A Novel Approach to Cardiovascular Health by Optimizing Risk Management (ANCHOR)
A Novel Approach to Cardiovascular Health by Optimizing Risk Management (ANCHOR)
Study Purpose and Design

 The goal of this study is to improve CVD risk in a primary care adult population, with the
 following primary objectives

 1. To improve management of global cardiovascular risk of patients within two primary care
 practices, thereby improving their overall cardiac health.

 2. To increase patient compliance with lifestyle aimed at pharmaceutical interventions
 aimed at decreasing global cardiovascular risk.

 Secondary objectives of the study are:

 1. To examine the utility of a process to improve the management of global cardiovascular
 risk of patients within two primary care practices.

 2. To explore the utility of a process that links primary care practices with existing
 community resources in order to manage cardiac risk factors better among individuals
 within those primary care practices.

 3. To determine the economic impact of a global risk assessment and management process
 within a primary care setting.
The Burden of Cardiovascular Disease

 Cardiovascular disease (CVD) remains the major cause of mortality in the developed world,
 accounting for almost 40% of all deaths in both the United States and Canada. It represents a
 substantial financial drain on society and contributes a significant burden to health care
 systems that are already under strain. Major modifiable risk factors for CVD include elevated
 blood pressure, cigarette smoking, elevated total plasma cholesterol and low high-density
 lipoproteins, diabetes, obesity, and sedentary lifestyle, at least one of which is present in
 80% of Canadians. Circulatory diseases (particularly heart disease, stroke and hypertension)
 cost the Nova Scotia health care system an estimated $961 million dollars per year. In Nova
 Scotia cardiovascular disease kills an estimated 2,900 Nova Scotians every year accounting
 for nearly 36% of all deaths in the province.

 Cardiovascular Disease Prevention in Primary Care Settings

 There is strong evidence linking improved risk factors among populations to improved health
 outcomes, and both epidemiological and community research have illustrated that the bulk of
 non-communicable diseases (NCDs) such as CVD are preventable, or at least their occurrence
 can be postponed. Because primary care physicians are most often the first point of contact
 for individuals in need of health care, general practice is well placed to facilitate change
 in patients' risk factor status and ensure more effective treatment of risk factors such as
 hypertension and hyperlipidemia. Currently primary care service delivery is expanding to
 include a broader network of providers such as nurses, dieticians, and pharmacists to enable
 more effective risk factor identification and management, and health promotion and disease
 prevention efforts across the continuum of care.

 Nova Scotia Context

 Currently in Nova Scotia, population health and disease prevention initiatives are underway
 that will support and reinforce the work of the current study, including primary health care
 transition fund initiatives, and strategic directions from the Office of Health Promotion
 that address major risk factors for cardiovascular disease. These provincial initiatives
 together with local projects ongoing in several communities provide an ideal opportunity for
 interfacing with a primary care global risk reduction initiative.

 Study Purpose and Design

 The goal of this study is to improve CVD risk in a primary care adult population, with the
 following primary objectives

 1. To improve management of global cardiovascular risk of patients within two primary care
 practices, thereby improving their overall cardiac health.

 2. To increase patient compliance with lifestyle and pharmaceutical interventions aimed at
 decreasing global cardiovascular risk.

 Secondary objectives of the study are:

 1. To examine the utility of a process to improve the management of global cardiovascular
 risk of patients within two primary care practices.

 2. To explore the utility of a process that links primary care practices with existing
 community resources in order to manage cardiac risk factors better among individuals
 within those primary care practices.

 3. To determine the economic impact of a global risk assessment and management process
 within a primary care setting.

 The intervention will be led by a study coordinator in each primary care setting and consist
 of a recruitment strategy, global risk factor assessment, behaviour change counseling, and
 risk factor management strategies based on the 5A's framework (assess, advise, agree, assist
 and arrange follow-up). Supports will be provided to study participants in making behaviour
 changes including counseling and follow-up, behaviour change tools, print resources, group
 education sessions, and an inventory of and links to community programs. Medication reviews
 and physician referrals will also be completed as required.

 A Steering Committee will guide the project and includes membership from the Principal
 Investigators, representatives from Pfizer Canada, Capital District Health Authority, the
 Cape Breton District Health Authority and the Nova Scotia Department of Health; and community
 stakeholders including community pharmacy, a physician and/or nurse from each site, other
 relevant allied health professionals (e.g., nutritionist) and the CEO from the Heart and
 Stroke Foundation of Nova Scotia. The initiative will be conducted over a three-year period
 and will comprise three phases as outlined in the following table.

 Research Methodology

 This is a pre-intervention and post-intervention longitudinal, prospective pilot study to
 evaluate study participants achievement of CVD risk factor reduction. The research will
 include a combination of quantitative and qualitative data to judge effectiveness of the
 interventions and to describe the intervention as it is implemented. The effectiveness of the
 approach will be examined using pre and post measures of key outcome variables. In addition
 to these outcome measures, process evaluation will monitor and assess the implementation of
 the interventions. The study will include baselines measurement, periodic assessments of
 process measures, outcome measurement and follow-up measurement. Following the baseline
 measurement through the GRA, patients will receive risk management interventions.

 The data will be analyzed using both quantitative and qualitative methods. Pre and post
 outcome measures will be analyzed using descriptive analytical techniques comparing means for
 continuous measures and proportions for categorical measures. Qualitative data will be
 managed and analyzed either manually or via QSR NUD*IST (Qualitative Solutions and Research
 Non-numerical Unstructured Data Indexing Searching and Theory-building) software. The
 qualitative analysis will consist of both content and thematic analysis.

 Sustainability and Dissemination

 The project will involve collaboration and integration with primary health care renewal
 efforts and community resources to build on existing infrastructure and thereby help to
 facilitate sustainability. Capacity building within primary care settings and mobilization of
 existing resources will also help to ensure a sustainable resource. Steering Committee
 members and other partners will ensure the project results and products are shared with their
 organizations and networks, and also more widely across the province. Project findings will
 be published in appropriate peer reviewed publications to further share the learning and
 disseminate findings.
Inclusion Criteria:

 -  30 years of age

 -  a patient of the primary care practices involved in the study

 -  able to provide informed consent

 Exclusion Criteria:

 -  under the age of 30

 -  not a patient of the primary care practices

 -  unable to provide informed consent