The National Telephone Lifestyle Coaching Pilot - Overview Sophia P. Hurley, MSPT Project Manager,...
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Transcript of The National Telephone Lifestyle Coaching Pilot - Overview Sophia P. Hurley, MSPT Project Manager,...
The National Telephone Lifestyle Coaching Pilot - Overview
Sophia P. Hurley, MSPTProject Manager, National Telephone Lifestyle Coaching PilotMOVE! Physical Activity Program Coordinator
October 2011
VETERANS HEALTH ADMINISTRATION
VHA Transformational Initiative: Preventive Care Program
• Part of “New Models of Care” T21 Transformational Initiative
• Focus on unhealthy behaviors to decrease risk for chronic conditions or as part of treatment for existing conditions
• Need to develop ways to provide more non-face-to-face care
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VETERANS HEALTH ADMINISTRATION
Creation of National TLC
• History– Ideas for new modalities to address challenges
providing 1:1 care for MOVE! – MOVE! Telephone Lifestyle Coaching (TLC) – MOVE! TLC Quality Improvement Project in VISN2– Simple coaching model based on MOVE! – Adapted for telephone coaching
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VETERANS HEALTH ADMINISTRATION
Creation of National TLC
• What we learned:– MOVE! TLC integrated with Primary Care– Local MOVE! team was skeptical at first, but were
very happy with outcomes– Effective communication between coaches and
clinicians– Results
• Patient and staff satisfaction, weight loss
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VETERANS HEALTH ADMINISTRATION
Creation of National TLC
• What we still need to determine:– Successful implementation across VISN lines– Application to other behaviors
• VISN 4 success with tobacco cessation– National implementation
• Develop a model that will be effective and desirable• Funding
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VETERANS HEALTH ADMINISTRATION
National TLC Details
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• Part of Transformational Initiatives, Preventive Care Program
• Telephone Lifestyle Coaching • Supplement Primary Care and PACT• Enhance and support
health coaching already available in VHA
VETERANS HEALTH ADMINISTRATION
National TLC Details
• Relieve burden on PC/PACT teams• Convenient, timely, cost-effective• Provide service without any space• Veteran centered• Aligned with stepped care model• Supports
– Health Promotion Disease Prevention– Healthy Living Messages
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VETERANS HEALTH ADMINISTRATION
Healthy Living Messages
Be involved in your health care Be tobacco free Eat wisely Be physically active Strive for a healthy weight Limit alcohol Get recommended screening tests
and immunizations Manage stress Be safe
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VETERANS HEALTH ADMINISTRATION
The Coaches
• Contract employees
– Alere Wellbeing Inc. (formerly Free & Clear)– Leader in tobacco cessation quitline services– Telephonic health coaching
– Prior VA experience– Effective communication
with healthcare team
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VETERANS HEALTH ADMINISTRATION
Participation Process
• Enrolled Veterans• Primary Care/PACT Visit• Conversation about health behavior change and
offer of TLC services• Veteran indicates readiness for behavior change
and interest in TLC services• PACT team generates CPRS consult for TLC
services
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VETERANS HEALTH ADMINISTRATION
Consult Template
• Consistent in all facilities• Simple drop down and/or check boxes• Designed to:
– aid in appropriate referrals– start Veteran thinking about health behavior change
and identifying goals• Veteran-centered
– Day/time/number for calls
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VETERANS HEALTH ADMINISTRATION
Participation Process
• Coach receives and completes consult– Enrollment call with Veteran– Schedule next call
• 10 outgoing calls over 6+ months– Weekly for first 3 calls– Bi-weekly to monthly for remaining 7 calls– Final evaluation call
• Unlimited inbound calls
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VETERANS HEALTH ADMINISTRATION
Pilot Details
• Sites– 5 VISNs (4, 8, 15, 16, 21)– 25 Facilities
• One or multiple behaviors may be addressed• Documentation in CPRS
– Consult completion– Coaching intervention notes– Alert primary care/PACT team as needed– Final summary note
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VETERANS HEALTH ADMINISTRATION
Facility Point of Contact
• Health Promotion/Disease Prevention Program Manager and Health Behavior Coordinator
• Coordinate and collaborate– Liaison between NCP, coaches and the pilot site– Communicate– Promote– Educate– Support– Guide– Resource Inventory
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VETERANS HEALTH ADMINISTRATION
Alere Wellbeing and Smoking Cessation
• Scientifically based and updated with current evidence• Quit For Life Program (25 years)
– Outcomes from large RCTs in peer-reviewed scientific journals– US PHS Clinical Practice Guideline for Treating Tobacco Use and
Dependence– Independent evaluations by public and private institutions
• University of Oklahoma (College of Public Health)• University of North Carolina – Chapel Hill• Professional Data Analysts, Inc.• The Gilmore Research Group• Social Solutions International
• VISN 4 experience since 2005
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VETERANS HEALTH ADMINISTRATION 16
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Referral to TLC Program
Via Consult
Pharmacy Process1. FC staff enter NRT/RX orders directly into CPRS for the
appropriate fulfilling pharmacy.2. Pharmacist determines if medication should be filled based
on veterans full health history.3. Medications are then filled and/or mail ordered to the
veteran. 4. Pharmacy does have the option to override FC coach
recommendations based on access to the full health history of the veteran.
Veteran Declines
Note made to CPRS, consult closed
Veteran Unreachable
Note made to CPRS, consult closed
1. Veteran consult is submitted to FC2. FC staff obtain consults daily and make multiple attempts
over a series of days to reach veteran to offer enrollment in Quit for Life® Program.
3. Veteran chooses to enroll, is unreachable or declines services (all statuses noted back to CPRS).
Veteran Enrolls1. Coach performs assessment, collects health conditions,
screens for use exclusions etc. and works with veteran to determine most appropriate course of medication to use.
2. This may include Patch, Gum, Lozenge, Bupropion or Chantix (Chantix screening done for Pittsburgh only at this time), or combo therapy.
3. Coach enters medication information in FC systems 4. The following morning (M-F) a report with all veterans, by
facility, indicating medication preference is printed.
FC NRT/RX PROCESS FLOW
FOR VISN 4
VETERANS HEALTH ADMINISTRATION
Pharmacy Role in National TLC
• Part of expanded TLC team• Support provision of services via TLC• Nicotine replacement therapy• Coaches will screen for NRT• Send recommendations back to PACT team• PACT will review and request appropriate/available
medications
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VETERANS HEALTH ADMINISTRATION
Screening Questions
• Quit date or planned quit date• Tobacco type• Tobacco per day• Time from waking to first cigarette• Current quit medications• Heart attack within last 2 weeks• Rapid/irregular heartbeat within past 2 weeks• Serious or worsening angina in last 2 weeks• Dental problems or jaw pain• Severe skin irritation to patch medication
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VETERANS HEALTH ADMINISTRATION
Pilot Details
• Facility Collaboration:– HPDP Program Manager– HBC – PACT– MOVE!– PMRS– VHEC– Voluntary Services
– Nutrition and Food Service
– Pharmacy– Smoking Cessation Lead
Clinician – Clinical Applications
Coordinator– PAO– Others….
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VETERANS HEALTH ADMINISTRATION
Pilot Details
• VISN Collaboration– HPDP Lead– PAO– Network Director– Chief Medical
Officer– Others…..
• National Collaboration– Veterans Crisis Line– NCP– Alere Wellbeing– HSR&D– OPH– Others…..
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VETERANS HEALTH ADMINISTRATION
Timeline
• Now– Implementation Planning
• Late Fall 2011– Launch
• Early-mid November
• Remainder of FY 2012-13 – Participation and Evaluation
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VETERANS HEALTH ADMINISTRATION
Thank you!
Sophia P. Hurley, [email protected]
3022 Croasdaile Drive, Suite 200Durham, NC 27705
(919) 383-7874 x 225www.prevention.va.gov
www.move.va.gov
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