Heart Health Project Heart Health Project

University of Pennsylvania School of Medicine

American Heart AssociationPennsylvania State University

PennHeartHealth

Funded by the Robert Wood Johnson FoundationFinding Answers Program

Overview of Project AimsOverview of Project Aims

Randomized controlled trial of a practice-based team intervention that combines peer coach with health educator support versus educational brochures

Evaluate effect on:

1) reduction of 4-year coronary artery disease (CAD) or CAD death risk,

2) reduction in systolic blood pressure, and

3) cost-effectiveness from a societal perspective.

PennHeartHealth

Increased Heart Risk in Blacks in Increased Heart Risk in Blacks in our Primary Care Practicesour Primary Care Practices

Black patients more likely to have uncontrolled hypertension than Whites in our practices

Black patients and White women are less likely to receive treatment for high cholesterol than white men

However, Black patients are more likely to have medication increased when their blood pressure is elevated than White patients

Why Peer SupportWhy Peer SupportTrained peer health educators significantly

improved adherence to cancer screening and cancer care in largely minority study populations Miller SM et al. J Natl Cancer Inst, 1997; Battaglia TA et al. Cancer, 2007, Turner BJ et al. JGIM, 2008

Peer role models offer support and strategies to change behavior in regard to medication adherence, diet, and exercise

Peer Coaches Help Keep Peer Coaches Help Keep Colonoscopy AppointmentsColonoscopy Appointments

Randomized controlled trial in our practices Trained peers called patients who were unlikely

to keep colonoscopy appointment Troubleshoot barriers to colonoscopy Patients who received peer calls were two times

more likely to attend the colonoscopy Patients were very satisfied with information they

received Successful!

Health Care Team to Help Reduce Health Care Team to Help Reduce Heart Disease RiskHeart Disease Risk

Health educatorMeets with the client to review personal risk factors

for heart disease Calculates their risk of heart disease and death of heart disease and death

from heart disease from heart disease Reviews barriers, offer information, set goalsReviews barriers, offer information, set goals

Peer coachServes as a role model of success from the same

communityOffers practice tips to reduce barriers Changes attitudes by showing can succeed Changes attitudes by showing can succeed

www.acponline.org/hpp/pcmh07.pdf

Study DesignStudy Design

250 patients with sustained elevated blood pressure

125 Intervention 125 control

3 peer coach calls and 2 educator visits + brochures

Brochures from AHA

Endpoint at 6 months(CAD risk, BP, LDL, weight)

PennHeartHealth

Target Patient PopulationTarget Patient Population

Black patients aged >40 to 75 with hypertension (2006), N=5,340

Uncontrolled hypertension (sustained elevation at two or more visits in one year) N=1,030) 30% recent high LDL cholesterol30% recent high LDL cholesterol 16% current smokers in records16% current smokers in records 35% diabetes 35% diabetes 26% known CAD or equivalent 26% known CAD or equivalent 40% >200 lbs40% >200 lbs

PennHeartHealth

Theory Underlying Our StudyTheory Underlying Our Study

Attitudes

Subjective norms

Perceived behavioral control

Intention to

Change

DesiredBehaviors

Peer Coach Support (n=10)Peer Coach Support (n=10) Attitudes – emphasize heart health

Beliefs and concerns about heart disease and risk factorsBeliefs and concerns about heart disease and risk factors Why we care in black communityWhy we care in black community How feels about personal CAD prevention planHow feels about personal CAD prevention plan

Social Norms Personal successes and challengesPersonal successes and challenges

Perceived Behavioral Control – barriers Adherence supportsAdherence supports Diet tipsDiet tips Exercise benefitsExercise benefits

WorkplanWorkplan5 6

CAB

7PC

8

HE

9 10

11 12

end-point

1

data

2 3

CAB

42008 2009

2009 20105 6 7 8 9 10

CAB

11 12

Analysis

1 2

Party

PennHeartHealth

Peer Coach Phone CallsPeer Coach Phone Calls

0

2

4

6

8

10

12

14

16

1 2 3 4 5 6 7 8 9 10 11 12 13 14

calls

pts/mo

total pts

Months7 PC x 20 patients = 140

Training ProgramTraining Program Two sessions – 3.5 hours each Four conference calls – review materials and

practice talking with clients Two practice calls – with team and with each other Update and troubleshoot conference calls every

other month Claire will touch base about problems monthly Meet twice a year for lunch at practice Party

Peer Coach ResponsibilitiesPeer Coach Responsibilities

Patient calls (up to four efforts to reach) Educate, support, role model desired outcome Record barriers, set goals, and leave barriers-

goals for Lenette Receive updated barriers-goals from health

educator visit, review, update at call, and leave message for Lenette

Record each effort to reach client Record time spent on calls

Final GoalsFinal Goals

Patients have improved blood pressures because of remembering medications and working with physician

Patients have healthier diets Patients have more active lifestyles Patients have lower cholesterol levels Patients and peer coaches and health educators

are pleased with the outcome of the project