuffs etc. Patient
EducationMaterials/instructions regarding HTN Patient
RemindersAppointments, adherence Promotion of self managementAccess
to resources/devices Team ChangeAdditions of role changes Financial
IncentivesReimbursement structure changes
Slide 27
Classification of Interventions classificationsexamples
Provider EducationMaterials/instructions given to providers
regarding appropriate care Provider RemindersPrompts to providers
to perform specific care tasks Provider Audit and FeedbackClinical
performance reports Facilitated relay of clinical data to providers
Patient clinical data transmitted from home BP cuffs etc. Patient
EducationMaterials/instructions regarding HTN Patient
RemindersAppointments, adherence Promotion of self managementAccess
to resources/devices Team ChangeAdditions of role changes Financial
IncentivesReimbursement structure changes
Slide 28
For instance.. Patient Interviews: HTN awareness (seriousness,
know their # s) Barriers to taking medication. Ideas on home BP
monitoring method (HBPM). Perceived healthcare disparities
(race/ethnicity/literacy level/SES). Ideas on phone or office self-
management support coaching program.
Slide 29
Current work: Develop and implement the phone coaching program.
Evidence regarding effectiveness NC programs
Slide 30
Evidence for phone coaching Hutchison et al. 2011 >1000
studies (Randomized controlled trials) 41 trials - 34 phone
coaching services. Wide variety of coaching models on several
different diseases. Overall the evidence supports that phone
coaching is an effective intervention especially for chronic
cardiovascular conditions and diabetes..with the most notable
benefits including..
Slide 31
Phone Coaching Improved patient compliance with self care
regimens. Increased patient confidence towards disease management.
Reduced hospital readmissions Improved mental health
Slide 32
Coaching activities ..Adjunct to provider care, not a
replacement Medication review (purpose, side effects) Involve
family members and friends as support Assist with empowerment (role
play) Augment problem solving skills Discuss food labels, low
sodium options Provide follow-up post hospitalization to ensure
understanding of medication regimen and to see that a follow-up
provider visit is scheduled Goal setting Smoking
cessation/behavioral counseling Many more..
Slide 33
NC Health Smart
http://www.shpnc.org/ncHealthSmart/faq-nchs-health- coach.aspx
www.shpnc.org
Slide 34
NC Health Smart
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Coaching from the NC from the State Health Plan! Weight control
Yall calling and know that you're going to call is really
motivating for me. Lost 22 pounds Improved diabetes control A1c
from 10.7 to 7.0% Control of BP. Medication adherence and with
resulting BPs from 177/92 to 124/70!
Slide 36
Coaching from the NC from the State Health Plan! Assistance
with understanding symptoms of an acute MI. Connected with patient
post hospitalization and started working with her on how to manage
her medications and laboratory testing post MI. The Graduate.
Fasting BGs from 160 to 70mg/dl.
Slide 37
Phone coaching : Duke team(s) Hayden Bosworth, PhD Nurse lead
phone coaching programs in NC. Center for Health Services Research
in Primary Care, Veterans Affairs Medical Center, Center for Aging
and Human Development, Duke Hypertension Center, and Duke Clinical
Research Institute.
Slide 38
Bosworth et al. - Improved BP control 475 patients from 32 zip
codes around Duke, 2 year intervention. Strategy: phone coaching
targeting HTN behaviors +/- home BP monitoring. Bottom line:
Improved BP control at minimal costs (~ $400 dollars per year
including BP monitors and bi-monthly coaching calls).
Slide 39
Bosworth and CCNC - Adherence. QI approach in 3 CCNC networks.
Measured pharmacy fill rates for HTN meds MPR. 6 month intervention
for 558 patients. Called every 3 weeks for a max of 10 calls.
Encounters included core modules - addressed each time (adherence
and medication tolerance. AND additional modules activated at
specific times (diet, HTN knowledge, social support).
Slide 40
Bosworth and CCNC - Adherence Those with at least one call
improved their medication adherence scores. And had higher fill
rates than non- participants. Medication Possession Ratios: very
poor if the ratio is < 0.6 poor if 0.6-0.8 good if 0.8
Slide 41
Average Medication Adherence Overtime: (a) intervention group
vs. (b) usual care Intervention Start a b Participants - MPR: 59%
to 77% NON-participants - MPR: 60% to 64%
Slide 42
Adherence compared to themselves Intervention Start Very Poor
Poor Good
Slide 43
More coaching partners.. People like Dr. Jonathan Rubens from
ActiveHealth management.
Slide 44
44 Health Plans, Hospitals, Health Systems
Slide 45
45 Employers Westinghouse UPS TVA IUOE
Slide 46
Socio-ecological Model
Slide 47
First of its kind in Brunswick Co.
Slide 48
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North Carolina Community Transformation Grant
Slide 52
Strategic Directions TobaccoFree Living Active Living and
Healthy Eating High Impact Quality Clinical and Other Preventive
Services (HTN and Cholesterol)
Slide 53
Policy, Environment, Programmatic, and Infrastructure Change
Policy Educate the public and stakeholders about policy
interventions to improve population health Environment create
social and physical environments that support healthy living
Programmatic Increase access to prevention programs to support
healthy living Infrastructure Change systems, procedures, and
protocols within communities and institutions that support healthy
behavior
Slide 54
Core Principles Maximize health impact through prevention
Advance health equity and reduce disparities Use and expand the
evidence base
Slide 55
North Carolina Strategies TobaccoFree Living Increase
smoke-free regulations of local government buildings and of indoor
public places. Increase tobacco-free regulations for government
grounds, including parks and recreational areas. Increase
smoke-free housing policies in affordable multi- unit housing and
other private sector market-based housing. Increase the number of
100% tobacco-free policies on community colleges campuses and state
and private university/college campuses.
Slide 56
North Carolina Strategies Active Living Increase the number of
convenience stores that increase the availability of fresh produce
and decrease the availability of sugar-sweetened beverages.
Increase the number of communities that support farmers markets,
mobile markets, and farm stands. Healthy Eating Increase the number
of communities that implement comprehensive plans for land use and
transportation. Increase the number of community organizations that
promote joint use/community use of facilities.
Slide 57
North Carolina Strategies High Impact Quality Clinical and
Other Preventive Services (High Blood Pressure and Cholesterol)
Increase the number of health care providers quality improvement
systems for clinical practice management of high blood pressure and
high cholesterol, weight management and tobacco cessation. Increase
the number of healthcare organizations that support tobacco use
screening and referral to cessation services.
Slide 58
North Carolina Strategies Increase the number of community
supports for individuals identified with high blood
pressure/cholesterol and tobacco use (e.g. Chronic Disease Self-
Management Programs, (CDSMP) weight management programs, tobacco
cessation programs).
Slide 59
CTG Regions 59
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Slide 61
Heart Healthy Lenoir Project P-50 Goals: Understand factors
that lead to worse health in Lenoir County. Understand factors that
lead to disparities within Lenoir County. R01- Patterson: Study
genetic footprints that affect treatment success. R01-
Ammerman/Keyserling: Test a sustainable program to improve
nutrition/physical activity and support weight loss. R01- DeWalt:
Test a system to improve blood pressure control through primary
care practices.
Slide 62
Control of High Blood Pressure and High Blood
Cholesterol-Strategies Strategies- Primary Care Health Systems
Promote systems to support self- management (e.g., telephonic
follow-up, linkages to home monitoring, self- management programs).
Promote system changes that integrate and sustain use of community
health workers and other healthcare extenders within healthcare
settings.
Slide 63
Timeline Yr 1 5/10-4/11 Yr 2 5/11-4/12 Yr 3 5/12-4/13 Yr 4
5/13-4/14 Yr 5 5/14-4/15 Get to know patients and practices Enroll
600 Implement/Test New Strategies Track Outcomes Analyze
results
Slide 64
Role of Hypertension in CVD HTN accounts for 27% of total CVD
events in women and 37% in men 60% of those with known HTN are on
medical therapy 50% of those on therapy are at their goal BP
Controlling BP reduces the risk of stroke (35-40%), myocardial
infarction (20-25%), and heart failure (50%) Chobanian et al. JAMA.
2003; 289:2560-2572. Jajjar and Kotchen. JAMA. 2003;
290:199-20.
Slide 65
HTN, It is important. WHO: credits HTN with 1 in every 8 deaths
It is the 3rd leading cause of death worldwide The most important
public health problem in developed countries. Agency for Healthcare
Research and Quality. Technical Review 9. January 2005. Controlling
hypertension is the single most effective clinical service for
reducing mortality Farley TA Am J Prev Med 2010