Community and Clinician Partnership for Prevention (C2P2) (Text Version)

On September 14, 2009, Alex R. Kemper made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1. 9 MB) (Plugin Software Help).

Slide 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', MSPH, ANP-BC

Funding: AHRQ; PBRN Task Order Request #1

Slide 2

Background

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

Slide 3

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

Slide 4

Chronic Care Model

Slide 5

Objective

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

Slide 6

Setting

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

Slide 7

Participants and Interventions

• 9 Practices (IM and FP)
  • Control
  • Passsive Intervention
  • Active Intervention

Duration of the Intervention: 6 month, starting spring 2008

Slide 8

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

Slide 9

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

Slide 10

Initial Community-Based Resources

• Tobacco Quitline
• Public Health Department Dietitians
• YMCA
• Duke Live-for-Life Program

Slide 11

Passive Intervention

• Brochure and referral material for selected community organizations:
• Practice kick-off meeting
• Brief help as requested

Slide 12

Practice Brochure

Slide 13

Practice Brochure

Slide 14

Active Intervention

• Passive Intervention Protocol plus:
  • Access to the "ACCTION Pack"
  • More regular contact with a "practice champion"

Slide 15

ACCTION Pack

Slide 16

ACCTION Pack

Slide 17

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

Slide 18

Tobacco Assessment

Slide 19

Tobacco Use

Slide 20

Tobacco Referral

No intervention effect

Slide 21

Diet Assessment

Slide 22

Diet Needs Modification

Slide 23

Diet Needs Referral

No intervention effect

Slide 24

Physical Activity Assessment

Slide 25

Physical Activity Needs Modification

Slide 26

Physical Activity Referral

No intervention effect

Slide 27

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

Slide 28

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

Slide 29

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

Slide 30

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

Slide 31

Thank You!