Dissemination of the Cardiovascular Risk Service

Cardiovascular disease (CVD) causes 2,200 deaths in Americans every day with one death every
39 seconds. Yet effective implementation of research-based interventions that reduce
CVD-related illness and death remains a substantial challenge. The objective of this study is
to test the scalability of a pharmacist-led, remote CVD risk and prevention services model in
large, organizationally and culturally diverse hospitals and health-systems, many with high
proportions of minority and underserved patients, using a pragmatic cluster-randomized
design. This service is called the Cardiovascular Risk Service (CVRS). There are limited data
on the barriers and facilitators of implementation to enhance the CVRS in these types of
diverse, complex health-systems. Therefore, scaling up our effective, innovative team-based
intervention will require an assessment of barriers and facilitators to CVRS adoption,
implementation, and maintenance. Our central hypothesis is that barriers and facilitators to
CVRS implementation will vary across diverse primary care offices. We will use mixed methods
including interviews, observations, and an innovative physician-pharmacist collaboration
survey we developed to predict implementation of pharmacy-based services. The rationale for
this proposed study is that overcoming barriers to implementation of a novel strategy to
improve secondary prevention of CVD will lead to innovative strategies for broader adoption
by health systems throughout the US.

Inclusion Criteria:

- Clinical Staff Subjects:

- Must be a current clinic or pharmacy service employee who works as a provider,
pharmacist, nurse, clerk or administrator

- Patient Subjects:

- English or Spanish speaking

- Seen in the clinic at least once in the previous 12 months

- Currently has one of the following diseases:

1. Diabetes with HA1c 9.0% or greater and/or

2. Hypertension (uncomplicated) with systolic blood pressure 150 mm Hg or
greater

- Informal Caregiver Subjects:

- Person identified by the patient subject who assists the patient subject with
activities of daily living or other aspects of the patient subject's healthcare

Exclusion Criteria:

- Study wide exclusions:

- Inability to give consent

- Nursing home residence

- No telephone

- Additional patient subject exclusions:

- Cancer with a life expectancy less than 24 months

- Pregnancy

- Diagnosis of dementia

- Plans to terminate care from the clinic within 24 months