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.
Highlights
Uncontrolled hypertension is one of the leading risk factors for cardiovascular disease
Eight of the nine health centers established collaborative approaches where external organizations assisted with tasks we identified that could be performed by an Self-measured blood pressure monitoring (SMBP) Supporter
In New York, all four participating health centers worked with the New York State Department of Health, which purchased home blood pressure monitors so they could be loaned to patients for SMBP
Summary
Uncontrolled hypertension is one of the leading risk factors for cardiovascular disease. Despite wide international use of SMBP as a standard of care [4,5,6] as well as the growing national evidence and endorsement of SMBP’s value in diagnosing and managing high blood pressure [2, 3], Ostchega et al estimated that fewer than 25% of US adults with hypertension engage in any home blood pressure monitoring [7]. While there are many obstacles to broad adoption of SMBP, there is keen interest in improving hypertension control and in developing clinical and community partnerships that promote health and wellbeing. This broadening of the locus of care can help people in their daily efforts to improve their own health [8, 9]
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