A Project to Promote Adherence to Blood Pressure Medication Among People Who Use Community Pharmacies in Rural Montana, 2014-2016.

Introduction: Pharmacists can assist patients in managing their blood pressure levels. We assessed whether adherence to blood pressure medication improved among people who used community pharmacies in rural Montana after pharmacists initiated consultations and distributed educational materials developed for the Million Hearts Initiative's "Team Up. Pressure Down.

Implementation of Strategies to Recognize and Control Hypertension in a Multispecialty Clinic, Montana, 2012-2013.

Benefis Medical Group, in Great Falls, Montana, improved identification and treatment of hypertension through multifaceted interventions. The interventions included adopting policies for collection of vital signs, enhancing system-level reporting capability, tracking patients for the registry, and conducting patient outreach activities. From baseline to follow-up (December 2012 through September 2013), the percentage of patients with a documented blood pressure increased from 67% to 80%, the percentage diagnosed with hypertension increased from 16% to 36%, and the percentage with blood pressure control increased from 41% to 64%.

Cooperative strategies to develop effective stroke and heart attack awareness messages in rural american Indian communities, 2009-2010.

Introduction: National initiatives to improve the recognition of heart attack and stroke warning signs have encouraged symptomatic people to seek early treatment, but few have shown significant effects in rural American Indian (AI) communities.

Methods: During 2009 and 2010, the Montana Cardiovascular Health Program, in collaboration with 2 tribal health departments, developed and conducted culturally specific public awareness campaigns for signs and symptoms of heart attack and stroke via local media. Telephone surveys were conducted before and after each campaign to evaluate the effectiveness of the campaigns.

Statewide efforts to narrow the rural-urban gap in acute stroke care.

Background: Rural-urban gaps in stroke care remain challenging in part because of the lack of resources, personnel, and necessary infrastructure.

Purpose: The purpose of this study was to assess changes in the acute stroke diagnosis and treatment capacity among rural hospitals before and after implementation of a regionwide stroke initiative.

Methods: In 2004, the Montana Cardiovascular Health Program partnered with stroke stakeholders throughout the state and surveyed hospitals in Montana and northern Wyoming to assess the availability of technology, services, and personnel for acute stroke care.

Stroke awareness: surveillance, educational campaigns, and public health practice.

Stroke is a leading cause of death and disability in the United States. However, there is limited public knowledge about stroke signs and symptoms and the importance of seeking immediate medical care. Educational efforts such as stroke awareness campaigns are one way of informing the public about stroke symptoms and the need for early medical treatment following their onset.

Impact of media on community awareness of stroke warning signs: a comparison study.

Prompt identification of the warning signs of ischemic stroke is critical to ensure appropriate and timely treatment. We implemented a 20-week public education campaign in one media market to increase community awareness of warning signs for stroke and the need to call 911. Telephone surveys were conducted in adults aged 45 years and older in the intervention county and a comparison county before and after the campaign to evaluate its impact.

Educational outreach to improve emergency medical services systems of care for stroke in Montana.

Objective: To improve stroke knowledge, identification, and acute care among first responders (FRs) and emergency medical technicians (EMTs) through educational outreach and support.

Methods: Beginning in 2006, the Montana Stroke Initiative implemented outreach to FRs and EMTs and emergency medical services (EMS) statewide. Cross-sectional telephone surveys of FRs and EMTs were used to evaluate changes in stroke knowledge and practice in 2006 (n = 988) and 2009 (n = 944), overall and in rural and urban counties.

The Montana cardiac rehabilitation regional outcomes project.

Purpose: Outcomes evaluation is a critical component in early outpatient cardiac rehabilitation (CR). The goal of this project was to develop a regional CR outcomes program to help facilitate quality improvement.

Methods: The Montana Outcomes Project initiated data collection on a uniform set of outcomes indicators.

How are we diagnosing cardiometabolic risk in primary care settings?

Aims: To assess attitudes, barriers and practices of clinicians in assessing and treating cardiometabolic risk in overweight adults.

Methods: In 2006, primary care physicians and mid-level practitioners in Montana were surveyed (N=430).

Results: Most primary care clinicians (95%) recognized the clinical benefit of weight loss, but many cited patient motivation (87%), lack of support services (61%), and lack of time (58%) as barriers.

Public education strategies to increase awareness of stroke warning signs and the need to call 911.

Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. We implemented a 20-week public education campaign to increase community awareness of warning signs for stroke and the need to call 911. Telephone surveys were conducted in adults aged 45 years and older before and after the intervention to evaluate its impact.

Awareness of cardiovascular disease risk in American Indians.

Objectives: The objective of this study was to identify factors associated with perceived risk for cardiovascular disease (CVD) among older American Indians.

Design: In 2003, a telephone survey was conducted in American Indians aged > or = 45 years who lived on or near the seven reservations in Montana. Respondents were asked about their history of CVD and selected risk factors and their perceived risk for CVD.

Improving access to quality diabetes education in a rural state: the Montana Quality Diabetes Education Initiative.

Purpose: Diabetes self-management education (DSME) is an integral component of diabetes care; however, skilled educators and recognized programs are not uniformly available in rural communities.

Methods: To increase access to quality DSME, the Montana Diabetes Control Program and the Montana chapter of the American Association of Diabetes Educators developed a mentoring program with 3 levels: basic, intermediate, and advanced. All participants were assisted by a volunteer certified diabetes educator (CDE) mentor.

Availability of diagnostic and treatment services for acute stroke in frontier counties in Montana and Northern Wyoming.

Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke.

Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming.

Extending the public health impact of screening for diabetes in high-risk populations: opportunities in American Indian communities.

Objective: To assess trends in diabetes screening among American Indian adults and identify opportunities to extend blood glucose screening to those at risk for undiagnosed diabetes and prediabetes.

Methods: In 1999, 2001, and 2003, approximately 1,000 American Indian adults aged 18 years and older living on or near the seven reservations in Montana were interviewed through telephone surveys.

Results: Of respondents without diagnosed diabetes, the proportion who recalled blood glucose screening for diabetes within the past 3 years increased from 68 percent in 1999 to 78 percent in 2003.

Defining disparities in cardiovascular disease for American Indians: trends in heart disease and stroke mortality among American Indians and whites in Montana, 1991 to 2000.

Background: Disparities in stroke and heart disease have been well defined in many populations in the United States. Relatively few studies, however, have assessed current disparities in cardiovascular disease in American Indian populations and compared trends with other regions of the United States.

Methods And Results: Using mortality data, age-adjusted all-cause, heart disease, and stroke mortality rates (per 100,000) were calculated for American Indians and whites from 1991 to 1995 and 1996 to 2000.

A field-based approach to support improved diabetes care in rural states.

Introduction: Diabetes care is a challenge in rural areas where primary care practices are faced with limited resources, few clinical information systems, and relative isolation from education programs and diabetes centers with multispecialty teams. This report describes an effective field-based approach to support improved care for patients with diabetes in primary care practices in rural states.

Methods: A collaborative effort between diabetes prevention and control programs in Montana and Wyoming and the University of North Dakota was established to provide support to rural primary care practices for improvement in diabetes care.

Perceived risk for developing stroke among older adults.

Background: Persons who perceive their risk for stroke accurately may be more likely to engage in prevention practices to reduce their risk.

Methods: In 2004, 800 adults aged 45 years and older in two counties participated in a telephone survey to assess their perceived risk for stroke and their history of stroke risk factors.

Results: Overall, 39% of respondents perceived themselves to be at risk for having a stroke.

Rural community knowledge of stroke warning signs and risk factors.

Introduction: Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. Public education campaigns in selected communities have helped to increase knowledge about stroke, but most data represent large metropolitan centers working with academic institutions. Much less is known about knowledge of stroke among residents in rural communities.

Increasing prevalence of cardiovascular risk factors among American Indians in Montana.

Background: Cardiovascular disease (CVD) is the leading cause of death among American Indians. The objective of this study was to assess trends in CVD and CVD risk factors among American Indians in Montana.

Methods: In 1999 and 2003, 1000 American Indian adults aged > or =18 years living on or near the seven reservations in Montana were interviewed each year using an adapted Behavior Risk Factor Surveillance System survey.

Increasing employee awareness of the signs and symptoms of heart attack and the need to use 911 in a State Health Department.

Introduction: Early recognition of the signs and symptoms of a heart attack can lead to reduced morbidity and mortality.

Methods: A workplace intervention was conducted among 523 Montana state health department employees in 2003 to increase awareness of the signs and symptoms of heart attack and the need to use 911. All employees received an Act in Time to Heart Attack Signs brochure and wallet card with their paychecks.

Increasing rate of diabetes in pregnancy among American Indian and white mothers in Montana and North Dakota, 1989-2000.

Objectives: The purpose of this study was to assess trends in diabetes in pregnancy in American Indian and whites mothers in Montana and North Dakota.

Methods: Montana and North Dakota birth records were utilized to assess trends in any diabetes in pregnancy in American Indians and whites from 1989 to 2000.

Results: From 1989 through 2000, there were 133,991 and 102,232 births in Montana and North Dakota, respectively.

Diabetes in Montana's Indians: the epidemiology of diabetes in the Indians of the Northern Plains and Canada.

The prevalence of diabetes is two- to threefold higher in American Indians in Montana compared with the non-Indian population. High rates of diabetes have also been described in Canadian aboriginal populations closely related to the tribes in Montana. Diabetes in pregnancy has increased among Indian mothers and high-birth-weight babies are increasingly likely to be born to Indian mothers with diabetes in pregnancy.