Sustainability for community-wide cardiovascular disease prevention:

1. Sustainability for community-wide cardiovascular disease prevention: The Cardiovascular Health Awareness Program + Action Plan Larry W Chambers MSc PhD FACE FFPHE; Janusz Kaczorowski MA PhD; Tina Karwalajtys MA PhD(c) Lisa Dolovich MSc PharmD; Tracy Gierman MA; Stephanie Laryea BSc; Megan Carter MA; For the CHAP Working Group CPHA June 2008

2. Collaborating Organizations

3. 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

4. CHAP Development Phase 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)

5. 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

6. 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

7. BP Status of Participants

8. CHAP Participant Characteristics

9. 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

10. 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

11. 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

12. 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

13. 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!

14. 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

15. Blood Pressure Action PlanTM

16. MedsCheck

17. CHAP+AP Strategies • Peer education and support • Focus on supporting participants to address risk factors • Peer mentors trained to provide support over time • Encouraging repeat visits • Capturing changes in priorities / readiness • Capturing strategies / resources / referrals discussed • Capturing changes in behaviours / risk factors

18. Strategies (2) • 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 • 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

19. Mentorship discussion form

20. Mentorship discussion form – repeat visit section

21. 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

22. Methods:Community Implementation Guide • Revising and expanding the Community Implementation Guide • Expanded chapters on: • Peer Health Mentors • Pharmacist role • New chapters on: • sustainability • FHTs

23. 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

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

25. 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

26. Implications for practice & policy CHAP+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

27. Contact Information Larry W. Chambers President and Chief Scientist Elisabeth Bruyère Research Institute a University of Ottawa & SCO Health Service Partnership lchamber@scohs.on.ca Janusz Kaczorowski Associate Professor Department of Family Practice University of British Columbia janusz.kaczorowski@familymed.ubc.ca Tina Karwalajtys Assistant Professor (PT) & Research Coordinator Department of Family Medicine McMaster University karwalt@mcmaster.ca

28. 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.