[ProCOR] Case for Prevention: Neighborhood-based screening clinic in United States
Case for Prevention: Neighborhood-based screening clinic in United States
Communities around the world are addressing barriers to access to preventive
health services by implementing programs in popular community sites such as
mosques and storefronts. A new study shows that locating a health clinic in a
neighborhood apartment doubled the success rate of African American patients
achieving blood pressure and cholesterol goals. The study was designed to test
the comparative effectiveness of a community intervention model and a primary
care model.
The intervention, described in "Impact of a community-based multiple risk factor
intervention on cardiovascular risk in black families with a history of
premature coronary disease," (Circulation. 2005 Mar 15;111(10):1298-304) can be
adapted for a variety of settings and populations. It was published in a special
theme issue of Circulation: Journal of the American Heart Association focusing
on health disparities.
The small study conducted in Baltimore, Maryland USA included 364 people whose
brothers or sisters had a history of premature coronary disease (before age 60),
thus placing the study group at high risk for heart disease. Participants, on
average, were 49 years old with a high school education. None had a personal
history of heart disease when they enrolled in the study.
Those who had risk factors for heart disease (for example, high blood pressure,
high cholesterol, current smoking history) were randomly assigned to two groups.
One group of 196 people received care in an apartment that served as a clinic.
The other 168 people received care at a traditional health care clinic. About
two-thirds of both groups were women and 80 percent of both groups had health
insurance.
The apartment-based clinic was centrally located within the community and easily
reached by walking, bus and subway. Free parking was available nearby. Patients
were accepted on a walk-in basis--appointments were not necessary. The
apartment's living room served as the reception area and included a play area
for children. The consultation room resembled a small office. The clinic also
included a treatment room and a small exercise room, where patients received
instruction on physical activity.
The clinic created a welcoming environment, more like visiting a friend's
apartment than entering a health-care setting. By providing readily accessible
care in the community and offering a flexible structure, the clinic helped
people return for evaluation.
A nurse practitioner and a community health worker familiar with the
neighborhood staffed the clinic. Patients received care only for risk factors
related to heart disease. An African-American physician who specializes in
urban African-American health consulted with the nurse practitioner and
community health worker once a month.
The control group visited a traditional clinic setting and received regular
primary care from their usual physicians. They received the same educational
materials that were provided at the apartment clinic as well as feedback about
their risk factor measurements and recommendations about how to manage them.
Costs and access (public transportation, etc.) were similar to the community
clinic.
The only difference between the two sites was the location and the presence of
the community health worker. At both sites, providers distributed prescription
cards that allowed patients to receive free medication related to the treatment
of coronary risk factors. Patients at both facilities also had access to free
exercise facilities at the neighborhood YMCA and to free smoking cessation
programs.
After one year, patients in the community-based program were two times more
likely than the traditional clinic patients to have achieved the cholesterol and
blood pressure goals established for both groups. Patients who received care
at the community clinic reduced their 10-year global risk of heart disease by 25
percent compared to a 3 percent reduction in patients who received care with
their usual physician (global risk indicates the predicted chance of having a
heart disease event within the next 10 years based on all of a person's risk
factors).
Patients at the community-based clinic also were more likely to receive a
prescription card, and 13 times more likely to use cholesterol-lowering
medication. Use of cholesterol and blood pressure-lowering medications
increased in both groups, but more so in the community program. Unexpectedly,
the small exercise room at the CBC site was a strong incentive. Participants
often came to exercise for 20 to 30 minutes at lunchtime or before or after
work, whereas commitment to a full evening at the YMCA 2 days a week appeared to
be more difficult. Still, 20% of the apartment-based clinic participants
exercised at the YMCA, enabled by a direct invitation from the community health
worker. Telephone interventions allowed participants to report progress on their
own schedule."
Researchers credit the community health worker with being a key factor to
helping patients understand how to use their pharmacy cards, visit local YMCAs
for physical activity, and comply with medication regimens. The authors state
that the community health worker "served as a culturally sensitive navigator
through the systems needed to alter risk factors, i.e., how to fill and use a
prescription, how to shop for and prepare healthier foods, and how to access an
exercise facility."
Future research will focus on determining whether adding a community health
worker to a regular care system has the same impact and lowers costs.
For more information:
"Impact of a community-based multiple risk factor intervention on cardiovascular
risk in black families with a history of premature coronary disease,"
(Circulation. 2005 Mar 15;111(10):1298-304)
Co-authors include Lisa R. Yanek, M.P.H.; Wallace R. Johnson, Jr., M.D.; Diane
Garrett; Taryn F. Moy, M.S.; Stasia Stott Reynolds, M.D.; Roger Blumenthal,
M.D.; Dhananjay Vaidya, M.D., Ph.D.; and Lewis C. Becker, M.D.
Correspondence to Dr Diane Becker, Division of General Internal Medicine, Johns
Hopkins Medical Institutions, 1830 E Monument St, Room 8028, Baltimore, MD
21287. E-mail dbecker@jhmi.edu
-----------------------
[ProCOR's "Case for Prevention" profiles community-based interventions and other
prevention initiatives around the globe to address cardiovascular risk factors.
These case studies summarize local and national examples of cost-effective,
successful strategies promoting heart health. "Case for Prevention" is part of
ProCOR's promotion of World Hypertension Day (Sunday, May 14) in collaboration
with the World Hypertension League (http://www.mco.edu/org/whl/whd.html)].
Members of the ProCOR network are encouraged to share their CVD prevention
activities-email your summary to procor@healthnet.org.]
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Communities around the world are addressing barriers to access to preventive
health services by implementing programs in popular community sites such as
mosques and storefronts. A new study shows that locating a health clinic in a
neighborhood apartment doubled the success rate of African American patients
achieving blood pressure and cholesterol goals. The study was designed to test
the comparative effectiveness of a community intervention model and a primary
care model.
The intervention, described in "Impact of a community-based multiple risk factor
intervention on cardiovascular risk in black families with a history of
premature coronary disease," (Circulation. 2005 Mar 15;111(10):1298-304) can be
adapted for a variety of settings and populations. It was published in a special
theme issue of Circulation: Journal of the American Heart Association focusing
on health disparities.
The small study conducted in Baltimore, Maryland USA included 364 people whose
brothers or sisters had a history of premature coronary disease (before age 60),
thus placing the study group at high risk for heart disease. Participants, on
average, were 49 years old with a high school education. None had a personal
history of heart disease when they enrolled in the study.
Those who had risk factors for heart disease (for example, high blood pressure,
high cholesterol, current smoking history) were randomly assigned to two groups.
One group of 196 people received care in an apartment that served as a clinic.
The other 168 people received care at a traditional health care clinic. About
two-thirds of both groups were women and 80 percent of both groups had health
insurance.
The apartment-based clinic was centrally located within the community and easily
reached by walking, bus and subway. Free parking was available nearby. Patients
were accepted on a walk-in basis--appointments were not necessary. The
apartment's living room served as the reception area and included a play area
for children. The consultation room resembled a small office. The clinic also
included a treatment room and a small exercise room, where patients received
instruction on physical activity.
The clinic created a welcoming environment, more like visiting a friend's
apartment than entering a health-care setting. By providing readily accessible
care in the community and offering a flexible structure, the clinic helped
people return for evaluation.
A nurse practitioner and a community health worker familiar with the
neighborhood staffed the clinic. Patients received care only for risk factors
related to heart disease. An African-American physician who specializes in
urban African-American health consulted with the nurse practitioner and
community health worker once a month.
The control group visited a traditional clinic setting and received regular
primary care from their usual physicians. They received the same educational
materials that were provided at the apartment clinic as well as feedback about
their risk factor measurements and recommendations about how to manage them.
Costs and access (public transportation, etc.) were similar to the community
clinic.
The only difference between the two sites was the location and the presence of
the community health worker. At both sites, providers distributed prescription
cards that allowed patients to receive free medication related to the treatment
of coronary risk factors. Patients at both facilities also had access to free
exercise facilities at the neighborhood YMCA and to free smoking cessation
programs.
After one year, patients in the community-based program were two times more
likely than the traditional clinic patients to have achieved the cholesterol and
blood pressure goals established for both groups. Patients who received care
at the community clinic reduced their 10-year global risk of heart disease by 25
percent compared to a 3 percent reduction in patients who received care with
their usual physician (global risk indicates the predicted chance of having a
heart disease event within the next 10 years based on all of a person's risk
factors).
Patients at the community-based clinic also were more likely to receive a
prescription card, and 13 times more likely to use cholesterol-lowering
medication. Use of cholesterol and blood pressure-lowering medications
increased in both groups, but more so in the community program. Unexpectedly,
the small exercise room at the CBC site was a strong incentive. Participants
often came to exercise for 20 to 30 minutes at lunchtime or before or after
work, whereas commitment to a full evening at the YMCA 2 days a week appeared to
be more difficult. Still, 20% of the apartment-based clinic participants
exercised at the YMCA, enabled by a direct invitation from the community health
worker. Telephone interventions allowed participants to report progress on their
own schedule."
Researchers credit the community health worker with being a key factor to
helping patients understand how to use their pharmacy cards, visit local YMCAs
for physical activity, and comply with medication regimens. The authors state
that the community health worker "served as a culturally sensitive navigator
through the systems needed to alter risk factors, i.e., how to fill and use a
prescription, how to shop for and prepare healthier foods, and how to access an
exercise facility."
Future research will focus on determining whether adding a community health
worker to a regular care system has the same impact and lowers costs.
For more information:
"Impact of a community-based multiple risk factor intervention on cardiovascular
risk in black families with a history of premature coronary disease,"
(Circulation. 2005 Mar 15;111(10):1298-304)
Co-authors include Lisa R. Yanek, M.P.H.; Wallace R. Johnson, Jr., M.D.; Diane
Garrett; Taryn F. Moy, M.S.; Stasia Stott Reynolds, M.D.; Roger Blumenthal,
M.D.; Dhananjay Vaidya, M.D., Ph.D.; and Lewis C. Becker, M.D.
Correspondence to Dr Diane Becker, Division of General Internal Medicine, Johns
Hopkins Medical Institutions, 1830 E Monument St, Room 8028, Baltimore, MD
21287. E-mail dbecker@jhmi.edu
-----------------------
[ProCOR's "Case for Prevention" profiles community-based interventions and other
prevention initiatives around the globe to address cardiovascular risk factors.
These case studies summarize local and national examples of cost-effective,
successful strategies promoting heart health. "Case for Prevention" is part of
ProCOR's promotion of World Hypertension Day (Sunday, May 14) in collaboration
with the World Hypertension League (http://www.mco.edu/org/whl/whd.html)].
Members of the ProCOR network are encouraged to share their CVD prevention
activities-email your summary to procor@healthnet.org.]
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