Implementation of Modified Cardiovascular Health Awareness Program for Canadian Adults on a Waiting List for a Family Physician

Introduction The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular diseases (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary care. Centralized waiting lists and prioritization based on urgency of medical need were created to address this problem. We aimed to assess the acceptability, CVD risk profile, and potential benefits of offering a modified version of CHAP to adults on the waiting list. Methods The implementation was conducted in Laval (Canada) between March and June 2016, targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centers. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured. They also received targeted healthy lifestyle and patient education materials and were referred to local programs including a medical follow-up, when required. Results A total of 1976 invitation letters were sent resulting in 281 (14.2%) participants. The average age of attendees was 58.1 (SD = 8.2) and a majority were female (58%, n = 163). A third of participants (34.2%, n = 96) had BP ≥140/90 and 11.4% (n = 32) were classified as having a very high risk for developing diabetes. Almost half (41.6%, n = 117) of participants were referred either to health promotion programs offered by local health authorities, to family physicians (4.6%, n = 13) or emergency departments (1.8%, n = 5) for short-term medical assistance. Conclusion Despite low participation rate, many adults on a waiting list had elevated risk for CVD and would greatly benefit from having a regular source of primary care.

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Implementation of the Cardiovascular Health Awareness Program (CHAP) for adults on a waiting list for a family physician

10.21203/rs.3.rs-21925/v2 ◽

2020 ◽

Author(s):

Janusz Kaczorowski ◽

Marie-Thérèse Lussier ◽

Magali Girard ◽

Audrey Beaulieu-Carbonneau

Keyword(s):

Community Health ◽

Family Physician ◽

Primary Healthcare ◽

Cardiovascular Health ◽

Family Physicians ◽

Waiting List ◽

Health Awareness ◽

Community Health Centres ◽

Regular Source ◽

Health Centres

Abstract Background: The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular disease (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary healthcare. Centralised waiting lists and prioritization based on urgency of medical need were created to address this problem. Our objective was to assess the potential benefits of offering a modified version of the CHAP program to adults on the waiting list.Methods: The implementation was conducted in Laval (Canada), targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centres. The sessions were facilitated by trained volunteers and supervised by a nurse. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured; received targeted healthy lifestyle and patient education materials; and were referred to local programs including a medical follow-up, when required. Results: A total of 2,036 invitation letters were sent resulting in 281 (14.2%) participants attending one of 26 3-hour sessions held in 4 community health centres, assisted by 33 volunteers and supervised by a nurse. The average age of attendees was 58.1 (SD=8.2) and a majority were female (58%, n=163). Most participants were sedentary (57.3%, n=161), had low fruit and vegetable consumption (54.4%, n=153), and were overweight (38.9%, n=109) or obese (41.7%, n=117). A third of participants (34.2%, n=96) had BP ≥140/90 and 11.4% (n=32) were classified as having a very high risk for developing diabetes. Over 40% (n=117) of participants were referred to health promotion programs offered by local health authorities and 4.6% (n=13) were referred to family physicians or emergency departments (1.8%, n=5) for short-term medical assistance.Conclusions: Many Laval adults on a waiting list for a family physician would greatly benefit from having a regular source of primary healthcare to prevent, delay, and manage their cardiovascular health.

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Implementation of the Cardiovascular Health Awareness Program (CHAP) for adults on a waiting list for a family physician

10.21203/rs.3.rs-21925/v1 ◽

2020 ◽

Author(s):

Janusz Kaczorowski ◽

Marie-Thérèse Lussier ◽

Magali Girard ◽

Audrey Beaulieu-Carbonneau

Keyword(s):

Community Health ◽

Family Physician ◽

Primary Healthcare ◽

Cardiovascular Health ◽

Family Physicians ◽

Waiting List ◽

Health Awareness ◽

Community Health Centres ◽

Regular Source ◽

Health Centres

Abstract Background The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular disease (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary healthcare. Centralised waiting lists and prioritization based on urgency of medical need were created to address this problem. Our objective was to assess the potential benefits of offering a modified version of the CHAP program to adults on the waiting list.Methods The implementation was conducted in Laval (Canada), targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centres. The sessions were facilitated by trained volunteers and supervised by a nurse. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured; received targeted healthy lifestyle and patient education materials; and were referred to local programs including a medical follow-up, when required.Results A total of 2,036 invitation letters were sent resulting in 281 (14.2%) participants attending one of 26 3-hour sessions held in 4 community health centres, assisted by 33 volunteers and supervised by a nurse. The average age of attendees was 58.1 (SD=8.2) and a majority were female (58%, n=163). Most participants were sedentary (57.3%, n=161), had low fruit and vegetable consumption (54.4%, n=153), and were overweight (38.9%, n=109) or obese (41.7%, n=117). A third of participants (34.2%, n=96) had BP ≥140/90 and 11.4% (n=32) were classified as having a very high risk for developing diabetes. Over 40% (n=117) of participants were referred to health promotion programs offered by local health authorities and 4.6% (n=13) were referred to family physicians or emergency departments (1.8%, n=5) for short-term medical assistance.Conclusions Many Laval adults on a waiting list for a family physician would greatly benefit from having a regular source of primary healthcare to prevent, delay, and manage their cardiovascular health.

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A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients [ISRCTN61739603]

BMC Family Practice ◽

10.1186/1471-2296-6-35 ◽

2005 ◽

Vol 6 (1) ◽

Cited By ~ 24

Author(s):

Tina Karwalajtys ◽

Janusz Kaczorowski ◽

Larry W Chambers ◽

Cheryl Levitt ◽

Lisa Dolovich ◽

...

Keyword(s):

Randomized Trial ◽

Family Practice ◽

Cardiovascular Health ◽

Health Awareness ◽

Community Based ◽

Awareness Program

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Participation in Cardiovascular Health Awareness Program (CHAP) by the Elderly Residents of Social Housing in Quebec: Social Network Analysis

10.21203/rs.3.rs-79393/v1 ◽

2020 ◽

Author(s):

Nadia Deville-Stoetzel ◽

Janusz Kaczorowski ◽

Gina Agarwal ◽

Marie-Thérèse Lussier ◽

Magali Girard

Keyword(s):

Social Network ◽

Social Network Analysis ◽

Network Analysis ◽

Social Housing ◽

Cardiovascular Health ◽

Qualitative Interviews ◽

Medium Size ◽

Attendance Rate ◽

Health Awareness ◽

Awareness Program

Abstract Background: The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular disease (CVD) prevention program in small to medium size communities in Ontario. Recently, CHAP has been adapted to target older individuals living in 14 social housing buildings in Ontario (7) and Quebec (7). The participation rates in the 10-months program varied across buildings in Quebec from 23.5% to 49.1%. Social network analysis (SNA) has been successfully used to assess and strengthen participation in health promotion programs. We applied SNA methods to investigate whether interpersonal relationships between tenants within buildings influence the participation in CHAP. Methods: We used sociometric questionnaires and complete network analysis, supplemented by qualitative interviews to examine relational dynamics of two buildings in Quebec with a low and a high attendance rates. All residents of the two buildings were eligible to be interviewed for the sociometric questionnaire. The participants for the qualitative part of the study were selected at random. Results: In total, 69 seniors participated in the study, including qualitative interviews. Among study participants selected for qualitative interviews, 10 attended almost all CHAP sessions, 10 attended once and 12 did not attend any. Quantitative results helped to identify well-known and appreciated local leaders. In building 1 which had a high attendance rate (34.3%), there was a main leader (In-degree or ‘named by others’ frequency 23.2%) who attended all sessions. In building 2 which had a low attendance rate (23.9%), none of the leaders had participated in CHAP sessions. Qualitative analysis showed that tenants who did not attend CHAP sessions (or other activities in the building) generally preferred to avoid conflicts, retaliation and gossip and did not want to get involved in clans and politics within the buildings. Conclusion: In order to increase attendance at CHAP sessions among residents of subsidized housings for seniors, we identified 4 potential strategies: increase participant confidentiality; deploy community peer-networks to enhance recruitment; pair attendants to ensure their future participation; intervene through an opinion leader or through bridging individuals.

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Long term outcomes of cluster randomized trial to improve cardiovascular health at population level: The Cardiovascular Health Awareness Program (CHAP)

PLoS ONE ◽

10.1371/journal.pone.0201802 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0201802 ◽

Cited By ~ 1

Author(s):

Simone Dahrouge ◽

Janusz Kaczorowski ◽

Lisa Dolovich ◽

Michael Paterson ◽

Lehana Thabane ◽

...

Keyword(s):

Randomized Trial ◽

Cardiovascular Health ◽

Population Level ◽

Cluster Randomized Trial ◽

Health Awareness ◽

Long Term Outcomes ◽

Awareness Program ◽

Cluster Randomized

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IMPROVING CARDIOVASCULAR HEALTH AT THE POPULATION LEVEL: A 39 COMMUNITY CLUSTER-RANDOMISED TRIAL OF THE CARDIOVASCULAR HEALTH AWARENESS PROGRAM (CHAP): PS.3.03

Journal of Hypertension ◽

10.1097/01.hjh.0000384008.86281.66 ◽

2010 ◽

Vol 28 ◽

pp. e602

Author(s):

J Kaczorowski ◽

LW Chambers ◽

L Dolovich ◽

B Farrell ◽

B McDonough ◽

...

Keyword(s):

Cardiovascular Health ◽

Randomised Trial ◽

Population Level ◽

Cluster Randomised Trial ◽

Health Awareness ◽

Cluster Randomised ◽

Awareness Program

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Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada

Trials ◽

10.1186/s13063-019-3806-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Gina Agarwal ◽

Magali Girard ◽

Ricardo Angeles ◽

Melissa Pirrie ◽

Marie-Thérèse Lussier ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Social Housing ◽

Cardiovascular Health ◽

Primary Care Providers ◽

Care Providers ◽

Health Awareness ◽

Awareness Program ◽

Ed Visits ◽

Cluster Randomized

Abstract Background The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors’ housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. Methods/design This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50–200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. Discussion It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. Trial registration ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.

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