CHAP and Ontario Health Teams

The Cardiovascular Health Awareness Program (CHAP) provides a solid foundation for a population-based cardiovascular disease (CVD) prevention within the newly announced Ontario Health Teams. It is evidence-based, made-in-Canada,inexpensive and easy to implement.

Problem:

 The current Ontario health care system does not provide a coordinated and well integrated strategy for effective,population-based, patient-centered cardiovascular disease risk assessment and prevention.

Cardiovascular disease, the most common chronic disease in Canada, is a leading cause for significant complications, morbidity, and mortality, and an unsustainable drain on health care budgets[1].  The latest reports indicate that 85% of Canadians are not meeting the weekly physical activity recommendations; fruit and vegetable consumption is in decline; consumption of processed and fast foods as well as heavy alcohol drinking are on the rise; while elevated rates of obesity and overweight remain virtually unchanged.  Together with excessive sodium consumption,smoking and excessive weight, this puts  60% of men and 45% of women at increased health risk for a range of chronic diseases including elevated blood pressure,  lipids and glucose levels. [2]  [3]  [4]  

 

 Impact: In Canada, 7.5 million people are living with hypertension. An additional 7.4 million people are at risk of hypertension and nine in 10 adults will develop hypertension if they live a normal lifespan. Hypertension is the most frequent reason for primary care visits in Canada and it costs the healthcare system over $13 billion annually (direct and indirect healthcare costs, 2010)[5] .

 

Opportunity: To reverse these trends, effective CVD disease prevention strategies must be urgently implemented to prevent or delay the development of a cascade of debilitating and costly health complications.  The newly announced Ontario Health Teams provide a unique opportunity for integrated and coordinated health care services that link primary care, community programs and resources, volunteers,specialist and hospital care for more effective CVD prevention. The Cardiovascular Health Awareness Program(CHAP) has the evidence, capacity and know-how to be a turn-key model for CVD risk assessment and prevention, integrated within the emerging Ontario Health Teams.

 CHAP is explicitly based on Wagner’s Chronic Care Model[6], and exemplifies the integrated care delivery system at the foundation of the Ontario Health Team mandate.  CHAP delivers community-based CVD risk assessment, follow up and monitoring, connecting with community programs and resources, looping – back to primary care providers, and enabling participants to acquire self-management skills.

 Built on many peer-reviewed research studies conducted in Ontario and elsewhere in Canada,starting in 2000, CHAP has:

  •  Identified adults with undiagnosed or uncontrolled high blood pressure.
  • Performed over 100,000 CVD risk assessments.
  • Substantially reduced participants’ blood pressure.
  • Been adapted to include people with diabetes, atrial fibrillation, of South Asian descent, low income earners and French language speakers.
  • Reduced the burden on physicians and other primary care providers to accurately assess and monitor blood pressure.
  • Reduced the number of people who are unaware of their high blood pressure status.
  • Improved monitoring of uncontrolled hypertensive patients.
  • Engaged volunteers, volunteer organizations and community groups to collaborate with health care providers.
  • Increased awareness and promotion of local resources around modifiable risk factors.
  • Empowered patients and their caregivers to take a more active role in their health care.
  • Increased the use of anti hypertensive medications.
  • Reduced cardiovascular-related hospitalization rates and health care system costs.

 CHAP is the main evidence supporting more intense screening for hypertension recommended by the Canadian Task Force on Preventive Health Care (CTFPHC)[7]  and the U.S. Preventive Services Task Force (USPSTF).

  By utilizing the untapped resources  in local community organizations and volunteer sectors, CHAP can contribute to a full and coordinated continuum of services,including health promotion, CVD prevention and community support services to advance integrated care. CHAP upholds the principles of community engagement and patient partnerships, in collaboration with primary care providers. 

RECOMMENDATION:  Ontario should include the Cardiovascular Health Awareness Program (CHAP) as a turn-key model for CVD risk assessment and prevention, anchoring emerging Ontario Health Teams’ integrated care delivery system.

IMPLEMENTATION:   The Cardiovascular Health Awareness Program (CHAP) is a community initiative that accurately measures blood pressure and CVD risk factors to help identify and monitor people who may be at high risk for cardiovascular disease. 

 How does is work? During a CHAP session, blood pressure is measured (using validated automated devices and protocols based on Hypertension Canada recommendations) and participants are assessed for cardiovascular/chronic disease risks in familiar settings such as pharmacies,places of worship, social housing buildings, and other community spaces. Locally recruited and trained volunteers assist participants in measuring their blood pressure and understanding their risk profiles. They also provide targeted healthy lifestyle and prevention education,and information on  locally available resources and support programs. With the participants’ permission, blood pressure readings and CVD risk profiles are shared with their family physician and pharmacist.

CHAP includes 6 essential elements:

  1. Free to participants and community wide
  2. Trained volunteer educators managed by a local lead community based organization with experience in managing volunteers
  3. Enhanced primary care linkages and continuity of care
  4. Validated devices and evidence-based protocols
  5. Comprehensive CVD risk assessment and education
  6. Evaluation

 How much will it cost?  Ina population of 100 000, implementing  CHAP at a cost of $100,000 ($1/resident/year) will save up to $200,000 annually in CVD-related hospitalizations.

CHAP is easy to implement in any community and has been rigorously evaluated in a series of controlled randomized studies. CHAP has been shown to add value in terms of the health and well being to participants and volunteers without additional costs to the health care system. Scaling up CHAP across Ontario will significantly improve the prevention and management of CVD of adults and thus reduce cardiovascular morbidity and mortality.

 Please contact Dr. Lisa Dolovich lisa.dolovich@uotoronto.ca ,  Dr. Janusz Kaczorowski , janusz.kaczorowski@umontreal.ca   or Dr. Gina Agarwal  agarg@mcmaster.ca   for more information.  CHAP Central has been supporting on-going research and community programming for almost 20years.  We offer best practises,   guidance and resources, built on a wealth of experience and research excellence.


 [1] Healthcare Costs Attributable to Hypertension: Canadian Population-Based Cohort Study. Weaver, C, et al. s.l. : American Heart Association, July 13, 2015, Hypertension, Vol. 66, pp. 1-11. 

[2] Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Dickinson HO, Mason JM, Nicolson DJ,Campbell F, Beyer FR, Cook JV. 2006, Journal of Hypertension, Vols. 24, back to cited text no.43, pp. 215-33.

[3] IDF Diabetes Atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Whiting, DR, Guariguata L, Weil C ShawJ. 2011, Diabetes Res ClinPrac, Vol. 94, pp. 311-321.

[4] Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Colley, RC, Carriguet D, Janssen I et al. 2011, Health Rep, Vol. 22, pp.15-23.

[5] Residual Lifetime Risk for Developong Hypertension in Middle-aged Women and Men. Vasan RS, Beiser A, Seshadri S,Larson MG, Kannel WB, D’Agostino RB et al. 8, 2002, JAMA, Vol. 287, pp.1003-1010.

[6] Quality improvement in chronic illness care; a collaborative approach. Wagner E, Glasgow RE,Davis C,et al. 2001, JT Community Journal QualityImprov, Vol. 27, pp. 63-80

[7] Canadian Task Force on Preventive Health Care (2014). Hypertension – Systematic Review. https://canadiantaskforce.ca/guidelines/published-guidelines/hypertension/. [Online] 2014. [Cited: April 15, 2018.] http://canadiantaskforce.ca.