Community and Clinician Partnership for Prevention (C2P2)

1. Community and Clinician Partnership for Prevention(C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’, MSPH, ANP-BC Funding: AHRQ; PBRN Task Order Request #1

2. Background • Unhealthy behaviors are common and lead to significant morbidity and mortality • Tobacco use • Poor diet • Lack of physical activity

3. Background • Rate of behavioral-based interventions to address unhealthy behaviors by primary care providers is low • Lack of knowledge • Poor self-efficacy • Challenge of delivering interventions in a busy setting with limited capacity

4. Chronic Care Model

5. Objective • To evaluate strategies to develop and foster linkages between primary care practices and community resources

6. www.learnnc.org Setting Orange County: Population: 120,000 Black: 13% Hispanic: 6% Durham County: Population 230,000 Black 37% Hispanic 11% Overall, 13% below FPL In North Carolina Tobacco: 25% Overweight: 36% Obese: 27% ≥20 minutes physical activity ≥3 days per week: <25% Ready to change: 44% who smoke, 60% with poor nutrition, 68% who lack exercise

7. 9 Practices (IM and FP) R Control Passive Intervention Active Intervention Participants and Interventions Duration of the Intervention: 6 month, starting spring 2008

8. Practices • Control • 3 family practice clinics • Passive Intervention • 1 family practice clinic • 2 internal medicine clinics • Active Intervention • 2 family practice clinics (1 with trainees) • 1 internal medicine

9. Initial Selection of Community-Based Resources • Behavioral-based interventions based on the 5 A’s • Must be accessible • Interested in new referrals • Able to participate in bi-directional communication

10. Initial Community-Based Resources • Tobacco Quitline • Public Health Department Dietitians • YMCA • Duke Live-for-Life Program

11. Passive Intervention • Brochure and referral material for selected community organizations: • Practice kick-off meeting • Brief help as requested

12. Practice Brochure

13. Practice Brochure

14. Active Intervention • Passive Intervention Protocol plus: • Access to the “ACCTION Pack” • More regular contact with a “practice champion”

15. ACCTION Pack

16. ACCTION Pack

17. Outcome Measures • Main Quantitative Measure: • Referral from practices to a community resource • Description of the barriers to and facilitators of developing linkages between practices and community resources

18. Tobacco Assessment

19. Tobacco Use

20. Tobacco Referral No intervention effect

21. Diet Assessment

22. Diet Needs Modification

23. Diet Needs Referral No intervention effect

24. Physical Activity Assessment

25. Physical Activity Needs Modification

26. Physical Activity Referral No intervention effect

27. What limited the impact of the interventions? • Little understanding about how to build collaborations • Physicians were not motivated to form collaborations, even when they were interested in engaging the community • Organizations had significant staff turnover • No method for bi-directional communication • Concerns about cost • Concerns about treatment • No information about outcomes

28. What limited the impact of the interventions? • ACCTION Pack • Difficult to use to get to information quickly • Not populated with local resources • Practices wanted handouts • Practices overwhelmed with material

29. Conclusions and Next Steps • Forming partnerships between clinicians and community-based organizations is difficult • Successful partnerships cannot be developed by bringing materials to practices alone

30. Conclusions and Next Steps • Future efforts should • work on bringing together potential partners and allowing them to develop mutually beneficial collaborations • focus on increasing consumer demand and the expectation that primary care providers will refer to such organizations

31. Thank You!