Cardiovascular Disease Prevention and Treatment in a Family Medicine Clerkship Bonnie T. Jortberg, MS, RD, CDE David Gaspar, MD Cynthia Villanueva, MS Department of Family Medicine University of Colorado at Denver and Health Sciences Center

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.

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

CVD Curriculum Colorado ranks 1st 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: our FM Clerkship is a rural rotation Received grant funds for 3 years from the Colorado Department of Public Health and Environment to implement a CVD curriculum in our FM Clinical Training Block

CVD Grant Objectives Objective #1: Provide education and outreach programs to rural Colorado physician-teachers (preceptors) on CVD evidence-based guidelines: Hold ½ day workshops in rural Colorado for our preceptors (interactive format, CME credit) Content: CVD “Clinical Pearls” (medications, lifestyle modification, new research) CVD/Obesity Guidelines

CVD Grant Objectives Objective #2: Implement a CVD prevention & early detection curriculum into the FM Clinical Training Block: CTB Orientation: Small group discussion of CVD case study Students need to complete the CHD Risk Score card and develop tx plan for case study patient Step counters Patient Follow-up postcards

CVD Grant Objectives Objective #3: Translate CVD curriculum materials into Spanish and implement in CTB Materials translated Will be implementing and evaluating materials this year

Evaluation Objective #1: Pre/post workshop questionnaire Results from 2 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 Standardized Patient Testing

Evaluation (Pre/Post Questionnaire) Pre-CTB (N=122) Post-CTB (N=109) Have you ever assessed CVD risk in a patient? Yes = 50% No = 50% Yes = 93% No = 6% Lowering LDL Cholesterol should be the primary target of CVD therapy? True = 52% False = 48% True = 74% False = 26%

Evaluation (Pre/Post Questionnaire) Pre-CTB (N = 122) Post-CTB (N = 109) Do you believe that you can influence patients to stop smoking? Yes = 50% No = 50% Yes = 40% Sometimes = 49% No = 11% Advise pt to quit smoking Yes = 43% Sometimes = 54% No = 3% Yes = 68% Sometimes = 32% No = 0%

Evaluation (Pre/Post Questionnaire) Pre-CTB (N = 122) Post-CTB (N = 109) Have you referred pts to Quitline/Quitnet Yes = 11% Sometimes = 32% No = 57% Yes = 40% Sometimes = 48% No = 12% Rating of use of CHD Score Card with Pt N/A Excellent = 23% Good = 43% Fair = 24% Poor = 8%

Contact Information Bonnie Jortberg Bonnie.jortberg@uchsc.edu 303.315.8078 Thank you!