Editor’s note:  Health centers are in a unique position to address health disparities, as providers in this healthcare setting primarily serve historically medically underserved communities and other special populations. These groups are typically at a higher risk for lifestyle-related chronic disease. ACLM’s multi-million-dollar investment in our National Training Initiative (NTI) and other projects that engage, support, and equip health center clinicians is a reflection of our vested effort to advance health equity.

We were proud to kick off NTI earlier this year and award 112 health center primary care providers that include physicians, nurse practitioners, and physician associates representing 37 states with scholarships to support training and certification in lifestyle medicine. Dr. Christen Johnson, a NTI scholar based in Columbus, Ohio, practices at Heart of Ohio Family Health Centers. She assembled an interdisciplinary team at her health center, which now offers lifestyle medicine interventions to patients living with or at risk for diabetes and other chronic diseases. In honor of the recent National Health Center Week, we present Dr. Johnson’s implementation model and explore the results that have been documented along the way.

It takes a village

Heart of Ohio Family Health Centers in Columbus, Ohio has impacted the lives of hundreds of patients through our comprehensive lifestyle medicine program.  These efforts started with a multidisciplinary team. While I serve as the physician on the team, the group also includes a dietitian, Abby Gerbers, RDN, LD, and a pharmacist, Anna Staudt, PharmD, RPh, who wanted to make a difference in patient outcomes surrounding hypertension.

The Heart on Hypertension Program

The Heart on Hypertension Program is a 12-week intensive program that focused on improving patient health literacy, motivational interviewing, goal-setting, and lifestyle changes.² The program is completely telehealth based to ensure barriers to access to care like transportation do not impact patients’ ability to participate. The timing of the sessions was also planned to accommodate those who may only be able to attend if the class falls on a break like the lunch hour as well as a session in the evening hours. Additionally, patients have opportunities to explore new types of exercise through virtual resources that are available to them at no-cost.

The initial pilot of the program showed to be successful, with 93% of patients achieving their goal of controlling their hypertension after completing at least eight of the 12 virtual sessions.²   Some 86% of these patients were able to maintain control of their blood pressure for at least 12 months after their sessions ended.² Patients also noted the positive impact the program had on their lives and even their family members.³ With the success of the Heart on Hypertension program, the team grew to include another pharmacist, Janessa Cohrs, PharmD, RPh, and decided to also take on diabetes with the Stop the Sugar Program. This program has also been successful in assisting patients and improving their A1c.

Lessons learned for improved success

After each cohort of patients began, similar barriers were found to prevent patients from completing the program. In the 12-week timeframe, some patients would have job changes or life events that would impact their ability to complete the program. Patients who did not complete at least eight of the 12 sessions had greater challenges in attaining control of their chronic diseases even when they continued to learn the same material in the individual setting.² Patients who needed to postpone their participation in the program noted frustration achieving or maintaining success due to the changes in consistency and group support. The programs were also limited to patients who spoke English, as interpreting services were unable to interpret for multiple languages during the sessions. This was a very large concern for the growing number of patients from many diverse backgrounds who were interested in participating in the program.

To overcome these challenges, the organization has recently piloted a general lifestyle medicine program that patients are able to enroll in. This program is a comprehensive lifestyle medicine program where patients meet with a clinician trained in lifestyle medicine for an evaluation. A care plan is then created using evidence- based recommendations that are completely customized around the patient’s personal goals, lifestyle, culture, and potential barriers that patients disclose.  These customizations also allow for plans to capture multiple chronic diseases at the same time, including hypertension, diabetes, hyperlipidemia, obesity, and more while remaining relevant to the patient’s culture and honoring personal identity. Through close follow up, intensive work with team members, and connection to community resources, this individualized approach to culturally relevant interventions has been successful in assisting over 50 patients in improving their health by achieving goals and adopting lifestyle changes that don’t ask them to conform to any culture other than their own.

While we know that the challenges to overcoming health disparities are great, this goes to show us the promise of using lifestyle medicine to achieve health equity is greater.

References:

1. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html
2. https://www.sciencedirect.com/science/article/abs/pii/S0027968423001530?via%3Dihub
3. https://www.heartofohiofamilyhealth.org/post/rosalind-glenn-a-path-to-better-health