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

Slide presentation from the AHRQ 2009 conference

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

Slide 1. Community and Clinician Partnership for Prevention (C2P2)

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

Slide 2. Background

Background

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

Slide 3

Slide 3. Background

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

Slide 4. Chronic Care Model

Chronic Care Model

Slide 5

Slide 5. Objective

Objective

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

Slide 6

Slide 6. Setting

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

Slide 7. Participants and Interventions

Participants and Interventions

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

Duration of the Intervention: 6 month, starting spring 2008

Slide 8

Slide 8. Practices

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

Slide 9. Initial Selection of Community-Based Resources

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

Slide 10. Initial Community-Based Resources

Initial Community-Based Resources

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

Slide 11

Slide 11. Passive Intervention

Passive Intervention

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

Slide 12

Slide 12. Practice Brochure

Practice Brochure

Slide 13

Slide 13. Practice Brochure

Practice Brochure

Slide 14

Slide 14. Active Intervention

Active Intervention

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

Slide 15

Slide 15. ACCTION Pack

ACCTION Pack

Slide 16

Slide 16. ACCTION Pack

ACCTION Pack

Slide 17

Slide 17. Outcome Measures

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

Slide 18. Tobacco Assessment

Tobacco Assessment

 BaselineMidpointFinal
Control41%56%56%
Passive46%53%54%
Active80%72%72%

Slide 19

Slide 19. Tobacco Use

Tobacco Use

 BaselineMidpointFinal
Control9%13%9%
Passive6%9%11%
Active14%12%13%

Slide 20

Slide 20. Tobacco Referral

Tobacco Referral

No intervention effect

 BaselineMidpointFinal
Control3% (1)0%2% (1)
Passive4% (1)0%7% (4)
Active6% (3)11% (6)5% (3)

Slide 21

Slide 21. Diet Assessment

Diet Assessment

 BaselineMidpointFinal
Control15%22%25%
Passive10%27%28%
Active36%31%38%

Slide 22

Slide 22. Diet Needs Modification

Diet Needs Modification

 BaselineMidpointFinal
Control8%16%19%
Passive7%21%24%
Active25%22%31%

Slide 23

Slide 23. Diet Needs Referral

Diet Needs Referral

No intervention effect

 BaselineMidpointFinal
Control3% (1)7% (5)7% (7)
Passive14% (4)6% (7)7% (9)
Active14% (11)6% (6)6% (10)

Slide 24

Slide 24. Physical Activity Assessment

Physical Activity Assessment

 BaselineMidpointFinal
Control21%27%30%
Passive17%32%29%
Active41%35%37%

Slide 25

Slide 25. Physical Activity Needs Modification

Physical Activity Needs Modification

 BaselineMidpointFinal
Control11%15%21%
Passive9%21%23%
Active21%21%30%

Slide 26

Slide 26. Physical Activity Referral

Physical Activity Referral

No intervention effect

 BaselineMidpointFinal
Control1% (2)3% (2)2% (2)
Passive2% (1)1% (1)1% (1)
Active8% (6)4% (4)0% (0)

Slide 27

Slide 27. What limited the impact of the interventions?

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

Slide 28. What limited the impact of the interventions?

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

Slide 29. Conclusions and Next Steps

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

Slide 30. Conclusions and Next Steps

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

Slide 31. Thank You!

Thank You!

Current as of December 2009
Internet Citation: Community and Clinician Partnership for Prevention (C2P2) (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/kemper/index.html