Themis Yiaslas is a Psychologist in the Behavioral Medicine Clinic; Ajay Sood is Chief, Endocrine Section; Gregory Ono and Cynthia Spann are Clinical Pharmacists; Tara Rogers-Soeder,Janelle Embree, and Carrie Caputo are Dietitians, Nutrition and Food Service; June Taylor is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. Rachel Kitazono is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and Saul Schaefer is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento. Correspondence: Themis Yiaslas (themis.yiaslas@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
HDRP is an adaptation of interdisciplinary lifestyle interventions that have resulted in regression of atherosclerotic blockages confirmed with invasive coronary angiography.15-17,22,28 HDRP currently is offered in a Behavioral Medicine Clinic at the Sacramento US Department of Veterans Affairs (VA) Medical Center (VAMC) in California. Program staff include a clinical health psychologist who organizes, coordinates, and act as the lead facilitator of the program; registered dietitians; clinical pharmacists; and a consulting physician. Patients engage in the 4-month core HDRP program in small cohorts (ie, 6-10 patients), and spouses/partners are highly encouraged to attend all sessions.
Components
Telephone screening. Patients are screened for the inclusion and exclusion criteria (Table 1). Patients engaging in a traditional CR program are included in the screening. Patients are informed that the program consists of lifestyle intervention, including emphasis on following a WFPB diet.
Health assessment. Once approved, all patients are instructed to complete baseline laboratory tests and questionnaires. Along with an electronic health record (EHR) review, a psychosocial assessment is completed by a licensed clinical health psychologist who assesses CVD history, eating behavior, exercise/physical activity, sleep, mental health, substance use, and social history, with the aim of enhancing our ability to help the patient to benefit from HDRP.29 The patient data are used to develop a case conceptualization (ie, integrated understanding of the particular patient’s psychiatric and medical diagnoses, behavioral patterns, social supports, lifestyle habits, strengths and weaknesses, and their interrelationships with each other and the patient’s environment), resulting in an individualized plan. Patients are encouraged to ask questions about the program, and those who are still interested are invited to attend a seminar. A request for medical clearance to participate in the program is initiated through the EHR or by patients scheduling an appointment with their HCP. All patients are medically cleared by their HCP for participation. Safe exercise recommendations also are provided and guide patient goals.
CVD risk profile. Patients complete psychosocial questionnaires and fasting laboratory tests to produce a tailored CVD risk profile. Laboratory tests include fasting lipid, fasting glucose, hemoglobin A1c (HbA1c) C-reactive protein, vitamin B12, and vitamin D. The same tests (excluding HbA1c) are completed 1 month later (after completing 4 group sessions) and again posttreatment (including HbA1c). Self-reported questionnaires are completed at the same time points, which include the Rate Your Plate dietary composition questionnaire, CHAMPS physical activity questionnaire for older adults, Beck Depression Inventory-II, and the Perceived Stress Scale.
Seminar. A 2-hour seminar provides patients and families with an opportunity to meet HDRP program staff, learn the background and rationale for chronic disease reversal, obtain a summary of the program, and hear a patient testimonial. Patients are asked to make a commitment, and the informed consent process includes all patients signing a behavioral contract.
Assessment and feedback. A licensed clinical health psychologist provides feedback to patients on their comprehensive CVD risk profile, using motivational interviewing.30,31 Smokers are encouraged to quit, and those interested are referred to their HCP and/or facility smoking cessation program.
Group sessions. Twelve weekly group sessions cover nutrition education and cooking, physical activity and exercise, stress management training, and medication reconciliation and adjustment. The nutrition component is the centerpiece of HDRP and is delivered by registered dietitians (Table 2). Patients are instructed to use the 3-week period between the HDRP seminar and the first core group session to try new recipes and prepare their kitchens, pantries, and mind-set to adopt the HDRP diet with 100% adherence. The WFPB diet used is consistent with the current guidelines of Caldwell Esselstyn, MD, and Dean Ornish, MD.32-34
