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Kaczorowski J, Lussier MT, Girard M, Beaulieu-Carbonneau A. Implementation of Modified Cardiovascular Health Awareness Program for Canadian Adults on a Waiting List for a Family Physician. J Prim Care Community Health 2021; 11:2150132720976484. [PMID: 33243046 PMCID: PMC7708698 DOI: 10.1177/2150132720976484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular diseases (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary care. Centralized waiting lists and prioritization based on urgency of medical need were created to address this problem. We aimed to assess the acceptability, CVD risk profile, and potential benefits of offering a modified version of CHAP to adults on the waiting list. METHODS The implementation was conducted in Laval (Canada) between March and June 2016, targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centers. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured. They also received targeted healthy lifestyle and patient education materials and were referred to local programs including a medical follow-up, when required. RESULTS A total of 1976 invitation letters were sent resulting in 281 (14.2%) participants. The average age of attendees was 58.1 (SD = 8.2) and a majority were female (58%, n = 163). A third of participants (34.2%, n = 96) had BP ≥140/90 and 11.4% (n = 32) were classified as having a very high risk for developing diabetes. Almost half (41.6%, n = 117) of participants were referred either to health promotion programs offered by local health authorities, to family physicians (4.6%, n = 13) or emergency departments (1.8%, n = 5) for short-term medical assistance. CONCLUSION Despite low participation rate, many adults on a waiting list had elevated risk for CVD and would greatly benefit from having a regular source of primary care.
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Affiliation(s)
- Janusz Kaczorowski
- University of Montreal, Montreal, QC, Canada.,CRCHUM, Montreal, QC, Canada
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Girard M, Kaczorowski J, Lussier MT, Martin V. Attendance, activation and health profiles of participants, a prospective study on a regional cardiometabolic disease self-management program in Laval, Canada. BMC Public Health 2021; 21:497. [PMID: 33711973 PMCID: PMC7953555 DOI: 10.1186/s12889-021-10558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Chronic diseases are responsible for over 70% of all deaths globally. While some self-management programs have been shown to be efficacious in preventing or altering trajectories for some chronic conditions, scaling-up and sustaining such programs beyond tightly-controlled study conditions remain a major challenge. CISSS-Laval partnered with the Cardiovascular Health Awareness Program team to co-develop Cible-santé/prévention and evaluate the first cohort of participants enrolled in the program, in order to better understand the program’s implementation and scope. The objective of the current study was to describe the profile of attendees and the level of engagement of participants in a new, region-wide cardiometabolic disease self-management program offered in Laval, Canada. Methods This was a prospective study with no comparison group. Potential participants were identified and referred to the program from April to December 2015 by their primary care health professional practicing in one of the city’s interdisciplinary primary care clinics. They had their blood pressure, waist circumference and body mass index measured by trained volunteers, and completed a questionnaire on health habits, level of activation and the risk of developing prediabetes and type 2 diabetes over the next 10 years. Results A descriptive analysis of the first cohort of 141 Cible-Santé/prévention participants showed very low attendance. Furthermore, only 1 in 10 of enrolled participants completed the full program. The program typically attracted adults with some risk factors associated with their conditions (high waist circumference, obesity), but with an already high level of knowledge, skills and confidence to participate in self-management activities. Conclusion This study provides a portrait of new participants to a self-management cardiometabolic disease program, which highlights the potential of supporting patients ready to make changes but also exposes the difficulty of attracting a larger number and diversity of participants and in encouraging completion of the program. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10558-6.
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Affiliation(s)
- Magali Girard
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.
| | - Janusz Kaczorowski
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
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Agarwal G, Girard M, Angeles R, Pirrie M, Lussier MT, Marzanek F, Dolovich L, Paterson JM, Thabane L, Kaczorowski J. Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada. Trials 2019; 20:760. [PMID: 31870415 PMCID: PMC6929306 DOI: 10.1186/s13063-019-3806-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/17/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors' housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. METHODS/DESIGN This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50-200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. DISCUSSION It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. TRIAL REGISTRATION ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
| | - Magali Girard
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
- Primary Care Research Team, Centre intégré de santé et des services sociaux de Laval, Laval, QC, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - J Michael Paterson
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare Research Institute, Hamilton, Canada
| | - Janusz Kaczorowski
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
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Taylor J, Semchuk W, Deschamps M, Sulz L, Tsuyuki RT, Duffy P, Wilson T. Pharmacist Intervention in Risk Reduction Study in High-Risk Cardiac Patients: The Effect of 2 Methods of Pharmacist Training. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350714000227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To assess the effect of intensive vs conventional training on pharmacist-suggested implementation of cardiac risk reduction efforts in community practice. Methods: Sixty-one volunteer pharmacists from 40 pharmacies were randomized to 1 of 2 educational groups: intensive or conventional training in cardiac risk reduction. With training complete, pharmacists identified and approached patients at high risk for coronary artery disease (CAD) at their practice sites to participate in the program. After a patient interview, pharmacists documented the relevant CAD risk factors and medication history, and then faxed this information, along with risk reduction recommendations, to the primary care physician. Patients were then encouraged to book a medical appointment for further assessment and treatment, if warranted. Follow-up occurred at 4, 16, and 24 weeks to determine if any pharmacist-suggested risk reduction measures had been implemented. Pharmacists were reimbursed $30 per patient accrued. Results: A total of 217 patients were enrolled in the study, and of those, 216 had follow-up data available for analysis. No significant differences were observed between the groups with respect to mean number of patients enrolled per pharmacist (4.3 vs 2.7) and the proportion of pharmacists completing at least 1 patient (17/27 vs 14/34). Feedback from pharmacists on program delivery indicated no significant difference in satisfaction with the training provided. The recommendations forwarded by pharmacists of the intensive group (35.8%) received greater acceptance by physicians than those in the conventional group (23.8%). Conclusion: Although results are preliminary, intensive training for pharmacists was more likely to result in improvements in cardiovascular risk reduction therapy than when conventional training was used.
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Angeles RN, Dolovich L, Kaczorowski J, Thabane L. Developing a Theoretical Framework for Complex Community-Based Interventions. Health Promot Pract 2013; 15:100-8. [DOI: 10.1177/1524839913483469] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Applying existing theories to research, in the form of a theoretical framework, is necessary to advance knowledge from what is already known toward the next steps to be taken. This article proposes a guide on how to develop a theoretical framework for complex community-based interventions using the Cardiovascular Health Awareness Program as an example. Developing a theoretical framework starts with identifying the intervention’s essential elements. Subsequent steps include the following: (a) identifying and defining the different variables (independent, dependent, mediating/intervening, moderating, and control); (b) postulating mechanisms how the independent variables will lead to the dependent variables; (c) identifying existing theoretical models supporting the theoretical framework under development; (d) scripting the theoretical framework into a figure or sets of statements as a series of hypotheses, ifthen logic statements, or a visual model; (e) content and face validation of the theoretical framework; and (f) revising the theoretical framework. In our example, we combined the “diffusion of innovation theory” and the “health belief model” to develop our framework. Using the Cardiovascular Health Awareness Program as the model, we demonstrated a stepwise process of developing a theoretical framework. The challenges encountered are described, and an overview of the strategies employed to overcome these challenges is presented.
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Affiliation(s)
| | - Lisa Dolovich
- McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, Hamilton, Ontario, Canada
| | - Janusz Kaczorowski
- Université de Montréal—Centre de recherche du CHUM (CRCHUM), Montreal, Quebec, Canada
| | - Lehana Thabane
- McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, Hamilton, Ontario, Canada
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Karwalajtys T, Kaczorowski J, Chambers LW, Hall H, McDonough B, Dolovich L, Sebaldt R, Lohfeld L, Hutchison B. Community Mobilization, Participation, and Blood Pressure Status in a Cardiovascular Health Awareness Program in Ontario. Am J Health Promot 2013; 27:252-61. [DOI: 10.4278/ajhp.101221-qual-408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To determine the feasibility of a community-wide approach integrated with primary care (Cardiovascular Health Awareness Program [CHAP]) to promote monitoring of blood pressure (BP) and awareness of cardiovascular disease risk. Design. Demonstration project. Setting. Two midsized Ontario communities. Participants. Community-dwelling seniors. Intervention. CHAP sessions were offered in pharmacies and promoted to seniors using advertising and personalized letters from physicians. Trained volunteers measured BP, completed risk profiles, and provided risk-specific education materials. Method. We examined the distribution of risk factors among participants and predictors of multiple visits and elevated BP. Results. Opinion leaders aided recruitment of family physicians (n = 56/63) and pharmacists (n = 18/19). Over 90 volunteers were recruited. Invitations were mailed to 4394 seniors. Over 10 weeks, there were 4165 assessments of 2350 unique participants (approximately 30% of senior residents). 37.5% of attendees had untreated (16%; 360/2247) or uncontrolled (21.5%; 482/2247) high BP. Participants who received a letter (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.1–3.0), had an initial elevated BP (OR 1.2, 95% CI 1.0–1.5), or reported current antihypertensive medication (OR 1.4, 95% CI 1.1–1.6) were more likely to attend multiple sessions (p ≤ .05 for all). Older age (≥ 70 years; OR 1.5, 95% CI 1.3–1.8), BMI ≥ 30 (OR 1.7, 95% CI 1.4–2.2), current antihypertensive medication (OR 1.6, 95% CI 1.3–1.9), and diabetes (OR 2.4, 95% CI 1.9–3.2) predicted elevated BP (p < .001 for all). Conclusion. The program yielded learning about community mobilization and identified a substantial number of seniors with undiagnosed/uncontrolled high BP.
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Agomo CO. The role of community pharmacists in public health: a scoping review of the literature. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2011.00074.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Development of the Volunteer Peer Educator Role in a Community Cardiovascular Health Awareness Program (CHAP): A Process Evaluation in Two Communities. J Community Health 2009; 34:336-45. [DOI: 10.1007/s10900-009-9149-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Enhancing hypertension awareness and management in the elderly: lessons learned from the Airdrie Community Hypertension Awareness and Management Program (A-CHAMP). Can J Cardiol 2008; 24:561-7. [PMID: 18612498 DOI: 10.1016/s0828-282x(08)70634-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND High blood pressure (BP) is an established and modifiable cardiovascular risk factor; however, awareness and management of this primarily asymptomatic disease remains suboptimal. OBJECTIVES The Airdrie Community Hypertension Awareness and Management Program (A-CHAMP) was a community-based BP program for seniors designed to improve public and health care provider awareness and management of hypertension. METHODS Volunteer peer health educators (VPHEs) were recruited from the community and trained to manage BP screening sessions in local pharmacies. Airdrie (Alberta) residents 65 years of age and older were invited by their family physicians (FPs) to attend the A-CHAMP sessions. VPHEs identified participants' cardiovascular risk factors, assessed BP with a validated automated device and implemented a management algorithm. Participants with BP higher than 159/99 mmHg were directed to their pharmacists and FPs. All participants with elevated BP at the initial A-CHAMP session were invited to return to a follow-up session four to six months later. RESULTS Thirty VPHEs were recruited and trained. All 15 FPs and all six pharmacies in Airdrie participated. VPHEs assessed 406 seniors (approximately 40% of Airdrie seniors) during the three-month program. One hundred forty-eight participants (36.5%) had elevated BP at their first session. Of these, 71% returned for the follow-up session four to six months later. The mean (+/- SD) systolic BP decreased by 16.9+/-17.2 mmHg (P<0.05, n=105) compared with their first visit, and 56% of participants (59 of 105) reached Canadian targets for BP. CONCLUSIONS A-CHAMP raised awareness, and identified and managed seniors with hypertension. At follow-up, BP showed statistically and clinically significant and sustained improvement. Participating health care providers and VPHEs indicated that A-CHAMP was effective and feasible in improving awareness and control of hypertension.
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