Collaboration and patient empowerment improve cardiovascular health for Nova Scotians

Share your thoughts: Scroll down to post a commentThe last four years have been the most professionally fulfilling in my 18-year nursing career. I have enjoyed and continue to enjoy a successful collaboration with primary-care physicians, pharmacists, dietitians and other healthcare professionals as part of Nova Scotia’s ANCHOR project: A Novel approach to Cardiovascular Health by Optimizing Risk Management. I have also witnessed the power of motivational interviewing, a technique that truly does motivate patients to set and achieve goals to improve their personal health.Most important, ANCHOR has improved health outcomes. In September 2010, preliminary results for the three-year program reveal significant reductions in participants' 10-year risk of having a coronary event, as measured by the Framingham risk score. One in four persons at moderate or high risk at baseline had moved to low risk upon “graduation” from the program. This was evident for both males and females. Both sexes also benefited from a significant reduction in metabolic syndrome. Theses outcomes were primarily due to successful lifestyle behavioural change, rather than an increase in pharmaceutical intervention.Exactly 1,509 patients consented to participate in the one-year intervention period of the three-year research initiative. Participating healthcare professionals were trained to use motivational interviewing and behavioural intervention techniques to help patients improve their overall cardiac health and reduce risk levels by making lifestyle changes and adhering to pharmaceutical therapy.There were two active intervention study sites and a control site, all primary-care practices. The program began with a Health Risk Assessment, establishing risk scores for each patient, which were reviewed with them. Patients were stratified into low-, moderate- or high-risk categories, based on their Framingham 10-year risk of a coronary event.Within a framework of individual case management and one-on-one counselling, we offered clinical and lifestyle interventions. The intensity of each intervention varied according to a patient’s readiness to change, as assessed using Prochasca’s scale (precontemplation, contemplation, preparation, action, maintenance). Patients set a goal to improve their cardiovascular health, and we met with most of them five or six times over the course of a year.A different approachWorking in a collaborative setting, assessing global cardiovascular risk factors, and helping patients set realistic goals and change behaviours was very rewarding as a cardiac nurse. It is quite different from the traditional didactic approach, in which I was trained to teach patients about cardiovascular risk and disease management. Instead, we empowered patients to set their own goals, and worked with them to develop healthy lifestyle behaviours and to adhere to treatment.ANCHOR has now progressed into a second phase—the Minimal Intervention Study, which will evaluate the efficacy of different levels of intervention to maintain or further enhance the improvements in health outcome achieved by the initial program. It is important to identify the most efficient means of sustaining health behaviour improvements by evaluating the “minimum dosage” or frequency required for patient-clinician contact. ANCHOR participants who have successfully changed their risk status have been recruited and will be assessed over a three-year period.Ultimately, it is hoped that the ANCHOR project will be reproduced elsewhere in Canada, as well as adapted to other disease states. I am honoured to be a part of such an amazing project that has and will continue to positively affect the cardiovascular health of Nova Scotians.The ANCHOR project, initiated in October 2006, is a partnership between the Nova Scotia Department of Health, Capital District Health Authority and the QEII Foundation, Cape Breton Health Authority, Heart and Stroke Foundation of Nova Scotia, and Pfizer Canada Inc., which provided $2 million in research funding.The study was launched in response to the fact that Atlantic Canadians have the highest risk of heart disease-related death in the country, and are above the national average for all key risk factors.Krista Courtney-Cox is a cardiac nurse working for the Capital District Health Authority, participating in the Duffus Health Centre ANCHOR practice site in Halifax.

Collaboration and patient empowerment improve cardiovascular health for Nova Scotians

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