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ALLHAT/JNC7 Dissemination Plan. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute. Improving Blood Pressure Treatment in the Community: A Joint Project of the NHBPEP and ALLHAT Collaborative Research Group. - PowerPoint PPT Presentation
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Improving Blood Pressure Improving Blood Pressure Treatment in the Community: A Treatment in the Community: A Joint Project of the NHBPEP and Joint Project of the NHBPEP and ALLHAT Collaborative Research ALLHAT Collaborative Research
GroupGroup
Chuke E. Nwachuku. MA, MPH, DrPHChuke E. Nwachuku. MA, MPH, DrPHClinical Application and Prevention ProgramClinical Application and Prevention Program
Division of Epidemiology and Clinical Division of Epidemiology and Clinical ApplicationsApplications
ALLHAT/JNC7 Dissemination Plan
U.S. Department of Health and Human
Services
National Institutes of Health
National Heart, Lung, and Blood Institute
ALLHAT/JNC Dissemination PlanALLHAT/JNC Dissemination Plan
Why is a dissemination plan needed?– Background
Facts about health innovations and applicationNHLBI Dissemination PolicyALLHAT’s unique place in the context of NHLBI dissemination infrastructure
ALLHAT/JNC Dissemination PlanALLHAT/JNC Dissemination Plan
What does the proposal comprise?What does the proposal comprise?– Review the broad based multipronged Review the broad based multipronged
approach previewed in a recent Lancet approach previewed in a recent Lancet and at the AHAand at the AHA
Update on current ALLHAT Update on current ALLHAT Dissemination activitiesDissemination activities
ALLHAT/JNC Dissemination PlanALLHAT/JNC Dissemination Plan
What is the process going forward?What is the process going forward?– NHLBINHLBI– ALLHAT Dissemination Committee and ALLHAT Dissemination Committee and
ALLHAT Steering CommitteeALLHAT Steering Committee– Executive Committee of the JNCExecutive Committee of the JNC– Field implementationField implementation– CoordinationCoordination– Ongoing reviewsOngoing reviews
Grol R and Grimshaw J; Lancet 2003 36Grol R and Grimshaw J; Lancet 2003 362: 1225-302: 1225-30
Facts about health innovation and Facts about health innovation and their applicationtheir application
Research shapes innovation for Research shapes innovation for clinicians and patientsclinicians and patients
10,000 new randomized trials included in 10,000 new randomized trials included in MEDLINE annually MEDLINE annually
350,000 trials have been identified by the 350,000 trials have been identified by the Cochrane CollaborationCochrane Collaboration
General Internists would need to read 20 General Internists would need to read 20 papers every day of the year to keep pacepapers every day of the year to keep pace
Guidelines such as JNC-7 and systematic Guidelines such as JNC-7 and systematic reviewsreviews
@Stone S J.R. Soc Med 2001;94:278 +@Stone S J.R. Soc Med 2001;94:278 +Ellerbeck et al JAMA 1995Ellerbeck et al JAMA 1995
Facts about health innovation and Facts about health innovation and their application their application (Cont’d)(Cont’d)
Clinicians are consistently slow to Clinicians are consistently slow to apply evidence in their practicesapply evidence in their practices
Benefits of hand hygiene well known since Benefits of hand hygiene well known since Ignaz Philipp Semmelweis over 100 years Ignaz Philipp Semmelweis over 100 years ago, yet compliance remains a problemago, yet compliance remains a problem@@
The benefits of fibrinolytics first documented The benefits of fibrinolytics first documented in 1986, yet the best estimates are that in 1986, yet the best estimates are that about 10 years later only 70% of “ideal” about 10 years later only 70% of “ideal” received lyticsreceived lytics++
Oliveria et al, Arch Intern Med 2002;162Oliveria et al, Arch Intern Med 2002;162
Facts about health innovation and Facts about health innovation and their application their application (Cont’d)(Cont’d)
Knowledge and awareness are not the Knowledge and awareness are not the same as doingsame as doing
About 76% aware and agree with JNC-VIAbout 76% aware and agree with JNC-VI
About 76% report usually following JNC About 76% report usually following JNC recommendationsrecommendations
About 61% report being satisfied with control About 61% report being satisfied with control of BPof BP
Yet only 35% of patients have SBP < 150 Yet only 35% of patients have SBP < 150 mmHgmmHg
There are questions about measurementThere are questions about measurement
CAREGAP is reported to be about 41%CAREGAP is reported to be about 41%
Selected Factors that Influence Selected Factors that Influence Dissemination and Implementation of Dissemination and Implementation of
InnovationInnovationSystems of Care Systems of Care
Access to careAccess to care
CoverageCoverage
Marketing influencesMarketing influences
ProviderProviderLack of knowledgeLack of knowledge
Lack of convictionLack of conviction
ForgetfulnessForgetfulness
Innovation biasInnovation bias
Marketing influencesMarketing influences
Patient LevelPatient LevelPreferencesPreferences
SymptomsSymptoms
Marketing InfluencesMarketing Influences
The Lancet. 362 October 25, 2003The Lancet. 362 October 25, 2003
Most Common Influencing FactorsMost Common Influencing Factors
Marketing Marketing InfluencesInfluences
The Lancet. 362 October 25, 2003The Lancet. 362 October 25, 2003
Marketing InfluencesMarketing Influences
NHLBI Dissemination PolicyNHLBI Dissemination Policy
Evolved and finalized during ALLHATEvolved and finalized during ALLHAT
Realization that traditional Realization that traditional approaches not fully effectiveapproaches not fully effective
Requires a detailed dissemination Requires a detailed dissemination plan for trials with potential for plan for trials with potential for immediate public health applicabilityimmediate public health applicability
Includes a requirement for evaluation Includes a requirement for evaluation of dissemination planof dissemination plan
ALLHAT First and UniqueALLHAT First and Unique
Unique features and challengesUnique features and challengesFirst trial completed under the new policyFirst trial completed under the new policy
ALLHAT Steering Committee packaged and ALLHAT Steering Committee packaged and published recommendations based on trial published recommendations based on trial resultresult
NHLBI has an existing HBP education NHLBI has an existing HBP education infrastructure (NHBPEP)infrastructure (NHBPEP)
JNC has packaged recommendations based JNC has packaged recommendations based on a synthesis of all available evidence in on a synthesis of all available evidence in HBP prevention and treatmentHBP prevention and treatment
Dissemination plan Dissemination plan mustmust meld both meld both
Branding of the Dissemination Branding of the Dissemination ProjectProject
Improving Blood Pressure Improving Blood Pressure Treatment in the Community: A Treatment in the Community: A Joint Project of the NHBPEP and Joint Project of the NHBPEP and ALLHAT Collaborative Research ALLHAT Collaborative Research
GroupGroup
Dissemination Proposal Dissemination Proposal FeaturesFeatures
Furthers traditional approachesFurthers traditional approachesPress release/press conferencePress release/press conference
Media coverage (usually short bursts)Media coverage (usually short bursts)
Presentation at scientific meetingsPresentation at scientific meetings
Publications in peer-reviewed journalsPublications in peer-reviewed journals
Utilizes academic detailing approaches Utilizes academic detailing approaches and based on intervention mapping theoryand based on intervention mapping theory
Health care providersHealth care providers
Formulary systems approachFormulary systems approach
Patient-oriented approach through PSAsPatient-oriented approach through PSAs
Prespecified evaluation componentPrespecified evaluation component
Dissemination Proposal Dissemination Proposal FeaturesFeatures
Health Care ProvidersHealth Care Providers– ALLHAT Regional OfficesALLHAT Regional Offices
200 Investigator Educators (15 details each)200 Investigator Educators (15 details each)
39,000 providers (13 contacts per detail)39,000 providers (13 contacts per detail)
Cues to action (Office posters and script Cues to action (Office posters and script cards)cards)
Direct to Patient ApproachesDirect to Patient Approaches– PSAPSA
Patient cue to provider on BP levelPatient cue to provider on BP level
Patient cue to provider on use of diureticsPatient cue to provider on use of diuretics
Dissemination Proposal Dissemination Proposal FeaturesFeatures
Formulary System ModificationFormulary System Modification– Persuasion through personal contactPersuasion through personal contact
10 major health plans10 major health plans
MedicaidMedicaid
Medicare (eventually)Medicare (eventually)
Professional Community InfluenceProfessional Community Influence– Persuasion via peer contactPersuasion via peer contact
Personal lettersPersonal letters
Association newslettersAssociation newsletters
Dissemination Proposal Dissemination Proposal FeaturesFeatures
Prespecified measures of successPrespecified measures of success– Process EvaluationProcess Evaluation
Deliverable program componentsDeliverable program components
– Outcomes EvaluationOutcomes EvaluationTrend analysis of prescribing practices Trend analysis of prescribing practices (nationally and within a specific health (nationally and within a specific health system) system)
Blood pressure control rates (specific health Blood pressure control rates (specific health system)system)
Update on Current ALLHAT Update on Current ALLHAT Dissemination Activities Dissemination Activities
200 presentations200 presentations
ManuscriptsManuscripts15 published15 published
37 in process37 in process
Dissemination aidsDissemination aidsReprintsReprints
SlidesSlides
NewsletterNewsletter
Dear colleague Dear colleague lettersletters
Frequently asked Frequently asked questionsquestions
MediaMediaPrintPrint
RadioRadio
TVTV
Internet messagesInternet messages
Guideline InputGuideline InputNHLBI JNC-7NHLBI JNC-7
Canadian BP Canadian BP GuidelinesGuidelines
NKF GuidelinesNKF Guidelines
Update on Current ALLHAT Update on Current ALLHAT Dissemination ActivitiesDissemination Activities
ALLHAT WebsitesALLHAT Websites– 89,000 users89,000 users– 2,230,341 hits2,230,341 hits
NHLBINHLBI
NHBPEP Coordinating Committee NHBPEP Coordinating Committee member organizationsmember organizations
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
Q1-02 Q2-02 Q3-02 Q4-02 Q1-03 Q2-03 Q3-03
ACEIs TotalACEIs Total
CCBs TotalCCBs Total
Diur TotalDiur Total
To
tal P
resc
rip
tio
ns
To
tal P
resc
rip
tio
ns
ALLHAT
*Source: IMS Health, National Prescription Audit Plus TM, 2003*Source: IMS Health, National Prescription Audit Plus TM, 2003 #Projected Q3-03#Projected Q3-03
Drug Utilization by ClassDrug Utilization by Class
#
#
#
Update on Current ALLHAT Update on Current ALLHAT Dissemination ActivitiesDissemination Activities
ALLHAT/JNC Dissemination PlanALLHAT/JNC Dissemination Plan
What is the process going forward?What is the process going forward?ALLHAT Dissemination Committee and the ALLHAT Dissemination Committee and the ALLHAT Clinical Trials Center revising ALLHAT Clinical Trials Center revising proposalproposal
ALLHAT Steering Committee will review ALLHAT Steering Committee will review revisionsrevisions
NHLBI will review proposalNHLBI will review proposal
JNC-7 Executive Committee group will JNC-7 Executive Committee group will review the proposed core messages review the proposed core messages
Field implementationField implementation
ALLHAT Dissemination PlanALLHAT Dissemination Plan
ALLHAT Dissemination PlanALLHAT Dissemination Plan
Dr. Paul K. Whelton, Chair of ALLHAT Dr. Paul K. Whelton, Chair of ALLHAT Dissemination Committee, quoted in a Dissemination Committee, quoted in a recent Lancet on the subject of ALLHAT recent Lancet on the subject of ALLHAT disseminationdissemination