Coach Trial Confirms Effectiveness of NP/CHW Intervention for CVD Risk Reduction Among Underserved Populations
Sunday, 04 November 2012 00:00
LOS ANGELES, November 2, 2012
Cost-effectiveness of COACH Trial reviewed at American Heart Association Scientific Sessions 2012
The Community Outreach and Cardiovascular Health (COACH) Trial, presented in the Nursing Science in Review: Top Trials in 2010-2012 session at the American Heart Association Scientific Sessions 2012 indicates that Nurse Practitioner/Community Health Worker (NP/CHW) team interventions of individualized treatment regimens can be an effective way to improve awareness and status of risk factors in underserved populations.
The study, presented by Dr. Jerilyn Allen, Associate Dean for Research at Johns Hopkins University School of Nursing and treasurer on the board of directors of the Preventive Cardiovascular Nurses Association (PCNA), randomly assigned 525 patients with documented cardiovascular disease, type 2 diabetes, hypercholesterolemia, or hypertension and levels of LDL cholesterol, blood pressure, or HbA1c that exceeded goals established by national guidelines into two groups: NP/CHW interventions or enhanced usual care (EUC). Baseline characteristics of participants included a mean age of 56, 71% female, 78% african american, 34% with private health insurance coverage, 54% with an income of less than $20,000 per year and 32% with less than a high school education.
Patients in the EUC group were offered only lab values and standard education materials, for risk factors, while NP/CHW intervention group received aggressive pharmacological management, tailored education and behavioral counseling for lifestyle modification, and problem solving to address barriers to adherence and control of risk factors. As a result, patients in the NP/CHW group had significant change in total cholesterol (difference, 19.7 mg/dL), LDL cholesterol (difference,15.9 mg/dL), triglycerides (difference, 16.3 mg/dL), systolic blood pressure (difference, 6.2 mm Hg), diastolic blood pressure (difference, 3.1 mm Hg), HbA1c (difference, 0.5%), and perceptions of the quality of their chronic illness care (difference, 1.2 points).
The preliminary results of this study were published in the November 2011 issue of Circulation. However, further information regarding the cost-effectiveness of this trial was presented at the American Heart Association Scientific Sessions 2012. Provider costs, drug costs and lab test costs were measured to determine and incremental cost of $627 per patient for one year of intervention vs. EUC. Per patient use of resources increased in the NP/CHW intervention patients due to an increase in the number of lab tests (11.5 for NP/CHW intervention patients vs. 5.4 in EUC patients), medications (4.3 for Np/CHW intervention patients and 3.7 for EUC patients), and costs for NP and CHW care visits, 7.6 and 5.3, respectively.
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