Establishing long-term medical follow-up in an underserved, high-risk population identified at a local health fair

Context: We are interested in establishing a health fair follow-up system to (1) address the overall impact of screening for chronic cardiovascular disease (CVD) and (2) measure the establishment of regular physician visits. Objective: To identify a cohort of attendees that meet high-risk criteria for CVD and to ensure they are matched with a medical home to receive continuity of care. Design: Cohort prospective study. Setting: A local health fair in Dallas, TX. Participants: Adult health fair attendees. Intervention: After an initial assessment using the Framingham score, attendees identified at moderate/high risk will complete clinical measurements (fasting glucose, lipid panel, blood pressure, and BMI) and receive information about community clinics. Quarterly follow-up phone calls will determine if attendees established ongoing healthcare management. Results: We followed-up with 35 attendees six months after the event. We found that 65% (n=23) visited a primary care physician (PCP) within six months. Of these, 57% (n=13) were diagnosed with CVD, which include hypertension (35%, n=6), hypercholesterolemia (59%, n=10), and type II diabetes mellitus (6%, n=1). After diagnosis by a PCP, 47% (n=8) of diseases are being treated with medicines, and 35% (n=6) are being treated by diet and exercise alone. These data suggest that screening has helped individuals at risk for CVD establish follow-up with a PCP and decrease overall health risk factors. Conclusions: Results of the study will be used to better assess the impact our health fair has on the community it serves annually. Furthermore, these data should allow us to construct an appropriate screening and referral system.