Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care

NCT ID: NCT01983813

Last Updated: 2019-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

302 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-19

Study Completion Date

2018-04-30

Brief Summary

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The trial will examine whether a centralized Prevention Health \& Cardiovascular Risk Service (PHCVRS) run by clinical pharmacists at the University of Iowa can be implemented in primary care offices and whether it can improve the care delivered to patients at risk for developing cardiovascular disease.

Detailed Description

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The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities.

This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects.

Conditions

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Diabetes Mellitus Hypertension Coronary Artery Disease Atrial Fibrillation Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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PHCVRS intervention

Each participant will receive communication with a clinical pharmacist for 12 months to decrease risk of developing cardiovascular disease.

Group Type EXPERIMENTAL

PHCVRS Intervention

Intervention Type OTHER

A clinical pharmacist at the PHCVRS will follow each participant in the PHCVRS arm for 12 months, including:

1. Contact via email, phone or text every 2-4 weeks
2. Assessment and counseling for medication adherence, side effects, and lifestyle modifications to decrease risk of cardiovascular disease.
3. Collaborative communication with the participant's physician to address gaps in screening or therapy, update medication list, and recommend medication changes.

Each participant in this arm will also have access to an online Personal Health Record that can be used to track medications, diagnosed conditions and laboratory values related to cardiovascular disease risk.

Personal Health Record

Intervention Type OTHER

Participant will be able to access an online Personal Health Record for tracking medications and diagnosed conditions

Usual care/Personal Health Record

Will receive usual medical care plus access to an online Personal Health Record, where the participant can document medications and diagnosed conditions.

Group Type OTHER

Personal Health Record

Intervention Type OTHER

Participant will be able to access an online Personal Health Record for tracking medications and diagnosed conditions

Interventions

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PHCVRS Intervention

A clinical pharmacist at the PHCVRS will follow each participant in the PHCVRS arm for 12 months, including:

1. Contact via email, phone or text every 2-4 weeks
2. Assessment and counseling for medication adherence, side effects, and lifestyle modifications to decrease risk of cardiovascular disease.
3. Collaborative communication with the participant's physician to address gaps in screening or therapy, update medication list, and recommend medication changes.

Each participant in this arm will also have access to an online Personal Health Record that can be used to track medications, diagnosed conditions and laboratory values related to cardiovascular disease risk.

Intervention Type OTHER

Personal Health Record

Participant will be able to access an online Personal Health Record for tracking medications and diagnosed conditions

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Section A: Demographic Criteria

1. Patient was seen in your clinic or practice at least once in the past 24 months
2. English-speaking male or female
3. Age is 50 or older at medical record screening

Section B: Risk Factors - Must have at least one of the following conditions
4. Uncontrolled diabetes (Hemoglobin A1c \> or + 7.5)
5. Elevated LDL cholesterol \> 110 for patients with PAD, CAD, stroke or diabetes or \> 140 otherwise
6. Elevated blood pressure with:

* Systolic BP \>= 140 or Diastolic BP \>=90 in persons with diabetes or chronic kidney disease OR
* Systolic BP \>= 150 in persons with uncomplicated hypertension

Section C: Cardiovascular Conditions - total number of risk factors in Section B (above) plus number of conditions Section C (below) must be THREE OR MORE
7. History of coronary artery disease
8. Previous Heart Attack
9. History of Stroke
10. History of Transient Ischemic Attack
11. History of Atrial fibrillation
12. History of Peripheral Vascular Disease / claudication
13. History of carotid artery disease
14. Current smoker
15. Obesity with BMI \> 30

Exclusion Criteria

16. Inability to give informed consent
17. Pregnant
18. Diagnosis of pulmonary hypertension (Note: secondary pulmonary hypertension is OK)
19. Cancer diagnosis with a life expectancy estimated less than 2 years
20. Residence in a nursing home or diagnosis of dementia
21. No telephone or a hearing impairment not allowing them to use a phone
22. Refusal to consider attempting to use the internet at home, community center, library, medical office or other source to access the PHRM
23. Patient has plans to move from the area or transfer care to a different clinic in the next 12 months
24. Omron blood pressure cuff cannot be used on patient's arm for any reason
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Korey Kennelty

OTHER

Sponsor Role lead

Responsible Party

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Korey Kennelty

Assistant Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Barry L. Carter, Pharm.D.

Role: PRINCIPAL_INVESTIGATOR

University of Iowa

Barcey T. Levy, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

University of Iowa

Locations

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Akron Mercy Medical Clinic

Akron, Iowa, United States

Site Status

Iowa Specialty Hospitals - Belmond Clinic

Belmond, Iowa, United States

Site Status

Employee Health Clinic, Mercy Cedar Rapids

Cedar Rapids, Iowa, United States

Site Status

Iowa Speciality Hospitals - Clarion Clinic

Clarion, Iowa, United States

Site Status

Great River Medical Group

Davenport, Iowa, United States

Site Status

Des Moines University Family Medicine Clinic

Des Moines, Iowa, United States

Site Status

Grinnell Regional Family Practice

Grinnell, Iowa, United States

Site Status

Knoxville Hospital Clinic

Knoxville, Iowa, United States

Site Status

Newton Clinic, P.C.

Newton, Iowa, United States

Site Status

UI Health Care-River Crossing

Riverside, Iowa, United States

Site Status

Siouxland Community Health Center

Sioux City, Iowa, United States

Site Status

Burlington Area Family Practice Center

West Burlington, Iowa, United States

Site Status

Countries

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United States

References

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Carter BL, Levy BT, Gryzlak B, Chrischilles EA, Vander Weg MW, Christensen AJ, James PA, Moss CA, Parker CP, Gums T, Finkelstein RJ, Xu Y, Dawson JD, Polgreen LA. A centralized cardiovascular risk service to improve guideline adherence in private primary care offices. Contemp Clin Trials. 2015 Jul;43:25-32. doi: 10.1016/j.cct.2015.04.014. Epub 2015 May 4.

Reference Type BACKGROUND
PMID: 25952471 (View on PubMed)

Yang R, Carter BL, Gums TH, Gryzlak BM, Xu Y, Levy BT. Selection bias and subject refusal in a cluster-randomized controlled trial. BMC Med Res Methodol. 2017 Jul 10;17(1):94. doi: 10.1186/s12874-017-0368-7.

Reference Type BACKGROUND
PMID: 28693427 (View on PubMed)

Kennelty KA, Polgreen LA, Carter BL. Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature. Curr Hypertens Rep. 2018 Jan 18;20(1):1. doi: 10.1007/s11906-018-0803-0.

Reference Type BACKGROUND
PMID: 29349522 (View on PubMed)

Carter BL. Will Team-Based Care Really be Implemented? J Clin Hypertens (Greenwich). 2015 Sep;17(9):692-3. doi: 10.1111/jch.12578. Epub 2015 Jun 1. No abstract available.

Reference Type BACKGROUND
PMID: 26032927 (View on PubMed)

Carter BL, Ardery G. Avoiding Pitfalls With Implementation of Randomized Controlled Multicenter Trials: Strategies to Achieve Milestones. J Am Heart Assoc. 2016 Dec 19;5(12):e004432. doi: 10.1161/JAHA.116.004432. No abstract available.

Reference Type BACKGROUND
PMID: 27993832 (View on PubMed)

Patel E, Pevnick JM, Kennelty KA. Pharmacists and medication reconciliation: a review of recent literature. Integr Pharm Res Pract. 2019 Apr 30;8:39-45. doi: 10.2147/IPRP.S169727. eCollection 2019.

Reference Type BACKGROUND
PMID: 31119096 (View on PubMed)

Carter BL. Collaborative care model for hypertension. J Clin Hypertens (Greenwich). 2018 Jan;20(1):96-97. doi: 10.1111/jch.13142. Epub 2017 Dec 13. No abstract available.

Reference Type BACKGROUND
PMID: 29237101 (View on PubMed)

Carter BL, Levy B, Gryzlak B, Xu Y, Chrischilles E, Dawson J, Vander Weg M, Christensen A, James P, Polgreen L. Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices. Circ Cardiovasc Qual Outcomes. 2018 Jun;11(6):e004188. doi: 10.1161/CIRCOUTCOMES.117.004188.

Reference Type RESULT
PMID: 29884657 (View on PubMed)

Other Identifiers

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201308707

Identifier Type: -

Identifier Source: org_study_id

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