The value of sustained initiatives targeting population health appears borne out by a dip in hospitalization and mortality rates associated with a communitywide cardiovascular disease prevention program in Maine.
The program is a cooperative project of local community groups and staff at Franklin Memorial Hospital, in Farmington, Maine, to help residents of Franklin County, a rural, low-income area with more than 22,000 residents in 1970. They started out in 1974 seeking to address hypertension and later expanded their reach to cholesterol, smoking, diet and physical activity.
Researchers, who published the findings Tuesday in JAMA, studied hospitalization and mortality in the area from 1970 to 2010 to determine whether the interventions changed behaviors and improved healthcare access and health outcomes.
About half the county's adults got health screenings through the program in its first four years, and the study suggests the effort yielded a 24% increase from 1975 to 1978 in the number of people who got their hypertension under control.
Follow-up interventions included monitoring, counseling and physician referrals for those who were found to have uncontrolled health conditions.
The scope of the program expanded to cholesterol in 1986, tobacco cessation in 1998 and diabetes management in 2000. By the 2010, health workers had logged more than 150,000 one-on-one interactions with residents from 1974 to 2010, averaging more than five encounters per resident.
The interventions were associated with a 24% increase from 1975 to 1978 in the number of residents who were able to manage blood pressure control. The study also found that cholesterol control among residents increased by 28% from 1986 to 2010. The rate of those who quit smoking increased from 48% in 1996 to 69% in 2000.
Hospitalizations per capita in Franklin County were less than expected between 1994 and 2006, according to the study, yielding a $5 million annual reduction in hospital charges.
Mortality rates, while already below the state average between 1970 and 1989, declined further between 1990 and 2010 to 42 deaths per 100,000 people, and income level became less of a factor in mortality in Franklin County compared with the rest of Maine.
“The experience in Franklin County suggests that community health improvement programs may be both feasible and effective,” study authors wrote. “This may be especially true in socio-economically disadvantaged communities where the needs are the greatest, as the increasing association of lower household income with higher mortality in Maine suggests.”
Experts say the findings are the first demonstration of the effect that prevention strategies could have for improving health risk factors of a community for a period spanning several decades, suggesting such programs can be effective if they're sustained over a significant period of time.
“I think this is quite encouraging to this kind of communitywide prevention approach,” said Dr. Kunihiro Matsushita, assistant scientist in epidemiology at the Johns Hopkins Bloomberg School of Public Health. “Particularly in the 21st century, using some kind of information technology we may be able to provide that kind of support much more efficiently compared to a few decades ago,” said Matsushita.
Dr. Robert Moser, executive director for the University of Kansas Hospital's Kansas Heart and Stroke Collaborative, said the study's findings showed the importance for health systems and communities alike to “adopt change” in their philosophies on addressing community health needs.
But even though they called the results encouraging, Moser and Matsushita—neither of whom were involved in the program or study—acknowledged that adoption of a similar type of model might not be feasible in larger, more urban communities where people don't tend to remain in one community for several decades. Both, however, said other rural areas were likely to benefit from similar types of sustained interventions.
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