A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices

Abstract

The Southeastern United States has the highest prevalence of hypertension and African Americans have disproportionately worse blood pressure control. The authors sought to evaluate the effect of a multicomponent practice-based quality improvement intervention on lowering mean systolic blood pressure (SBP) at 12 and 24 months compared with baseline among 525 patients, and to assess for a differential effect of the intervention by race (African Americans vs white). At 12 months, both African Americans (−5.0 mm Hg) and whites (−7.8 mm Hg) had a significant decrease in mean SBP compared with baseline, with no significant between-group difference. Similarly, at 24 months, mean SBP decreased in both African Americans (−6.0 mm Hg) and whites (−7.2 mm Hg), with no significant difference between groups. Notably, no significant racial disparity in mean SBP at baseline was shown. The intervention was effective in lowering mean SBP in both African Americans and whites but there was no differential effect of the intervention by race.

The effect of a practice‐based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care

“…Participants who were 18 years and older, current patients from 1 of the 6 participating practices in the study, had a systolic BP ≥150 mm Hg during at least one office visit in the last year from the electronic health records (EHRs) and/or medical records, and provided informed consent were enrolled in this study. A CONSORT diagram of participant enrollment as well as primary blood pressure outcomes have been provided in a prior publication …”

“…As noted in the design and outcome manuscripts by Halladay and colleagues and Cene and colleagues, 38% of the participants also co‐participated in a lifestyle component of the intervention that aimed to improve their diet quality and increase their physical activity. To adjust for the effects of the lifestyle component of the intervention in the analysis, information regarding participation in the lifestyle intervention was also collected and used in the analysis.…”

“…This study was a secondary data analysis of the Heart Healthy Lenoir (HHL) hypertension Project that was designed to reduce disparities in HTN control in a rural county in NC; details of the HHL project were previously published. 20,21 In this study, investigators focused on changes in medication adherence and associated changes in BP from a prospective, practice-based, multicomponent quality improvement intervention that included an evidence-based and literacy-sensitive health-coaching component. The prospective study was conducted in rural primary care settings and evaluated using a cohort of patients with uncontrolled HTN.…”

“…We prescreened 796 patients, 574 patients attended an enrollment visit, and 49 of these were not eligible; therefore, there were 525 participants who met the inclusion criteria and enrolled in the parent study at baseline. 21 Among these 525 participants, 477 were included in this study who had at least 1 record on medication adherence and BP. The majority of the patients were female, black, and reported an annual household income of <$40 000.…”

Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations

“…Details of the design, setting, participants, and implementation are described in detail in Halladay et al [29] and Cene et al [30]. Briefly, we conducted a prospective cohort intervention study using a community based participatory approach that included input from a community advisory committee and the staff at local practices to help inform the intervention content and delivery.…”