CHAP-EMR : A pilot study

Cardiovascular Health Awareness Program – Electronic Medical Records (CHAP-EMR): A pilot study.

Researchers :

• Simone Dahrouge, PhD | Director of Research and Scientist, C.T. Lamont Primary Health Care Research Centre of the Bruyere Research Institute, Ottawa.
• Janusz Kaczorowski BA, MA, PhD | Director of Research and Professor, Department of Family and Emergency Medicine, University of Montreal.
• Larry Chambers PhD, FACE, HonFFPH(UK), FCAHS | Scientist, Past President (2001-2011) of the Bruyère Research Institute.
• Lisa Dolovich BScPhm, PharmD, MSc | Research Director and Professor, Department of Family Medicine, McMaster University. Scientist & Associate Director, Centre for Evaluation of Medicines, St Joseph’s Healthcare, Hamilton.
• Laura Muldoon MD, MPH, FCFP | Somerset West Community Health Centre, Ottawa.
• Richard Birtwhistle MD, MSc, CCFP, FCFP | Centre for Studies in Primary Care, Queen’s University.
• David Barber MD | Department of Family Medicine, Queens University.
• Jyoti Kotecha MPA, CChem, MRSC | Centre for Studies in Primary Care, Queen’s University.
• Clare Liddy BSc, MD, MSc, CCFP, FCFP | C.T. Lamont Primary Health Care Research Centre.
• Marie-Hélène Chomienne | Faculty of Medicine, Departments of Family Medicine and Epidemiology and Community Health, University of Ottawa.

Background:

The original CHAP trial demonstrated its effectiveness in small to medium-sized rural and semi-urban Ontario communities, with sessions conducted in community-based pharmacies and senior participants invited via a community-wide invitation strategy. It is likely that aspects of the program would need to be adapted to be implemented in the downtown core of a large urban community. The CHAP Working Group of researchers was supplemented by family physician-researchers to develop a strategy to implement CHAP sessions within interprofessional primary care practices in downtown Ottawa that serve a diverse population of seniors.

Objective:

The dual goals of the CHAP-EMR pilot study are to assess the feasibility of:

(1) Implementing the CHAP in urban interprofessional primary care practices (Community Health Centres and Family Health Teams) that serve a diverse population of seniors in the downtown Ottawa area;

(2) Using electronic medical record (EMR) data securely extracted by the Canadian Primary Care Sentinel Surveillance Network, or CPCSSN to select eligible primary care patients and conduct data analyses.

Methods:

Lead physicians and/or executive directors of Community Health Centres and Family Health Teams in Ottawa were invited to participate in the CHAP-EMR pilot project. We collaborated with CPCSSN to extract relevant EMR data to create a list of eligible senior patients (aged 65+) to be invited to CHAP sessions. CHAP sessions were held during weekdays within patients’ respective family medicine practice. Minor adaptations to the CHAP were made to meet the needs of the diverse patient population at each of the practices (e.g., bilingual volunteers and cultural interpreters were available during CHAP sessions to encourage participation of seniors who did not speak English as their first language). In addition to volunteer-led blood pressure assessment using an automated unit, volunteers measured participants’ body mass index (height and weight), waist circumference, and introduced them to Champlain Healthline (an online resource with information about local community resources for health). For patients who agreed to share their results with their family medicine provider, EMR and CHAP session data were used to generate reports to providers about their patients’ risk of heart disease and diabetes.

Findings:

Four practices participated in the CHAP-EMR pilot project, and about 1 in 5 invited seniors (n=431) attended one of the 19 CHAP sessions that were held in participating practices from November 2014-February 2015. Sessions were facilitated by 47 trained volunteers and 12 cultural interpreters.

Implications:

The CHAP-EMR pilot project demonstrated that:

• CHAP sessions are feasible within urban, interprofessional primary care practices, and can be adapted to meet the needs of a diverse senior patient population; and
• EMR data can be securely extracted and used to facilitate participant selection and data analyses, and to provide important heart health information about patients to primary care providers.