Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks

Background Peer support can improve health for patients with chronic conditions; however, evidence for disease prevention is less clear and peer recruitment strategies are not well described. This paper describes a study protocol to evaluate a peer support intervention to improve hypertension control and reduce cardiovascular disease (CVD) risk. Methods & research design Target enrollment for this two-site study is n = 400. Eligibility criteria include Veterans enrolled in Veterans Health Administration (VHA) primary care with poorly controlled hypertension and one other cardiovascular disease risk (smoking, overweight/obesity, or hyperlipidemia) who live in census tracts with high rates of hypertension. Enrolled participants are randomized to a home-based peer delivered self-management intervention (5 home visits and 5 phone calls with a peer health coach) versus usual care. The primary outcome is a change in systolic blood pressure (SBP) and secondary outcomes include change in CVD risk and health care use. Results Trial results are pending and participant enrollment is ongoing. We recruited peer coaches from Veterans who lived in census tracks with the highest rates of hypertension. To recruit Veteran peer coaches, we asked primary care providers ( n = 41) and team nurses ( n = 35) to nominate patients who they thought would be a good fit for the peer coach position (based on successful self-management and health care navigation) ( n = 73 nominated from 964 patients). We interviewed 12 Veterans and trained 5 peer coaches. Conclusions Results of this trial will inform peer support programs targeted to provide community-based delivery of prevention services to patients in high-risk areas. Trial registration Clinicaltrial.gov identifier NCT02697422 Trial status Enrollment for the randomized trial phase began in September 2017 and will be complete September 2019.