Abstract 15794: COACH Program Effective in Improving Risk Factors in Vulnerable Populations
Disease management and prevention in medically underserved patients with CVD or at high risk for CVD is complex. The purpose of this study was to test the effectiveness of a nurse practitioner (NP)/community health educator(CHE) model of care in urban community health centers on improving patients CVD risk factors and their perceptions of the quality of their chronic illness care. Patients with CVD, type 2 diabetes, hypertension, and/or hypercholesterolemia were randomized to receive usual care (UC) or a 1 year CVD risk management intervention including self-management from a NP/CHE team (I). Outcomes included lipids and HbA1c measured in a standardized laboratory, blood pressure measured according to JNC VII guidelines, and patients' assessments of chronic illness care (PACIC), measured by the PACIC instrument (possible score 1 – 5). A total of 525 patients participated in the randomized trial (I = 261, UC = 264); mean age 56 ± 12 years, 71% female, 78% Black; 54% with annual household income ≤ $20,000, and only 34% with private health insurance. Patients in the two groups did not differ significantly on baseline sociodemographic, PACIC scores or clinical characteristics, except for total cholesterol, triglycerides and HbA1c. Intention to treat analyses comparing changes in outcomes while controlling for baseline differences using general linear mixed model tests revealed statistically and clinically significant mean changes in total cholesterol (I: −24 ± 44.8; UC:− 4.8 ± 39.4, p< 0.0001), triglycerides (I: −23.8 ±137.7; UC:− 3.6 ± 59.9, p= 0.029), LDL cholesterol (I: −19 ± 38.9; UC:− 3.9 ± 34.7, p<0 .0001), HbA1c (I: −0.4 ± 1.8; UC:− 0.05 ± 1.4, p=0.015), systolic blood pressure (I: −6.9 ± 21.8; UC:− 2 ± 19.5, p= 0.006), diastolic blood pressure (I: −4.2 ± 11.5; UC:− 1.9 ± 10.1, p= 0.014), and PACIC score (I: +1.4 ± 1; UC:+0.2 ± 0.9, p< 0.0001). The Results of this study demonstrate that a NP/ CHE model of care can be an effective approach to improve CVD risk factor management and perceptions of quality of care in an underserved population with complex medical conditions. Further study is needed to determine how this translates into improved morbidity and mortality from CVD.
- © 2010 by American Heart Association, Inc.