Evaluating the efficacy of telephone-based outreach in addressing hypertension control among black men with severe hypertension: An observational study.

Abstract

The high prevalence of uncontrolled hypertension (systolic blood pressure [SBP] ≥140mmHg or diastolic blood pressure [DBP] ≥90mmHg) in Black patients represents a significant racial health disparity in the United States. This study evaluated the efficacy of a telephone-based strategy for inviting high-risk patients with severe hypertension to weekly self-management education classes. Further, the study assessed how the outreach intervention correlated with relevant quality improvement outcomes, including improved blood pressure and primary care follow-up among our clinic population of Black men with severe hypertension. A cohort of 265 Black men aged ≥18years with SBP ≥160mmHg or DBP ≥100mmHg at the most recent clinic visit were identified using Epic reports formatted for Federal Uniformed Data Set annual reporting. Telephone outreach was used to invite the cohort to attend weekly in-person classes facilitated by various healthcare professionals. Logistic regression was performed to determine the associations between being reached by phone with (1) class attendance and (2) follow-up appointment attendance. Most of the Black men were single (57.4%, n=152), 49.1% had history of alcohol or substance use (n=130), and 35.8% (n=95) was uninsured. The average age was 55.6years (SD=11.6). After controlling for sociodemographic factors, being reached by phone was significantly associated with an increased likelihood of patient attendance at follow-up appointments (OR=1.91, p=.038) but not with class attendance (OR=2.45, p=.155). Patients who attended a follow-up appointment experienced significant reductions in both SBP and DBP at 9months. Telephone outreach was labor-intensive but effective in keeping under-resourced patient populations engaged in primary care. Future work should aim to develop more efficient strategies for engaging high-risk patients in self-monitoring education to manage hypertension.