Yulong Gu National Institute for Health Innovation University of Auckland (Friday, 10.05am, Opus International Room)

1. The Caring Does Matter (CDM) Initiative:
To Improve Cardiovascular Medication
Adherence in Pacific People
Jim Warren, Yulong Gu (Helen), John Kennelly
The National Institute
for Health Innovation

2. Why the interest?
• Burning platform
– Increased rates of chronic illness
– Ageing population
– Cost / workforce / delivery meltdown!
– Even if we were satisfied with current quality
of health delivery, it’s not sustainable
• Long-term conditions as the target
• Lots of data
– Computerisation naturally lays down data, which
can be used to improve patient management

3. Chronic conditions, esp. anything
‘vascular’
• Amenable (and interesting) for analysis of
long sequences in transactional electronic
health records (EHRs)
• E.g. blood pressure (BP) is a huge risk factor
– CVD risk doubles for every 20/10 mm Hg
• Also implicated in kidney failure
– Very controllable with medication
– Several classes of medication with different side-
effects and benefits/indications (makes it
interesting!)
• Statins/cholesterol and blood sugar control
also very relevant

4. CDM Initiative
• A feasibility study
– Structured care, based on West Fono program
• To identify and intervene on suboptimal
management of CVR
– Medication adherence gaps - MPR

5. How to identify intervention targets?
• Demographics
• CVR scores
• Prescriptions

6. Pacific adults (20+) grouped into 4:
 having high CVR risk (>=10%) and low
MPR (<80%)
 having no CVR screening recorded in
the last five years and aged 35 or over
 having high CVR risk (>=10%) but
MPR OK (>=80%)
 having low CVR risk (<10%) or having
no CVR screening recorded in the last
five years but being younger than 35

7. Group 1 Patient List example
Pt Age Gen- Eth- Anti- Oral Last CVR
ID der nicity hypertensives Cholesterol Diabetes screening CVR
medications date
1 64 M Tongan None <80% None 30-Sep-11 99
2 60 F Samoan OK OK <80% 13-Mar-12 99
3 51 M Samoan None <80% None 6-Sep-11 99
Other
4 81 M OK None <80% 11-Nov-11 30
Pacific
5 63 M Samoan <80% Recent start None 19-Oct-11 22
6 62 M Samoan <80% None None 14-Apr-12 22
7 65 M Samoan <80% <80% <80% 10-Jan-12 21
8 63 M Samoan <80% <80% <80% 17-Jul-11 18
9 58 F Samoan <80% None None 16-May-12 16
10 63 M Fijian None None None 22-Jul-09 15
…

8. 9,128 Pacific adults in 10 clinics
Clinics Practice Pacific patient Pacific patient Pacific patient
ID patient population # (% in total population population
population # practice population) 20+ # 35+ #
A 6884 5144 (75%) 3060 2001
B 12984 1872 (14%) 1038 627
C 5696 1634 (29%) 934 600
D 11939 1481 (12%) 764 470
E 4794 1355 (28%) 726 471
F 5863 1316 (22%) 702 438
G 13112 1114 (8%) 610 384
H 1564 1103 (71%) 669 429
I 4875 583 (12%) 331 194
J 9633 534 (16%) 294 171
Total: 77344 16136 (21%) 9128 5785

9. 1,021 with high CVR & low MPR
Practice High CVR & low MPR # (% No CVR & 35+ # (% in
ID in Pacific 20+ at the clinics) Pacific 35+)
A 522 (17%) 855 (43%)
B 67 (6%) 370 (59%)
C 91 (10%) 297 (50%)
D 58 (8%) 293 (62%)
E 61 (8%) 207 (44%)
F 50 (7%) 272 (62%)
G 55 (9%) 195 (51%)
H 71 (11%) 157 (37%)
I 29 (9%) 51 (26%)
J 17 (6%) 115 (67%)
Total: 1021 (11%) 2812 (49%)

10. CVR profile of Group 1
99
45-49 14%
40-44 0%
35-39 0%
3%
30-34
1%
25-29 10-14
4% 43%
20-24
10%
15-19
25%

11. Physiological profile of Group 1
Measurements Mean Standard Pt # (%)
deviation measured in
last five years
BP Last systolic BP 133.1 17.69 534 (52%)
Average of last three systolic
133.6 15.54 464
BP results (45%)
Last diastolic BP 82.3 11.84 533 (52%)
Average of last three diastolic
82.1 10.28 462
BP results (45%)
HbA1c Last HbA1c in DCCT-aligned 188 (18%)
7.1 2.03
(%)
Last HbA1c in IFCC- 78 (8%)
63.6 26.24
standardised (mmol/mol)
Last Total-to-HDL cholesterol ratio 4.94 1.02 218 (21%)
Last BMI 33.6 6.60 400 (39%)

12. 66% 35+ in Group 1 & 2

13. Feedback from participating clinicians
 Enthusiasm for studies addressing the
needs of PI wrt BP management
 Acceptance of structured care models
 Understanding PI
 Lack of resources and capacity
– CDM nurse
– Minimize disruption to existing services

14. Conclusions – so far
• Not a RCT
• Feasibility study
• A lot of data is already there
– It can reveal opportunities for
process improvement
• Going to scale with CDM
– Opportunities and challenges

15. Acknowledgements
• The Caring Does Matter Initiative is funded by
the Ministry of Health’s Pacific Grant Fund.
• We would also like to thank the West Fono
management and staff, esp. Mr. Tevita Funaki
Mr. Anthony Tuitahi, and Ms Tai Boyce for
supporting the program.
• We extend our thanks to the staff of
participating general practices for
accommodating the study.
Further info: h.gu@auckland.ac.nz