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Community-Based Multiple Risk Factor Intervention for Cardiovascular Risk

An Evidence-Based Practice

Description

This program is a community-based multiple risk factor intervention on cardiovascular risk in African American families with a history of premature coronary disease. This program targets the siblings of an individual diagnosed with coronary heart disease under age 60. Participants in the program have a physical examination and medical history taken by a cardiologist. During community-based care visits at an easily accessible nonclinical site, a nurse practitioner performs physical assessments, evaluates patients for pharmacotherapy, and monitors compliance. A community health worker provides dietary counseling, smoking cessation support, and exercise counseling, with follow-up telephone interventions available. Participants requiring pharmacotherapy are given a pharmacy charge services card that allows them to obtain risk factor therapy prescriptions free of charge at any pharmacy. Sibling participants can also attend 2 free exercise sessions per week at the YMCA.

Goal / Mission

The goal of this program is to reduce the risk of coronary heart disease among African American families with a history of coronary disease.

Results / Accomplishments

In a randomized trial comparing the community-based care group with a group receiving enhanced primary care (offering the same risk-specific materials, recommendations for behavioral changes, pharmacy card, and access to YMCA programming, explained by a primary care provider). At a one-year follow-up, a significantly larger proportion of the community-based care group achieved goal levels of LDL cholesterol and blood pressure when compared to the enhanced primary care group (p < 0.0001 and p = 0.0004, respectively). The intervention group significantly reduced overall coronary heart disease risk, whereas no reduction was seen in the control group (p < 0.0001). Participants in the community-based care group had significant between-group shifts in the 10-year prediction of hard events, with an increased number of individuals in the very-low-risk group, significantly reduced intermediate-risk group, and reduced high-risk group (p < 0.0001).

About this Promising Practice

Organization(s)
Johns Hopkins Division of General Internal Medicine
Primary Contact
Diane Becker, ScD, MPH
Division of General Internal Medicine
Johns Hopkins Medical Institutions
1830 E Monument St, Room 8028
Baltimore, MD 21287
(410) 955-7781
dbecker@jhmi.edu
http://www.hopkinsmedicine.org/gim
Topics
Health / Heart Disease & Stroke
Health / Physical Activity
Health / Prevention & Safety
Organization(s)
Johns Hopkins Division of General Internal Medicine
Source
Circulation
Date of publication
Mar 2005
Location
Baltimore, MD
For more details
http://circ.ahajournals.org/cgi/content/full/111/1...
Target Audience
Racial/Ethnic Minorities

Related Promising Practices

  1. Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)
  2. Nurse-Led Secondary Prevention in Coronary Heart Disease
  3. Complete Health Improvement Program (CHIP) (formerly the Coronary Health Improvement Project)

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.