Prevention Research Center (PRC) Research Aligns with Task Force Recommendations on Clinical Hypertension Management
In May 2012, the Community Preventive Services Task Force recommended team-based care for patients with hypertension (high blood pressure), on the basis of strong evidence from 2 systematic reviews that together included 77 scientific studies. The studies show that patients’ control of blood pressure improved when care was provided by a team that included a physician as well as a nurse, dietitian, pharmacist, community health worker, or social worker—rather than by a physician alone. Several Prevention Research Center (PRC) researchers are conducting studies that involve team-based care for hypertension.
Researchers at the Boston University PRC are investigating whether public housing residents will readily seek health care and enroll in health promotion programs with the help of resident health navigators (RHNs). RHNs are public housing residents trained as community health workers who can help their fellow residents navigate the health care system. The study builds on previous research showing that RHNs are effective in motivating fellow residents to use a traveling health screening van and to attend follow-up appointments.1
Participants in the current study are screened for various conditions, including hypertension. According to Boston PRC researcher Tracy Battaglia, MD, MPH, 64% of the 600 participants screened so far have hypertension - blood pressure greater than 140/90.2 That is despite the fact that most of the study participants report having a primary care provider.
“Even though a majority of participants are seeing health care providers, their blood pressure is not controlled,” says Dr. Battaglia. “These findings suggest that a team-based approach to hypertension management may be appropriate. This approach is exactly what the current study is assessing through using resident health navigators.”
“The task force recommendations are definitely on point,” agrees Alwyn Cohall, MD, director of the Columbia University PRC. “Having other partners in the healthcare delivery team involved, all bringing their collective expertise and viewpoints to bear on the patient, is very important,” he said. “Patients have multiple opportunities to converse with members of the team. So they have the ability to get information reinforced and get questions answered in different ways.”
Dr. Cohall is researching strategies to reduce hypertension among adults in the largely African-American community of Harlem, New York. African Americans have a higher prevalence of hypertension than white Americans. He is looking at whether study participants will take steps to reduce their blood pressure after they are given a locally relevant health information workbook and access to a website (gethealthyharlem.org3) or whether a community health worker is needed to help them take those steps.
According to Darren DeWalt, MD, MPH, of the University of North Carolina at Chapel Hill PRC, team-based care is a key health care strategy. He is working on blood pressure management strategies with six primary care practices in North Carolina, part of the so-called stroke belt of the United States.
“Some patients may feel more comfortable talking with a medical assistant or nurse than with a doctor,” Dr. Dewalt said. “So it could be helpful for those patients to get blood pressure information from these staff members.”
The task force recommends that patients should be actively engaged in their own care and given tools and resources for self-management; patients are the first member of their blood pressure control team, Dr. DeWalt said that’s important. “Care is going to work better if the patient is considered part of the team, not just someone to whom doctors administer treatment and prescribe medication.”
1 Rorie J, Smith A, Evans T, et al. Using resident health advocates to improve public health screening and follow-up among public housing residents, Boston, 2007-2008. Prev Chronic Dis. 2011;8(1).
2 Battaglia TA, Rorie JL, Primeau SW, et al. Caron SE, Bhosrekar SG, Chen B, Bowen DJ. Recruiting Public Housing Residents into a Patient Navigation Research Program. Poster session presented at: 5th Annual Clinical and Translational Science Award National Conference; 2012 August 23-24, 2012; Bethesda, MD.
3 Khan SA, Ancker JS, Li J, Kaufman D, Hutchinson C, Cohall A, Kukafka R. GetHealthyHarlem.org: developing a web platform for health promotion and wellness driven by and for the Harlem community. AMIA Annual Symposium Proceedings 2009;2009:317-21.