The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial.

BACKGROUND: Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. METHODS: Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. PRIMARY OUTCOME: mean difference in HbA1c at 6 months in intervention group individuals compared to control. SECONDARY OUTCOMES: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis. DISCUSSION: CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03481335 ), registered March 29, 2018.

Development of a community health and wellness pilot in a subsidised seniors' apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS).

BACKGROUND: Older adults have higher risk of developing cardiovascular disease, diabetes and falls, leading to costly emergency medical service (EMS) calls and emergency room visits. We developed the Community Health Assessment Program through EMS (CHAP-EMS) that focuses on health promotion/prevention of hypertension and diabetes, links with primary care practitioners, targets seniors living in subsidized housing, and aims to reduce morbidity from these conditions, thereby reducing EMS calls. In this pilot study, we evaluated the feasibility of implementing the CHAP-EMS, attendance rates, prevalence of high blood pressure and cardiovascular risk factors. METHODS: In this pilot study the CHAP-EMS was implemented in the intervention site over a 12 month period. BP, lifestyle, cardiovascular risk and EMS call rates were collected and descriptive analyses performed. Participants were residents (low income seniors) of a subsidized housing complex in Hamilton, Ontario. Two paramedics provided once-weekly sessions, measuring BP, assessing diabetes/lifestyle risk (CANRISK questionnaire) and discussed prevention/local wellness activities in the intervention site. Follow up was invited. RESULTS: A total of 1365 visits with 79 unique participants occurred; 48 (25.2%) visited at least twice; mean age was 72.2; 87.2% were 65 years of age and older and 68.1% were female; 90.3% had a family doctor. Overall, 45.2% had elevated BP initially from the total; 50.0% of participants previously diagnosed with hypertension had elevated BP while 33.3% not previously diagnosed had elevated BP. Almost 1 in 5 (19.4%) had diabetes; 66.7% had moderate to high risk of developing diabetes. CONCLUSION: This pilot study indicates that CHAP-EMS is a feasible program that could have impact on BP, lifestyle factors, diabetes risk and EMS calls in the buildings in which it was implemented.

Group interprofessional chronic pain management in the primary care setting: a pilot study of feasibility and effectiveness in a family health team in Ontario.

BACKGROUND: Approximately 18.9% of Canadians live with chronic pain. Primary care reform in Ontario presents unique opportunities to assess approaches to help these patients. OBJECTIVE: To assess the feasibility of an interprofessional primary care-based program for patients living with chronic pain, and to examine the potential impact of such a program on quality of life and health resource utilization. METHODS: An embedded mixed-methods evaluation (randomized controlled trial with waiting list control and semistructured interviews) of an eight-week series of small group sessions exploring multifactoral aspects of pain management was performed. Participants were randomly assigned to early intervention (EI) or delayed intervention (DI) groups. All participants received the intervention; the DI group served as a control group for comparison with the EI group. Outcomes included the Short Form-36 Health Survey version 2 (SF-36v2), medication use and health care utilization. Qualitative interviews were conducted to identify areas for program improvement. RESULTS: A total of 240 patients were recruited and 63 agreed to participate. The mean (± SD) age of the participants was 55±14.1 years and 62.3% were female. There was no significant difference in the mean change in SF-36v2 summary scores between the EI and DI groups. However, the SF-36v2 subscale score for bodily pain was significantly improved in the EI group compared with the DI group after six months of observation (mean difference = 13.1 points; P<0.05). There was also significant improvement in this score when both groups were pooled and aggregate preintervention and postintervention scores were compared. There was a significant decrease in the mean number of clinic visits in the six-month period following the intervention compared with the six-month period before the intervention (P=0.043). CONCLUSION: An interprofessional program in primary care for patients living with chronic pain may lead to improvements in quality of life and health resource utilization. The challenges to the feasibility of the program and its evaluation are recruitment and retention of patients, leading to the conclusion that the program, as it was conducted in the present study, is not appropriate for this setting.