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VHA Transformational Initiative: Preventive Care Program

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Presentation on theme: "VHA Transformational Initiative: Preventive Care Program"— Presentation transcript:

0 The National Telephone Lifestyle Coaching Pilot - Overview
Sophia P. Hurley, MSPT Project Manager, National Telephone Lifestyle Coaching Pilot MOVE! Physical Activity Program Coordinator October 2011

1 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 “New Models of Care” also includes PACT, Virtual Medicine Telehealth, Specialty Care (SCAN/ECHO), Virtual Medicine Non-Telehealth (Secure Messaging), others Unhealthy behaviors: smoking, physical inactivity, unhealthy eating, overweight/obesity, stress, problem alcohol use

2 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

3 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

4 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 Because of VISN 2 being on a common VISTA platform, was an easy test site/area

5 National TLC Details Part of Transformational Initiatives, Preventive Care Program Telephone Lifestyle Coaching Supplement Primary Care and PACT Enhance and support health coaching already available in VHA

6 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 Mention current version of Stepped Care Model.

7 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 The nine healthy living messages are a foundation for HPDP care to encourage Veterans to choose healthy behaviors. These evidence-based healthy living messages include a brief overall message and more detailed information for those Veterans who have a deeper interest in the topic. These messages are posted on the NCP website, and the NCP Intranet website

8 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

9 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

10 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

11 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

12 Pilot Details Sites One or multiple behaviors may be addressed
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 VISN 4 – All facilities VISN 8 – West Palm Beach only VISN 15 – All facilities except Wichita VISN 16 – Baton Rouge only VISN 21 – All facilities except Hawaii and Philippines

13 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 Interactions with the Veterans Listen to the Veteran Offer and explain options Support Veteran choice Work as a team Partnership options Ongoing conference calls with NCP/AW during implementation Feedback and expertise on clinical application Coordination of patient care as needed Support for evaluation Be as involved as you’d like to be – we will welcome it

14 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

15 Consistent with what VHA does
Meds may be different from what VHA does, restriction of meds to NRT option only Stepped care process

16 Referral to TLC Program FC NRT/RX PROCESS FLOW FOR VISN 4
Via Consult Veteran consult is submitted to FC 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. Veteran chooses to enroll, is unreachable or declines services (all statuses noted back to CPRS). Veteran Declines Note made to CPRS, consult closed Veteran Enrolls Coach performs assessment, collects health conditions, screens for use exclusions etc. and works with veteran to determine most appropriate course of medication to use. This may include Patch, Gum, Lozenge, Bupropion or Chantix (Chantix screening done for Pittsburgh only at this time), or combo therapy. Coach enters medication information in FC systems The following morning (M-F) a report with all veterans, by facility, indicating medication preference is printed. Veteran Unreachable Note made to CPRS, consult closed Pharmacy Process FC staff enter NRT/RX orders directly into CPRS for the appropriate fulfilling pharmacy. Pharmacist determines if medication should be filled based on veterans full health history. Medications are then filled and/or mail ordered to the veteran. Pharmacy does have the option to override FC coach recommendations based on access to the full health history of the veteran. FC NRT/RX PROCESS FLOW FOR VISN 4

17 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

18 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

19 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…. Veterans Crisis Line

20 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…..

21 Timeline Now Late Fall 2011 Remainder of FY 2012-13
Implementation Planning Late Fall 2011 Launch Early-mid November Remainder of FY Participation and Evaluation

22 3022 Croasdaile Drive, Suite 200
Thank you! Sophia P. Hurley, MSPT 3022 Croasdaile Drive, Suite 200 Durham, NC (919) x 225

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