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Service Delivery Innovation Profile

With Support From Web-Based Tools, Pharmacists Help Individuals Adopt Healthier Behaviors, Reduce Cardiovascular Risk


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Snapshot

Summary

Under a program known as HealthyHeartClub.com, pharmacists work with individuals with or at risk for heart disease, educating them on ways to reduce cardiovascular risk and helping them set and reach goals related to health outcomes and health-related behaviors, including diet, physical activity, and medication adherence. Designed to support primary care providers' work with patients, the program consists of pharmacists conducting an initial inperson consultation, weekly check-ins via e-mail, and monthly group classes, supported by a patient-friendly Web site that provides easy-to-understand information and tools to track progress toward established goals. Although comprehensive results from a formal evaluation will not be available until 2012, representative case reports suggest the program has increased participants' levels of physical activity, which, in turn, has helped them lose weight and lower systolic blood pressure.

Evidence Rating (What is this?)

Suggestive: The evidence consists of average changes in key metrics in 5 representative participants who have been in the program for roughly 3 months; metrics include steps per day, weight, and systolic blood pressure.
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Developing Organizations

CreativePharmacist.com
Evans, GAend do

Use By Other Organizations


Date First Implemented

2010
Eight pharmacies initiated a pilot test in October 2010; the program expanded to other pharmacies in early 2011.

Problem Addressed

Many patients with or at risk for chronic illness, including cardiovascular disease, do not routinely engage in health-promoting behaviors, such as consistently taking medications as prescribed, eating properly, getting enough physical activity, and refraining from smoking. Unhealthy behaviors often lead to negative outcomes (including premature death) and high costs. Pharmacists represent an effective but underutilized resource in helping individuals adopt healthier behaviors.
  • Failure to adopt health-promoting behaviors: Many Americans with or at risk for chronic illnesses do not regularly take their medications, eat healthfully,1 or engage in physical activity. For example, only about half of patients take their medications as prescribed.2
  • Leading to negative health outcomes, high costs: Smoking, physical inactivity, poor diet, and problem drinking can lead to or exacerbate a variety of chronic diseases and acute health episodes, including cardiovascular disease. Collectively, these behaviors account for approximately 37 percent of deaths (and 70 percent of preventable deaths) in the United States.3 They also drive up health care costs. For example, lack of medication adherence alone costs almost $300 billion a year.2
  • Unrealized potential of pharmacists: Pharmacists are ideally positioned to assist physicians in promoting healthy behaviors, particularly taking medications appropriately but also eating a proper diet, getting adequate levels of physical activity, and refraining from smoking. Pharmacists’ frequent interactions with patients provide the opportunity to reinforce messages from physicians and support patients in setting and achieving health-related goals. At present, however, relatively few pharmacists play this role.

What They Did

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Description of the Innovative Activity

Pharmacists work with individuals with or at risk for heart disease, educating them on ways to reduce cardiovascular risk and helping them set and reach goals related to health outcomes and health-related behaviors, including diet, physical activity, and medication adherence. Designed to support primary care physicians' work with patients, the program consists of an initial inperson consultation, weekly check-ins via e-mail, and monthly group classes, supported by a patient-friendly Web site that provides easy-to-understand information and tools to track progress toward established goals. Key program elements are described below:
  • Instore marketing: Potential members learn about the program through signs posted throughout participating pharmacies. Pharmacists also proactively approach individuals who might benefit, including those taking certain medications or buying particular products, such as a blood pressure machine. In conversations with prospective members, pharmacists emphasize the program’s ability to support the individual and his/her doctor in setting and meeting health-related goals, such as reducing blood pressure or cholesterol levels. Pharmacists often invite those interested to attend one of the monthly group sessions (see bullet below) to learn more about the program.
  • Signup with individual pharmacist: Those interested can sign up for the program in the pharmacy, at the monthly meeting, or through the online system (see below for more details). Enrollees sign up to work with an individual pharmacist within a participating store, with all future interactions being with that pharmacist.
  • Monthly fee to create accountability: In most participating pharmacies, members pay between $20 and $30 a month for program services. Some employers or insurers may share in this cost in the future, with enrollees still paying something so as to create accountability for behavior change.
  • Initial face-to-face visit: After enrollment, the pharmacist and enrollee meet in person for approximately 15 to 20 minutes. During this session, they jointly agree on a few achievable goals related to the enrollee's health, such as reducing blood pressure along with associated behavior-related goals, such as eating more healthfully, quitting smoking, and exercising more frequently. The pharmacist also measures height and weight to calculate body mass index (BMI) and gives the enrollee a laboratory request form for the doctor’s office to complete. The form asks for the individual’s most recent blood pressure and cholesterol levels, smoking status, and medications.
  • Ongoing tracking and education via Web site: A user-friendly Web site facilitates ongoing tracking and education of enrollees, including communication between the pharmacist and enrollee. Key functions include the following:
    • Initial and weekly tracking: The enrollee or pharmacist enters the initial baseline information from the face-to-face visit and laboratory request form into the system. (The site includes a brief video orienting new members to the site and how to enter this information.) Enrollees periodically log on to update information that has changed, ideally on a weekly basis. Those who do not log in each week receive an automated reminder from the system. Pharmacists will proactively reach out via telephone to members who do not log in for several weeks.
    • Individualized education and support: At each login, the enrollee sees a note from his or her pharmacist (e.g., reminders to engage in physical activity), along with a list of personal health goals and key health indicators. This section displays the most recent information on blood pressure, cholesterol, BMI, weight, average number of steps taken each day, and whether the individual has been taking medications as prescribed and has met goals for exercise and physical activity for the week. At the bottom of the login page, enrollees can access easy-to-understand graphs that plot trends in each indicator, thus highlighting progress or potential problem areas. The top of every page displays the individual’s current 10-year risk of a heart attack, based on the American Heart Association heart attack risk calculator tool.
    • Practical tips to promote healthy living: A separate section of the site includes practical tips related to healthy eating and physical activity, including a recipe and physical activity of the week; a "meal mixer" function that provides customized recipes (including diabetic-friendly and gluten-free meals) based on food available in the house; 3-day-a-week workout routines; and brief blogs and articles on related topics, such as how to meet dietary guidelines. A resources section provides access to downloadable tools to support individuals in reaching their goals, such as blood sugar and blood pressure logbooks, the laboratory request form, a medicine list form, and customized nutrition facts.
    • Opportunity to ask questions: The enrollee can ask his or her pharmacist a question through the Web site, such as whether to start taking fish oil or daily aspirin. The pharmacist reviews and replies to these e-mail questions in a timely manner.
  • Additional tools to support members: Some participating pharmacies provide members with a pedometer, blood pressure monitor, and/or other resources to support them in meeting goals. For example, during the pilot study, Cardinal Health (a pharmacy wholesaler that partnered with the program developer) provided the eight participating pharmacies with pedometers for distribution to members. Some of these pharmacies created a kit that included not only the pedometer, but also a blood pressure monitor, exercise bands, “healthy” calendars, and a step-by-step guide to improving health-related behaviors.
  • Regular pharmacist review and weekly check-in: The pharmacist receives a notification every time a member logs in and updates his or her information. The pharmacist reviews this information for every member, typically during natural downtime in his or her day. The pharmacist pays attention to the individual's progress versus established goals and then sends out one of several prepopulated but customizable e-mails intended to create accountability for changing behavior and achieving established goals. The content of the e-mail varies according to how members are faring, as outlined below:
    • For those meeting goals: This e-mail offers positive reinforcement and encouragement, and reminds the member to attend the upcoming monthly class and to check-in again next week. For example, this e-mail might read as follows: "I have recently reviewed your information and am excited to see progress toward your health goals! I encourage you to continue working toward your goals each day.
 Here are the top three goals that I have listed for you: lose 40 pounds at a rate of 1 to 2 pounds per week, quit smoking, and reduce blood pressure to a goal rate of 130/80 mm Hg. Don't be discouraged if you don't meet all your goals all of the time. . . . you are doing a great job so far. Be sure to print your records and a lab request form before each doctor's visit and enter the information under the 'My Health' section on the HealthyHeartClub.com site. Remember, we are here to assist you in any way possible. Please feel free to contact me through the site or at the pharmacy if I can offer assistance in any way. 
Also, don't forget to attend our next Healthy Heart Club class the 4th Wednesday of each month. You won't want to miss this month's meeting. Keep up the great work." 

    • For those not meeting goals: The text of this e-mail will be quite similar to the one outlined above, although it briefly acknowledges that the individual did not meet all of his/her goals for the week and provides encouragement in a positive manner to keep working toward meeting the goals.
  • Monthly group classes: Each month, participating pharmacists host hour-long group classes that provide practical advice on various topics related to reducing cardiovascular risk, such as eating healthfully (e.g., how to adhere to a low-sodium diet) and getting more exercise. Held either in the pharmacy or somewhere in the community, these sessions include roughly 15 minutes of “open-air” time in which attendees get to know one another, 30 minutes of scripted presentation (using patient-friendly visuals and messages that resonate with patients), and 15 minutes of question-and-answer time with the pharmacist.
  • Coordination and communication with primary care physicians: Pharmacists communicate regularly with primary care physicians about the program, primarily through written materials provided to members. These communications emphasize the program as a way to support the physicians in their work with patients, as outlined below:
    • Welcome letter and laboratory request form: Each new member receives a letter from the pharmacist to be given to his/her primary care physician. This letter informs the doctor that the patient has enrolled and emphasizes the program’s ability to support the doctor in promoting healthier patient behaviors and better outcomes. The laboratory request form includes similar language.
    • Patient progress report: The Web site allows the member to print a document that charts progress toward all goals in a graphical format. The member brings this document to every office visit, making it easy for physicians to gauge progress, provide encouragement and support, and identify and address problem areas.

Context of the Innovation

CreativePharmacist.com is a privately held, independent company that developed and launched the HealthyHeartClub.com program. David Pope, PharmD, a pharmacist at Barney’s Pharmacy in Augusta, GA, founded and co-owns the company (along with Barry Bryant, RPh, owner of Barney’s Pharmacy, and Web-developer Daniel Lawson), which focuses on using pharmacists to create greater accountability among patients for their health and health-related behaviors. They felt that pharmacists represented an effective, available, but largely untapped opportunity for supporting patients in this manner, and that pharmacists would be attracted to the concept as a way to bring in new customers, create greater loyalty, and boost sales among existing patrons. The company’s first program focused primarily on diabetes education. Based on its success, Dr. Pope decided to broaden the focus to overall wellness, with an emphasis on reducing cardiovascular risks. To that end, he launched HealthyHeartClub.com and then partnered with Cardinal Health (a pharmacy wholesaler) to conduct a pilot test in eight independent pharmacies.

Did It Work?

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Results

Although more comprehensive results from a formal study will not be available until 2012, representative case reports suggest the program has increased participants' levels of physical activity, which, in turn, has helped them lose weight and lower systolic blood pressure.
  • More physical activity: In a group of 5 representative members who have been in the program for approximately 3 months, the average number of steps taken per day has more than quadrupled since enrollment, from less than 2,000 to roughly 8,000.
  • Weight loss: Among the same 5 members, average weight loss has been 12 pounds.
  • Lower blood pressure: The 5 participants have, on average, reduced their systolic blood pressure by 4 mm Hg during their time in the program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of average changes in key metrics in 5 representative participants who have been in the program for roughly 3 months; metrics include steps per day, weight, and systolic blood pressure.

How They Did It

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Planning and Development Process

Key steps included the following:
  • Developing Web site, related materials: A team of health care professionals, including pharmacists, nurse educators, information technology specialists, and others, developed the Web site and associated educational tools and resources. The team focused on creating a user-friendly, easy-to-navigate site that offers educational content for the lay individual, including liberal use of visuals and language that resonates with the consumer. All content goes through peer review before being released to the site.
  • Training pharmacists: Most pharmacists with doctorate degrees know how to work with patients on disease management issues. To support them in this work, Cardinal Health created a 2-day continuing education program for participating pharmacists that focuses on how they can have a positive impact in working with members to reduce cardiovascular risk.
  • Introducing program to area doctors: In addition to the ongoing interactions with primary care physicians outlined earlier, participating pharmacists typically discuss their intention to start the program with area doctors before the official launch. (In the course of their everyday work, pharmacists naturally develop relationships with a group of doctors in the local area.) CreativePharmacist.com provides marketing materials to assist pharmacists with this task.

Resources Used and Skills Needed

  • Staffing: The program typically requires no new staff, as participating pharmacists fit program-related activities into natural downtime during the day. To date, no pharmacy has hired staff for the program. The typical pharmacist currently works with roughly 15 members at a time, with one (Dr. Pope) handling 45.
  • Costs: Participating pharmacies pay $199 a month to CreativePharmacist.com; this fee covers access to the program Web site and related tools, including scripted presentations and patient-friendly educational content and tools.
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Funding Sources

The program is funded through fees paid by pharmacists and members, as outlined previously.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Design program with target audience in mind: The pilot test demonstrated that members (even older ones) will use a Web-based program. This high level of usage has been achieved by creating content that caters specifically to the needs of the target audience. For example, those between the ages of 40 and 60 (the primary users of the program) want practical advice on how to eat healthfully and get regular exercise within the constraints of their daily life. Program content has been designed with these needs in mind.
  • Require some payment from members: Individuals will feel greater accountability if they have to pay something each month. Even if insurers or employers agree to financially support the program, make sure that members still have some “skin in the game.”
  • Cater to pharmacist workflow, financial interests: Pharmacists may initially resist the idea of adopting this program. However, they will likely be receptive once they understand that program activities take place during natural downtime in their day, and that the program has the potential to improve health outcomes and bring them new customers and revenues. CreativePharmacist.com developed a video of a pharmacist who joined and benefited from the program; prospective pharmacists can view this video, hearing firsthand from a peer about how it helps both pharmacists and members.
  • Create mechanisms to communicate with physicians: As noted earlier, several program elements help to ensure that physicians understand the program, particularly how it supports (rather than replaces) their work with patients.

Sustaining This Innovation

  • Remind pharmacists to contact “no-shows”: In spite of the monthly fee and automated reminders, some members may not regularly check in on the Web site. To encourage their continued participation, pharmacists should call those who do not log in for a few weeks to remind them of the program's many potential benefits.
  • Promote ongoing contact between program, physician: Pharmacists should encourage members to print out their information sheets in advance of each physician visit, thus letting physicians see firsthand how the program helps patients over time. After seeing these potential benefits, some physicians begin recommending the program to nonadherent patients, as they welcome the opportunity to provide these individuals with additional support that cannot be offered during time-pressed office visits.

Spreading This Innovation

CreativePharmacist.com is currently in discussions with various organizations about adopting and/or supporting HealthyHeartClub.com, including pharmacies, grocery stores, employers, and insurers. Currently, roughly 500 pharmacies participate in a similar program offered by CreativePharmacist.com focused on diabetes. Several other organizations have created separate programs that use pharmacists to work with individuals with chronic illness, including pharmacy chains (e.g., Walgreens, Medicine Shoppe), grocery stores (e.g., Kroger, Raley’s), and insurers (e.g., UnitedHealth Group, Humana).4

Use By Other Organizations


More Information

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Contact the Innovator

David D. Pope, PharmD, CDE
Editor-in-Chief, CreativePharmacist.com
Editor-in-Chief, HealthyHeartClub.com
Director, Barney's Pharmacy Diabetes and Wellness Center
858 Jasmine Tr.
Evans, GA 30809
(706) 691-9434
E-mail: david@creativepharmacist.com

Innovator Disclosures

Dr. Pope founded and co-owns CreativePharmacist.com, which owns HealthyHeartClub.com.

References/Related Articles

The Web-based patient tools and educational information are available at: http://www.healthyheartclub.com. More information about pharmacist participation in the program is available at http://www.creativepharmacist.com.

Footnotes

1 Centers for Disease Control and Prevention. Fruit and vegetable consumption among adults—United States 2005. MMRW Morb Mortal Wkly Rep. 2007;56(10):213-7. [PubMed] Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a2.htm?s_cid=mm5610a2_e.
2 Andrews M. Pharmacists Expand Role to Help Educate and Coach Patients. Kaiser Health News. March 15, 2011.
3 Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-45. [PubMed]
4 Abelson R. Pharmacists Take a Larger Role on Health Team. New York Times. August 14, 2010. Available at: http://www.nytimes.com/2010/08/14/health/14pharmacist.html?_r=3&pagewanted=print.
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: June 08, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: August 13, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: July 23, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.