Post on 21-Jan-2017
Improving Cardiovascular Health With Improved Medication Adherence
Improving Cardiovascular Health With Patient Peer Support GroupsMonisha BhatiaFoundations in healthcare Delivery August 28, 2016
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Case: Mr. H55 year old African American male PMH diabetes, hypertension SHxcurrently on disability, former construction worker, unemployed, no children, divorced, noted barriers to care include inconsistent transportationActive smoker, no alcohol or drugsFHxFather (deceased): lung cancer, diabetes, bipolar disorderMother: fibromyalgia, hyperlipidemia
PE: BP 140/100, HR 80, RR 12, BMI 27No significant findings on physical exam
Labs: Total cholesterol 150; HDL 80Medications: metformin, atorvastatin, lisinopril
Social, engaging Real world circumstances Long history, success story Did not necessarily have all resources, not perfect Had started sticking to diet, walking regularly despite physical limitations
ASCVD Risk Calculation
AHA Statistical UpdateDariush Mozaffarian et al. Circulation. 2016;133:e38-e360Available at: https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_483974.pdf
Community Resources for CVD Improvement
CHIP: Rockford Illinois Reduce coronary risk factor levelsCommunity based and medical settingsCommunity programming with video lectures, class discussions, nutrition workshopsClubCHIP programhttp://www.healthynashville.org/index.php?module=promisepractice&controller=index&action=view&pid=3358
Heart to Heart5 year community based chronic disease prevention projectCommunity groups to develop worksite wellness programs, implement grocery store point of purchase programs, and publish health promotion messages in local newspapers, community bulletins, and local radio programming. Fitness, walking, smoking cessation, and shopping for nutritional foods.
Hearts for LifeRisk profile by completing questionnairsSmall group educational sessions about reducing risk behaviorsPresentation by trained public health nurse about heart disease risk factors and risk reduction stratgeies
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Patient Peer Support Group Risk Reduction ProgramIn detail
Patient Peer Support Group > 40 years old Greater than 15% 10 year risk of ASCVD coronary death or nonfatal myocardial infarctionFatal or nonfatal stroke >1 nonideal health behavior as identified by clinician Medication CompliancePhysical ActivityDiet and Nutrition
TARGET POPULATION
Patient Peer Support Group
Reduce the number of nonideal health characteristics
in patients >40 years old with >15% 10 year risk of ASCVD
using a peer support program and wellness model.
GOALS
Patient Peer Support GroupPLANNED INTERVENTION
Patient Peer Support GroupMEASURING SUCCESS
Questionnaires might also inform future improvements.12
Patient Peer Support GroupTIME COURSE TO DETERMINE IMPROVEMENT
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Patient Peer Support GroupSupport groups are a very common approach to solving complex health problems.At VanderbiltAHA Comprehensive Lifestyle Peer Group-Based Interventions have been useful in improving cardiovascular risk factors.
This approach rewards both educators and group participants in a low-cost fashionJUSTIFICATION
Gmez-Pardo E, Fernndez-Alvira J, Vilanova M, et al. A Comprehensive Lifestyle PeerGroupBased Intervention onCardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.J Am Coll Cardiol.2016;67(5):476-485. doi:10.1016/j.jacc.2015.10.033.
45-50 years with one risk factor. After 6 hours of education related to cardiovascular risk factors,the subjects were randomized into a peer group for self-management control group for 12 months. Monthly meetings involving the discussion of risk factors and then specific risk factors that applied to them individually. Mean change in composite score of blood pressure, exercise, weight, eating and tobacco use. Each item had a 3 point maximum. Communities were in S14