and Thomas A Kent MD Anjail Sharrief MD MPH Johanna Morton MD Robin Brey MD VSTOP II V ideo Teleconference Technology to Implement Patient S elfmanagement TO P revent Stroke ID: 760348
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Slide1
Jane A. Anderson PhD, RN, FNP-BC and Thomas A. Kent MDAnjail Sharrief, MD, MPHJohanna Morton, MDRobin Brey, MD
V-STOP II
V
ideo Teleconference Technology to
Implement Patient
S
elf-management
TO
P
revent Stroke
Slide2V-STOP II
& the Texas Plan to Reduce Cardiovascular Disease & Stroke
Goal 1: Strategies that Support/Reinforce Healthy BehaviorGoal 2: Community - Clinical Linkages EnhancementsGoal 3: Health Systems Interventions
The V-STOP-Stroke Program
Slide3Therapy / Ischemic Stroke Etiology
Thrombotic – Carotid Intervention/AntiplateletsCardioembolic – Anticoagulation
HTN, DM, Hyperlipidemia, ObesityMeet Target Values for BP – A1c – LDL – BMI
Patient Education & Self-managementSmoking Cessation - Health Diet - Physical Activity - Decrease Alcohol Consumption
The V-STOP Intervention
Slide4Feasibility of Providing Videoteleconference Self-management TO Prevent Stroke
A risk
factor reduction program for patient with
stroke or TIA
P
reviously tested within the VA’s telehealth network
Shown to improve:
Access to specialty care services
S
troke
risk
knowledge
P
hysical and emotional quality
of
life
S
elf-management behaviors
C
ommunication
with health care
providers
Slide5Study Design
Pilot study within the Lone Star Stroke VT network to deliver the V-STOP program. Four LSS hubs deliver V-STOP II in 2 spoke sites.V-STOP II will be delivered across 8 outpatient facilities in Texas.
Slide6Patient Criteria
History
of stroke and/or TIA within 6
months
Two
or more uncontrolled stroke risk
factors
BP
>
140/90
HgA1C
>
7
LDL-C
>
100 * based
on high risk category because patients have had stroke
and may have
other risk factors, current smoker, obesity * BMI of 30 kg/m² or
higher.
Age
18 or older
Read
and speak English or Spanish
Access
to a telephone
Willing
to
participate
in video teleconference group education
Slide7V-STOP Intervention
3 individual VT clinic visits with a stroke specialist (MD and NP providers)
3
VT group classes for
self-management education and support
Slide8Phase
1
2 hub sites delivering to 1 spoke site each
Clinician Interviews
Focus Group Evaluation
Access/Acceptability
Stroke Specific Knowledge
P
atient Outcomes
VT Group SM
Phase 2
4 hub sites delivering to 2 spoke sites
VT Clinic
VT Clinic
Refine V-STOP
Format
VT Clinic
VT Group SM
VT Group SM
VT Clinic
VT Clinic
VT Clinic
VT Group SM
VT Group SM
VT Group SM
Methods
Slide9Study Startup & Milestones
7/14 -9 /1410/14 - 12/141/15 - 3/154/14 - 6/157/15 - 9/15Hire & Train Staff Hub SitesInitiatedCompletedSite Visits InitiatedCompletedStudy Materials InitiatedCompletedVT EquipmentInitiatedCompletedContracts w/ Spoke SitesInitiatedIRB Approval all SitesInitiatedCompletedRedCap DatabaseCompletedHub Site TrainingCompleted
Slide10We Are Here
OctNovDecJanFebMarAprMayJunJulAugSeptOctNovDecJanFebMarInitiate Phase 1 Recruit and enroll patients Initiate intervention Data collection Complete focus groups Data analysis Revise V-STOP II Initiate Phase II Recruit and enroll patients Data collection Statistical analysis Dissemination of findings
Slide11Outcomes
Describe the Effect of V-STOP
Access - Acceptability
Patient Knowledge
Self-management Skills
Patient Outcomes
Baseline
Wk 1Wk 2Wk3Wk 4 Wk 5Wk6Wk12Wk18Data CollectionV- STOP InterventionData Collection Data Collection
Slide12Measures
V-STOP Course Evaluation
Access/Attendance/Acceptability
Telemedicine Satisfaction Questionnaire
V-STOP Satisfaction Questionnaire
Primary Measures
Stroke Risk Knowledge Test
(investigator developed pre/post test)
Lorig K et al. Outcome Measures for Health Education and Other Health
Care Interventions. Thousand Oaks CA: Sage Publications; 1996)
Self-efficacy for Managing Chronic Disease Scale
Communication with Health Care Providers Scale
Exercise Behaviors Scale
Cognitive Symptoms Management Scale
Disability Scale
Exploratory Measures
Biophysical measures
BP, A1C, Smoking, BMI, physical activity
NINDS-specified Common Data Elements (CDE).
Slide13Conclusions
We have developed a stroke prevention & patient self-management program and will test this in LSS telemedicine network
Aligns with Texas Plan to Reduce Cardiovascular
Test
implementation strategies that specifically support and reinforce healthy behavior for patients with stroke
Test feasibility
of linking specialty care
resources
for stroke with follow-up stroke care in the community through a telehealth
network
Identify barriers
and facilitator strategies for establishing a telehealth systems to deliver stroke secondary prevention to underserved Texas residents
Provides preliminary data and established partnerships for grant applications to NIH and other funding agencies
Slide14Acknowledgments:
Kendall Brown, BSN,
RN
Yvette
Gutierrez, BSN, RN
Barbara Kimmel, MS, MSc., CCRP
Munachi
Okpala
, BSN, RN
Jacqueline Posey
,
BSN, RN
Betsy Sansom, BSN,
RN
Pamela
Willson, PhD, RN, FNP-BC
Marci
Wilson,
RN
Thank you!