ANCHOR An Interdisciplinary Community- Based Research Project in Nova Scotia: Overview & Some Preliminary Results

Transcription

1 ANCHOR An Interdisciplinary Community- Based Research Project in Nova Scotia: Overview & Some Preliminary Results

2 Why ANCHOR? Growing burden of cardiovascular/metabolic conditions and their risk factors - Atlantic Canadians have the greatest CV risk factor burden and the highest rates of CVD death Concordance with national primary care renewal strategy - Community-based teams focused on prevention and enhanced disease management ANCHOR was conceived to address these issues Aimed to improve global CV risk of patients within the primary care setting through adherence with lifestyle and drug therapy Involved a public-private stakeholder collaboration and multidisciplinary, community-based approach to care

3 Study Goal and Objectives Goal: - To improve 10-year Framingham cardiac event risk in the primary care practice adult population - Primary endpoint was a full grade reduction in Framingham score: High (risk >20% ) Moderate (risk 10%- 20% ) Low (risk 0%-9% ) Primary Objective: To improve cardiovascular risk management of patients via increased compliance with lifestyle and evidence-based drugs Secondary Objective To determine the economic impact of implementing the ANCHOR model within a primary health care setting

4 Study Design Prospective case control design with 1 year intervention 1500 participants, 750 in each of two sites Halifax Alternate funding arrangement Sydney Typical fee-for-service funding Comparison cohort in a 3 rd primary care site Second Sydney site provided the control group Pre-post measurement: Health risk assessment Objective parameters (e.g., BP, lipids, glucose) Readiness to change, motivation, barriers Other parameters, including drug and health service use to inform economic analysis

5 The Anchor Team Practice-based physician lead Nurse coordinators Dieticians Consultants Exercise specialist and physiotherapist Community pharmacist Social Worker on site in Halifax Practice Mental health nurse Study investigators Project Manager

6 The ANCHOR Model Global Risk Assessment HRA Review and Goal Setting Counseling Targeted Interventions Follow Up and Support Education Sessions Community Programs Medication Review Specialty Referral

7 Preliminary Results Final sample size: N = 1090 (27% loss to follow up) Low risk: 324 (30%) Moderate risk: 363 (33%) High risk without established disease:198 (18%) High risk with established disease: 206 (19%) Study cohort for analysis: N = 561 Moderate or high risk patients WITHOUT established disease

8 Results ANCHOR Intervention: Baseline Risk Category (N = 561) 100% 90% % 80% n=363 70% % 60% n=270 50% n=198 40% 30% n=145 n=146 20% 10% 0% Low Moderate High Baseline n/a 64.71% 35.29% Post 25.85% 48.13% 26.02% Risk Category Overall NNT = 8

9 Results ANCHOR Intervention: Metabolic Syndrome Excluding those with Established Diseases (N = 561) Baseline Post 20.86% n= % 46.35% 79.14% n=301 n=260 n=444 No MS MS No MS MS p<0.0001

10 Behavioral Intervention: The Cornerstone of ANCHOR

11 Patient ANCHOR How Skills development did so that competency we in get here? behaviour change intervention is reached Motivational A script to guide the counselors during the counseling sessions Enhancement Development of process measures to be implemented at each intervention session Behaviour Modification Clinician Emotion Management

12 Key Lessons Learned and Portability of the Model to the Health System

13 Key Lessons Learned Importance of innovation, partnership and collaboration Promote the value of interdisciplinary teams to clients & clinicians Invest in team building & training on an ongoing basis Develop clear benchmarks for project implementation & evaluation

14 Portability and Sustainability Behavioural intervention: skill based A key model component with applicability beyond the ANCHOR Project Behavioral Change Institute ( Capital District Health Authority) Health risk assessment tool Modified using Canadian clinical guidelines, local expertise and feedback from the ANCHOR Team Alignment with PHC provincially & other jurisdictions Collaborative care models focused on health promotion and disease prevention using interdisciplinary team Portable to other contexts Model, tools & expertise (e.g., cardiac rehab, diabetes education centres)

15 ANCHOR Evolution

16 Beyond ANCHOR ANCHOR might work, but how can it be made to last? Need to identify those who benefit from ANCHOR and give them support over time Successes are people who reduce risk and maintain their gains

17 Minimal Intervention Study To evaluate the efficacy of different intervention doses so as to maintain or further enhance the health outcome improvements of the original ANCHOR intervention Important to identify the most efficient way of sustaining health behavior improvements by finding the minimum dosage or frequency of patient-clinician contact ANCHOR participants who successfully changed their risk status have been recruited to this follow-up initiative

18 Minimal Intervention Study Randomized Intervention Over 3 Years No Contact (Control Group) Stable Low Contact (2:2 Group) * * * * Stable High Contact (4:4 Group) * * * * * * * * Formal reassessment with HRA Years * Contact to review goal setting/progress

19 Thank you! ANCHORPROJECT.CA