sustainability for community-wide cardiovascular disease prevention:

1

Sustainability for community-wide cardiovascular disease prevention:

The Cardiovascular Health The Cardiovascular Health Awareness Program + Action PlanAwareness Program + Action Plan

Larry W Chambers Larry W Chambers MSc PhD FACE FFPHE; MSc PhD FACE FFPHE; Janusz Kaczorowski MA PhD; Janusz Kaczorowski MA PhD; Tina Karwalajtys MA PhD(c) Tina Karwalajtys MA PhD(c)

Lisa Dolovich MSc PharmD; Tracy Gierman MA; Lisa Dolovich MSc PharmD; Tracy Gierman MA; Stephanie Laryea BSc; Megan Carter MA; Stephanie Laryea BSc; Megan Carter MA; For the CHAP Working GroupFor the CHAP Working Group

CPHA June 2008CPHA June 2008

2www.CHAPprogram.ca

Collaborating Organizations

3www.CHAPprogram.ca

What is CHAP?

The Cardiovascular Health Awareness Program (CHAP):

connects hospital, community and primary care sectors includes peer volunteer-led sessions for blood

pressure (BP) and cardiovascular disease (CVD) risk assessment and education

provides results to participants, family physicians, and pharmacists

4www.CHAPprogram.ca

CHAP DevelopmentPhase 1: Is it feasible to offer CV health promotion sessions in pharmacies?

Dundas pilot (2001) Ottawa pilot (2002) Ottawa and Hamilton (CHAT – 2003)

Phase 2: Can CHAP work at a community level? Community-wide implementation in Grimsby & Brockville (CHAP – 2004) Airdrie Cardiovascular Health Awareness and Management Program

(A-CHAMP – 2005-2006, Alberta)

Phase 3: Does CHAP work at a community level? Multi-community implementation and evaluation (C-CHAP – 2006)

Phase 4: Can CHAP be sustained at a community level? Sustaining and evaluating an enhanced CHAP (CHAP+AP – 2008)

5www.CHAPprogram.ca

CHAP across Ontario – a province wide evaluation study 20 program & 19 intervention communities 20 communities successfully launched CHAP Approximately 25% (n=15,889) of older adults in

communities attended at least one CHAP session Almost 40% of participants had elevated BP at their

initial visit and the prevalence of modifiable risk factors was high

6www.CHAPprogram.ca

CHAP x 20 communities 21,500 residents on average 214/341 physicians ‘actively participated’ 129/145 pharmacies held sessions 577 volunteers recruited & trained (547 supported sessions

1,265 sessions held 27,358 assessments 15,889 participants

7www.CHAPprogram.ca

BP Status of Participants18%

4%

33%

4%

41%

Elevated & unaware Diagnosed, not treated or controlled

Treated & uncontrolled Diagnosed, not treated, normal

Treated & controlled

8www.CHAPprogram.ca

CHAP Participant CharacteristicsCharacteristic (Self-Reported) Overall CHAP

Program (n = 15,889)

Age (y): Mean (SD) 71.9 (9.7)

Female (%) 60

Diagnosed with Diabetes (%) 15

Diagnosed with High Cholesterol (%) 41

Diagnosed with Hypertension (%) 54

History of Transient Ischemic Attack (%) 8

High Blood Pressure (Systolic ≥140 mmHg; ≥130 mmHg if Diabetes, %) 37

Smokers (%) 9

Physically Inactive (%) 20

Low Fruit & Vegetable Intake (< 5 servings/day, %) 27

Body Mass Index (>25, %) 63

High Alcohol Consumption (2 or more drinks/day, %) 10

Low Fruit & Vegetable Intake (< 5 servings/day, %) 27

9www.CHAPprogram.ca

CHAP+Action Plan - Objectives Develop and implement a sustainable community-wide

CVD program that is viable and builds on local community resources to enable continuity of care for people with chronic disease

Evaluate the processes, performance and outcomes derived from CHAP, providing a picture of how the program links to other services/resources and supports individuals to address modifiable risk factors

10www.CHAPprogram.ca

From Awareness to Action Opportunity to respond to elevated / uncontrolled BP

among past CHAP participants Can provide on-going follow-up and support Add new innovations: expanded role of volunteers,

Blood Pressure Action PlanTM

Capitalize on new provincial developments: expansion of FHTs and MedsCheck


Methods: Community-driven CV health promotion CHAP+AP emphasizes:

building supports for self-management of CVD risk factors incorporating follow-up activities integrated care across sectors quality improvement

Local partner organizations generate a plan to strengthen and sustain CHAP within their communities


Methods: Target audience

CHAP+AP targets patients at increased risk of cardiovascular disease

Initial approach will include assisting FPs to invite participants from 2006 to return if BP elevated

New FPs assisted to generate a list of patients ‘Ticket’ option continuing Raising community awareness


New Components

Peer Health Educator Mentors (PHMs) Enhanced role of volunteers at sessions Facilitation of community education activities

Blood Pressure Action Plan™ (Heart & Stroke Foundation of Canada)

MedsCheck Pharmacist Intervention

NEW!

NEW!

NEW!


What is a Peer Health Mentor? Volunteer trained to provide additional support on

addressing modifiable risk factors to participants at sessions and in the wider community

At the sessions, PHMs will facilitate completion of CHAP Risk Profile and H&S Action Plan, review with participants, discuss priorities and strategies for addressing risk factors, and provide resources/referrals

In the community, PHMs can engage in additional health promotion activities in partnership with existing agencies/programs


Blood Pressure Action PlanTM


MedsCheck


CHAP+AP Strategies1. Peer education and support

Focus on supporting participants to address risk factors Peer mentors trained to provide support over time

2. Encouraging repeat visits Capturing changes in priorities / readiness Capturing strategies / resources / referrals discussed Capturing changes in behaviours / risk factors


Strategies (2)3. Partnering with local organizations to offer:

‘Check-off’ requests for more information about programs Local options with strategy in place for follow-up

‘Sign-ups’ for new or existing programs Strategy in place for follow-up

‘Referrals’ for appointment with a health professional or other locally available service

In partnership with FPs or local resources

4. Follow-up strategy for referrals offered: Follow-up call to provide more information on community resources Reminder calls before a first program activity or event Follow-up to make requested appointments via FP / FHT Facilitating education sessions delivered by CHAP+AP PHMs


Mentorship discussion form

CHAP+AP Mentorship Discussion Form For each question, please solidly fill in one circle like this (NOT like this or this ). Thanks!

Participant Visit Information 1. Did you participate in the CHAP 2006 program?..................................................... Yes OR No 2. Is this session the first visit or repeat visit to the CHAP+AP Program? .............. First OR Repeat

3. Did you complete a Heart and Stroke Blood Pressure Action PlanTM today?....... Yes OR No 4. Have you previously completed a Heart and Stroke Action Plan TM? ................... Yes OR No 5. What priorities/goals were identified for you on your CHAP+AP Risk Profile Recording Form and/or Heart and Stroke Action

PlanTM? (Fill in all that apply):

Alcohol Blood Pressure Cholesterol Diabetes Physical activity

Stress Fat Salt Smoking Weight

Risk Factors Identified from Your Assessment Today 1. What risk factors did you discuss with the Peer Health Educator today?


Stress Fat Salt Smoking Weight 2. What modifiable risk factors would you like to change? (Fill in all that apply):


Stress Fat Salt Smoking Weight 3. What community referrals/programs were offered to you today? (Fill in all that apply)

Community program/talk Family physician/FHT provider

Pharmacist / MedsCheck Social worker

Dietitian / Smoking cessation counselor Other:______________________________

4. What information did you receive today to help you in achieving your priorities/goals? (Fill in all that apply and provide the name of the source) Brochure or poster: ____________________________________________________________________________________________

Internet resource: _____________________________________________________________________________________________

Information on local community resource: __________________________________________________________________________

Other: ______________________________________________________________________________________________________ 5. What steps are you planning to take to achieve priorities/goals based on today’s discussion? (Fill in all that apply)

Attending/joining a community program See an allied health professional (select below): Starting a physical activity program after consulting

family physician Pharmacist /

MedsCheck Dietitian Family physician/ Family

Health Team Provider Reviewing educational material Social worker Smoking cessation counselor

Other: _______________________________________________________________________________________________________ Repeat Visit Information – Complete Only if this is a Repeat Visit to CHAP+AP 1. What steps have you taken to achieve your priorities/goals since your last CHAP+AP session?

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________ 2. Indicate which referral you followed up with since your last CHAP+AP session (Fill in all that apply):

Community program/talk Family Physician/FHT provider


Dietitian / smoking cessation counselor Other:______________________________

3. Since your last CHAP+AP visit, has there been a change in any of the following? (Fill in all that apply):

Recently diagnosed with high cholesterol by a doctor

Recently diagnosed with diabetes by a doctor

Recently diagnosed with high blood pressure (hypertension) by a doctor

Blood pressure Cholesterol level Consumption of high fat food

Fruit and vegetable intake Salt use Alcohol use

Physical activity Smoking status Stress

Weight/Body Mass Index (BMI) Medication use Other:______________________________ Next Visit Information 1. Did you discuss a return visit to a CHAP+AP session?............................................ Yes OR No? 2. Are you planning to return to a CHAP+AP session?.................................................. Yes OR No?

[Community] Session Pharmacy ID


CHAP+AP Mentorship Discussion Form For each question, please solidly fill in one circle like this (NOT like this or this ). Thanks!

Participant Visit Information 1. Did you participate in the CHAP 2006 program?..................................................... Yes OR No 2. Is this session the first visit or repeat visit to the CHAP+AP Program? .............. First OR Repeat

3. Did you complete a Heart and Stroke Blood Pressure Action PlanTM today?....... Yes OR No 4. Have you previously completed a Heart and Stroke Action Plan TM? ................... Yes OR No 5. What priorities/goals were identified for you on your CHAP+AP Risk Profile Recording Form and/or Heart and Stroke Action

PlanTM? (Fill in all that apply):


Stress Fat Salt Smoking Weight

Risk Factors Identified from Your Assessment Today 1. What risk factors did you discuss with the Peer Health Educator today?


Stress Fat Salt Smoking Weight 2. What modifiable risk factors would you like to change? (Fill in all that apply):


Stress Fat Salt Smoking Weight 3. What community referrals/programs were offered to you today? (Fill in all that apply)

Community program/talk Family physician/FHT provider


Dietitian / Smoking cessation counselor Other:______________________________

4. What information did you receive today to help you in achieving your priorities/goals? (Fill in all that apply and provide the name of the source) Brochure or poster: ____________________________________________________________________________________________

Internet resource: _____________________________________________________________________________________________

Information on local community resource: __________________________________________________________________________

Other: ______________________________________________________________________________________________________ 5. What steps are you planning to take to achieve priorities/goals based on today’s discussion? (Fill in all that apply)

Attending/joining a community program See an allied health professional (select below): Starting a physical activity program after consulting

family physician Pharmacist /

MedsCheck Dietitian Family physician/ Family

Health Team Provider Reviewing educational material Social worker Smoking cessation counselor

Other: _______________________________________________________________________________________________________ Repeat Visit Information – Complete Only if this is a Repeat Visit to CHAP+AP 1. What steps have you taken to achieve your priorities/goals since your last CHAP+AP session?

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________ 2. Indicate which referral you followed up with since your last CHAP+AP session (Fill in all that apply):

Community program/talk Family Physician/FHT provider


Dietitian / smoking cessation counselor Other:______________________________

3. Since your last CHAP+AP visit, has there been a change in any of the following? (Fill in all that apply):

Recently diagnosed with high cholesterol by a doctor

Recently diagnosed with diabetes by a doctor

Recently diagnosed with high blood pressure (hypertension) by a doctor

Blood pressure Cholesterol level Consumption of high fat food

Fruit and vegetable intake Salt use Alcohol use

Physical activity Smoking status Stress

Weight/Body Mass Index (BMI) Medication use Other:______________________________ Next Visit Information 1. Did you discuss a return visit to a CHAP+AP session?............................................ Yes OR No? 2. Are you planning to return to a CHAP+AP session?.................................................. Yes OR No?

[Community] Session Pharmacy ID

Mentorship discussion form – repeat visit section


Methods: Launching CHAP+AP

CHAP team continues to work with community partners Sharing community-specific CHAP 2006 data Update / think tank meeting November 2007 Weekly electronic meetings via Adobe Connect Debriefing session planned for fall 2008 Community visits newsletters

Involving FHTs in more communities FHT physician champion Debriefing meeting planned for fall 2008

Refining enhanced program components Updated training New materials for download


Methods: Community Implementation Guide Revising and expanding

the Community Implementation Guide

Expanded chapters on: Peer Health Mentors Pharmacist role

New chapters on: sustainability FHTs


Progress / Findings:

13 communities developed a plan to sustain CHAP

PrimaCare Family Health Team led CHAP in Paris in 2006 and continues as lead in 2008

Involving other FHTs operating in the 20 CHAP communities

partnerships with local agencies more active role in CHAP


Community Total # in community # of High Risk PtsAurora 818 192

Leamington 966 240

Orangeville 839 281

Paris 611 235

Stratford 861 325

Strathroy 583 166

Thorold 377 137

Tillsonburg 1101 400

Wallaceburg 356 184

Woodstock 627 167

Bracebridge 732 202

Gravenhurst 329 83

Collingwood 1139 469

Cornwall 1166 413

Elliot Lake 739 294

Kenora 693 265

Lindsay 902 277

Orillia 1311 543

Pembroke 1169 527

Port Hope 570 210

TOTALSTOTALS 1588915889 56105610

‘High Risk’: BP > 140/90 or 130/80 if DM present


Currently underway

CHAP+AP sessions started in communities May / June Piloting of H&S ‘BP Action Plan’

Initating partnerships with additional FHTs

Plans to engage with remaining 7/20 communities

Implementation Guide planning with input from community partners, FHTs


Implications for practice & policyCHAP+AP can…

provide a sustainable model for CV health promotion that can inform prevention strategies for other chronic diseases

strengthen continuity of care between health-care and community sectors

contribute to building the evidence needed for better decision-making across health planning regions


Contact Information

Larry W. ChambersPresident and Chief ScientistElisabeth Bruyère Research Institute a University of Ottawa & SCO Health Service [email protected]

Janusz KaczorowskiAssociate ProfessorDepartment of Family PracticeUniversity of British [email protected]

Tina KarwalajtysAssistant Professor (PT) & Research CoordinatorDepartment of Family MedicineMcMaster [email protected]


Abstract

Background The Cardiovascular Health Awareness Program (CHAP) connects hospital, community and primary care sectors,

and includes peer volunteer-led sessions for blood pressure (BP) and cardiovascular disease (CVD) risk assessment and education, with provision of results to participants, family physicians, and pharmacists. In 2006, 20 communities launched CHAP. Approximately 25% (n=15,889) of older adults in the 20 communities attended at least one CHAP pharmacy session. Almost 40% of participants had elevated BP at their initial visit and the prevalence of modifiable risk factors was high.

Objective The aim of CHAP+ Action Plan (AP) is to develop and implement a community-wide CVD program that is viable

and builds on local community resources to enable continuity of care for people with chronic disease. The evaluation provides knowledge about the processes, performance and outcomes derived from CHAP, providing a picture of how the program links to other services in a sensible way that works for people who need them.

Methods CHAP+AP emphasizes building supports for self-management of CVD risk factors, incorporating follow-up

activities, and integrated care across sectors and quality improvement. Local partner organizations generate a plan to strengthen and sustain CHAP within their communities.

Practice/Policy Implications CHAP+AP includes program enhancements to engage Family Health Teams, incorporate the new Meds Check

pharmacist consultation program in Ontario, and expand the volunteer role to include facilitation activities. Thirteen communities developed a plan to sustain CHAP. CHAP+AP aims to strengthen continuity of care between health-care and community sectors and contribute to building the evidence needed for better decision-making across health planning regions.

sustainability for community-wide cardiovascular disease prevention:

Documents

enhanced chap chap ap

chap work

chap sessionalmost

community level

past chap participants

evaluation cchap

communitywide implementation

grimsby brockville chap