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
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.
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.
The Canadian Effort to Prevent and Control Hypertension.
Can Other Countries adopt Canadian Strategies?
Current Opinion in Cardiology 2010:25:366-372.
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
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):
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
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
CHEP Recommendations Task Force
Convince Canadians and especially Canadian health care professionals that
The Recommendations Development Process is Designed to
the recommendations are the right ones for Canadians
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
CHEP: Diagnos&c Algorithm
CHEP: IMPLEMENTATION
Can J Cardiol 2006;22:595-‐98
Implementa&on requires strong partnerships of commiUed people and organiza&ons
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
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
ü For health care professionals
ü For patients
www.hypertension.ca
Implementation: Access and Dissemination
ü For health care professionals ü For health care professional
organizations
www.whleague.org
Implementation: Access and Dissemination
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
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%
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
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.)
New programs and directions
• Internet based education programs • Mobile device app • Pharmacy based htn care • Automated CV risk assessment • Core curriculum videos
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