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The Canadian Hypertension Education Program (CHEP)

Putting Evidence Into Practice

Norm Campbell, MD

Disclosure Statement of Financial Interest

I,  Norm  Campbell  DO  NOT  have  a  financial  interest/arrangement  or  affilia<on  with  any  healthcare  related  companies  that  could  be  perceived  as  a  real  or  apparent  conflict  of  interest  in  the  context  of  the  subject  of  this  presenta<on.  

Objec&ves  •  Discuss  the  Canadian  Hypertension  Educa&on  Program  approach  and  impact  to  date.  

•  Review  the  evolu&on  of  the  Canadian  effort  and  future  plans.  

The  Canadian  Effort  to    Prevent  and  Control  Hypertension.  

   Can  Other  Countries  adopt  Canadian  Strategies?    

Current Opinion in Cardiology 2010:25:366-372.

Improvement in key clinical indicators of hypertension management in Canada

* As presented at the Canadian Cardiovascular Congress Oct 2007 CHHS 1985-1992 CHMS 2012/13

Lifestyle  Changes  AGer  Hypertension  Diagnosis  

.

0

20

40

60

80

Smoking BMI 25+ Inactive Alcohol 9+

Per

cen

t

Age Standardized Rates of Lifestyle Change After a Hypertension Diagnosis

A B

-1.6%

+1.4% -2.4%

-0.1%

Can J Cardiol 2008;24;3:199-204.

A  is  pre  diagnosis  and  B  is  up  to  2  years  post  diagnosis  Source  NPHS  (1994-­‐2002):    

Canadian Hypertension Education Program (CHEP) Concept Development

1990s

Discussions on how to improve blood pressure control

2000

CHEP established - Knowledge dissemination program - Rigorous annually updated program

2003 Formal outcomes program added

Hypertension Canada

Outcomes Research

Task Force

Evidence-Based Recommendations

Task Force

Implementation Task Force

Public policy Oversight for National HypertensionStrategy

HSFC CIHR Chair in Hypertension Prevention and Control

Steering committee- now operations committee

CHEP Recommendations Task Force

Convince Canadians and especially Canadian health care professionals that

The Recommendations Development Process is Designed to

the recommendations are the right ones for Canadians

The Canadian Hypertension Education Program: Key Messages

Know Current BP

Encourage Home BP monitoring

Assess and Manage CV

Risk

Sustainable Lifestyle

Modification Treat to Target

 CHEP:  Diagnos&c  Algorithm

CHEP:  IMPLEMENTATION  

Can  J  Cardiol  2006;22:595-­‐98

Implementa&on  requires  strong  partnerships  of  commiUed  people  and  organiza&ons

CHEP Implementation: Engage Stakeholders

Engage

Patients and the Public

ALL Health Care Professionals

Active Participation

Individuals directly involved in the management of

hypertension

Individuals who oversee the health

care system

Implementation: Key Steps

•  Patient educational materials that suit them •  Keep it new and interesting •  Remove identified barriers to access

resources

Develop Resources

•  Harmonize hypertension recommendations Agreement Among

National Organizations

•  Including training schools

Establish networks of health care professional

organizations

ü  For health care professionals

ü  For patients

www.hypertension.ca

Implementation: Access and Dissemination

ü  For health care professionals ü  For health care professional

organizations

www.whleague.org

Implementation: Access and Dissemination

Have hypertension management and outcomes changed in Canada since

CHEP? ü Improvements in awareness ü Improvements in treatment ü Changes mirror CHEP recommendations ü Increasing intensity of therapy over time ü Improvements in BP control ü Improvements in outcomes

Changes in Stroke, Heart failure (chf) and Acute Myocardial Infarction (ami) after CHEP starts in 1999

-1.9 %

-4.8%

-0.5%

-4.8%

-3.7%

-5.8%

CVD rate in Canada (per 100,000)

10001100120013001400150016001700180019002000210022002300240025002600

year

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Antihypertensive Drug Prescription rate in Canada

CHEP  starts  

CHEP  starts  

Summary-Discussion •  CHEP was designed to be a model that could be

expanded to CVD risk and or to other substantive chronic non communicable diseases /risks.

•  Aspects of the CHEP program can be used in other countries with adoption to local context (Yaroslavl Russia, Iran etc.)

New programs and directions

•  Internet based education programs •  Mobile device app •  Pharmacy based htn care •  Automated CV risk assessment •  Core curriculum videos