The Maryland Cardiovascular
Health Promotion Program
MVP Score!
Fadia T. Shaya, PhD, MPH
Associate Professor
f
fshaya@rx.umaryland.edu
@
May 29th, 2010
MVP Score!
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Problem: African Americans at high risk
CVD greatest morbidity, mortality burden
Prevention is available
Prior success of intervention and education
Background
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The leading cause of death in males: Cardiovascular
disease (CVD)
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African American males disproportionately affected by CVD (435
vs. 323 per 100,000 in Caucasian men)1
The prevalence of hypertension: 42
42.6%
6% in African
American males vs. 32.5% in Caucasian males
Minority males usually under-diagnosed
under diagnosed, diagnosed late
and under-treated even after being diagnosed
1. National Vital Statistics Reports (NVRS). 2008, 24;56:1-120
3
Current Study Goals
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Engage patients and community
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Significant impact of direct to patient approach
Impact of pharmacists
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Hypothesis:
H
th i P
Patients
ti t who
h are empowered
d th
through
h
information and monitoring by pharmacists, and
encouraged to reach out to peers
peers, achieve better
outcomes
Community Engagement
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Full-fledged outreach, education, intervention and research
evaluation program
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Based on “train the trainer”
b pharmacist
by
h
i t approach
h
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Aim: improve awareness
awareness,
health-seeking behavior
and outcomes of CVD
Build on Community Engagement
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Spread information,
empower patients
Information tree cascade
Starting with positive
deviants*
E
Empower
patients
ti t
Build teams
Economic incentives for
teams
* Marsh DR. The Power of Positive
Deviance. BMJ;329:1177-1179 (2004)
Place in Translation Research
Phase 1 translation (T1) research seeks to move a basic discovery
into a candidate health application.
Phase 2 translation (T2) research assesses the value of T1
application for health practice leading to the development of
evidence based guidelines
evidence-based
guidelines.
Phase 3 translation (T3) research attempts to move evidence-based
guidelines
id li
iinto
t h
health
lth practice,
ti
th
through
hd
delivery,
li
di
dissemination,
i ti
and
d
diffusion research.
Phase 4 translation (T4) research seeks to evaluate the "real world"
health outcomes of a T1 application in practice.
7
Risk Factors for HTN
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Smoking
Overweight/Obesity (BMI > 25 kg/m2)
Low physical activity (<30 minutes 3 to 4
ti
times
per week)
k)
High
g Total Cholesterol ((> 190 mg/dl)
g )
Diabetes
Age Men > 55 yo and Women > 65 yo
The Rationale for Pharmacists
in Community Engagement
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
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Access and cultural fluency
Knowledge of patients and environments
Central drug information source for patient
and
d prescriber
ib
Full access to p
patient medication p
profile
Monitoring of therapeutic outcomes
MTM
Study Design
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A longitudinal cohort study
Patients randomly assigned to either an
intervention or control group
Inclusion Criteria
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Age 18 and older
Uncontrolled high BP
10
Scheme
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Built on team culture
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Align financial incentives and recognition
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Sustainability
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http://content.nejm.org/content/vol358/issue21/imag
es/data/2249/DC1/NEJM_Christakis_2249a1.shtml?
sid=ST2008052600601
id ST2008052600601
12
Intervention
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Intervention: Hypertension education sessions,
offered once a month
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Three-part education module: education, prevention,
and treatment of hypertension
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H
Hypertension
t
i education
d
ti manuall
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Methods
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Patients in the intervention group
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Patients reach out and invite relatives or friends to
participate in the program
Each patient with other people in social network forms
a small cluster
People in each cluster take part in the hypertension
education sessions
Patients in the control group
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Receive usual care
14
Baseline Information
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BP measurement: every 3 months, total 2.5 yrs
Medical history
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Risk factors such as smoking and drinking alcohol
Comorbidities
F il Hi
Family
History
Hospitalization and surgeries
Patient Knowledge in Hypertension
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Instrument used: 12-item validated survey
To evaluate the impact of the intervention on the improvement
of patient knowledge of hypertension
15
Patients’ BP by Group
Control (n=236)
MVP (n=236)
P Value
Mean
Std
Mean
Std
Age (years)
55
0.95
48
0.86
<0.0001
Baseline DBP2 (mm Hg)
90
0.77
88
0.54
0.0202
Baseline SBP2 (mm Hg)
150
1.12
146
0.69
0.0030
1st Follow-up DBP3(mm
Hg)
88
0.85
86
0.58
0.0166
1st Follow-up
p SBP3((mm
Hg)
150
1.18
144
0.75
<0.0001
1st Follow-up days
200
6.47
145
6.64
<0.0001
Note: 1. DBP and SBP represent diastolic and systolic blood pressure respectively.
16
Patients’ Profiles by Group
Control ((n=236))
MVP ((n=236))
P value
Gender
Female
Male
N
117
119
Race
Black
Other
18 39
18-39
40-64
>=65
213
23
31
142
63
90.25
9.75
13 14
13.14
60.17
26.69
234
2
65
150
19
99.15
0.85
27 54
27.54
63.56
8.05
<0.0001
Yes
No
Yes
No
Yes
No
Yes
No
69
167
52
184
20
216
24
212
29.24
70.76
22.03
77.97
8.47
91.53
10 17
10.17
89.83
62
174
58
178
13
223
26
149
26.27
73.73
24.58
75.42
5.51
94.49
11 02
11.02
63.14
0.4718
A group
Age
Diabetes
Smoking status
Achieve goal1
(Baseline)
Achieve goal1 (1st
Follow-up)
%
49.58
50.42
N
57
178
%
24.15
75.42
<0.0001
<0 0001
<0.0001
0.5136
0.2064
<0 0001
<0.0001
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Goal Achievement
Survival analysis for time to achieve goal - Cox proportional Hazard model (N=410)
Variable
Estimate
P Value
Hazard Ratio
95% Hazard Ratio
Confidence Intervals
Group
0 68
0.68
0.0493
1 98
1.98
1 00
1.00
3 92
3.92
Male
0.05
0.8819
1.05
0.56
1.98
Black
-0.73
0.1602
0.48
0.17
1.34
Age 40
40-64
64 vs
vs. 18
18-39
39
-0
0.53
53
0 1395
0.1395
0 59
0.59
0 29
0.29
1 19
1.19
Age >=65 vs. 18-39
-0.73
0.1342
0.48
0.19
1.25
Diabetes
-1.63
0.0101
0.20
0.06
0.68
Smoking
-0.25
0 25
0 4762
0.4762
0 78
0.78
0 39
0.39
1 55
1.55
Baseline SBP2
-0.03
0.0430
0.97
0.94
1.00
Baseline DBP2
-0.03
0.0895
0.97
0.93
1.01
Notes:1 Goal is defined as: For patients without diabetes (systolic blood pressure<140 mmHg)
Notes:1.
mmHg), for patients with diabetes (systolic blood pressure<130
mmHg)
2. SBP is for systolic blood pressure; DBP is for diastolic blood pressure.
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Conclusions
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The social networking intervention doubled
the rate of BP control
Diabetes was significantly and negatively
associated with BP decrease
19