Telemedicine cardiovascular risk reduction in Veterans

Abstract

Background Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical Pharmacy Specialist (CPS), telephone administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk. Methods Randomized controlled trial including patients with hypertension (blood pressure (BP) > 150/100 mmHg) or elevated low density liporotein (LDL) (> 130 mg/dl). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined. Conclusion Given the national prevalence of CVD and the dismal rates of risk factor control; intensive, but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans.

Patient-Reported Medication Adherence Barriers Among Patients with Cardiovascular Risk Factors

“…CITIES has been described in detail elsewhere. 15,16 In brief, CITIES was a tailored behavioral and educational pharmacist-administered and telephone-based intervention for reducing CVD risk. Patients were recruited from November 2011 until April 2014.…”

Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease

“…Each of these are unique reasons that improving the burden of CVRFs among Veterans using health system-based interventions might be more feasible compared to non-VA PD populations in the US. Similar large scale interventions for treating CVRFs in high risk populations have already been designed and conducted within the VA health system [40, 41]. Lessons learned from such CVRF-specific trials may also improve the design of future large-scale PD trials.…”

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

“…These modules include medication reconciliation, pill refill, disease knowledge/ risk perception, weight management, diet, exercise, smoking cessation, stress reduction, sleep apnea, insomnia, mental health, and hypoglycemia; these factors are not only important to patients' CVD outcome, but are also topics for targeting and tailoring of intervention materials. 22 …”

“…At each call the pharmacist delivers both tailored and standard information from study modules. 22 This monthly frequency was designed based on several factors, including previous experience, 2,20 clinical response, and response to goal setting. One month allows sufficient elapsed time to note discernible effects from medication changes, while still calling soon enough to mitigate any potential adverse events.…”

“…22 In brief, potential CITIES participants are identified through an electronic health record query to locate patients who were enrolled in one of three primary care clinics affiliated with the Durham VA Medical Center (Durham, NC). Eligible participants have active outpatient diagnoses codes for hypertension and/or hyperlipidemia with poor control over the last 12 months and are 40 years or older at the time of enrollment.…”