Tuesday, October 25, 10:30
a.m.-noon
PBRNs: Making Prevention Possible Through H
Authors
J. Mold1; D. Schillinger2; D. Meyers3;
S. Woolf4.
1University of Oklahoma, Oklahoma City, OK;
2University of California, San Francisco, San
Francisco, CA;
3Agency for Healthcare Research and Quality (AHRQ),
Rockville, MD;
4Medical College of Virginia, Richmond, VA.
Background
Practice Based Research Networks (PBRNs) are participatory
research and quality improvement organizations that harness the
experience and insights of practicing primary care clinicians to
deepen our understanding of primary care and improve health and
health care in diverse communities. The Agency for Healthcare
Research and Quality supports the development of U.S. PBRNs and
has funded innovative projects utilizing health information
technology (HIT) to increase the delivery of preventive health
services. This presentation will highlight the work of networks
in rural Oklahoma, suburban Virginia, and inner-city San
Francisco.
Methods
The Oklahoma Physicians Research/Resource Network (OKPRN)
serves over 500,000 patients through 91 primary care practices
scattered throughout the state. As part of its prevention
efforts, OKPRN has developed partnerships with the State
Department of Health and the Oklahoma Medicaid program. Current
studies include the use of HIT to enhance the delivery and
documentation of primary and secondary preventive services and
the development and implementation of the state's first
electronic infectious disease surveillance system. The Virginia
Ambulatory Care Outcomes Research Network (ACORN) is evaluating
an EHR platform to help clinicians screen and give brief advice
to patients with unhealthy health behaviors (including tobacco
use and physical inactivity) and to efficiently refer them to
community resources for more intensive assistance. ACORN is also
testing websites that empower patients to learn about
recommended healthy lifestyle choices, develop individualized
action plans, and obtain e-mail reminders to promote health
behavior change. The UCSF Collaborative Research Network's
IDEALL Project is exploring whether novel clinical strategies
can help overcome communication barriers for low and very low
literacy English, Spanish, and Chinese speakers with diabetes in
five safety net health centers in San Francisco. The project is
seeking to establish the reach and effectiveness of an automated
telephone diabetes management system through a 3-arm randomized
controlled trial.
Results
N/A
Discussion
N/A
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Preventing Chronic Diseases With Lifestyle Change: A
Randomized Clinical Trial
Authors
S. Aldana1; R.L. Greenlaw2; H. Diehl3;
A. Salberg4; R.M. Merrill5; S. Ohmine6.
1Brigham Young University, Provo, UT;
2University of Illinois at Chicago, Chicago, IL;
3Lifestyle Medicine Institute, IL;
4SwedishAmerican Health System, IL;
5Brigham Young University, UT;
6Brigham Young University, NY.
Background
One of the largest lifestyle clinical trials, this
study determined the behavioral and clinical impact of a
therapeutic lifestyle modification intervention on a group of
community volunteers.
Methods
Participants included 348 volunteers aged 24-81 years
from the Rockford, IL, metropolitan area who participated in a
randomized clinical trial. The intervention group attended a
40-hour lecture educational course delivered over a four-week
period. Participants learned the importance of making better
lifestyle choices and how to make improvements in nutrition
and physical activity. Changes in nutrition and physical
activity behavior, and several chronic disease risk factors,
were assessed at baseline and 6 months.
Results
Beneficial mean changes in scores tended to be
significant for the intervention group but not for the control
group. Intervention participants showed significant 6-month
change in all nutrition and physical activity measures, and
all clinical measures except triglycerides and high
sensitivity C-reactive protein. Total cholesterol and LDL were
slightly worse after six months. Change score comparisons
between the intervention and control groups were significant
for all nutrition and physical activity variables, weight,
body fat, diastolic blood pressure, resting heart rate, and
HDL. The control group experienced comparatively small but
significant improvements in systolic and diastolic blood
pressure, body fat, and HDL, but reported significantly worse
total cholesterol and LDL.
Discussion
This therapeutic lifestyle modification program
can significantly improve nutrition and physical activity
behavior and can reduce many of the risk factors associated
with common chronic diseases.
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Culturally and Linguistically Appropriate Online Programs
To Improve Diet and Weight Management Among Hispanics
Author
D.G. Schroeder, Emory University / DrTango, Atlanta, GA.
Background
Hispanics are the fastest growing demographic group in U.S.
Poor diets, low physical activity, overweight and
obesity-related diseases (e.g. diabetes) are prevalent among
this population. Tailored, culturally- and linguistically
appropriate (CLAS) health information technologies have
tremendous potential for improving the diets, physical
activity levels and weight-related health conditions of
minorities. With funding from Robert Wood Johnson Foundation
Health e-Technologies Initiative, we are rigorously evaluating
the potential of Spanish-language, interactive technologies to
improve the health of minority patients, community and managed
care members and employees.
Methods
Surveys of online Hispanics (n=100,000+) that have
completed an interactive diet, fitness and health evaluation
as part of MiDieta(™). Focus groups of Hispanics regarding
body image, dieting and weight management preferences and
experiences. Randomized trial in collaboration with two
managed care plans (AtlantiCare, NJ and Blue Cross Blue Shield
of Florida, FL).
Results
Hispanics are online and actively using health
information technologies at a much higher rate than their SES
or literacy levels would portend. Hispanics are actively using
online diet and weight management services in Spanish. They
prefer diet and wellness problems that are tailored to their
traditional cooking patterns and foods. Quasi-experimental
results find significant and sustained weight loss for
Hispanics that use interactive applications. The baseline
results of the randomized trial will be reported.
Discussion
The highly personalized and interactive nature of
health information technologies allow for an extremely
tailored and culturally-appropriate interventions around diet,
fitness and weight management. Hispanics and other minority
groups are enthusiastic about the fact that they can receive
such guidance based on their culture, language and foods.
Broadband and mobile technologies, which are both used widely
by Hispanics, will provide even greater opportunities for
delivery of culturally-specific health communications at a
low-cost.
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The Impact of the Know Your Health (KYH) Program on
Underserved Diabetic and Hypertensive Patients in a Community
Setting
Authors
T. Lawther1; H. Nyanteh2; J. Pippins3;
E. Cabral3; R. Cain4.
1Duval County Health Department, Jacksonville, FL;
2Northeast Florida Healthcare Institute,
Jacksonville, FL;
3Pfizer Inc, New York, NY;
4Lem Turner Family Medical Care and Florida Medical
Association, Jacksonville, FL.
Background
Know Your Health (KYH) is a health-literate,
culturally sensitive education program that focuses on
prevention and wellness. It is designed to enhance communication
between patients and their providers and result in sustained
behavioral change and improved health outcomes. A partnership
was developed with Duval County Department of Health, local
community health clinics, and the KYH program to provide a
framework for health promotion through civic and faith-based
organizations in conjunction with the Healthy Jacksonville
Initiative. As a result of this collaboration we have begun to
assess if the provision of KYH educational literature provided
to a predominantly African-American patient population with type
2 diabetes or hypertension has an impact on control of blood
pressure and glucose as well as utilization of hospital services
and patient medication adherence.
Methods
This is an ongoing, prospective randomized controlled
trial in underserved Florida community health clinics. Eligible
patients are those with baseline glycosylated hemoglobin > 8.0
or blood pressure > 140/90.
Results
Two hundred and forty four total patients have met our
inclusion criteria, received the KYH educational literature, and
are enrolled in the study. The majority of our participants are
African-American. (96%). There are 180 patients with
hypertension and 99 patients with type 2 diabetes (co-morbid
patients are counted twice). Thus, the majority of patients have
hypertension (74%). We will evaluate the impact of the KYH
educational intervention on our main outcome measures, which
include change in diastolic blood pressure (DBP), systolic blood
pressure (SBP), glycosylated hemoglobin (HbA1C), patient
medication adherence (Morisky score), patient satisfaction, and
utilization of emergency department (ED) services from baseline
to 6 months.
Discussion
These findings will assess if a culturally sensitive
health education intervention focused on health literacy can
achieve clinically measured improvement in type 2 diabetes and
hypertension in an underserved, predominantly African-American
population.
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