31
Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’, MSPH, ANP-BC Funding: AHRQ; PBRN Task Order Request #1

Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Embed Size (px)

Citation preview

Page 1: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Community and Clinician Partnership for Prevention(C2P2)

Alex R. Kemper, MD, MPH, MS

Philip Sloane, MD, MPH

Rowena Dolor, MD, MHS

Tricia L. Trinite’, MSPH, ANP-BC

Funding: AHRQ; PBRN Task Order Request #1

Page 2: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Background

• Unhealthy behaviors are common and lead to significant morbidity and mortality– Tobacco use– Poor diet– Lack of physical activity

Page 3: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Background

• Rate of behavioral-based interventions to address unhealthy behaviors by primary care providers is low– Lack of knowledge– Poor self-efficacy– Challenge of delivering interventions in a busy

setting with limited capacity

Page 4: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Chronic Care Model

Page 5: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Objective

• To evaluate strategies to develop and foster linkages between primary care practices and community resources

Page 6: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Setting

www.learnnc.org

Orange County: Population: 120,000 Black: 13% Hispanic: 6%Durham County: Population 230,000 Black 37% Hispanic 11%Overall, 13% below FPL

In North Carolina Tobacco: 25% Overweight: 36% Obese: 27% ≥20 minutes physical activity ≥3 days per week: <25%

Ready to change: 44% who smoke, 60% with poor nutrition, 68% who lack exercise

Page 7: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Participants and Interventions

Control

Duration of the Intervention: 6 month, starting spring 2008

9 Practices

(IM and FP)

Passive

Intervention

Active

Intervention

R

Page 8: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Practices

• Control– 3 family practice clinics

• Passive Intervention– 1 family practice clinic– 2 internal medicine clinics

• Active Intervention– 2 family practice clinics (1 with trainees)– 1 internal medicine

Page 9: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Initial Selection of Community-Based Resources

• Behavioral-based interventions based on the 5 A’s

• Must be accessible

• Interested in new referrals

• Able to participate in bi-directional communication

Page 10: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Initial Community-Based Resources

• Tobacco Quitline

• Public Health Department Dietitians

• YMCA

• Duke Live-for-Life Program

Page 11: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Passive Intervention

• Brochure and referral material for selected community organizations:

• Practice kick-off meeting

• Brief help as requested

Page 12: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Practice Brochure

Page 13: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Practice Brochure

Page 14: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Active Intervention

• Passive Intervention Protocol plus:– Access to the “ACCTION Pack”– More regular contact with a “practice

champion”

Page 15: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

ACCTION Pack

Page 16: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

ACCTION Pack

Page 17: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Outcome Measures

• Main Quantitative Measure: – Referral from practices to a community

resource

• Description of the barriers to and facilitators of developing linkages between practices and community resources

Page 18: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Tobacco Assessment

Baseline Midpoint Final

Control 41% 56% 56%

Passive 46% 53% 54%

Active 80% 72% 72%

Page 19: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Tobacco Use

Baseline Midpoint Final

Control 9% 13% 9%

Passive 6% 9% 11%

Active 14% 12% 13%

Page 20: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Tobacco Referral

Baseline Midpoint Final

Control 3% (1) 0% 2% (1)

Passive 4% (1) 0% 7% (4)

Active 6% (3) 11% (6) 5% (3)

No intervention effect

Page 21: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Diet Assessment

Baseline Midpoint Final

Control 15% 22% 25%

Passive 10% 27% 28%

Active 36% 31% 38%

Page 22: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Diet Needs Modification

Baseline Midpoint Final

Control 8% 16% 19%

Passive 7% 21% 24%

Active 25% 22% 31%

Page 23: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Diet Needs Referral

Baseline Midpoint Final

Control 3% (1) 7% (5) 7% (7)

Passive 14% (4) 6% (7) 7% (9)

Active 14% (11) 6% (6) 6% (10)

No intervention effect

Page 24: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Physical Activity Assessment

Baseline Midpoint Final

Control 21% 27% 30%

Passive 17% 32% 29%

Active 41% 35% 37%

Page 25: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Physical Activity Needs Modification

Baseline Midpoint Final

Control 11% 15% 21%

Passive 9% 21% 23%

Active 21% 21% 30%

Page 26: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Physical Activity Referral

Baseline Midpoint Final

Control 1% (2) 3% (2) 2% (2)

Passive 2% (1) 1% (1) 1% (1)

Active 8% (6) 4% (4) 0% (0)

No intervention effect

Page 27: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

What limited the impact of the interventions?

• Little understanding about how to build collaborations– Physicians were not motivated to form

collaborations, even when they were interested in engaging the community

– Organizations had significant staff turnover– No method for bi-directional communication

• Concerns about cost• Concerns about treatment• No information about outcomes

Page 28: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

What limited the impact of the interventions?

• ACCTION Pack– Difficult to use to get to information quickly– Not populated with local resources– Practices wanted handouts– Practices overwhelmed with material

Page 29: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Conclusions and Next Steps

• Forming partnerships between clinicians and community-based organizations is difficult

• Successful partnerships cannot be developed by bringing materials to practices alone

Page 30: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Conclusions and Next Steps

• Future efforts should – work on bringing together potential partners

and allowing them to develop mutually beneficial collaborations

– focus on increasing consumer demand and the expectation that primary care providers will refer to such organizations

Page 31: Community and Clinician Partnership for Prevention (C2P2) Alex R. Kemper, MD, MPH, MS Philip Sloane, MD, MPH Rowena Dolor, MD, MHS Tricia L. Trinite’,

Thank You!