The Canadian Hypertension Education Program (CHEP) Putting … · 2015. 2. 26. · Canadian...
Transcript of The Canadian Hypertension Education Program (CHEP) Putting … · 2015. 2. 26. · Canadian...
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The Canadian Hypertension Education Program (CHEP)
Putting Evidence Into Practice
Norm Campbell, MD
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Disclosure Statement of Financial Interest
I, Norm Campbell DO NOT have a financial interest/arrangement or affilia<on with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presenta<on.
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Objec&ves • Discuss the Canadian Hypertension Educa&on Program approach and impact to date.
• Review the evolu&on of the Canadian effort and future plans.
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The Canadian Effort to Prevent and Control Hypertension.
Can Other Countries adopt Canadian Strategies?
Current Opinion in Cardiology 2010:25:366-372.
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Improvement in key clinical indicators of hypertension management in Canada
* As presented at the Canadian Cardiovascular Congress Oct 2007 CHHS 1985-1992 CHMS 2012/13
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Lifestyle Changes AGer Hypertension Diagnosis
.
0
20
40
60
80
Smoking BMI 25+ Inactive Alcohol 9+
Per
cen
t
Age Standardized Rates of Lifestyle Change After a Hypertension Diagnosis
A B
-1.6%
+1.4% -2.4%
-0.1%
Can J Cardiol 2008;24;3:199-204.
A is pre diagnosis and B is up to 2 years post diagnosis Source NPHS (1994-‐2002):
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Canadian Hypertension Education Program (CHEP) Concept Development
1990s
Discussions on how to improve blood pressure control
2000
CHEP established - Knowledge dissemination program - Rigorous annually updated program
2003 Formal outcomes program added
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Hypertension Canada
Outcomes Research
Task Force
Evidence-Based Recommendations
Task Force
Implementation Task Force
Public policy Oversight for National HypertensionStrategy
HSFC CIHR Chair in Hypertension Prevention and Control
Steering committee- now operations committee
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CHEP Recommendations Task Force
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Convince Canadians and especially Canadian health care professionals that
The Recommendations Development Process is Designed to
the recommendations are the right ones for Canadians
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The Canadian Hypertension Education Program: Key Messages
Know Current BP
Encourage Home BP monitoring
Assess and Manage CV
Risk
Sustainable Lifestyle
Modification Treat to Target
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CHEP: Diagnos&c Algorithm
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CHEP: IMPLEMENTATION
Can J Cardiol 2006;22:595-‐98
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Implementa&on requires strong partnerships of commiUed people and organiza&ons
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CHEP Implementation: Engage Stakeholders
Engage
Patients and the Public
ALL Health Care Professionals
Active Participation
Individuals directly involved in the management of
hypertension
Individuals who oversee the health
care system
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Implementation: Key Steps
• Patient educational materials that suit them • Keep it new and interesting • Remove identified barriers to access
resources
Develop Resources
• Harmonize hypertension recommendations Agreement Among
National Organizations
• Including training schools
Establish networks of health care professional
organizations
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ü For health care professionals
ü For patients
www.hypertension.ca
Implementation: Access and Dissemination
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ü For health care professionals ü For health care professional
organizations
www.whleague.org
Implementation: Access and Dissemination
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Have hypertension management and outcomes changed in Canada since
CHEP? ü Improvements in awareness ü Improvements in treatment ü Changes mirror CHEP recommendations ü Increasing intensity of therapy over time ü Improvements in BP control ü Improvements in outcomes
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Changes in Stroke, Heart failure (chf) and Acute Myocardial Infarction (ami) after CHEP starts in 1999
-1.9 %
-4.8%
-0.5%
-4.8%
-3.7%
-5.8%
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CVD rate in Canada (per 100,000)
10001100120013001400150016001700180019002000210022002300240025002600
year
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Antihypertensive Drug Prescription rate in Canada
CHEP starts
CHEP starts
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Summary-Discussion • CHEP was designed to be a model that could be
expanded to CVD risk and or to other substantive chronic non communicable diseases /risks.
• Aspects of the CHEP program can be used in other countries with adoption to local context (Yaroslavl Russia, Iran etc.)
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New programs and directions
• Internet based education programs • Mobile device app • Pharmacy based htn care • Automated CV risk assessment • Core curriculum videos