Heart 2 Heart:  Increasing Access to Cardiovascular Screenings and Follow Up

 

Beginning in 1997, Anderson County, South Carolina offered free cardiovascular screenings, called HeartScore, at two large events in February.  These screenings include blood pressure, blood sugar, cholesterol panel, heart rhythms, carotid bruits test (for stroke), body mass index, sleep assessment and family history.  The total value of the screening to participants is more than $150 per person.  In 2004, with the addition of the Heart 2 Heart Team, HeartScore underwent the following changes which allowed the program to do more than just provide results and can link participants with needed resources: the screening sites expanded from two to five; follow up counseling sessions were expanded; and screenings were focused on priority populations so as to include target, low-income, minority and rural neighborhoods in the area. In addition to the individual counseling sessions, which were offered one week after the screening, a “care connector” mechanism was provided for participants identified as high risk, having no form of insurance or no medical home. These participants can now be referred to appropriate resources in Anderson such as the Anderson Free Clinic. 

 

The intentions of the changes were three fold.  First, the team wanted to increase the participation of those at high risk of developing cardiovascular disease.  Second, it was important to start referring those targeted individuals to follow up care resources.  Last, the team wanted to be able to track participation and capture the data in an effort to prove the effectiveness of such a program.

 

Environmental Change Initiation

 

HeartScore staff were aware of the success of the screenings every year but had little hard data to prove this success.  When Heart 2 Heart was formed through the receipt of a grant, it seemed natural to expand already existing and successful programs rather than implement something new.  Grass roots leaders came together and determined a more cohesive approach to the screenings could work.  Local community data suggested target neighborhoods were at higher risk of not being screened for cardiovascular disease, having more risk factors and less access to care. 

 

Public Health Agency Roles

 

The Anderson Health Department was the leader in facilitating these changes.  The health department received the Heart 2 Heart grant, hired a grant manager and provided staff resources for the project.  Health department staff participated in the screenings, entered data and coordinated advisory councils in each target neighborhood.  In addition to these efforts, the health department was able to link the community partners with state level resources with the State Budget and Control Board’s Office of Research and Statistics as well as the Department of Health and Environmental Control’s Division of Cardiovascular Services.  These linkages are providing detailed analysis of the project.

 

Major Partners

 

In addition to the partners mentioned above, the following partners and their involvement included: 

1.  The Anderson Health Department – provide data collection, program coordination and referral follow up. 

2.  AnMed Health – provide marketing for screening events, staff events, and fund the lab costs of processing the cholesterol results. 

3.  Partners for a Healthy Community/Healthy People 2010 Coalition – provide staffing, marketing and coordination. 

4.  Clemson University and Tri-County Technical College – provide health science and nursing students at the screenings and counseling sessions. 

5.  MedShore Emergency Services – volunteers. 

6.  The Town of Iva – provide local input, marketing and screening location. 

7.  Senior Solutions - provide local input, marketing and screening location. 

8.  Morningside Community Development Center - provide local input, marketing and screening location. 

9.  Anderson Free Clinic – provide prescription assistance and follow up care to participants. 

 

Official Support

 

Locally, many public officials have supported this effort.  City council members have expressed support.  The Town of Iva Mayor’s office has provided support in the form of marketing and coordination.  AnMed health management has also played a key role in supporting these efforts.  The Public Health Region 1 Director is also a key player in allowing staff time to participate in the activities.

 

Results from the Environmental Change

 

The Heart 2 Heart team is tracking the impact of the implemented changes.  To date, only baseline data has been collected.  In year one (2004) of the changes, 1060 people participated in the screenings.  This was an increase from the year before in which 650 people participated.  Data is now being captured, which accomplishes one of the primary objectives of this project.  In addition, past data will be back entered to allow for a retrospective study of the screenings.  Anecdotal evidence suggests increased participation in the highest risk categories and increased referrals to follow up care.  In one small screening (80 screened), three people were identified as having a previously unknown heart irregularity.  All three were immediately referred to their physicians.  In all three cases, the individuals were admitted to the hospital prior to the counseling sessions.  Observances also indicate more people are going to their physicians for prescriptions and care.  In the summer of 2005, data from past years will be entered into the database and compared with the data from years one and two (2004, 2005).  Reminder cards are now being sent out to all past participants to encourage them to attend present screenings.  This will help maintain consistent participation from year to year.

 

Opposition

 

There was not any opposition to the change.  The partners were very excited about the opportunity the changes gave us and were very willing to help with it in any way possible.  Partners embraced the objectives and collaborated to meet them.  Local administrators and officials continue to lend support. With that dual buy-in, policy environmental changes have been steady and progressive.  We were very fortunate that everyone involved saw the bigger picture and was willing to help out.

 

Lessons Learned

 

A major lesson learned for the planning teams is the importance of coordination and evaluation.  The process of coordinating and following an individual through the healthcare system is at times, a challenge.  It is particularly challenging to capture referral and follow up information.  Also noted is the importance of community collaborations and partnerships in the success of the screenings.

 

Submitted By

 

Kimberly Tillman, B.S., CHES and Kandi Fredere, MHA, CHES

CVH Grant Manager, Associate Director of Public Health Community Systems

South Carolina Public Health Region 1

220 McGee Road

Anderson, SC 29625

(864) 231-1952 or (864) 260-5802

(864) 260-5676 FAX

tillmaky@dhec.sc.gov 

frederkc@dhec.sc.gov