Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach

Lyne Lalonde, Johanne Goudreau, Éveline Hudon, Marie-Thérèse Lussier, Céline Bareil, Fabie Duhamel, Lise Lévesque, Alain Turcotte, Gilles Lalonde, Group for TRANSIT to Best Practices in Cardiovascular Disease Prevention in Primary Care, Lyne Lalonde, Johanne Goudreau, Éveline Hudon, Marie-Thérèse Lussier, Céline Bareil, Fabie Duhamel, Lise Lévesque, Alain Turcotte, Gilles Lalonde, Group for TRANSIT to Best Practices in Cardiovascular Disease Prevention in Primary Care

Abstract

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model-based program of interventions, but no one has as yet offered a description of precisely how to apply the approach.

Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model-based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation.

Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program.

Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined.

Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.

Keywords: Participatory research; cardiovascular diseases; health services; intervention development; knowledge translation; prevention; primary care; risk factors.

Conflict of interest statement

Declaration of conflicting interests: The following authors report conflicts of interest: Lyne Lalonde is currently conducting a research sponsored by Pfizer Canada Inc. Marie-Thérèse Lussier has recently completed a study sponsored by AstraZeneca Canada Inc. Since 2011, Eveline Hudon has been leading a workshop sponsored by AstraZeneca Canada Inc. on interprofessional collaboration. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Summary of the five-step participatory process.
Figure 2.
Figure 2.
Schematic representation of the interprofessional follow-up in the TRANSIT program. TRANSIT: TRANSforming InTerprofessional clinical practices to improve cardiovascular diseases prevention in primary care.

References

    1. Hackam DG, Leiter LA, Yan AT, et al. Missed opportunities for the secondary prevention of cardiovascular disease in Canada. Can J Cardiol 2007; 23(14): 1124–1130.
    1. Kones R. Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention. Ther Adv Cardiovasc Dis 2011; 5(1): 61–81.
    1. Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001; 20(6): 64–78.
    1. Hung DY, Rundall TG, Tallia AF, et al. Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q 2007; 85(1): 69–91.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002; 288(14): 1775–1779.
    1. Hroscikoski MC, Solberg LI, Sperl-Hillen JM, et al. Challenges of change: a qualitative study of chronic care model implementation. Ann Fam Med 2006; 4(4): 317–326.
    1. Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv 2001; 27(2): 63–80.
    1. Barcelo A, Cafiero E, de Boer M, et al. Using collaborative learning to improve diabetes care and outcomes: the VIDA project. Prim Care Diabetes 2010; 4(3): 145–153.
    1. Schouten LM, Hulscher ME, van Everdingen JJ, et al. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ 2008; 336(7659): 1491–1494.
    1. Gugiu PC, Westine CD, Coryn CL, et al. An application of a new evidence grading system to research on the chronic care model. Eval Health Prof 2013; 36(1): 3–43.
    1. Schonlau M, Mangione-Smith R, Chan KS, et al. Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care? Ann Fam Med 2005; 3(3): 200–208.
    1. Grimshaw J, McAuley LM, Bero LA, et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf Health Care 2003; 12(4): 298–303.
    1. Newton PJ, Halcomb EJ, Davidson PM, et al. Barriers and facilitators to the implementation of the collaborative method: reflections from a single site. Qual Saf Health Care 2007; 16(6): 409–414.
    1. Van Bokhoven MA, Kok G, van der Weijden T. Designing a quality improvement intervention: a systematic approach. Qual Saf Health Care 2003; 12(3): 215–220.
    1. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff (Millwood) 2005; 24(1): 138–150.
    1. Mainz J. Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 2003; 15(6): 523–530.
    1. Donabedian A. Evaluating the quality of medical care. Milbank Q 2005; 83(4): 691–729.
    1. Hoffman A, Montgomery R, Aubry W, et al. How best to engage patients, doctors, and other stakeholders in designing comparative effectiveness studies. Health Aff (Millwood) 2010; 29(10): 1834–1841.
    1. Lalonde L, Goudreau J, Hudon E, et al. Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care—a participatory action research project. Fam Pract 2012; 29(6): 733–741.
    1. Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. Br Med J 2000; 320(7228): 178–181.
    1. Calderon C, Balague L, Cortada J, et al. Health promotion in primary care: how should we intervene? A qualitative study involving both physicians and patients. BMC Health Serv Res 2011; 11(1): 62.
    1. Schmittdiel JA, Grumbach K, Selby JV. System-based participatory research in health care: an approach for sustainable translational research and quality improvement. Ann Fam Med 2010; 8(3): 256–259.
    1. Lalonde L, Goudreau J, Hudon E, et al. Development of an interprofessional program for cardiovascular prevention in primary care: a participatory research approach—supplemental material, (2013, accessed 15 August 2013).
    1. Fitch K, Bernstein SJ, Aguilar MS, et al. The RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: RAND Corporation, 2001.
    1. Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. Thousand Oaks, CA: SAGE, 1994, 338 p.
    1. Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream. Circulation 2009; 119(19): 2633–2642.
    1. Desrosiers G. Bill 90: repercussions for all nurses. Perspect Infirm 2007; 4(3): 8–10.
    1. Berra K. Does nurse case management improve implementation of guidelines for cardiovascular disease risk reduction? J Cardiovasc Nurs 2011; 26(2): 145–167.
    1. Carter BL, Rogers M, Daly J, et al. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med 2009; 169(19): 1748–1755.
    1. Shojania KG, Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006; 296(4): 427–440.
    1. Santschi V, Chiolero A, Burnand B, et al. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med 2011; 171(16): 1441–1453.
    1. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010; 48(10): 923–933.
    1. Haskell WL, Berra K, Arias E, et al. Multifactor cardiovascular disease risk reduction in medically underserved, high-risk patients. Am J Cardiol 2006; 98(11): 1472–1479.
    1. Plotnikoff RC, Pickering MA, Glenn N, et al. The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. J Phys Act Health 2011; 8(7): 944–954.
    1. Lauritzen T, Borch-Johnsen K, Sandbaek A. Is prevention of Type-2 diabetes feasible and efficient in primary care? A systematic PudMed review. Prim Care Diabetes 2007; 1(1): 5–11.
    1. Hamer M, Stamatakis E, Kivimaki M, et al. Psychological distress, glycated hemoglobin, and mortality in adults with and without diabetes. Psychosom Med 2010; 72(9): 882–886.
    1. Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ 2008; 34(5): 815–823.
    1. Deakin T, McShane CE, Cade JE, et al. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 2: CD003417.
    1. Diedrich A, Munroe DJ, Romano M. Promoting physical activity for persons with diabetes. Diabetes Educ 2010; 36(1): 132–140.
    1. Rubak S, Sandbaek A, Lauritzen T, et al. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005; 55(513): 305–312.
    1. Thompson DR, Chair SY, Chan SW, et al. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs 2011; 20(9–10): 1236–1244.
    1. Jansen YJ, Foets MM, de Bont AA. The contribution of qualitative research to the development of tailor-made community-based interventions in primary care: a review. Eur J Public Health 2010; 20(2): 220–226.
    1. Kothari AR, Bickford JJ, Edwards N, et al. Uncovering tacit knowledge: a pilot study to broaden the concept of knowledge in knowledge translation. BMC Health Serv Res 2011; 11: 198.
    1. Mainz J. Developing evidence-based clinical indicators: a state of the art methods primer. Int J Qual Health Care 2003; 15(Suppl. 1): i5–i11.
    1. Block RC, Pearson TA. Organizing services for cardiovascular prevention. Curr Treat Options Cardiovasc Med 2007; 9(4): 278–286.
    1. Nemis-White J, Mackillop J, Bennett M, et al. Addressing primary care needs: a participatory approach to collaborative policy development. Healthc Pap 2011; 11(2): 69–78.

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