Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models

Abstract

Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

County‐Level Trends in Hypertension‐Related Cardiovascular Disease Mortality—United States, 2000 to 2019

“…Within telehealth visits, self‐measured BP monitoring, an evidence‐based approach, represents a key opportunity for clinicians to help their patients achieve and maintain optimal BP levels. 58 , 59 zCritically, given the stark differences in hypertension‐related CVD mortality by race and ethnicity and place, actions to prevent hypertension and improve subsequent clinical outcomes must be equitably implemented to avoid exacerbating existing disparities and to ultimately eliminate all disparities. Disparities in hypertension prevention, detection, and control are aided by unequal access to and engagement with healthy environments and the medical system, which, in turn, are rooted in more upstream social determinants of health, including poverty, stress, and racial and ethnic discrimination.…”

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions

“…Overall, SMBP compared with isolated in-office BP measurement has multiple benefits and is a proven prognostic indicator of CVD, stroke, and target organ damage. (Table 1) [19,28,29].…”

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education

“…4 Remote patient monitoring is particularly well suited for screening programs and for the management of chronic conditions such as diabetes and hypertension because it can reduce the cost and burden of in-person clinic visits. [5][6][7][8] Research is emerging that suggests telephone and video visits may be a preferred method of health care delivery for some patients and may have a significant effect on advancing health care in the future. 9,10 Patients report being satisfied with the use of telemedicine and remote home monitoring for the management of chronic conditions.…”