October 24, 2017

Arkansas Prevention Research Center CDC Site Visit Review

C O P H Dean James Raczynski P h D, F. A. H. A.

Dr. James Raczynski, Dean

In October, we hosted a site visit for what we refer to as the Arkansas Prevention Research Center (ARPRC), which has just finished its eighth year of continuous funding from the Centers for Disease Control and Prevention (CDC). We have another two years of funding in this cycle before we’ll need to compete for continuation funding again. After spending 2½ days with visitors from the CDC and additional time before that in preparing for it, it’s still on my mind, so I thought I’d spend a little time explaining what we’re trying to do as an example of research across a broad spectrum of topics being addressed by COPH faculty, staff and students.

I have the pleasure of serving as the PI/Center Director for the ARPRC, but the real work is done by the directors of five core units (Community Engagement and Partnerships, Communications, Training and Technical Assistance, Dissemination and Translation, and Evaluation) and a group of faculty, staff and students working on the core research project. Partnership and community are at the heart of what we do in the ARPRC (and the COPH). All of the Center’s activities are a joint effort involving not only faculty in the COPH but also members of the Arkansas Department of Health (ADH) and of the Arkansas Delta communities in which we’re working. The organizational structure reflects this COPH/ADH/Community partnership, even in the administrative core which provides management and leadership for the Center.  There are too many people involved in ARPRC to list individuals; however, let me mention one, Dr. Martha Phillips, who serves as the ARPRC Deputy Director for Administration and works to provide oversight for all of our activities.

The primary research project being funded by the Center’s core funding focuses on reducing uncontrolled hypertension in a randomized, controlled trial. Uncontrolled hypertension was an issue identified by leadership of the three major partners as we were planning the most recent funding application. Data show Arkansas has led the nation for many years in the number of stroke deaths and has high rates of uncontrolled hypertension in the state overall, with particularly high rates in the Delta region of the state.  Data suggest that about 50% of Arkansas adults over the age of 18 are hypertensive and about 30% of adults have uncontrolled hypertension. These rates are substantially higher than rates found in the nation overall. Evidence is strong that Community Health Advisors (CHAs), who are lay persons trained to deliver health promotion programs in communities, can make a difference in hypertension control by working with people in their homes. However, the scientific evidence from randomized, controlled trials is limited, and no one to our knowledge has evaluated the cost-effectiveness of a program that seeks to provide care in a stepped approach, increasing the intensity of the intervention only as needed, to minimize costs but maximize benefit. Hence, the ARPRC is collecting this evidence from over 600 people recruited in Desha and Chicot counties, randomizing people to either usual care or a structured CHA-delivered, stepped-care intervention. Community residents from Desha and Chicot counties serve on a Community Advisory Committee, which provides advice and guidance for the project, helping us know what works in their communities and being sure that community voices are heard as the project is implemented.

A Partners’ Advisory Committee has been developed with key healthcare leaders and policy-makers, representing a number of Arkansas agencies and significant healthcare stakeholder groups. These partners provide external guidance for the project and help identify the factors and policies that need to be addressed as we develop plans for dissemination and translation, if the program proves to be cost effective. This committee is co-chaired by Dr. Nate Smith, State Health Officer and ADH Director; Dr. Dan Rahn also served as co-chair until his recent departure from UAMS.

Centers, such as the ARPRC and the recently funded Arkansas Center for Health Disparities (ARCHD), allow us to maintain a focus in the COPH on high-priority areas of public health, build partnerships, engage communities, develop pilot projects that help us prepare competitive grant applications, and provide training opportunities for junior faculty and students (both within COPH and elsewhere at UAMS). Centers encourage faculty to work in interdisciplinary teams to address issues of importance to the health of Arkansans and others across the nation. We are pleased to have the funding from the CDC, as well as the National Institute of Minority Health and Health Disparities for the ARCHD, to support these efforts.