title: The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers.
abstract: The burden of cardiovascular disease (CVD) among minority and low-income populations is well documented. This study aimed to assess the impact of patient activation and shared decision-making (SDM) on medication use through the Office-Guidelines Applied to Practice (Office-GAP) intervention in Federally Qualified Healthcare Centers (FQHCs). Patients (243) with diabetes and CHD participated in Office-GAP between October 2010 and March 2014. Two-site (FQHCs) intervention/control design. Office-GAP integrates health literacy, communication skills education for patients and physicians, decision support tools, and SDM into routine care.
  
  
  METHODS
  1) implementation rates, 2) medication use at baseline, 3, 6, and 12 months, and 3) predictors of medication use. Logistic regression with propensity scoring assessed impact on medication use. Intervention arm had 120 and control arm had 123 patients. We found that program elements were consistently used. Compared to control, the Office-GAP program significantly improved medications use from baseline: ACEIs or ARBs at 3 months (OR 1.88, 95% CI = 1.07; 3.30, p < 0.03), 6 months (OR 2.68, 95% CI = 1.58;4.54; p < 0.01); statin at 3 months (OR 2.00, 95% CI = 0.1.22; 3.27; p < 0.05), 6 months (OR 3.05, 95% CI = 1.72; 5.43; p < 0.01), Aspirin and/or clopidogrel at 3 months OR 1.59, 95% CI = 1.02, 2.48; p < 0.05), 6 months (OR 3.67, 95% CI = 1.67; 8.08; p < 0.01). Global medication adherence was predicted only by Office-GAP intervention presence and hypertension. Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.
authors: Michigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United States.
authors: Adesuwa
authors: A
authors: Olomu
authors: Michigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United States.
authors: Nazia Naz
authors: NN
authors: Khan
authors: Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824, United States.
authors: David
authors: D
authors: Todem
authors: Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824, United States.
authors: Qinhua
authors: Q
authors: Huang
authors: Michigan State University College of Human Medicine, 788 Service Road, B329 Clinical Center, East Lansing, MI 48824, United States.
authors: Esha
authors: E
authors: Kumar
authors: Center for Ethics and Humanities in the Life Sciences, Michigan State University, Division of Health Services Research, Department of Medicine, Room B213 Clinical Center, East Lansing, MI 48824, United States.
authors: Margaret
authors: M
authors: Holmes-Rovner
keywords: Federally qualified health center; Guidelines based care in outpatient settings; Medication adherence; Secondary prevention of heart disease; Shared decision-making