The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers

Abstract

The burden of cardiovascular disease (CVD) among minority and low-income populations is well documented. This study aimed to assess the impact of patient activation and shared decision-making (SDM) on medication use through the Office-Guidelines Applied to Practice (Office-GAP) intervention in Federally Qualified Healthcare Centers (FQHCs).Patients (243) with diabetes and CHD participated in Office-GAP between October 2010 and March 2014. Two-site (FQHCs) intervention/control design. Office-GAP integrates health literacy, communication skills education for patients and physicians, decision support tools, and SDM into routine care. Main measures: 1) implementation rates, 2) medication use at baseline, 3, 6, and 12 months, and 3) predictors of medication use. Logistic regression with propensity scoring assessed impact on medication use. Intervention arm had 120 and control arm had 123 patients. We found that program elements were consistently used. Compared to control, the Office-GAP program significantly improved medications use from baseline: ACEIs or ARBs at 3 months (OR 1.88, 95% CI = 1.07; 3.30, p < 0.03), 6 months (OR 2.68, 95% CI = 1.58;4.54; p < 0.01); statin at 3 months (OR 2.00, 95% CI = 0.1.22; 3.27; p < 0.05), 6 months (OR 3.05, 95% CI = 1.72; 5.43; p < 0.01), Aspirin and/or clopidogrel at 3 months OR 1.59, 95% CI = 1.02, 2.48; p < 0.05), 6 months (OR 3.67, 95% CI = 1.67; 8.08; p < 0.01). Global medication adherence was predicted only by Office-GAP intervention presence and hypertension.Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.

Improving diabetic patients’ adherence to treatment and prevention of cardiovascular disease (Office Guidelines Applied to Practice—IMPACT Study)—a cluster randomized controlled effectiveness trial

“…Office-GAP is a patient activation intervention to improve communication and patient-provider partnerships through brief patient and provider training in shared decision-making (SDM) and use of a guidelinebased checklist. In a pilot study under the PI's K-award, among minority and low income T2DM and CVD patients, Office-GAP improved medication use, BP control, CVD knowledge, SDM, and patient and provider satisfaction with their communication at 6 months [9][10][11]. However, improvements were not sustained.…”

“…The second is the clinical encounter as a site for shared decision-making (SDM), between patients and providers, scaffolded by a checklist. Together, these first two steps constitute the Office-GAP intervention [9][10][11]. The third component is a mobile health-messaging program (Way2Health) that provides patients with ongoing between visit support, information, and a means to contact their provider between visits.…”

“…We have described the Office-GAP intervention in previous peer-reviewed publications [9,10,21]. Briefly, after recruitment, patients in the Office-GAP group will attend (1) one scheduled group visit (90-120 min; 4-6 patients at a time), conducted by the research assistants and (2) follow-up visits with their primary care providers within 1 month and then at 3, 6, 9, and 12 months after the group visit.…”

Sex Differences in Statin Prescribing in Diabetic and Heart Disease Patients in FQHCs: A Comparison of the ATPIII and 2013 ACC/AHA Cholesterol Guidelines

“…The primary results have been published previously. 23,24 We present here the analysis of 206 patients who completed the study with the information on statin use.…”

“…As previously reported, 23,24 the Office-GAP intervention included 3 key elements: (1) physician training, (2) patient activation/engagement intervention, and (3) Office-GAP checklist. 24 The checklist was based on the guidelines of the AHA/ACC on secondary prevention of heart disease and the American Diabetes Association 25 and provided a systematic list of evidence-based medications/interventions for patient and provider to review together at 2 regularly scheduled visits at 3 and 6 months.…”