Using Community Health Workers to Reduce the Risk of Heart Disease

With growing evidence that the use of community health workers (CHWs) can increase access to care, improve patient outcomes, and reduce healthcare costs, CHWs are being progressively recognized as essential members of the modern healthcare team. A powerful force for bridging the gap between primary care practices and communities, CHWs can provide a variety of services from promoting healthy behavior to helping patients navigate the complicated health care system. Because of all this, it becomes increasingly important to engage CHWs in rural areas where disease rates are high.

Realizing the potential CHWs have for improving disease outcomes in high-risk populations, researchers from the UNC Center for Health Promotion and Disease Prevention (HPDP) are currently testing an innovative program called the Carolina Heart Alliance Networking for Greater Equity (CHANGE) project. Sponsored by the CDC, the CHANGE project aims to reduce the risk of cardiovascular disease in rural and medically underserved communities through the use of CHWs.

The CHANGE research team is led by Dr. Samuel Cykert, a Professor of Medicine at UNC Chapel Hill in the Division of General Internal Medicine and Clinical Epidemiology. Dr. Cykert brings extensive experience in addressing health disparities and chronic care management to the team. Additionally, he is a strong proponent of engaging CHWs in patient centered care.

[box] “CHWs are great providers of peer support, outreach, teaching and reengagement. They represent a way to engage and teach so that patients and other community members understand health and chronic illness better.” [/box]

For this project, which began in 2014, Dr. Cykert and his team have partnered with both Roanoke Chowan Community Health Center and Hertford Public Health Authority to test their approach in Herford County, NC. After about a year of developing the plan, the team employed two community health workers to help identify and recruit individuals with uncontrolled cardiac risk factors and help them work on diet, exercise, tobacco cessation and medication adherence. The program also encourages family members or neighbors to join the teaching sessions so they can engage in primary prevention for themselves and form a social network to support the index patient. Additionally, the CHANGE research team uniquely uses electronic tablets to assist and support the CHWs, connect CHWs to the clinic, and gather program data.

While the project still has a long way to go, it’s been quite successful so far, with approximately 120 enrollees to date. In the first intervention group, 15 of the 18 patients with uncontrolled hypertension got it under control and 18 of the 36 overweight patients lost weight. Additionally, through screening for hypertension, the group has so far identified seven cases of untreated patients who are now all controlled. Seeing this success, Dr. Cykert hopes that one day this program can be expanded to other communities.

“If you could disseminate this to other underserved rural communities, these type of results would lead to an enormous reduction in cardiovascular events and a significant slowing of the diabetes epidemic,” he says.

As the research team at HPDP and others across the state work hard to gather more evidence to support the work of CHWs, it also becomes important for them to collaborate with others. In an effort to do just that, the Community Health Worker Summit was held just a few weeks ago in Greensboro, NC. The overall purpose of the event was to summarize findings of a group working to establish CHW workforce and come up with best use cases. Additionally, attendees of the meeting shared findings and engaged stakeholders among health systems, payers and other interested parties. This type of collaboration is what will hopefully lead to increased recognition and integration of CHWs into healthcare teams.

For more information about the CHANGE project, click here.