Abstract P212: A Community Intervention For Hypertension Control Using Health Worker Outreach And Algorithmic Software-driven Blood Pressure Management

Abstract

Background: Hypertension (HTN) in black and brown communities remains under-diagnosed and poorly controlled. Obstacles include access, lack of trust, social determinants of health (SDOH) and insufficient licensed providers. We hypothesized that a multi-faceted solution, combining screening, identification and support to address SDOH, and a remote software-driven HTN management program that shifts work to care navigators would be effective in controlling HTN. Methods: We launched a 500-person pilot in Detroit, MI, in March 2022. Community Health Workers (CHW) screened for patients with HTN in the community and surveyed them for SDOH. Patients received a cellular-enabled blood pressure (BP) cuff. Medications were initiated, titrated and side effects monitored according to a software-driven algorithm implementing latest HTN guidelines. Patients were contacted by a care navigator or community health worker using a combination of phone, text message, and email. Medication and testing were ordered by a licensed provider. Program success was evaluated based on proportion of patients who reached BP targets and patient satisfaction surveys. Results: During the initial deployment, 135 patients were screened and 86 (64%) were found to have Stage 1 HTN or greater. A total of 48 patients consented to join the program and 25 received a confirmatory BP measurement and cellular BP device. The average age of enrolled patients was 58±11 years with 52% females (N = 13), with 100% identified as Black. The median BP was 149/91mmHg, (IQR 144-159/87-98 mmHg). HTN severity on enrollment was 4% Stage 1, 59% Stage 2, and 37% Stage 3. Sixty-five % of patients were already taking one or more anti-HTN agents. A mean of 0.8 dose changes were made per patient per week. Results of the initial 250 managed patients will be presented including the percentage that reached BP goals, the number of medications required, time to reach goal, as well as impact of SDOH measures on BP control. Conclusions: Screening directly in an urban community resulted in a higher than expected rate of hypertension and included a high rate of stage 3 disease. A community-centered remote software-driven HTN program was feasible to implement.