DEMOGRAPHIC CHARACTERISTICS, BLOOD PRESSURE CONTROL, AND OTHER CARDIOVASCULAR RISK FACTORS IN FEDERALLY QUALIFIED HEALTH CARE CENTER PATIENTS WITH DIABETES: A BASELINE ANALYSIS OF THE OFFICE-GAP IMPACT (OFFICE-GUIDELINES APPLIED TO PRACTICE IMPROVING DIABETIC PATIENTS' ADHERENCE TO TREATMENT AND PREVENTION OF CARDIOVASCULAR DISEASE) PROGRAM

Document Type

Conference Proceeding

Publication Date

6-27-2024

Publication Title

J Gen Intern Med

Keywords

hemoglobin A1c, adult, blood pressure, blood pressure regulation, cardiovascular disease, cardiovascular risk, cardiovascular risk factor, Caucasian, clinical practice guideline, conference abstract, current smoker, demographics, depression, diabetes mellitus, diabetic patient, diastolic blood pressure, drug therapy, female, glucose blood level, glycemic control, health center, Hispanic, human, hyperlipidemia, hypertension, major clinical study, male, medication compliance, Michigan, patient compliance, practice guideline, prevalence, prevention, probability, risk factor, shared decision making, text messaging

Abstract

BACKGROUND: Mortality from cardiovascular disease (CVD) is higher in people with diabetes mellitus compared to non-diabetic due to the increased prevalence of CVD risk factors. Diabetes and Hypertension control is low particularly in patients receiving care from Federally qualified health centers (FQHCs). Interventions seeking to increase patient and provider communication and partnerships and increase medication adherence should improve risk factors control and decrease cardiovascular risk. The Office-Gap IMPACT study (Office-Guidelines Applied to Practice Improving Diabetic Patients' Adherence to Treatment and Prevention of Cardiovascular Disease) is a patient activation intervention seeking to improve communication and patient-provider partnerships through brief patient and provider training in shared decision-making, and use of a guideline-based checklist to improve medication adherence. METHODS: This study aimed to describe individual level demographic and clinical characteristics of patients enrolled in the Office- GAP IMPACT study, assess the associations between these characteristics and baseline blood pressure level and glycemic level and assess the differences in blood pressure and glycemic control in three different counties in Michigan. Two hundred and sixty-one patients enrolled in seventeen clinical teams in 12 FQHCs located in Alcona, Ingham, and Saginaw counties in Michigan were randomized into one of two experimental groups with equal probability: intervention (group 1): Office-Gap + Texting vs. control (group 2): Texting only. Demographic data obtained at baseline was analyzed. RESULTS: Of 261 patients, the presence of Cardiovascular risk factors, including Hyperlipidemia (70%) and hypertension (69%) was high. Only 9% had a BMI <25, 23% were current smokers and 45% participants reported depression. The mean HbA1c was 9.9 ± 1.6 with majority of participants having HbA1c (65%) greater than 9. The mean systolic and diastolic blood pressures were 136.8 ± 18.9 mmHg and 81.1 ± 11.2 mmHg. Only 26% had blood pressure under 130/80 mmHg and 56% had blood pressure under 140/90 mmHg. The white, black and Hispanic racial makeup of the three counties was found to 76%, 19%, 9% in Saginaw; 75%, 13%, 8% in Ingham; and 96%, 0.8% and 2 % in Alcona. CONCLUSIONS: Patients with diabetes who are receiving medical care at FQHC's are not a homogeneous group but instead represent a diversity of demographic categories. We found the prevalence of depression to be much higher than reported in previous studies of patients with diabetes. The high prevalence of CVD risk factors and the low rate of BP control in this diabetic population is a huge concern.

Volume

39

First Page

S771

Last Page

S772

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