Impact of Pharmacists and Student Pharmacists in Educating and Screening Low-Income Women for Cardiovascular Disease

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1 Vlume 3 Number 2 Article Impact f Pharmacists and Student Pharmacists in Educating and Screening Lw-Incme Wmen fr Cardivascular Disease Natalie A. DiPietr Kristen Finley Sbta Martin R. Giannamre Fllw this and additinal wrks at: Recmmended Citatin DiPietr NA, Sbta KF, Giannamre MR. Impact f Pharmacists and Student Pharmacists in Educating and Screening Lw-Incme Wmen fr Cardivascular Disease. Inv Pharm. 2012;3(2): Article INNOVATIONS in pharmacy is published by the University f Minnesta Libraries Publishing.

2 Student Prject Impact f Pharmacists and Student Pharmacists in Educating and Screening Lw-Incme Wmen fr Cardivascular Disease Natalie A. DiPietr, PharmD, MPH 1, Kristen Finley Sbta, PharmD, BCPS 1, and Martin R. Giannamre, PharmD, BCPS 2 1 Raabe Cllege f Pharmacy, Ohi Nrthern University and 2 The Krger C., Clumbus OH Funding supprt: Supplies (such as educatinal materials and bld pressure cuffs) were funded thrugh an Ohi Nrthern University Faculty Develpment Grant. Previus presentatin: A subset f this data was presented at the 2011 American Pharmacists Assciatin Annual Meeting, Seattle, WA. Cnflict f Interest: Nne Acknwledgements: 1) Jennifer Clark, RPh, Directr f Pharmacy Services, Health Partners f Western Ohi; 2) Ohi Nrthern University student pharmacists wh participated in the prgram Keywrds: cardivascular diseases; wmen s health; indigent; pharmacist; pharmacy student Abstract Objectives: T evaluate the effectiveness f an educatinal interventin n knwledge f cardivascular disease (CVD) and t increase awareness f risk factrs amng female patients f a cmmunity health center with an n-site 340B pharmacy. Methds: The prgram cnsisted f a 10-minute educatinal interventin and brief pre-test, pst-test, and participant satisfactin survey. Adult female patients at the clinic fr any prvider visit r prescriptin fill were eligible t participate. Participants met individually with a student pharmacist r faculty member and verbally cmpleted the pre-test. The participant received educatin regarding CVD, risk factrs, and symptms f mycardial infarctin and were screened fr hypertensin and/r hyperlipidemia. The pst-test was then verbally administered. Participants answered the satisfactin survey privately. Based n individual needs, educatinal materials and infrmatin n available pharmacy clinical services were prvided. The university IRB deemed the study exempt. Results: Eighty-fur individuals received educatinal materials and/r a screening test. Of thse, 30 wmen (mean age 46.9 years) cmpleted the educatinal interventin. Thirteen (43%) reprted smking; 22 (73%) identified themselves as verweight. Furteen (47%) indicated a preexisting diagnsis f hypertensin. Crrect respnses fr 6 f 8 knwledge-based questins were statistically significantly imprved frm pre-test t pst-test (p<0.05). Twenty-nine patients (97%) rated the prgram as useful r very useful. Cnclusin: CVD is the leading cause f death in U.S. wmen. Data frm this prgram indicate that thrugh screening and educatin, pharmacists and student pharmacists can impact female patients knwledge f CVD risk factrs. Cntinued effrts in this area may help t reduce the public health burden f CVD. Intrductin Pharmacists and student pharmacists are becming increasingly engaged in primary and secndary preventin effrts aimed t imprve the public s health. Primary preventin aims t prevent r reduce the ccurrence f disease. Pharmacists and student pharmacists further primary preventin effrts in numerus ways, including vaccinatin prgrams, needle exchange prgrams, and patient educatin. Secndary preventin refers t activities directed t detect disease at an early stage. The many types f screening prgrams implemented by pharmacists and student pharmacists are examples f secndary preventin. 1 Crrespnding authr: Natalie A. DiPietr, PharmD, MPH Assistant Prfessr f Pharmacy Practice Raabe Cllege f Pharmacy, Ohi Nrthern University 525 S. Main St., Ada, OH n-dipietr@nu.edu; Phne: Fax: A significant public health initiative, Millin Hearts TM, has been recently launched by the U.S. Department f Health and Human Services. The gal f this campaign is t prevent 1 millin heart attacks and strkes ver the next 5 years thrugh public-private partnerships t empwer individuals t make heart-healthy chices and t fcus n 4 cre elements f care fr thse wh need treatment. 2 Pharmacy rganizatins including the American Pharmacists Assciatin and the American Assciatin f Clleges f Pharmacy, amng thers, are partnering with the Millin Hearts campaign and are encuraging pharmacists and student pharmacists t becme invlved. 3,4 This paper details the utcmes f an educatinal prgram t raise awareness and imprve knwledge abut cardivascular disease (CVD) amng lw incme wmen. The prgram, titled Heart-t- Heart, was develped and implemented by pharmacy faculty and student pharmacists and prvides a framewrk that can be replicated r adapted fr ther prgrams , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 1

3 Student Prject Objectives The primary bjective f this study was t evaluate the effectiveness f a 10- minute educatinal interventin n imprving knwledge f CVD and t increase the awareness f risk factrs amng female patients f a Federally Qualified Health Center (FQHC). The secndary bjective f this study was t measure participant satisfactin with the educatinal prgram. Methds Research Prject Setting The research prject was cnducted at Health Partners f Western Ohi (previusly named Allen Cunty Health Partners) lcated in Lima, Ohi. Health Partners f Western Ohi (HPWO) is funded by the U.S. Department f Health and Human Services as a FQHC. HPWO cnsists f tw health centers lcated in nrthwest Ohi (Lima and New Carlisle) that prvide primary healthcare services t indigent patient ppulatins, regardless f their ability t pay. Prescriptin services thrugh varius prgrams (340B cmpetitive pricing, Pfizer Sharing the Care, Astra Zeneca AZ&ME, and thers) are available t help meet the patients medicatin needs. Pharmacists meet with patients fr medicatin therapy management (MTM) and chrnic disease management thrugh prvider referral at bth health centers. Clinical services prvided by pharmacists include diabetes, chlesterl, asthma, chrnic bstructive pulmnary disease (COPD), and hepatitis C. Study Design The Ohi Nrthern University (ONU) Institutinal Review Bard apprved this study as an exempted research prject. This prspective study was cnducted nce a mnth frm December 2009 t April 2010 at the Lima health center f HPWO. Ptential study participants were eligible fr inclusin if they were 18 years f age r lder, female, and currently a patient f HPWO r present at HPWO with a friend r family member wh was a patient f the clinic. Any male patients interested in the educatinal prgram were permitted t participate; hwever, data frm male patients are nt included in the results f this study. HPWO persnnel, wh include physicians, nurse practitiners, and health center supprt staff, were educated n the prgram. During scheduled appintments, clinic healthcare prviders encuraged patients t attend the prgram. Pharmacists als identified ptential participants fr the study by referring patients wh picked up prescriptins fr CVD. Wmen in the waiting rm were als infrmed f the pprtunity t participate in the educatinal prgram. The authrs designed the pre- and pst-tests, 10-minute educatinal script, and participant satisfactin survey. Student pharmacists participating in the delivery f this pharmacy service attended a seminar where training materials utlining the frmat and bjectives f the prgram were distributed. Als during the training sessin, students were educated abut the imprtance f implementing the interventin in a cnsistent manner and were educated abut verbal and nn-verbal cues t avid; the students then practiced delivering the scripts and pre/pst-tests. The students als perfrmed bld pressure checks, which were assessed by a faculty member fr accuracy. The pre- and pst-tests were adapted frm a published crsssectinal survey develped by pharmacists t assess knwledge f CVD amng cmmunity residents. 5 The tests were then pilted in a grup f eleven randmly-selected HPWO patients t evaluate face-validity. The finalized pretest (Appendix 1) cnsisted f eight knwledge-based questins that assessed participants awareness f CVD risk factrs and lifestyle mdificatins, and 12 questins t cllect participant characteristics (family histry, scial histry, demgraphics). The pst-test (Appendix 2) was immediately administered fllwing the educatinal interventin, and cntained the identical knwledge-based questins frm the pre-test. An ONU pharmacy faculty member and three t five student pharmacists set up the prgram in a semi-private rm f the clinic each mnth. A rati f ne student: ne participant was utilized during the prgram, and students verbally administered the pre-test befre the interventin. Students then prvided 10 minutes f scripted infrmatin t each participant, fcusing n the preventin and management f CVD. The prgram script (Appendix 3) was develped utilizing recmmendatins frm the U.S. Preventive Services Task Frce; 6 Jint Natinal Cmmittee n Preventin, Detectin, Evaluatin, and Treatment f High Bld Pressure (JNC 7); 7 and the American Heart Assciatin evidence-based guidelines fr preventin f CVD in wmen. 8 The script was written at an apprpriate literacy level, and the use f medical jargn was avided. In additin, appraches t patient educatin and cunseling abut CVD specifically fr wmen 9,10 and ethnically-diverse, lw-incme wmen 11 were incrprated. Educatinal tpics included mdifiable and nn-mdifiable risk factrs and lifestyle mdificatins such as nutritin, physical activity, and smking cessatin. Participants were infrmed that wmen may experience ne r multiple traditinal (e.g., discmfrt r pressure in the chest; shrtness f breath; pain in ne r bth arms, the upper back, neck, jaw, r stmach) and/r nn-traditinal (e.g., nausea and vmiting; breaking ut in a cld sweat; dizziness r lightheadedness; anxiety) symptms f a mycardial infarctin (MI). Wmen were als educated , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 2

4 Student Prject abut steps t take if experiencing these symptms (e.g., calling 911 immediately but n later than 5 minutes). Bld pressure measurements were taken and recrded n a wallet-sized card during the educatinal sessin if participants vluntarily chse t have it measured. In additin, during tw sessins students ffered free chlesterl screenings (lab panel including ttal chlesterl, LDL, HDL, triglycerides, and glucse). Fllwing the interventin, students verbally administered the pst-test. Participants were then prvided additinal cunseling and educatinal pamphlets (n tpics such as hypertensin, strke, diabetes, chlesterl management, and smking cessatin) that targeted the participant s identified risk factrs. Participants were als referred t ther pharmacy services at HPWO, such as smking cessatin, if apprpriate. The satisfactin survey develped by the authrs (Appendix 4) was cmpleted independently by each participant t elicit mre frank feedback; the frm was sealed in an envelpe befre being submitted. Participants were numbered sequentially as they enrlled int the study. Pre-test, pst-test, and satisfactin surveys were numbered t facilitate matching and allwed fr the assessment f change in knwledge; these numbers were nt linked t identifiable infrmatin. All test and survey data were cllected via Scantrn cmputer scan frms. Data were scanned int an Access 2003 database. Micrsft Excel 2007, Micrsft Access 2007 and Minitab Versin 15 were utilized t calculate all statistical analyses. Descriptive statistics were calculated fr multiple parameters. The paired t-test was utilized t assess whether differences in pre-test results and pst-test results were statistically significant. Alpha was set a priri at <0.05. Results Eighty-fur individuals participated in sme aspect f the prgram. Frty-fur received nly educatinal materials r a screening test due t time cnstraints. Frty participants initiated the educatinal interventin; 10 were mitted frm the final analysis due t incmpletin f the entire interventin (n=7) r male sex (n=3). Therefre, 30 ttal wmen were included in the analysis. Baseline demgraphics and clinical characteristics f the 30 wmen wh cmpleted the educatinal interventin are utlined in Table 1. Mst reprted risk factrs fr CVD, and many had tw r mre risk factrs and/r c-mrbidities. Test Scres: A perfect scre n bth the pre-test and psttest was 34 pints. Individual and mean pre- and pst-test scres are displayed in Figure 1. The mean pre-test scre per participant = /- 4.9 pints (range pints). The mean pst-test scre per participant = /- 2.4 pints (range pints). There was a statistically significant increase in mean test scres between the pre- and pst-test (p<0.001). Table 2 shws the difference in the mean pre- and pst-test scres fr each questin n the pre- and pst-test. There was an imprvement in pst-test scres fr each questin. Crrect respnses t six questins were statistically significant fr imprved pst-test scres: identificatin f fds high in sdium; identificatin f a healthy bld pressure reading; identificatin f a healthy ttal chlesterl value; identificatin f MI warning signs; identificatin f crrect actin t take if experiencing MI symptms; and identificatin f risk factrs fr CVD in wmen. Test Scres fr Identificatin f Warning Signs f MI: Figure 2 illustrates the changes in pre- vs. pst-test scres fr crrect identificatin f MI warning signs in wmen. The number f crrect respnses n the pst-test was greater than the pretest fr every sign r symptm with the exceptin f feeling faint which drpped frm 23 t 21. Relatinships between Disease States and Demgraphics vs. Changes in Ttal Scres: N changes were demnstrated when the data was analyzed cmparatively fr the presence f c-mrbidities and cardivascular risk factrs in relatin t changes in ttal test scres. Satisfactin: All participants privately cmpleted the satisfactin survey (n=30). Satisfactin data demnstrated that 22 participants (73.3%) learned cardivascular risk factrs f which they were previusly unaware. Twenty-nine (97%) participants rated the prgram t be either useful r very useful and indicated they wuld recmmend the prgram t thers. Twenty-five (83%) participants planned t discuss their results with their physician. Discussin The Millin Hearts TM campaign has made raising awareness and prviding educatin abut CVD a pririty fr healthcare prfessinals t imprve their patients health. CVD is the leading cause f death fr men and wmen in the United States (U.S.)., 12 and the lifetime incidence f CVD is nearly 1 in 2 wmen. 8 Hwever, data have shwn that 55% f wmen knw that CVD is the leading cause f death fr bth sexes in the U.S., and nearly 40% d nt perceive themselves t be at risk. 10 Twenty-five percent f wmen surveyed indicated that their healthcare prvider had nt emphasized that heart health was imprtant, and 20% relayed that they had nt , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 3

5 Student Prject been clearly tld hw they can change their risk status. 10 Data indicating that many wmen may nt realize that they are at risk fr CVD has led t the develpment f prgrams such as The Heart Truth 13 and Make the Call: Dn t Miss a Beat 14 t persnalize and deliver infrmatin n these risks specifically t wmen. On a lcal level, the need fr access t free infrmatin and screening fr CVD amng female residents f Lima, Ohi (where 30.3% f the residents have incmes belw the federal pverty level 15 ) spurred the develpment f this prgram. The data frm the Heart-t-Heart prgram supprt recently published studies shwing that pharmacists and/r student pharmacists can have a psitive impact n patient assessment f CVD and satisfactin with such services in clinic, cmmunity pharmacy, and cmmunity center settings in the United States. 5,16-19 A strength f the Heart-t-Heart prgram was the pre- and pst-test design, as these previus studies did nt cllect participant knwledge bth befre and after the interventin. Anther strength was the student training sessin t review the standardized script and pre/pst-test materials, which helped t ensure cnsistency in the delivery f the prgram. The fact that wmen received specific, persnalized infrmatin and recmmendatins at the cnclusin f the sessin was anther benefit f the prgram design. Based n risk factrs identified during the prgram, wmen received specific referrals and /r patient educatin materials after they had taken the pst-test. Limitatins t this study include the small sample size and vluntary participatin; participants may nt be representative f the verall female clinic ppulatin due t self-selectin bias. The data n intentin t fllw-up with physician was self-reprted; the design f the study did nt allw fr tracking f patient appintments r fr the evaluatin f lng-term retentin f knwledge. Finally, anther limitatin t the study design is the lack f a cntrl grup. Prgrams like Heart-t-Heart can be incrprated int intrductry r advanced pharmacy practice experiences (IPPE r APPE), prviding pprtunities fr student pharmacists t be expsed t primary and secndary preventin cncepts and t impact patient knwledge and assessment. Public health is emphasized in pharmacy educatin, 20,21 and these types f prgrams enable student pharmacists t augment their didactic educatin with experiential learning. Additinally, the implementatin f these prgrams allws fr further study f the impact f such interventins in larger numbers f wmen in different patient care settings. Future studies may be designed t cllect infrmatin n lng-term knwledge retentin, behavir change, and/r clinical utcmes amng participants f the educatinal interventin t prvide insight regarding its clinical significance. Thrugh educatin and screening fr CVD, pharmacists and student pharmacists can fulfill an imprtant rle in public health activities while advancing the pharmacy prfessin s prvisin f patient-centered care. Cnclusin CVD is the leading cause f death in U.S. wmen. The data frm this prgram indicate that thrugh screening and educatin, pharmacists and student pharmacists can impact female patients knwledge f cardivascular risk factrs. Additinally, mst prgram participants fund this type f prgram t be useful and wuld recmmend it t thers. Cntinued effrts in this area may help t reduce the public health burden f CVD in wmen. References 1. Farris KB, Jhnsn KA. Pharmacists in public health: it's a gd start! J Am Pharm Assc. 2010;50: Centers fr Disease Cntrl and Preventin. Millin Hearts. TM Accessed at April 26, New public-private sectr initiative aims t prevent 1 millin heart attacks and strkes in five years. U.S. Department f Health and Human Services Press Office, September 13, Accessed at a.html, April 26, New Millin Hearts TM tls annunced by partners. Centers fr Disease Cntrl and Preventin press release, Nvember 3, Accessed at ss_release_ pdf, April 26, Mney LA, Franks AM. Evaluatin f cmmunity health screening participants knwledge f cardivascular risk factrs. J Am Pharm Assc 2009;49(4): The Pcket Guide t Clinical Preventive Services, Recmmendatins f the US Preventive Services Task Frce. Agency fr Healthcare Research and Quality. Accessed at December 10, The Seventh Reprt f the Jint Natinal Cmmittee n Preventin, Detectin, Evaluatin, and Treatment f High Bld Pressure Accessed at nc7full.pdf, April 26, , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 4

6 Student Prject 8. Msca L, Banca CL, Benjamin EJ, et al. Evidencebased guidelines fr cardivascular disease preventin in wmen: 2007 update (American Heart Assciatin Guidelines). J Am Cll Cardil. 2007;49: Msca L, Mchari-Greenberger H, Dlr RJ, et al. Twelve-year fllw-up f American wmen's awareness f cardivascular disease risk and barriers t heart health. Circ Cardivasc Qual Outcmes. 2010;3: Msca L, Mchari H, Christian A, et al. Natinal study f wmen s awareness, preventive actin, and barriers t cardivascular health. Circulatin. 2006;113: Gettlemen L, Winkleby MA. Using fcus grups t develp a heart disease preventin prgram fr ethnically diverse, lw-incme wmen. J Cmm Health. 2000; 25(6): Centers fr Disease Cntrl and Preventin. Leading causes f death in females, United States, Accessed at April 26, Office n Wmen s Health. The Heart Truth. Accessed at April 26, Office n Wmen s Health. Make the call. Dn t miss a beat. Accessed at April 26, U.S. Census Bureau. State and cunty quick facts, Lima (city), Ohi. Accessed at April 26, Miller SW, Darsey E, Heard TJ, et al. Outcmes f a multidisciplinary partnership t imprve cardiac wellness: an pprtunity fr pharmacists. Cnsult Pharm. 2010;25: Olenak, JL, Calpin M. Establishing a cardivascular health and wellness prgram in a cmmunity pharmacy: screening fr metablic syndrme. J Am Pharm Assc. 2010;50: Garrisn GD, Lubwski TJ, Miller SM, et al. Multi-site heart disease risk assessment service prvided by pharmacy students. Am J Pharm Educ. 2010;74(3): Liu YF, Mentele LJ, McDnugh RP. Cmmunity pharmacist assessment f 10-year risk f crnary heart disease fr unin wrkers and their dependents. J Am Pharm Assc. 2008;48: Accreditatin Cuncil fr Pharmacy Educatin. Accreditatin standards and guidelines: Prfessinal degree prgram in pharmacy leading t the dctr f pharmacy degree. Accessed at April 26, Center fr the Advancement f Pharmaceutical Educatin educatinal utcmes. Accessed at nts/cape2004.pdf, April 26, , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 5

7 Student Prject Appendix 1 Pre-Test Knwledge Questins Hw much d yu feel yu knw abut risk factrs fr heart disease? A little Sme A lt Which f the fllwing fds are high in sdium? Please mark all that apply. fresh vegetables fresh fruit canned sup frzen dinners ptat chips lean meat Which f the fllwing fds has high fat/chlesterl cntent? Please mark all that apply. biscuits hamburger cheese french fries plain turkey sandwich skim milk Hw many servings f fruits and vegetables shuld a persn have in ne day? Please chse ne answer. 0 (nt necessary t eat fruits r vegetables every day) at least 1-2 at least 3-5 What is cnsidered a healthy bld pressure reading? Please chse ne answer 70/40 120/80 150/90 160/100 Dn t knw / Nt sure A healthy fasting (haven t eaten recently) ttal chlesterl is: Please chse ne answer Less than 50 Less than 100 Less than 200 Less than 400 Dn t Knw / Nt Sure As a wman, which f the fllwing warning signs f a heart attack shuld yu watch fr? Please mark all that apply. Chest pain r discmfrt Anxiety Pain in the arm, back, neck, jaw, r stmach Truble sleeping Feel unusually tired and weak Shrtness f breath (feeling like yu can t get enugh air) Nausea Breaking int a cld sweat Feeling faint r wzy If yu think yu have any symptms f a heart attack, what shuld yu d? (chse ne answer) Call 911 immediately but n later than 5 minutes Call yur dctr immediately but n later than 5 minutes Wait t see if the symptms g away befre calling fr help Which cnditin(s) increase a wman s risk fr heart disease? Please mark all that apply. High bld pressure Heartburn Age ver 55 years Diabetes Family histry Lack f activity High chlesterl Smking Obesity/verweight Demgraphic Questins Why are yu at the clinic tday? (Please mark all that apply) t see a dctr pharmacy t see a dentist Other specify t take a family member fr an appintment , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 6

8 Student Prject Other than during pregnancy, have yu ever been tld by a dctr, nurse, r ther healthcare prvider that yu have hypertensin, als called high bld pressure? N I ve been tld I have brderline high bld pressure (als called pre-hypertensive) I dn t knw r I m nt sure Other than tday, abut hw lng has it been since yu last had yur bld pressure checked by a healthcare prvider? Never Less than 1 year Between 1 2 years Between 2 5 years Mre than 5 years I dn t knw r I m nt sure Are yu currently taking prescriptin medicatin fr high bld pressure? N I dn t knw r I m nt sure Other than during pregnancy, have yu ever been tld by a dctr r ther healthcare prvider that yu have diabetes r high bld sugar? N I ve been tld I have brderline diabetes r pre-diabetes I dn t knw r I m nt sure Have yu ever been tld by a dctr, nurse, r ther health prfessinal that yur bld chlesterl is high? N I dn t knw r I m nt sure Including living and deceased, was yur father, mther, sisters r brthers, ever tld by a health prfessinal that they had heart disease (including a heart attack r strke)? N I dn t knw r I m nt sure D yu currently smke r use tbacc prducts? N IF NO, Have yu ever smked? N IF YES, Hw lng ag did yu quit smking? mnths D yu cnsider yurself nw t be: Overweight Underweight Abut the right weight dn t knw r I m nt sure , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 7

9 Student Prject Hw ld are yu tday? years {Nte t interviewer: recrd the patient s sex d nt ask unless necessary} Patient s sex Male Female Which ne r mre f the fllwing wuld yu say is yur race r ethnicity? (Mark all that apply) White Black r African American Hispanic Asian Other [specify] What is the highest grade r year f schl yu cmpleted? Please chse ne answer. Never attended schl r nly attended kindergarten Elementary schl (grades 1 thrugh 8) Sme high schl High schl graduate Sme cllege r technical schl Cllege graduate Graduate r Prfessinal Schl (Masters, Dctrate, r Prfessinal Degree) Reference: Mney LA, Franks AM. Evaluatin f cmmunity health screening participants knwledge f cardivascular risk factrs. J Am Pharm Assc 2009;49(4): , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 8

10 Student Prject Appendix 2 Pst-Test Knwledge Questins Hw much d yu feel yu knw abut risk factrs fr heart disease? A little Sme A lt Which f the fllwing fds are high in sdium? Please mark all that apply. fresh vegetables fresh fruit canned sup frzen dinners ptat chips lean meat Which f the fllwing fds has high fat/chlesterl cntent? Please mark all that apply. biscuits hamburger cheese french fries plain turkey sandwich skim milk Hw many servings f fruits and vegetables shuld a persn have in ne day? Please chse ne answer. 0 (nt necessary t eat fruits r vegetables every day) at least 1-2 at least 3-5 What is cnsidered a healthy bld pressure reading? Please chse ne answer 70/40 120/80 150/90 160/100 Dn t knw / Nt sure A healthy fasting (haven t eaten recently) ttal chlesterl is: Please chse ne answer Less than 50 Less than 100 Less than 200 Less than 400 Dn t Knw / Nt Sure As a wman, which f the fllwing warning signs f a heart attack shuld yu watch fr? Please mark all that apply. Chest pain r discmfrt Anxiety Pain in the arm, back, neck, jaw, r stmach Truble sleeping Feel unusually tired and weak Shrtness f breath (feeling like yu can t get enugh air) Nausea Breaking int a cld sweat Feeling faint r wzy If yu think yu have any symptms f a heart attack, what shuld yu d? (chse ne answer) Call 911 immediately but n later than 5 minutes Call yur dctr immediately but n later than 5 minutes Wait t see if the symptms g away befre calling fr help Which cnditin(s) increase a wman s risk fr heart disease? Please mark all that apply. High bld pressure Heartburn Age ver 55 years Diabetes Family histry Lack f activity High chlesterl Smking Obesity/verweight Reference: Mney LA, Franks AM. Evaluatin f cmmunity health screening participants knwledge f cardivascular risk factrs. J Am Pharm Assc 2009;49(4): , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 9

11 Student Prject Appendix 3 Educatinal Prgram/Script #1) Intrduce self Hi, my name is and I am a pharmacy student at Ohi Nrthern University. We are wrking n this prject t find ut hw much patients knw abut heart disease and hw it affects their life. When the prject is finished, we will find ut if patients d r d nt have a gd understanding f heart disease; this will help us educate mre patients in the future. First I will give yu a survey; I will read it t yu and I want yu t answer the questins as best as yu can. The survey is cmpletely vluntary, and yu may end the survey at any time withut penalty. We are nt cllecting yur name; any infrmatin btained in the survey will be cnfidential and yu will never be identified. #2) Administer pre-test Read t participant and recrd answers n pre-test #3) Ask t take participant s bld pressure If participant declines, mve nt next step. Take bld pressure. Recrd reading n card and give t participant. Yur bld pressure reading is. This is cnsidered as very high ( 140/90)/ a little high ( /81-99)/ nrmal (120/80 r belw), but we cannt diagnse yu. Please be sure t share this piece f paper with yur dctr, and he r she will tell yu if there is anything yu need t d. Fr participants with diabetes, encurage them that their bld pressure shuld be belw 130/80 In the event a participant s bld pressure exceeds 180/110 r is symptmatic (chest pain, heart palpitatins, shrt f breath, dizzy, sweating) stp immediately and find a faculty member. #4) Prvide educatinal interventin 1-6 Heart disease is imprtant fr wmen t learn mre abut because 1 in 2 wmen will develp heart disease smetime in her life. There are things that wmen may d that increase their chances f develping heart disease. These include: being verweight, unhealthy eating habits, smking, having high bld pressure, high chlesterl and high bld sugar. There are als sme things wmen can t change, but it is very imprtant t knw that it may impact whether r nt smene develps heart disease. Age Yu cannt change yur age and just being ver the age f 55 increases yur risk f develping a heart prblem. Family histry Yu als cannt change yur family histry and if yur parents, grandparents, brthers and sisters, r even yur children have ever been diagnsed with heart disease, yur risk fr develping it is greatly increased. Frtunately, there are things yu can change First is, nutritin and weight Maintaining a healthy weight is very imprtant because being verweight greatly increases yur risk f develping heart disease. Eating 3-5 servings (1 serving is abut ½ cup) f fruits and vegetables every day can help yu maintain a healthy weight and keep yur bdy healthy. Avid eating a lt f salt. This can be dne by nt using the salt shaker t salt fd at mealtime and aviding fds such as canned sup, frzen dinners and ptat chips. Try t limit fds that are high in fat in rder t keep yur chlesterl lw. Avid fds such as: French fries, biscuits, hamburgers and dnuts. Secnd is, activity Try t exercise fr abut 30 minutes 3-4 times per week , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 10

12 Student Prject Even a quick walk arund the blck every day r taking the stairs instead f the elevatr can help yur heart! Talk t yur dctr befre any starting any majr changes t yur daily activity level. Third is, bld pressure Try t keep yur bld pressure at r belw the nrmal level f 120/80 in rder t reduce yur risk fr develping heart prblems. Next is, chlesterl Try t keep yur ttal chlesterl at r belw the nrmal level f 200 mg/dl t help prtect yur heart. There are tw types f chlesterl: gd chlesterl, HDL and bad chlesterl, LDL. Yu als want t manage yur bld sugar It is very imprtant t keep yur bld sugar cntrlled, especially if yu have diabetes, in rder t keep yur bdy healthy. Last is, smking. If participant DOES NOT currently smke: I m happy t hear that yu d nt smke, because smking increases the chances f develping heart disease. Be sure t avid smking in the future as well. If participant DOES currently smke: Quitting smking is the best thing yu can d fr yur health. It is especially imprtant nt t smke if yu take birth cntrl pills! Yu shuld recgnize signs/symptms f a heart attack and knw what t d. By taking the right actin, it may save yur life r help reduce lng-term damage. Signs/symptms f heart attack The signs f a heart attack can be different in wmen than in men. While men ften have chest pain r pressure, wmen may r may nt experience chest pain during a heart attack. There are a number f signs f a heart attack that are mre likely t ccur in wmen and these are: discmfrt r pressure in the chest; pain in ne r bth arms, the upper back, neck, jaw, r stmach; nausea and vmiting; breaking ut in a cld sweat; dizziness r lightheadedness; anxiety; truble breathing r shrtness f breath; and pale r clammy skin. What t d call 911 immediately D nt wait lnger than 5 minutes. Call 911 directly rather than yur dctr s ffice. It is s imprtant t be infrmed abut yur health, especially when it cmes t yur heart! Taking steps tday in rder t reduce yur risk can help yu live a much healthier life in the years t cme. #5) Administer pst-test Read t participant and recrd answers n pst-test , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 11

13 Student Prject #6) Based n participant s risk factrs listed belw, prvide the apprpriate educatinal materials and infrmatin regarding referrals (ex: clinic services, Ohi Tbacc Quit Line, etc) Participant has high bld pressure based n reading Participant is verweight/bese Participant smkes Participant is currently taking medicatins fr bld pressure r diabetes Participant is ver 50 years ld #7) Give satisfactin survey and envelpe and explain hw t cmplete it (Frm labeled Satisfactin Questins) Have participant cmplete the frm in the rm befre she leaves. Take participant t separate area f rm; be sure t give her privacy. Instruct the participant t put the frm int envelpe and seal it befre turning it in. References 1. The Pcket Guide t Clinical Preventive Services, Recmmendatins f the US Preventive Services Task Frce. Agency fr Healthcare Research and Quality. Accessed at December 10, The Seventh Reprt f the Jint Natinal Cmmittee n Preventin, Detectin, Evaluatin, and Treatment f High Bld Pressure Accessed at April 26, Msca L, Banca CL, Benjamin EJ, et al. Evidence-based guidelines fr cardivascular disease preventin in wmen: 2007 update (American Heart Assciatin Guidelines). J Am Cll Cardil. 2007;49: Msca L, Mchari-Greenberger H, Dlr RJ, et al. Twelve-year fllw-up f American wmen's awareness f cardivascular disease risk and barriers t heart health. Circ Cardivasc Qual Outcmes. 2010;3: Msca L, Mchari H, Christian A, et al. Natinal study f wmen s awareness, preventive actin, and barriers t cardivascular health. Circulatin. 2006;113: Gettlemen L, Winkleby MA. Using fcus grups t develp a heart disease preventin prgram fr ethnically diverse, lwincme wmen. J Cmm Health. 2000; 25(6): , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 12

14 Student Prject Appendix 4 - Satisfactin Questins Did tday s prgram identify any risk factrs fr heart disease that yu were nt aware f befre? N I dn t knw r I m nt sure D yu plan t talk t a dctr t fllw up n what yu learned tday? Please chse ne answer. N, I will d this tday, I will d this within 1-3 mnths, I will d this but it will take lnger than 3 mnths I dn t knw r I m nt sure Hw useful was tday s prgram fr increasing yur understanding f each f yur risk factrs fr heart disease? Please chse ne answer. Nt useful Smewhat useful Useful Very useful Wuld yu recmmend this prgram t a friend r family member? N , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 13

15 Participant Identificatin Number Student Prject Figure 1. Individual and Mean Pre- and Pst-Test Scres Number f Pints Earned (Test Scre) Pre-Test Scre Pst-Test Scre Mean scre (N=30) , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 14

16 Ttal Scre per Warning Sign Student Prject Figure 2. Pre- vs Pst-Test Cmparisn f Crrect Identificatin f Mycardial Infarctin (MI) Warning Signs in Wmen PRE 10 POST 5 0 Chest pain+ Arm pain+ Shrtness f breath+ Nausa Cld sweat Feeling faint Warning Signs f MI Anxiety Sleep prblem Tired + indicates Traditinal Warning Sign , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 15

17 Student Prject Table 1. Characteristics f Study Participants (N=30) Parameter Number (%) a Sex Female 30 (100) Caucasian 18 (60) Black 10 (33) Race/Ethnicity Self-reprted cardivascular disease risk factrs b Educatin Hispanic 0 (0) Asian 0 (0) Other 1 (3) Multiple chices selected 1 (3) Overweight 22 (73) Family histry f heart disease 18 (60) Hypertensin 14 (47) Smking 13 (43) Antihypertensive medicatin 12 (40) Hyperchlesterlemia 10 (33) Diabetes 7 (23) Sme high schl 7 (23) High schl graduate 10 (33) Sme cllege 8 (27) Cllege graduate 3 (10) Graduate/prfessinal schl 1(3) N respnse 1 (3) Mean+ Standard Deviatin (Range) Age (yrs) (18-78) a. Ttal percentage may nt equal 100% due t runding b. Ttal percentage exceeds 100% as sme participants reprted > 2 risk factrs Table 2. Scre Summary By Individual Questin (N=30) Questin Perfect Scre Mean Pre- Mean Pst- Change in Mean p value b fr Questin Test Scre Test Scre Scre a High sdium fds * High fat fds Recmmended number f servings f fruits/vegetables per day Healthy bld pressure reading * Healthy ttal chlesterl reading <0.001* Mycardial infarctin (MI) warning * signs in wmen Actin if MI symptms * Risk factrs fr cardivascular disease in wmen * a. Calculated by Mean Pst-Test Scre minus Mean Pre-Test Scre b. Calculated by paired t-test; asterisk (*) indicates statistical significance , Vl. 3, N. 2, Article 77 INNOVATIONS in pharmacy 16