Abstract 130: Do Safety-Net Patients have Access to Cardiovascular Risk Factors Control?
Authors: Olomu Adesuwa , Gautam Bikki , Buda Bethany , Joplin Indrea , Holland Kyrah , Hsu Wei-Wen , Chahal Gurpreet , Therman Alexis , Todem David , Holmes-Rovner Margaret 
Published: March 2022

Background:
Cardiovascular disease (CVD) risk factor control is critical to reducing CVD risk and adverse outcomes. Recent studies from CDC revealed that American adults who smoke decreased from 20.9% in 2005 to 19.3% in 2010.In addition, prevalence of obesity appears to be slowing or leveling off. However,minority and low-income populations face barriers of literacy and poverty blocking access to the benefits of efficacious strategies to control these risk factors for CVD. Federally Qualified Health centers (FQHCs {Safety-Net Clinics}) provide care for low income and medically underserved populations.

Objectives:
1) Determine if obese diabetic/ CVD patients in FQHCs have access to community resources for weight loss. 2) Determine smoking rates and accessibility to smoking cessation programs for these populations.

Methods:
This study is part of the Office- Guidelines Applied to Practice (Office-GAP) project, designed to improve secondary prevention of heart disease for diabetic and CVD patients in FQHCs in Michigan. We analyzed 242 patients that participated in Office-GAP group visits (September 2010-December 2012). Patients completed a health survey at baseline that included demographic characteristics, comorbidity, smoking status, weight, having access to weight loss programs and nutrition counseling, and access to smoking cessation programs. Chart abstraction was performed for relevant data by trained research assistants. Descriptive analysis was performed on the cross sectional data that was obtained.

Results:
Among the enrolled patients 53.71% (130 of 242) were obese (BMI > 30). Mean age=53.69; male=33.07% (43 of 130); white=47.69% (62 of 130). Analysis revealed that 55.85% (105 of 188) diabetics, 57.06% (109 of 191) hypertensives and 57.57% (19 of 33) MI patients were obese. Only 57.42% (58 of 101) and 62.5% (40 of 64) patients said they have access to weight loss programs and nutrition counseling respectively. Furthermore, 78.46% (102 of 130) and 61.54% (80 of 130) patients stated having a problem getting into weight loss and nutrition counseling programs respectively. Current smokers were 31.4% (76 of 242) with {(blacks=35.29% (30 of 85), whites=41.75% (38 of 91) and other races=12.12% (8 of 66)}. Further analysis revealed 63.64% (21 of 33) patients with history of myocardial infarction, 28.19% (53 of 188) diabetics and 48.65% (18 of 37) of asthmatics were smokers with 69.74% (53 of 76) stating they have problems accessing smoking cessation programs.

Conclusion:
Very high proportions of diabetic and CVD patients are obese in FQHCs. Many lack access to programs that can assist with weight loss. Smoking rates remain high, with many patients reporting difficulty in accessing smoking cessation programs in FQHCs. There is an urgent need for strategies to improve access to smoking cessation and weight loss programs in FQHCs to decrease cardiovascular risk, morbidity and mortality.