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Thank You Janet

Thank You Janet. ABCS of Heart Disease and Stroke Prevention Our Challenge Our Partners Jacquie Halladay MD MPH, UNC-CH Lindsay Beavers, CCME. ABCS of Heart Disease and Stroke Prevention. Aspirin: Increase low dose aspirin therapy according to recognized prevention guidelines .

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Thank You Janet

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  1. Thank You Janet

  2. ABCS of Heart Disease and Stroke PreventionOur ChallengeOur PartnersJacquie Halladay MD MPH, UNC-CH Lindsay Beavers, CCME

  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.

  4. http://www.cdc.gov/DHDSP/programs/nhdsp_program/docs/ABCs_Guide.pdfhttp://www.cdc.gov/DHDSP/programs/nhdsp_program/docs/ABCs_Guide.pdf

  5. National Heart Disease and Stroke Prevention (NHDSP) Program Anchored in the Socio-ecological Model.

  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”

  7. Linked to “Policy and Systems Change” outcome measures

  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.

  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)

  10. HDSP- CCME - Heart Lessons

  11. The ABCS of Heart Disease and Stroke Prevention Janet Reaves Memorial Conference February 3, 2012

  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.

  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

  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.

  15. SWYH Banner Ads • SWYH banner page on the SWYH website • www.startwithyourheart.com • Home > Health Professionals > SWYH Banners

  16. Educational Material, cont. • Other materials: • 8,000 blood pressure index cards • 5,000 consumer ABCS flyers • 7,500 stroke magnets

  17. Educational Material • Brochures on stroke, blood pressure, and cholesterol have been printed and provided to health coordinators.

  18. Media Outreach • Sodium op-ed was published in the N&O on December 23, 2011. • http://www.newsobserver.com/2011/12/23/1728502/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.

  19. Community Outreach Activities • Conduct outreach activities in 2012, predominantly in eastern North Carolina • February 2012 • Provide ABCS flyers to be distributed at a Go Red Gala in Greenville on Feb. 5 • Provide an ABCS insert for church bulletins to 35 churches in eastern NC through Cornerstone Ministries • May 2012 • Send ABCS flyers to 21 Wal-Mart pharmacies in eastern NC to distribute to their patients

  20. Questions? 100 Regency Forest Drive, Suite 200, Cary, NC 27518 800.682.2650 • www.thecarolinascenter.org

  21. Heart-Healthy Lenoir Blood Pressure Control Project:ECU / UNC-Chapel Hill PI’s: Alice Ammerman, Darren DeWalt, Cam Patterson

  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

  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.

  24. Stanford-USFC EBPC • Performed a systematic reviews of interventions aimed at reducing BP’s among people with HTN.

  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

  26. Classification of Interventions

  27. Classification of Interventions

  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.

  29. Current work: Develop and implement the phone coaching program. • Evidence regarding effectiveness • NC programs

  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…..

  31. Phone Coaching • Improved patient compliance with self care regimens. • Increased patient confidence towards disease management. • Reduced hospital readmissions • Improved mental health

  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…..

  33. NC Health Smart www.shpnc.org http://www.shpnc.org/ncHealthSmart/faq-nchs-health-coach.aspx

  34. NC Health Smart

  35. Coaching from the NC from the State Health Plan! • Weight control • “Ya’ll 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 BP’s from 177/92 to 124/70!

  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 BG’s from 160 to 70mg/dl.

  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.

  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).

  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).

  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

  41. Average Medication Adherence Overtime: (a) intervention group vs. (b) usual care a Participants - MPR: 59% to 77% Intervention Start b NON-participants - MPR: 60% to 64%

  42. Adherence compared to themselves Very Poor Poor Good Intervention Start

  43. More coaching partners.. • People like Dr. Jonathan Rubens from ActiveHealth management.

  44. Health Plans, Hospitals, Health Systems

  45. Employers UPS IUOE TVA Westinghouse

  46. Socio-ecological Model

  47. First of its kind in Brunswick Co.

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