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).

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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

	Baseline	Midpoint	Final
Control	41%	56%	56%
Passive	46%	53%	54%
Active	80%	72%	72%

Slide 19

Tobacco Use

	Baseline	Midpoint	Final
Control	9%	13%	9%
Passive	6%	9%	11%
Active	14%	12%	13%

Slide 20

Tobacco Referral

No intervention effect

	Baseline	Midpoint	Final
Control	3% (1)	0%	2% (1)
Passive	4% (1)	0%	7% (4)
Active	6% (3)	11% (6)	5% (3)

Slide 21

Diet Assessment

	Baseline	Midpoint	Final
Control	15%	22%	25%
Passive	10%	27%	28%
Active	36%	31%	38%

Slide 22

Diet Needs Modification

	Baseline	Midpoint	Final
Control	8%	16%	19%
Passive	7%	21%	24%
Active	25%	22%	31%

Slide 23

Diet Needs Referral

No intervention effect

	Baseline	Midpoint	Final
Control	3% (1)	7% (5)	7% (7)
Passive	14% (4)	6% (7)	7% (9)
Active	14% (11)	6% (6)	6% (10)

Slide 24

Physical Activity Assessment

	Baseline	Midpoint	Final
Control	21%	27%	30%
Passive	17%	32%	29%
Active	41%	35%	37%

Slide 25

Physical Activity Needs Modification

	Baseline	Midpoint	Final
Control	11%	15%	21%
Passive	9%	21%	23%
Active	21%	21%	30%

Slide 26

Physical Activity Referral

No intervention effect

	Baseline	Midpoint	Final
Control	1% (2)	3% (2)	2% (2)
Passive	2% (1)	1% (1)	1% (1)
Active	8% (6)	4% (4)	0% (0)

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!