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The National Telephone Lifestyle Coaching Pilot - Overview Sophia P. Hurley, MSPT Project Manager, National Telephone Lifestyle Coaching Pilot MOVE! Physical.

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Presentation on theme: "The National Telephone Lifestyle Coaching Pilot - Overview Sophia P. Hurley, MSPT Project Manager, National Telephone Lifestyle Coaching Pilot MOVE! Physical."— Presentation transcript:

1 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

2 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 1

3 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 2

4 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 3

5 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 4

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

7 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 6

8 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 7

9 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 8

10 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 9

11 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 10

12 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 11

13 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 12

14 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 13

15 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 14

16 VETERANS HEALTH ADMINISTRATION 15

17 16 Referral to TLC Program Via Consult Pharmacy Process 1.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 FC 2.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 Enrolls 1.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

18 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 17

19 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 18

20 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…. 19

21 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….. 20

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

23 VETERANS HEALTH ADMINISTRATION Thank you! Sophia P. Hurley, MSPT sophia.hurley@va.gov 3022 Croasdaile Drive, Suite 200 Durham, NC 27705 (919) 383-7874 x 225 www.prevention.va.gov www.move.va.gov 22


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