A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

Kressin, Nancy R.; Long, Judith A.; Glickman, Mark E.; Bokhour, Barbara G.; Orner, Michelle B.; Clark, Christine; Rothendler, James A.; Berlowitz, Dan R.

doi:10.18865/ed.26.1.27

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…These findings suggest that stable health insurance alonethough helpful in controlling BP -is insufficient to fully address uncontrolled BP for everyone, especially given that rates of UBP are still high (regardless of insurance instability), overall. These findings echo other work showing that MA health insurance reform alone was not sufficient to ameliorate racial/ethnic differences in healthcare utilization, [19,20] and studies of stably insured veteran patients using Veterans Affairs healthcare have found similar rates of uncontrolled BP to those observed in this study [21].…”

Section: Discussionsupporting

confidence: 88%

Is insurance instability associated with hypertension outcomes and does this vary by race/ethnicity?

Kressin

Terrin

Hanchate

et al. 2020

BMC Health Serv Res

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Background: Stable health insurance is often associated with better chronic disease care and outcomes. Racial/ ethnic health disparities in outcomes are prevalent and may be associated with insurance instability, particularly in the context of health insurance reform. Methods: We examined whether insurance instability was associated with uncontrolled blood pressure (UBP) and whether this association varied by race/ethnicity. We used a retrospective longitudinal observational cohort study of patients diagnosed with hypertension who obtained care within two health systems in Massachusetts. We measured the UBP, insurance instability, and race of 43,785 adult primary care patients, age 21-64 with visits from 1/2005-12/2013. Results: We found higher rates of UBP for blacks and Hispanics at each time point over the entire 9 years. Insurance instability was associated with greater rates of UBP. Always uninsured black patients fared worst, while white and Hispanic patients with consistent public insurance fared best. Conclusions: Stable insurance of any type was associated with better hypertension control than no or unstable insurance.

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Section: Discussionsupporting

confidence: 88%

Is insurance instability associated with hypertension outcomes and does this vary by race/ethnicity?

Kressin

Terrin

Hanchate

et al. 2020

BMC Health Serv Res

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“…Furthermore, providers preferred DHTs that required minimal training (n=3) [29,35,36]. Providers valued adequate technical support when using DHTs as a part of their clinical workflow (n=3) [30,34,35].…”

Section: Resultsmentioning

confidence: 99%

“…DHTs that were easy to use and included timely technical support [19,24,30,34,36,46,47,49,50] fostered patient engagement (n=9). Older patients and those with less experience using technology reported that technical support was a facilitator (n=2) [47,48].…”

Section: Resultsmentioning

confidence: 99%

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Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review

Palacholla¹,

Fischer²,

Coleman³

et al. 2019

JMIR Cardio

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BackgroundThe uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management.ObjectiveThis scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators.MethodsThis review followed the methodological framework developed by Arskey and O’Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies.ResultsA total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients.ConclusionsFindings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide...

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“…Prior studies have reported similar challenges reducing observed racial and socioeconomic disparities . Although multiple interventions exist to improve BP control in minority populations, there is limited evidence that these interventions are effective in reducing overall disparities .…”

Section: Discussionmentioning

confidence: 94%

A community‐wide quality improvement initiative to improve hypertension control and reduce disparities

Fortuna

Rocco

Freeman³

et al. 2019

J of Clinical Hypertension

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A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

Cited by 12 publications

References 41 publications

Is insurance instability associated with hypertension outcomes and does this vary by race/ethnicity?

Is insurance instability associated with hypertension outcomes and does this vary by race/ethnicity?

Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review

A community‐wide quality improvement initiative to improve hypertension control and reduce disparities

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