Cardiovascular Disease Prevention and Treatment in a Primary Care Training Block Bonnie T. Jortberg, MS, RD, CDE David Gaspar, MD Department of Family Medicine University of Colorado Denver Anschutz Medical Campus

Cardiovascular Disease Prevention: Why Teach this in Medical School? Approximately 120 million Americans have one or more chronic diseases This accounts for 70-80%of health care costs Epidemic of obesity and type 2 diabetes 2003 Association of American Medical Colleges survey of medical students reported only 46% believed that “appropriate time” had been devoted to nutrition instruction.

1995 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

CVD Curriculum-Local Needs –Colorado ranks 1 st for the lowest rate of CVD, but CVD still accounts for 32% of all deaths of Colorado residents –Colorado CVD rates higher in rural areas: we have a required Rural and Community Care year 3 clerkship combined with a Adult Ambulatory Care clerkship in an 8-week clinical block (shared competencies) –Received grant funds for 3 years from the Colorado Department of Public Health and Environment to implement a CVD curriculum

CVD Grant Objectives Objective #1:Objective #1: Provide education and outreach programs to rural Colorado physician-teachers (preceptors) on CVD evidence-based guidelines: –5 half-day workshops/year in rural Colorado for our clerkship clinical faculty and staff –Content: CVD pharmacology “Clinical Pearls”, lifestyle modification, new research, CVD & Obesity Guidelines (interactive format, CME credit) –Teaching Skills

CVD Grant Objectives Objective #2: Implement a CVD prevention & early detection curriculum into the 8-week Year 3 Primary Care Block: Small group CVD case study at orientation During Rotation-students complete CHD Risk Score cards and behavioral contracting for 15 patient over 8 weeks Step counters to 15 patients and office staff Patient Follow-up postcards and phone calls Didactic session on Nutrition during Adult Ambulatory Care component

CVD Grant Objectives Objective #3: Translate and implement CVD curriculum materials into Spanish –Materials translated –Implemented materials last year and will evaluate materials this year

Evaluation Objective #1: –Pre/post workshop questionnaire –Results from 9 workshops: Overall evaluation of workshops = 4.6 (5.0 likert scale) 75% of participants state that they intend to change their practice habits as a result of attending the workshop

Evaluation Objective #2: Pre/post CTB online questionnaire Completion of 5 CHD Risk Score Cards Patient Follow-up Postcards 2 Standardized Patient Encounters

Evaluation (Pre/Post Questionnaire) QuestionPre-CTB (N=204) Post-CTB (N=189) Have you ever assessed CVD risk in a patient? Yes = 47% No = 53% Yes = 99% No = 1% Lowering LDL Cholesterol should be the primary target of CVD therapy? True = 52% False = 48% True = 65% False = 35%

Evaluation (Pre/Post Questionnaire) Pre-CTB (N = 204) Post-CTB (N = 189) Do you believe that you can influence patients to stop smoking? Yes = 45% Sometimes = 55% No = 0% Yes = 68% Sometimes = 32% No = 0% Advise pt to quit smoking Yes = 33% Sometimes = 56% No = 11% Yes = 71% Sometimes = 29% No = 0%

Evaluation (Pre/Post Questionnaire) Pre-CTB (N = 204) Post-CTB (N = 189) Have you referred pts to Quitline/Quitnet Yes = 9% Sometimes = 37% No = 54% Yes = 37% Sometimes = 59% No = 4% Rating of use of CHD Score Card with Pt N/A Excellent = 21% Good = 47% Fair = 26% Poor = 6%

YesNo Did you learn anything new about your risk of heart disease from my teaching session? 89%11% Was the information I gave you about your risk of heart disease helpful? 100%0% Was the information I gave you about your risk of heart disease understandable? 99%1% Did you set a weight loss goal?54%44% Are you planning on wearing your step counter on most days? 85%13% Patient Initial Postcard Results (N = 187)

YesNo Teaching session teach about your risk of CHD? 96%2% (2% no answer) Did you decrease your total fat and saturated fat intake? 88%7% (5% no answer) Patient 4-Week Follow-Up Postcard (N = 77)

YesNoAve. Weight Loss Ave. Weekly Steps Have you lost any weight? 70%24% (6% n/a) If yes, how much?7.62 lbs Wear step counter?85%6% (9% n/a) If yes, what are your daily steps? 6183 Patient 4-Week Follow-Up Postcard (N = 77)

Contact Information Bonnie Jortberg – Thank you!