Community-based Interventions to Reduce Disparities in Management of Severe Uncontrolled Hypertension in the Southeastern United States

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2024-05-25

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2023

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Abstract

Background: Hypertension is the leading preventable cause of death and disability around the globe, with clinically and socially derived factors. Despite international guidelines and interventions for care, over 1.28 billion adults 30-70 years old worldwide had hypertension in 2019, and only 42% were diagnosed and treated. Similarly, over 122 million (46.7%) adults in the United States (US) had hypertension between 2017 and 2022, 25.7% had their diagnosis under control, and 38.3% were unaware. Inequities in prevalence and management rates significantly impact minority populations, specifically Black Americans. This study aims to critically appraise foundational efforts and evaluate recent adaptations of a quality improvement project, Closing the Gap on Health Disparities and Health Outcomes in Hypertension (CTG), aiming to reduce hypertension disparities through community-centered interventions. Methods: We conducted a comprehensive critical appraisal using the A comprehenSive tool to Support rEporting and critical appraiSal of qualitative, quantitative, and mixed methods implementation reSearch outcomes (the ASSESS tool) on CTG’s 2017-2019 intervention cycle. Additionally, prospective intervention analysis was conducted for CTG’s Fall 2022 Intervention Cycle using descriptive statistical analysis. Participants of both evaluations were low-middle income patients of a local Federally Qualified Health Center (FQHC) who were recently diagnosed with severe hypertension of SBP >180 mmHg or DBP >110 mmHg, were >18 years old, and had visited one of the FQHC’s nine sites in the past 12 months. Results: CTG’s community-centered telephone outreach effectively re-engaged high-risk patients to primary care. Patients who participated in individualized telephone outreach and used self-monitoring blood pressure BP cuffs were more likely to decrease their blood pressure than those who did not. Conclusion: Telephone outreach and self-monitoring BP cuffs are important tools for reducing BP and health disparities for Black Americans. Further research is needed to incentivize and increase the capacity for other FQHCs and other low-resourced health centers to provide telemedicine services and free self-monitoring BP cuffs.

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Wambugu, Vivien (2023). Community-based Interventions to Reduce Disparities in Management of Severe Uncontrolled Hypertension in the Southeastern United States. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/27810.

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