The National Telephone Lifestyle Coaching Pilot - Overview

The National Telephone Lifestyle Coaching Pilot - Overview

The National Telephone Lifestyle Coaching Pilot - Overview Sophia P. Hurley, MSPT Project Manager, National Telephone Lifestyle Coaching Pilot MOVE! Physical Activity Program Coordinator October 2011 VHA Transformational Initiative: Preventive Care Program Part of New Models of Care T21 Transformational Initiative Focus on unhealthy behaviors to decrease risk for chronic conditions or as part of treatment for existing conditions Need to develop ways to provide more non-faceto-face care VETERANS HEALTH ADMINISTRATION

2 Creation of National TLC History Ideas for new modalities to address challenges providing 1:1 care for MOVE! MOVE! Telephone Lifestyle Coaching (TLC) MOVE! TLC Quality Improvement Project in VISN2 Simple coaching model based on MOVE! Adapted for telephone coaching VETERANS HEALTH ADMINISTRATION 3 Creation of National TLC What we learned: MOVE! TLC integrated with Primary Care

Local MOVE! team was skeptical at first, but were very happy with outcomes Effective communication between coaches and clinicians Results Patient and staff satisfaction, weight loss VETERANS HEALTH ADMINISTRATION 4 Creation of National TLC What we still need to determine: Successful implementation across VISN lines Application to other behaviors VISN 4 success with tobacco cessation National implementation Develop a model that will be effective and desirable

Funding VETERANS HEALTH ADMINISTRATION 5 National TLC Details Part of Transformational Initiatives, Preventive Care Program Telephone Lifestyle Coaching Supplement Primary Care and PACT Enhance and support health coaching already available in VHA VETERANS HEALTH ADMINISTRATION 6

National TLC Details Relieve burden on PC/PACT teams Convenient, timely, cost-effective Provide service without any space Veteran centered Aligned with stepped care model Supports Health Promotion Disease Prevention Healthy Living Messages VETERANS HEALTH ADMINISTRATION

7 Healthy Living Messages Be involved in your health care Be tobacco free Eat wisely Be physically active Strive for a healthy weight Limit alcohol Get recommended screening tests and immunizations Manage stress Be safe VETERANS HEALTH ADMINISTRATION 8

The Coaches Contract employees Alere Wellbeing Inc. (formerly Free & Clear) Leader in tobacco cessation quitline services Telephonic health coaching Prior VA experience Effective communication with healthcare team VETERANS HEALTH ADMINISTRATION 9 Participation Process Enrolled Veterans Primary Care/PACT Visit Conversation about health behavior change and offer of TLC services Veteran indicates readiness for behavior change

and interest in TLC services PACT team generates CPRS consult for TLC services VETERANS HEALTH ADMINISTRATION 10 Consult Template Consistent in all facilities Simple drop down and/or check boxes Designed to: aid in appropriate referrals start Veteran thinking about health behavior change and identifying goals Veteran-centered Day/time/number for calls VETERANS HEALTH ADMINISTRATION

11 Participation Process Coach receives and completes consult Enrollment call with Veteran Schedule next call 10 outgoing calls over 6+ months Weekly for first 3 calls Bi-weekly to monthly for remaining 7 calls Final evaluation call Unlimited inbound calls VETERANS HEALTH ADMINISTRATION 12

Pilot Details Sites 5 VISNs (4, 8, 15, 16, 21) 25 Facilities One or multiple behaviors may be addressed Documentation in CPRS Consult completion Coaching intervention notes Alert primary care/PACT team as needed Final summary note VETERANS HEALTH ADMINISTRATION

13 Facility Point of Contact Health Promotion/Disease Prevention Program Manager and Health Behavior Coordinator Coordinate and collaborate Liaison between NCP, coaches and the pilot site Communicate Promote Educate Support Guide Resource Inventory VETERANS HEALTH ADMINISTRATION 14

Alere Wellbeing and Smoking Cessation Scientifically based and updated with current evidence Quit For Life Program (25 years) Outcomes from large RCTs in peer-reviewed scientific journals US PHS Clinical Practice Guideline for Treating Tobacco Use and Dependence Independent evaluations by public and private institutions University of Oklahoma (College of Public Health) University of North Carolina Chapel Hill Professional Data Analysts, Inc. The Gilmore Research Group

Social Solutions International VISN 4 experience since 2005 VETERANS HEALTH ADMINISTRATION 15 VETERANS HEALTH ADMINISTRATION 16 Referral to TLC Program Via Consult 1. Veteran consult is submitted to FC 2. FC staff obtain consults daily and make multiple attempts over a series of days to reach veteran to offer enrollment in

Quit for Life Program. 3. Veteran chooses to enroll, is unreachable or declines services (all statuses noted back to CPRS). Veteran Declines Note made to CPRS, consult closed 1. 2. Veteran Unreachable Note made to CPRS, consult closed 3. 4. 1.

FC NRT/RX PROCESS FLOW FOR VISN 4 2. 3. 4. Veteran Enrolls Coach performs assessment, collects health conditions, screens for use exclusions etc. and works with veteran to determine most appropriate course of medication to use. This may include Patch, Gum, Lozenge, Bupropion or Chantix (Chantix screening done for Pittsburgh only at this time), or combo therapy. Coach enters medication information in FC systems The following morning (M-F) a report with all veterans, by facility, indicating medication preference is printed.

Pharmacy Process FC staff enter NRT/RX orders directly into CPRS for the appropriate fulfilling pharmacy. Pharmacist determines if medication should be filled based on veterans full health history. Medications are then filled and/or mail ordered to the veteran. Pharmacy does have the option to override FC coach recommendations based on access to the full health history of the veteran. 17 Pharmacy Role in National TLC

Part of expanded TLC team Support provision of services via TLC Nicotine replacement therapy Coaches will screen for NRT Send recommendations back to PACT team PACT will review and request appropriate/available medications VETERANS HEALTH ADMINISTRATION 18 Screening Questions

Quit date or planned quit date Tobacco type Tobacco per day Time from waking to first cigarette Current quit medications Heart attack within last 2 weeks Rapid/irregular heartbeat within past 2 weeks Serious or worsening angina in last 2 weeks

Dental problems or jaw pain Severe skin irritation to patch medication VETERANS HEALTH ADMINISTRATION 19 Pilot Details Facility Collaboration: HPDP Program Manager HBC PACT MOVE! PMRS VHEC Voluntary Services VETERANS HEALTH ADMINISTRATION

Nutrition and Food Service Pharmacy Smoking Cessation Lead Clinician Clinical Applications Coordinator PAO Others. 20 Pilot Details VISN Collaboration HPDP Lead PAO Network Director Chief Medical Officer

Others.. VETERANS HEALTH ADMINISTRATION National Collaboration Veterans Crisis Line NCP Alere Wellbeing HSR&D OPH Others.. 21 Timeline Now Implementation Planning Late Fall 2011 Launch

Early-mid November Remainder of FY 2012-13 Participation and Evaluation VETERANS HEALTH ADMINISTRATION 22 Thank you! Sophia P. Hurley, MSPT [email protected] 3022 Croasdaile Drive, Suite 200 Durham, NC 27705 (919) 383-7874 x 225 VETERANS HEALTH ADMINISTRATION 23

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