the national telephone lifestyle coaching pilot - overview sophia p. hurley, mspt project manager,...

The National Telephone Lifestyle Coaching Pilot - Overview

Sophia P. Hurley, MSPTProject Manager, National Telephone Lifestyle Coaching PilotMOVE! Physical Activity Program Coordinator

October 2011

VETERANS HEALTH ADMINISTRATION

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-face-to-face care

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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

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• 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

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• 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

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National TLC Details

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• Part of Transformational Initiatives, Preventive Care Program

• Telephone Lifestyle Coaching • Supplement Primary Care and PACT• Enhance and support

health coaching already available in VHA


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

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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

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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

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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

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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

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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

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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

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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

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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

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VETERANS HEALTH ADMINISTRATION 16

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Referral to TLC Program

Via Consult

Pharmacy Process1. FC staff enter NRT/RX orders directly into CPRS for the

appropriate fulfilling pharmacy.2. Pharmacist determines if medication should be filled based

on veterans full health history.3. Medications are then filled and/or mail ordered to the

veteran. 4. Pharmacy does have the option to override FC coach

recommendations based on access to the full health history of the veteran.

Veteran Declines

Note made to CPRS, consult closed

Veteran Unreachable

Note made to CPRS, consult closed

1. Veteran consult is submitted to FC2. 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 Enrolls1. Coach performs assessment, collects health conditions,

screens for use exclusions etc. and works with veteran to determine most appropriate course of medication to use.

2. This may include Patch, Gum, Lozenge, Bupropion or Chantix (Chantix screening done for Pittsburgh only at this time), or combo therapy.

3. Coach enters medication information in FC systems 4. The following morning (M-F) a report with all veterans, by

facility, indicating medication preference is printed.

FC NRT/RX PROCESS FLOW

FOR VISN 4


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

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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

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Pilot Details

• Facility Collaboration:– HPDP Program Manager– HBC – PACT– MOVE!– PMRS– VHEC– Voluntary Services

– Nutrition and Food Service

– Pharmacy– Smoking Cessation Lead

Clinician – Clinical Applications

Coordinator– PAO– Others….

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Pilot Details

• VISN Collaboration– HPDP Lead– PAO– Network Director– Chief Medical

Officer– Others…..

• National Collaboration– Veterans Crisis Line– NCP– Alere Wellbeing– HSR&D– OPH– Others…..

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Timeline

• Now– Implementation Planning

• Late Fall 2011– Launch

• Early-mid November

• Remainder of FY 2012-13 – Participation and Evaluation

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Thank you!

Sophia P. Hurley, [email protected]

3022 Croasdaile Drive, Suite 200Durham, NC 27705

(919) 383-7874 x 225www.prevention.va.gov

www.move.va.gov

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mailto:[email protected]

http://www.prevention.va.gov/

http://www.move.va.gov/

the national telephone lifestyle coaching pilot - overview sophia p. hurley, mspt project manager,...

Documents

health care

health history

support health coaching

vha slide

tlc program

veteran consult

tlc services veteran

telephone coaching