Abstract
Purpose statement: Assessment of cardiovascular risk is an integral component of an annual preventive health exam. This project enhanced a family practice clinic’s annual assessment process to include patient education on cardiovascular health and a follow-up phone call to improve patient understanding of risk and emphasize opportunities for lifestyle modification. The patient education component included cardiovascular risk screening, while the telephone follow-up component reinforced the education and equipped patients with strategies to make lifestyle changes and take the lead in their own health. The Transtheoretical Model of Change provided the framework to evaluate the patient’s readiness to change.|Background: Cardiovascular disease is the leading cause of death and healthcare cost in the United States. It imposes considerable impact on the quality of life and several contributing factors are preventable. Simple lifestyle changes can reduce risk, but many patients continue to be disinterested in their treatment plan. The project took place at a small primary care clinic where a single provider completes all annual preventative care visits. Based on cardiovascular risks identified at the visit, the provider completes a formal lab review, and communicates with the patient to address findings and treatment plan. Prior to project implementation, readiness to change and understanding of cardiovascular risk was not intentionally included in documentation and progress was based on repeat lab findings.|Practice changes and Implementation strategies: The practice change augments the current clinic process. Patient education introducing cardiovascular risk is provided during the annual exam utilizing American Heart Association written materials, then reinforced by the provider at the time of the encounter. An individually focused teaching and coaching intervention, based upon lab results, occurs during the lab review. The visit is initiated by the provider, and possible lifestyle modifications to address cardiovascular risk are highlighted. The follow up call, post lab review, offers time for the patient to ask any lingering questions and to discuss initial intention to change. To evaluate intention to change, a pre-educational survey is completed at the annual exam and a post-educational survey is administered to the patient verbally at the follow up call.|The intervention requires no additional visit for the patient and is complete within two weeks of their annual preventive care visit. The goal is to strengthen education that in turn motivates the patient to be a leader in their own care. The project can be replicated and is sustainable.|Results: Forty-two patients received their annual physical exam and received their cardiovascular educational handout, twenty-five patients completed both the pre and post-survey. Patients participating in all aspects of the project reported improvement in their perspective of their cardiovascular risks. Eight of 25 altered their healthy daily habits to reduce their risks (32%), and eleven increased their daily exercise (44%). Twelve participants improved their heart healthy diet (48%), and thirteen reported intentions to make heart healthy behavior changes (52%). After completion of the project and review of results, clinic staff and provider agreed evaluating patient’s intentions to change contributes to success in reducing cardiovascular risk.|Conclusions: Despite a small number of participants and short duration of the project, this project identified a gap in patient knowledge and the need for additional cardiovascular education in the primary care setting. The process change holds promise as an effective and sustainable intervention.