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Healthy Heart Initiative and the Role of the Pharmacist

Healthy Heart Initiative and the Role of the Pharmacist. Alexis Beyer, PharmD, NCPS Cherokee Indian Hospital Healthy Heart Pharmacist. Objectives. Understand the Healthy Heart Initiative grant program and the benefits of risk reduction.

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Healthy Heart Initiative and the Role of the Pharmacist

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  1. Healthy Heart Initiative and the Role of the Pharmacist Alexis Beyer, PharmD, NCPS Cherokee Indian Hospital Healthy Heart Pharmacist

  2. Objectives • Understand the Healthy Heart Initiative grant program and the benefits of risk reduction. • Assess the need and value of pharmacist participation in the Healthy Heart Initiative grant program. • Understand the outcome measures for tracking cardiovascular health. • Compare patient outcomes of Eastern Band Cherokee Indian (EBCI) Healthy Heart participants with that of EBCI patients diagnosed with diabetes but NOT enrolled in the Healthy Heart Program.

  3. Facts At a Glance • 3.3 Million: Number of American Indians & Alaska Natives (AI & AN) according to 2007 U.S. Census • 16.3%: Number of AI & AN adults diagnosed with DM compared with 8.7% of non-Hispanic Caucasians • 68%: Percent increase in DM from 1994 to 2004 in AI & AN youth aged 15-19 years • ~ 2 times higher: Likelihood of AI & AN to have diabetes compared with non-Hispanic Caucasians

  4. Facts At a Glance (cont.) • 58%: Increase in diabetes prevalence among AI & AN aged 20-29 from 1990 to 1998, compared to 9.1% of general U.S. population • 3 times higher: Death rate due to diabetes for AI & AN compared with general U.S. population • 3 – 4 times higher: The risk for developing cardiovascular disease in AI & AN with diabetes compared with AI & AN without diabetes • 66%: Percent of AI & AN with cardiovascular disease that had prior history of diabetes Data from DHHS: http://www.ihs.gov/medicalprograms/diabetes/

  5. Healthy Heart Initiative • Indian Health Service (IHS) Grant Program • Targets individuals with Diabetes • Clinical, team-based, intensive case-management approach using current clinical guidelines • Goal: Reduce the risk of cardiovascular disease • Funded by IHS Special Diabetes Program for Indians (SDPI) • Division of Diabetes Treatment and Prevention

  6. Inclusion Criteria Diagnosis of diabetes Exclusion Criteria Prediabetes Pregnancy or postpartum < 1yr Dialysis Age < 18 Current substance abuse Unstable chronic conditions Diagnosis of cancer & on chemo or radiation Participation Criteria

  7. Cherokee HHI Staff • Full Time • Certified Nursing Assistant • Registered Nurse • Exercise Physiologist • Part Time • Physician’s Assistant • Pharmacist

  8. Participation Requirements • Baseline visit • Labs • Monthly case management visits • Completion of Course: Balancing Your Life and Diabetes: Honoring the Gift of Heart Health • Monthly activities • Encouraged but not required

  9. Incentives for Participation in Cherokee’s HHI program • Medication alignment • Medication pick-up at clinic visits; no wait time • Prizes & healthy meals provided at activities • Points for all visits and activity participation; grocery voucher • INCREASED CONTROL OF CV RISK!!!

  10. Pharmacist’s Role • Baseline patient visit • Follow-up case management visits • Medication fills for • Nurse case management visits • Provider medical visits • Pharmacy case management visits • Dose changes and/or new medications • Participate in all team activities • Prepare and teach group classes

  11. Baseline Pharmacist Visit • Full MTM review • DM SOC • Immunizations • Labs/Vitals • Medications • Education • Recommendations for provider • Count/align all medications

  12. Pharmacist Involvement in Case Management & Goal Setting • Intensive • Monthly individual visits • Quarterly f/u with provider • Goal Setting • Specific • Attainable • Tobacco Cessation Education

  13. Patient Classes • Balancing Your Life and Diabetes: Honoring the Gift of Heart Health • Group class • Meets weekly for five weeks • Pharmacist leads class on diabetes medications

  14. Cherokee HHI Activities • Family Involvement • Walks/Easy hikes • Healthy Tips Cookout • Exercise classes • Ti-chi • Yoga • Zumba • Stress Management • Healthy Holiday Parties • Gardening Tips

  15. Glucose Control A1c < 7% BP Control <130/80 Lipid Control Primary target: LDL < 100 (< 70 with CVD) Secondary: TG <150 Treatment Targets/Outcome Measures

  16. Patient measures at day zero A1c at goal: 32 BP at goal: 36 LDL at goal: 49 TG at goal: 33 HDL at goal: 23 Current patient measures A1c at goal: 34 BP at goal: 55 LDL at goal: 57 TG at goal: 41 HDL at goal: 32 Cherokee Healthy Heart Participant Results81 Total Participants

  17. Cherokee Healthy Heart Participants

  18. 81 Patient Participants Reduction in A1c 40 (49.38%) Reduction in BP 37 (45.68%) Reduction in LDL 29 (35.80%) Reduction in TG 36 (44.44%) Increase in HDL 39 (48.15%) Cherokee Healthy Heart Participant Results Since Baseline HHI Visit • 78 of 81 patients enrolled in Cherokee’s Healthy Heart Initiative Program have improved in at least one area since their baseline visit

  19. Diagnosed with DM; Why Participate in the HHI Program?

  20. Comparison of EBCI HHI Patients vs. EBCI Patients with Diagnosis of DM, Not Enrolled in HHI

  21. Summary • Healthy Heart Initiative grant program • Reduce CVD through targeted risk reduction • Pharmacists are valuable assets in disease state management • Intensive case-management improves patient outcomes

  22. Interested in HHI Grant Program? • Division of Diabetes Treatment and Prevention   • www.ihs.gov/MedicalPrograms/Diabetes/ • diabetesprogram@ihs.gov

  23. Contributions • Special thanks: • LT Janet Dudley, PharmD Pharmacy Resident for CIHA • Non-HHI pt data collection • Chenoa Gass, RN Cherokee Healthy Heart Nurse Case Manager • HHI pt data collection

  24. References • Cherokee Indian Hospital Electronic Health Record, 2012. • Colorado School of Public Health (n.d.), Healthy Heart Initiate Program. Retrieved on January 21, 2012 from: http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/CAIANH/sdpi/Pages/sdpi.aspx • Indian Health Service (n.d.), Diabetes in American Indians and Alaska Natives. Retrieved on May 3, 2012 from: http://www.ihs.gov/medicalprograms/diabetes/ • National Institutes of Health (n.d.). National Diabetes Information Clearinghouse. Retrieved on May 3, 2012 from: http://diabetes.niddk.nih.gov/

  25. Questions Alexis Beyer, PharmD, NCPS Cherokee Indian Hospital alexis.beyer@cherokeehospital.org alexisrosebeyer@gmail.com

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