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
