Download Community Preventive Services Task Force

Promoting Million Hearts® Goals Using The Community Preventive
Services Task Force Recommendations
A Focus on Risk Factors for Cardiovascular Disease
A CONVERSATION WITH:
John M. Clymer, Member, U.S. Community Preventive Services Task Force
Philip Huang, MD, MPH, Medical Director, Austin-Travis County Health and Human Services
August 28th, 2014
Community Preventive Services Task Force Findings
on Effectiveness of Interventions:
1) To Prevent Cardiovascular Disease
2) To Reduce Tobacco Use
CONTEXT FOR EVIDENCE-BASED PUBLIC
HEALTH
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Benefits of Basing Guidelines on Systematic
Research Synthesis
 Reliability
• Move us beyond anecdote and selective use of scientific
evidence
 Transparency
• Reduce bias
• Make assumptions and procedures clear
 Synthesis
• Streamline enormous amounts of data
• Reconcile or explain variable results
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Benefits of Basing Guidelines on Systematic
Research Synthesis
 Reliability
• Move us beyond anecdote and selective use of scientific
evidence
 Transparency
• Reduce bias
• Make assumptions and procedures clear
 Synthesis
• Streamline enormous amounts of data
• Reconcile or explain variable results
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Systematic Reviews and
Developing Recommendations
Evaluations
of individual
programs
Individual
Studies
Narrative Review
Systematic Review
Meta-analysis
Evaluation of
evaluations
Findings
Recommend
Recommend
against
Insufficient
What Do Public Health Interventions Look Like?
 Programs, services, and policies
• Often implemented opportunistically to address perceived needs,
considering available resources
• Seldom permit random allocation to intervention and control
conditions
 Usually more “complex” than clinical interventions
• Multiple facets that vary across locations
• Often adapted to meet local needs and resources
• Rarely implemented in isolation—several potential confounding
factors to consider
• Results may depend on context
 Potential for substantial health impact at a modest cost
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OBJECTIVES AND GUIDING PRINCIPLES
OF THE COMMUNITY GUIDE
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The Community Guide*
 Product of an independent
US Task Force: Community
Preventive Services Task
Force
 A focus on populationbased interventions in:
• Communities
• Health care systems
 Evidence-based
recommendations and
conclusions regarding use
*www.thecommunityguide.org
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Topics for Community Guide Reviews (as of 2013)
Reviews Organized by Environment
Health Equity
Social Environment
Reviews by Risk Behavior
Reviews by Specific Condition
Alcohol abuse/misuse
Cancer
Tobacco use
Mental health
Poor nutrition
Vaccine-preventable disease
Physical inactivity
Violence
Unhealthy sexual behaviors
Motor vehicle injuries
Cardiovascular disease prevention
Diabetes
Oral health
Reviews Organized by Setting
Reviews Organized by Life Stage
Worksite health promotion
Adolescent health
Special Projects
Health communications
Pandemic influenza
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2013 Community Preventive Services Task Force
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Jonathan C. Fielding, MD, MPH, MBA
Barbara K. Rimer, DrPH
Bruce N. Calonge, MD, MPH
Marshall Chin, MD, MPH, FACP
John M. Clymer
Karen Glanz, PhD, MPH
Ron Goetzel, PhD
Larry Green, DrPH
David Grossman, MD, MPH
Robert L. Johnson, MD
Shiriki Kumanyika, PhD, MPH
C. Tracy Orleans, PhD
Nico P. Pronk, PhD
Gilbert Ramirez, DrPH
Patrick Remington, MD, MPH
Los Angeles County Dep. Of Public Health
University of North Carolina
Colorado Trust
University of Chicago
Alliance to Make US Healthiest
University of Pennsylvania
Emory University
UC San Francisco
Group Health Cooperative
UMD-New Jersey Medical School
University of Pennsylvania
Robert Wood Johnson
HealthPartners
West Virginia University
University of Wisconsin
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Overarching Goals of the
Community Guide
Develop evidence-based guidance on interventions to
improve population health that is of maximum utility
for decision-makers:
• Provide evidence-based recommendations
• Assess economic efficiency
• Highlight important evidence gaps
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Issues Considered in Community Guide Reviews
Intervention
(policy or program)
Considerations for
Implementation
Population
or
Group
Costs
Additional
Benefits?
?
Potential
Harms?
?
Reduced
Morbidity
and
Mortality
Intended
Outcomes
(Behavior, Health)
Economic Efficiency
Benefits
Is the evidence applicable to “my population”?
Task Force Findings Options
 Recommend
• Based on strong evidence
• Based on sufficient evidence
 Recommend against
• Based on strong evidence
• Based on sufficient evidence
 Insufficient evidence to
recommend for or against
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Example Logic Model: Strategies to Prevent CVD
Interventions to
Prevent CVD risk
conditions (and CVD)
Interventions to
Increase/ Improve control
of CVD Risk Conditions
Biological
Tobacco Use
Behavioral
Alcohol
Environmental
Nutrition
Social Context
Obesity
Hyperlipidemia
Health Care
Physical
Activity
Diabetes
Determinants
Hypertension
Interventions to
Increase/Improve
management of clients
with CVD
CVD Risk
Conditions
Prevented /
Reduced /
Controlled
Intermediate Health Outcomes
Reduced
CVD
Morbidity
And
Mortality
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COMMUNITY PREVENTIVE SERVICES TASK
FORCE RECOMMENDATIONS FOR
CARDIOVASCULAR DISEASE
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Example Priorities List for Task Force
Consideration: CVD Prevention
1. Interventions to improve hypertension control
2. CVD risk reduction interventions that bundle preventive services
3. Health system implementation/organizational variables and processes
4. Policies to reduce dietary sodium
5. Comprehensive Tobacco Control programs*
6. Community-based campaigns to increase awareness
7. Improved access to quality care for CVD
8. Setting-based CVD risk reduction interventions
9. Technology-enabled CVD risk reduction interventions
<Task Force consensus additions (if any)>
*Intervention review covered by CG Tobacco team
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Community Guide CVD Prevention Reviews
Intervention
Description
Task Force Finding
Team-based
care (TBC)
A health systems intervention that
uses a team—including primary care
providers, other health professionals
(usually nurses and pharmacists),
and patients—working together to
improve blood pressure control
among patients at risk for CVD
Strong Evidence
• Increased proportion of
patients with controlled BP
• Reduced Systolic and
Diastolic BP
Reducing outof-pocket costs
(ROPC)
ROPC for medications to control high
blood pressure and high cholesterol,
when combined with additional
policies or actions to improve patient–
provider interaction and patient
knowledge
Strong Evidence
• Improved medication
adherence
• Improved BP and cholesterol
outcomes
Computer-based information
Clinical
systems, specifically aimed at CVD
Decisionprevention, designed to assist
Support
healthcare providers in implementing
Systems (CDSS)
clinical guidelines at the point of care
Sufficient Evidence
• Improved screening for CVD
risk factors by providers
• Improving practices for CVDrelated preventive care,
clinical tests, and treatments
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Community Guide Tobacco Use Reduction Reviews
Intervention
Description
Task Force Finding
Comprehensive
Tobacco Control
Programs
These programs are typically organized and
funded at the state level in the U.S., providing
a platform for effective implementation of
core components such as mass-reach health
communication interventions, state-wide
cessation services, and partnerships with
community-based coalitions and programs to
pursue grassroots-level efforts to reduce
tobacco use.
Strong Evidence
• Reduced tobacco use
prevalence
• Reduced tobacco product
consumption
• Increased quitting
• Reduced secondhand
smoke exposure
• Reduced tobacco-related
morbidity and mortality
Increase the
Unit Price of
Tobacco
Products
Public policies at the federal, state, or local
level that increase the purchase price per unit
of sale for tobacco products. The review
considered excise tax through legislations or
fees levied on tobacco products at the point of
sale.
Strong Evidence
• Reduced tobacco use
prevalence
• Reduced tobacco product
consumption
• Increased quitting
• Reduced initiation of
tobacco use
• Reduced tobacco-related
morbidity and mortality
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Community Guide Tobacco Use Reduction Reviews (contd.)
Intervention
Description
Task Force Finding
Smoke-free
Policies
Public-sector regulations and privatesector rules that prohibit smoking in
indoor spaces and designated indoor
and outdoor public areas.
Strong Evidence
• Reduced secondhand
smoke exposure
• Reduced tobacco use
prevalence
• Reduced initiation of
tobacco use
• Increased quitting
• Reduced tobacco-related
morbidity and mortality
Mass-reach
Health
Communication
Interventions
Interventions target large audiences
through various media channels (TV,
radio, print, out-of-home placements,
digital) to change knowledge, beliefs,
attitudes, and behaviors about tobacco
use. Intervention messages are typically
developed through formative research
and broadcasted on TV, targeting both
tobacco users and the general public.
Strong Evidence
• Reduced tobacco use
prevalence
• Increased use of
available services, e.g.,
quitlines
• Increased quitting
• Reduced initiation of
tobacco use
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Community Guide Tobacco Use Reduction Reviews (contd.)
Intervention
Quitline
Interventions
Description
Evidence-based behavioral counseling
offered via telephone to support tobacco
users who want to quit. Quitlines typically
offer proactive counseling (cessation
specialists schedule follow-ups) that is
widely accessible, convenient to use, and
generally at no cost to callers.
Reducing OutPolicy or program changes that make
of-Pocket Costs evidence-based treatments more
for Evidenceaffordable. Benefit changes may be
based Cessation communicated to tobacco users and health
Treatments
care providers to increase use of these
benefits in quitting efforts.
Mobile Phone- Interventions use interactive features to
based Cessation deliver evidence-based information,
Intervention
strategies, and behavioral support directly
to tobacco users interested in quitting.
Messages are targeted to specific
populations, tailored to specific users, or
automated.
Task Force Finding
Strong Evidence
• Increased quitting
Strong Evidence
• Increased quitting
Sufficient Evidence
• Increased quitting
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Community Guide CVD Prevention
http://www.thecommunityguide.org/cvd/index.html
Community Guide Tobacco Use Reduction
http://www.thecommunityguide.org/tobacco/index.html
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Acknowledgement
Evidence-Based Recommendations Slides from the
Community Preventive Services Task Force
Provided Courtesy of
Anil Thota, MBBS, MPH
[email protected]
Community Guide Branch
Center for Surveillance, Epidemiology, and Laboratory Services (CSELS)
Division of Epidemiology, Analysis, and Library Services (DEALS)
Disclaimer
The findings and opinions expressed in this
presentation are those of the presenters and the
Community Preventive Services Task Force. They may
not represent the official positions of the Centers for
Disease Control and Prevention (CDC).
The Centers for Disease Control and Prevention provides
administrative, research, and technical support for the Community Preventive
Services Task Force.
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