The purpose of this study was to evaluate the effectiveness of an ongoing Inter-professional Collaborative Practice (IPCP) program for the reduction of cardiovascular risk among economically and medically vulnerable individuals. To improve the access to quality primary health care services and reduce cardiovascular risk for vulnerable individuals, an IPCP program has been implemented into The Larry Combest Community Health and Wellness Center (LCCHWC), a federally-qualified nurse managed health center in west Texas, since 2014. All IPCP team members including advanced practice nurses, clinical pharmacists/pharmacy residents, psychologists, registered dietitians, community health workers, and licensed social workers received evidence-based TeamSTEPPS and Motivational Interview trainings. Team based care is provided to patients who have cardiovascular diseases (CVDs), or are at high risk of CVDs.
Method
Study Sample
Patients who receive medical care at Larry Combest Community Health and Wellness Center and have cardiovascular diseases (CVDs), or are at high risk of CVDs, which has at least one of the following chronic conditions: Hypertension, Diabetes, Dyslipidemia, Insulin Resistance, Prehypertension, Tobacco Use, Metabolic Syndrome, Overt Coronary Artery Disease and Established Cardiovascular Disease, defined as documented history of PAD, abnormal ABI, TIA, or stroke, and CHF are recruited to participate in this study.
From March, 2014 to April 2017, 257 eligible patients have been enrolled in this evaluation study, and 114 patients received at least 60 minutes additional health services provided by the IPCP team than regular primary care services.
Measurements
Patients’ clinical and psychosocial/behavioral outcomes were measured at baseline, and are tracked throughout the program until the end of the intervention period, or until the patient is dismissed from the program.
- Clinical outcomes: e.g., HbA1c, blood pressure, ER visits
- Psychosocial /behavioral outcomes: e.g., depression, self-efficacy of chronic diseases management
- Behavioral outcomes: e.g., medication adherence
- Services outcomes: e.g. type of services, acceptance of enabling service
Results
Baseline data show that 65% of patients enrolled (N = 168) have two or more chronic conditions, 49% are on five or more prescription drugs, over 64% are unfunded, and over 25% are Medicaid/Medicare participants. Hypertension is the leading chronic condition (89.7%), followed by diabetes (68%), obesity (80.6%), dyslipidemia (22.2%), existing coronary artery disease (13.6%), asthma/COPD (7.8%) and other chronic conditions (33.5%). 14.8 percent of the patients had mild depression, and over 15.2% had moderate to severe depression (measured by PHQ-9) at baseline.
The collection of post-intervention data is ongoing, some of the behavioral outcomes collected at baseline (<45 days of enrollment), half-year (45 days-180 days), and one year (>=180 days) are listed in the table below.
|
Baseline |
Half-Year |
One year |
|
|
SF-12 v2 PCS MCS |
43.9±12.9 48.9±19.0 |
41.7±10.9 50.6±9.7 |
37.2±10.7 47.9±14.7 |
|
PHQ-9 |
7.0±6.5 |
10.5±6.9 |
7.3±6.6 |
|
SEMCD |
8.4±1.6 |
7.4±2.1 |
7.6±1.6 |
|
SED |
7.3±1.7 |
7.8±1.8 |
8.0±2.0 |
In year 2016, 70.7% of the HTN participants had controlled blood pressure and 45.4% of Diabetes participants had HbA1c<8%.
Conclusion
The IPCP services meet the physical, social and psychological needs for the economically and medically vulnerable populations. Improvements in patients’ clinical and behavioral outcomes are observed through this program.
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