A Mixed-Methods Approach for Evaluating Implementation Processes and Program Costs for a Hypertension Management Program Implemented in a Federally Qualified Health Center

Abstract

Team-based care approaches are effective at improving hypertension control and have been used in clinical practice to improve hypertension outcomes. This study implemented and evaluated the Hypertension Management Program (HMP), which was originally developed in a high-resource health setting, in a health system with fewer resources and a patient population disproportionately affected by hypertension. Our objectives were to describe how a health system could adapt HMP to meet their needs and calculate total program costs. HMP uses a team-based, patient-centered approach involving clinical pharmacists who contribute to managing patients who have hypertension and ultimately preventing premature death due to uncontrolled hypertension. HMP has 10 components (e.g., EHR patient registries and outreach lists, no copayment walk-in blood pressure checks). Our project involved implementing the key components of HMP in a federally qualified health center (FQHC) in South Carolina. Adaptations from the key components of HMP were made to fit the participants’ settings. A mixed-methods evaluation assessed implementation processes, program costs, and implementation facilitators and barriers. From September 2018 to December 2019, clinical pharmacists conducted 758 hypertension management visits (HMVs) with 316 patients with hypertension. Total program costs for HMP were $325,532 overall and $16,277 per month. Monthly cost per patient was $3.62. The high engagement among clinical pharmacists, along with provider engagements, followed up by the subsequent referral of patients to HMP, facilitated the implementation process. Staff members observed improvements in hypertension control, which increased participation buy-in. Barriers included staff turnover, the perception among some providers that HMP took too much time, as well as perception of HMP as a pharmacy-specific initiative. A team-based, patient-centered approach to hypertension management can be adapted for FQHCs or similar settings that serve patient populations disproportionately affected by hypertension.

Preventing and Managing Chronic Disease Through Implementation Science: Editor’s Introduction to the Supplemental Issue

“…Rigorous research and evaluation of implementation in action is critical to understanding the mechanisms of how strategies operate in specific contexts to effect implementation outcomes. Tucker-Brown et al ( 2023 ) present a rigorous mixed methods evaluation, adapted from an established methodology developed by Leviton and Gutman ( 2010 ), of the implementation of the Hypertension Management Program in a federally qualified health center. The evaluation included a review of program documents, qualitative interviews, and micro-costing to evaluate implementation processes, facilitators and barriers, and the values of resources used to implement the program.…”

A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

“…Several articles in this special issue evaluated implementation processes and costs of program delivery within historically marginalized communities. For example, Tucker-Brown et al evaluated implementing a hypertension management program, originally developed in a high-resource health setting, in a multi-site, southeastern Federally Qualified Health Center (FQHC) (Tucker Brown et al, 2023). The team-based, patient-centered program required adaptations to better suit the FQHC setting.…”