The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers
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 Feder...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2016-12-01
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| Series: | Preventive Medicine Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211335516300705 |
| _version_ | 1818899413845671936 |
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| author | Adesuwa Olomu Nazia Naz Khan David Todem Qinhua Huang Esha Kumar Margaret Holmes-Rovner |
| author_facet | Adesuwa Olomu Nazia Naz Khan David Todem Qinhua Huang Esha Kumar Margaret Holmes-Rovner |
| author_sort | Adesuwa Olomu |
| collection | DOAJ |
| description | 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; 5.53; 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. Keywords: Secondary prevention of heart disease, Guidelines based care in outpatient settings, Federally qualified health center, Shared decision-making, Medication adherence |
| first_indexed | 2024-12-19T19:47:35Z |
| format | Article |
| id | doaj.art-0d1a4dc88a2b494698d29153e81e2235 |
| institution | Directory Open Access Journal |
| issn | 2211-3355 |
| language | English |
| last_indexed | 2024-12-19T19:47:35Z |
| publishDate | 2016-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Preventive Medicine Reports |
| spelling | doaj.art-0d1a4dc88a2b494698d29153e81e22352022-12-21T20:08:05ZengElsevierPreventive Medicine Reports2211-33552016-12-014357363The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare CentersAdesuwa Olomu0Nazia Naz Khan1David Todem2Qinhua Huang3Esha Kumar4Margaret Holmes-Rovner5Michigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United States; Corresponding author at: 788 Service Road, B329 Clinical Center Building, East Lansing, MI 48824, United States.Michigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United StatesDepartment of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824, United StatesDepartment of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824, United StatesMichigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United StatesCenter for Ethics and Humanities in the Life Sciences, Michigan State University, Division of Health Services Research, Department of Medicine, Room B213 Clinical Center, East Lansing, MI 48824, United StatesThe 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; 5.53; 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. Keywords: Secondary prevention of heart disease, Guidelines based care in outpatient settings, Federally qualified health center, Shared decision-making, Medication adherencehttp://www.sciencedirect.com/science/article/pii/S2211335516300705 |
| spellingShingle | Adesuwa Olomu Nazia Naz Khan David Todem Qinhua Huang Esha Kumar Margaret Holmes-Rovner The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers Preventive Medicine Reports |
| title | The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers |
| title_full | The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers |
| title_fullStr | The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers |
| title_full_unstemmed | The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers |
| title_short | The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers |
| title_sort | office guidelines applied to practice program improves secondary prevention of heart disease in federally qualified healthcare centers |
| url | http://www.sciencedirect.com/science/article/pii/S2211335516300705 |
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