1. Heart Health Project University of Pennsylvania School of Medicine American Heart Association Pennsylvania State University Funded by the Robert Wood Johnson Foundation Finding Answers Program

2. Overview of Project Aims Randomized controlled trial of a practice-based team intervention that combines peer coach with health educator support versus educational brochures Evaluate effect on: 1) reduction of 4-year coronary artery disease (CAD) or CAD death risk, 2) reduction in systolic blood pressure, and 3) cost-effectiveness from a societal perspective. Penn Heart Health

3. Increased Heart Risk in Blacks in our Primary Care Practices Black patients more likely to have uncontrolled hypertension than Whites in our practices Black patients and White women are less likely to receive treatment for high cholesterol than white men However, Black patients are more likely to have medication increased when their blood pressure is elevated than White patients

4. Why Peer Support Trained peer health educators significantly improved adherence to cancer screening and cancer care in largely minority study populations Miller SM et al. J Natl Cancer Inst, 1997; Battaglia TA et al. Cancer, 2007, Turner BJ et al. JGIM, 2008 Peer role models offer support and strategies to change behavior in regard to medication adherence, diet, and exercise

5. Peer Coaches Help Keep Colonoscopy Appointments Randomized controlled trial in our practices Trained peers called patients who were unlikely to keep colonoscopy appointment Troubleshoot barriers to colonoscopy Patients who received peer calls were two times more likely to attend the colonoscopy Patients were very satisfied with information they received Successful!

6. Health Care Team to Help Reduce Heart Disease Risk Health educator   Meets with the client to review personal risk factors for heart disease  of heart disease and death from heart disease  Calculates their risk of heart disease and death from heart disease  Reviews barriers, offer information, set goals Peer coach   Serves as a role model of success from the same community   Offers practice tips to reduce barriers  Changes attitudes by showing can succeed www.acponline.org/hpp/pcmh07.pdf

7. Study Design 250 patients with sustained elevated blood pressure 125 Intervention125 control 3 peer coach calls and 2 educator visits + brochures Brochures from AHA Endpoint at 6 months (CAD risk, BP, LDL, weight) Penn Heart Health

8. Target Patient Population Target Patient Population Black patients aged >40 to 75 with hypertension (2006), N=5,340 Uncontrolled hypertension (sustained elevation at two or more visits in one year) N=1,030) 30% recent high LDL cholesterol 30% recent high LDL cholesterol 16% current smokers in records 16% current smokers in records 35% diabetes 35% diabetes 26% known CAD or equivalent 26% known CAD or equivalent 40% >200 lbs 40% >200 lbs Penn Heart Health

9. Theory Underlying Our Study Attitudes Subjective norms Perceived behavioral control Intention to Change Desired Behaviors

10. Peer Coach Support (n=10) Attitudes – emphasize heart health Beliefs and concerns about heart disease and risk factors Beliefs and concerns about heart disease and risk factors Why we care in black community Why we care in black community How feels about personal CAD prevention plan How feels about personal CAD prevention plan Social Norms Personal successes and challenges Personal successes and challenges Perceived Behavioral Control – barriers Adherence supports Adherence supports Diet tips Diet tips Exercise benefits Exercise benefits

11. Workplan 56 CAB 7 PC 8 HE 910 1112 end- point 1 data 23 CAB 4 20082009 2010 5678910 CAB 1112 Anal ysis 12 Party Penn Heart Health

12. Peer Coach Phone Calls Months 7 PC x 20 patients = 140

13. Training Program Two sessions – 3.5 hours each Four conference calls – review materials and practice talking with clients Two practice calls – with team and with each other Update and troubleshoot conference calls every other month Claire will touch base about problems monthly Meet twice a year for lunch at practice Party

14. Peer Coach Responsibilities Patient calls (up to four efforts to reach) Educate, support, role model desired outcome Record barriers, set goals, and leave barriers- goals for Lenette Receive updated barriers-goals from health educator visit, review, update at call, and leave message for Lenette Record each effort to reach client Record time spent on calls

15. Final Goals Patients have improved blood pressures because of remembering medications and working with physician Patients have healthier diets Patients have more active lifestyles Patients have lower cholesterol levels Patients and peer coaches and health educators are pleased with the outcome of the project