Abstract 12338: Office-Guidelines Applied in Practice (Office-GAP) Program in a Federally Qualified Health Center Increased Patient Knowledge and Medication Use
Introduction: Federally Qualified Health Centers (FQHCs) serve low income and underserved populations. The Office-Guidelines Applied in Practice (Office-GAP) program sought to build collaboration between patients and physicians to improve outcomes in a FQHC.
Objectives: 1) Adapt the ACC GAP tools for patient-centered secondary prevention in outpatient settings. 2) Improve knowledge of coronary heart disease (CHD) and use of evidence based medications. 3) Assess patients’ comfort with discussing prevention and treatment with physicians.
Methods: The process evaluation tested feasibility of provider training, improving patient understanding of CHD and use of Office-GAP tools. Two doctors, 1 nurse-practitioner, 8 staff, and 146 patients with a diagnosis of CHD or diabetes mellitus in one FQHC participated in this pilot study from Sep 2009 to Dec 2010. After a group visit, patients followed up with physician visits using GAP tools. McNemar's test was used to examine change over time in the proportions of patients using aspirin, ACEI, beta blockers, and statins. Patients satisfaction and knowledge were rated on an ordinal scale; log linear models tested for pre-test to post-test change.
Results: All providers and staff attended the 90-minute Office-GAP training; 95/146 patients attended 90 minute group visits (50% Male; 52% White), 75 (79.0%) completed their second Office-GAP provider visit. Use of GAP tools increased knowledge of CHD (81% of participants), CHD prevention and treatment options (85%), comfort with discussing prevention and treatment (66%), and making treatment decisions (63%) after the group visit. Log linear models confirmed longitudinal increases on all four measures. Preliminary analysis shows a significant increase in aspirin use (64% vs. 79%; p=.01) and trend toward increased use of ACEI (80% vs. 83%; p=.73), beta blockers (52% vs. 62%; p=.23) and statin (58% vs. 68% p=.15).
Conclusions: Office-GAP increased knowledge, comfort with discussing prevention and treatment among heart disease and diabetes patients in a FQHC. It also increased the use of aspirin and shows trends toward increased use of other evidence based medications. Further evaluation is needed to establish its reach, effectiveness, and cost-effectiveness.
- © 2011 by American Heart Association, Inc.