- Data-driven risk stratification and population health management strategies improved hypertension management by six percent in a safety-net clinic, indicating a promising approach for reducing care disparities, says a study published in Circulation: Cardiovascular Quality and Outcomes.
Improving hypertension control is a high priority in healthcare. According to the researchers, controlling blood pressure (BP) rates in US hypertension patients could prevent 56,000 cardiovascular events, 13,000 deaths, and save the healthcare industry $4.5 billion annually.
Despite the broad availability of clinical guidelines, the team noted that over 40 percent of US patients have blood pressure rates above recommended goals.
The group wanted to determine whether hypertension management interventions, such as the program implemented at Kaiser Permanente Northern California (KPNC), could help improve BP control in safety-net clinics.
These clinics mainly provide care to minorities and low-income patients, many of whom have disproportionately high rates of hypertension. The CDC reports that the condition is most prevalent in black males, and that black individuals are twice as likely to die from uncontrolled hypertension as whites are.
The team adapted the KPNC hypertension control intervention and implemented the strategy in a network of 12 safety-net clinics to evaluate its impact on BP control rates, as well as its effects on racial and ethnic subgroups.
The adapted program consisted of four key elements, including a patient registry to identify chronic disease patients and highlight gaps in care and an evidence-based treatment intensification protocol.
The program also featured a standardized BP measurement protocol and BP check visits led by registered nurse and pharmacist staff.
After the program implementation, overall BP control rates at the initial pilot site improved by six percent, jumping from 68 percent to 74 percent over a two-year period.
At the other 11 clinics, BP control rates also improved from 69 percent to 74 percent over a 15-month period.
In addition, the use of fixed-dose combination drugs increased from 11 percent to 14 percent at the pilot site, and from 10 to 13 percent at the other 11 organizations. This is an important improvement, the researchers noted, as fixed-dose combination medications are associated with better BP control and lower costs.
Source: Circulation: Cardiovascular Quality and Outcomes
While all racial groups experienced significant improvements in BP control, the team pointed out that there remained a persistent gap between blacks and whites across all 12 sites.
At the initial pilot site, blacks improved their BP control from 63 percent to 67 percent, while BP control increased from 67 percent to 72 percent in whites.
For blacks at the other 11 organizations, BP control increased from 60 to 66 percent, while whites experienced an improvement of 69 percent to 75 percent.
Although the gap between the two groups did not widen throughout the study, the researchers suggest that certain minority groups may benefit from additional population health interventions that are tailored to their specific needs.
“Our findings underscore what has been observed in other settings—that effective health system interventions in clinical settings may improve health outcomes for groups disproportionately affected by a condition, but may not eliminate disparities between groups,” the researchers stated.
“Improving BP control in black patients may require dual efforts focused on clinical settings that care for black patients and also on the barriers specific to the population and may include interventions targeting modifiable experiences, behaviors, and perhaps physiology that are pertinent to black patients.”
A recent study from Cedars-Sinai Medical Center is an example of an intervention that bridges gaps in care by bringing preventive services into the community setting. The organization enlisted 52 black-owned barbershops in the LA area to offer blood pressure checks and pharmacist-led consultations to customers in an effort to improve BP control among black men.
After six months, participants in the barbershop study saw their BP drop by an average of 27.0 mm Hg, demonstrating that targeted interventions based in the community are an effective means of improving hypertension control.
The safety-net clinic researchers state that their results show the positive impacts of interventions in these settings, and that these programs could help to improve BP management in minority and low-income patients.
“This study demonstrates that evidence-based treatment protocols are transportable to safety net settings and could play a pivotal role in achieving improved BP control and reducing hypertension disparities,” the team concluded.
“Our findings can inform adoption of best practices to improve BP control at safety-net clinics which must play a pivotal role in achieving nation-wide improvements in BP control and reducing socioeconomic disparities in hypertension.”