Dr. Visaria established the American Preventive Screening and Education Association (APSEA), a non-profit organization focused on reducing the burden of diabetes and hypertension in the local community through community-based health screenings, preventive education, and research. APSEA trains students and volunteers to provide basic health screenings and preventive education, and then provides practical, immersive experiences for students and patients alike to prevent or manage diabetes/hypertension. Prior to establishing APSEA, Dr. Visaria conducted a crude community needs assessment. The community needs assessment identified a high proportion of uncontrolled, untreated, and undiagnosed hypertension among NJ adults of diverse backgrounds. It also identified a lack of routine monitoring of blood pressure and a lack of education among healthcare-related students and professionals on new BP guidelines and measurement technique as detailed by the AHA/AMA. The high prevalence of uncontrolled blood pressures in the local NJ community negatively affects cardio-metabolic health outcomes. Uncontrolled BP is in part due to lack of awareness about the disease, lack of guidance on lifestyle preventive strategies, and lack of BP monitoring.
Accordingly, the 5-year objectives of APSEA were to 1) From September 2017 to December 2022, teach 500 pre-medical undergraduates (from Rutgers- New Brunswick, New Jersey Institute of Technology, or The College of New Jersey) and medical students (from Rutgers Robert Wood Johnson Medical School and New Jersey Medical School) through a rigorously developed training curriculum on hypertension and diabetes screening and preventive education; 2) From September 2017 to December 2022, perform blood pressure and BMI/bioimpedance-based fat percentage measurements on 1,000 NJ participants across 20 community locations in Central and North Jersey. Additionally, Dr. Visaria published an Amazon book (Pocket Guide: Basic Health Screening) and an online course (https://www.udemy.com/course/naditraining/) as components of the training curriculum.
With the establishment of American Preventive Screening and Education Association (APSEA), Dr. Visaria and colleagues developed a lifestyle medicine training curriculum focused on BP measurement and management. The curriculum incorporated both theoretical and practical training components, culminating in a three-part OSCE-style assessment. There was an emphasis on accurate BP measurement technique given recent AHA and AMA guidance on need for improved BP technique among healthcare professionals, as well as preventive lifestyle strategies. From 2017-2023, APSEA trained nearly 1,250 Rutgers, NJIT, and TCNJ undergraduates, and 280 NJMS, RWJMS, and Rowan SOM medical students. Among a sample of 128 Rutgers undergraduate students trained in 2021-2022, 104 (81%) passed assessments, and 58 (45%) attended at least 1 community health screening. Among 29 students with complete data on pre- and post-training questionnaires, the mean (SD) BP-taking confidence increased 1.3 (1.2) points (on a 1-5 point Likert scale; p< 0.001). Scores for knowledge-based questions increased by a mean (SD) 2.3 (1.7) points (p=0.002). This significant increase was present for all individual questions. Regarding health screening, from 2017-2023, certified students contributed more than 3,100 volunteer hours, and screened nearly 7,000 participants at 360 health screenings across 56 community locations. These locations included Farmer’s Markets, religious places, public libraries, senior centers, collaborative events with local hospitals, festivals, apartment complexes, among others. The most common barriers to controlled BP included 1) lack of medication compliance, 2) lack of BP monitor at home, and 3) lack of regular PCP visits.
From March 2022 to September 2022, APSEA also enrolled its first cohort of 18 participants interested in a 6-month, lifestyle change-based longitudinal program pairing students (‘APSEA Buddy’) with participants who would provide personalized lifestyle advice and accountability, along with monthly virtual lectures and screenings done by Dr. Visaria. He also helped participants by driving to their homes and helping them go through their food pantries to understand nutrition labels and differences between healthy and unhealthy food items for diabetes prevention. Among five participants with pre-diabetes who had data recorded, there was significantly improved quality of care, weight loss, reduction in body fat percentage, and reduction in A1c.