CATAPULT: Breaking The Pressure Barrier
Abstract
Quality improvement project
Breaking the pressure barrier: The impact of bundle interventions on blood pressure management in a resident’s clinic
Introduction
The prevalence of hypertension continues to increase. Despite all the advancement in therapy only half of these patients achieve BP <140/90.HTN has an estimated cost of $131 billion mainly due to being one of the main risk factors for coronary artery disease, stroke, and heart failure. To curb this, the American college of cardiology and the American heart association have provided recommendations to help manage hypertension. This includes modification of lifestyle behaviors, medications, and improving access to care. This study assesses the use of a bundle intervention that addresses lifestyle, access to resources, and antihypertensive medication adherence in the management of hypertension in a resident clinic.
Method
This was a prospective one-year long study done at a resident care clinic. Patients aged ≥ 18 years seen between June 1, 2022 and December 31, 2022 with a blood pressure (BP) ≥ 140/90 mmHg were included in the study. Those with end stage renal disease (ESRD) and pregnancy were excluded. The intervention bundle focused on: education, resources and access to care. 1.Education: Patient were given a goody bag which included: education material on hypertension and its management, a pill organizer, home BP device, a BP log, exercise prescription as well as DASH diet instructions.2.Resources: Patients received 6 weekly classes about healthy diet and free fresh fruits and vegetables, home BP device and transportation to their clinic appointments if they couldn’t afford it .3.Access to care: They were followed at 6 weeks intervals ,3 visits conducted by a physician and 2 visits for BP control conducted by our medical assistants. During which adherence to medications was evaluated using hill-bone BP adherence scale (HBS) focusing on sodium intake and adherence to medications in addition to hypertension control is assessed by home BP logs and in clinic BP measurements regardless of their insurance status. Data were analyzed using excel.
Result
There were 21 participants with a retention rate of 71% (15/21). The median age was 55 years, 61.9% were males, and 47.6% were blacks or African Americans. The average body mass index was 35.89 kg/m2, 23.8% smoke cigarettes, 47.6% had diabetes mellitus, 23.8% had chronic kidney disease.14.3% had coronary artery disease and 4.8% had stroke. The HBS scores at the beginning of the study ranged from 41 – 64, with a median 51 . At the end of the study, there was an average reduction in systolic and diastolic blood pressure of 13.75 mmHg and 5.9 mmHg. Patients with high hill bone medication adherence scale scores at the beginning of the study had a better systolic and diastolic blood pressure control at 6 weeks.
Discussion
Most of the study participants had comorbidities associated with poorly controlled hypertension such as diabetes mellitus, obesity, and chronic kidney disease. They were remarkably nonadherent to hypertension management interventions as characterized by their high HBS scores. The use of the bundle intervention led to an improvement in the blood pressure control. This study shows that this intervention can lead to better control of hypertension, and this strategy may help address the adverse outcomes associated with uncontrolled hypertension. Large studies are needed to further evaluate these findings.
Keywords
Hypertension, Chronic disease management, residency clinic, social determinants of health
CATAPULT: Breaking The Pressure Barrier
Quality improvement project
Breaking the pressure barrier: The impact of bundle interventions on blood pressure management in a resident’s clinic
Introduction
The prevalence of hypertension continues to increase. Despite all the advancement in therapy only half of these patients achieve BP <140/90.HTN has an estimated cost of $131 billion mainly due to being one of the main risk factors for coronary artery disease, stroke, and heart failure. To curb this, the American college of cardiology and the American heart association have provided recommendations to help manage hypertension. This includes modification of lifestyle behaviors, medications, and improving access to care. This study assesses the use of a bundle intervention that addresses lifestyle, access to resources, and antihypertensive medication adherence in the management of hypertension in a resident clinic.
Method
This was a prospective one-year long study done at a resident care clinic. Patients aged ≥ 18 years seen between June 1, 2022 and December 31, 2022 with a blood pressure (BP) ≥ 140/90 mmHg were included in the study. Those with end stage renal disease (ESRD) and pregnancy were excluded. The intervention bundle focused on: education, resources and access to care. 1.Education: Patient were given a goody bag which included: education material on hypertension and its management, a pill organizer, home BP device, a BP log, exercise prescription as well as DASH diet instructions.2.Resources: Patients received 6 weekly classes about healthy diet and free fresh fruits and vegetables, home BP device and transportation to their clinic appointments if they couldn’t afford it .3.Access to care: They were followed at 6 weeks intervals ,3 visits conducted by a physician and 2 visits for BP control conducted by our medical assistants. During which adherence to medications was evaluated using hill-bone BP adherence scale (HBS) focusing on sodium intake and adherence to medications in addition to hypertension control is assessed by home BP logs and in clinic BP measurements regardless of their insurance status. Data were analyzed using excel.
Result
There were 21 participants with a retention rate of 71% (15/21). The median age was 55 years, 61.9% were males, and 47.6% were blacks or African Americans. The average body mass index was 35.89 kg/m2, 23.8% smoke cigarettes, 47.6% had diabetes mellitus, 23.8% had chronic kidney disease.14.3% had coronary artery disease and 4.8% had stroke. The HBS scores at the beginning of the study ranged from 41 – 64, with a median 51 . At the end of the study, there was an average reduction in systolic and diastolic blood pressure of 13.75 mmHg and 5.9 mmHg. Patients with high hill bone medication adherence scale scores at the beginning of the study had a better systolic and diastolic blood pressure control at 6 weeks.
Discussion
Most of the study participants had comorbidities associated with poorly controlled hypertension such as diabetes mellitus, obesity, and chronic kidney disease. They were remarkably nonadherent to hypertension management interventions as characterized by their high HBS scores. The use of the bundle intervention led to an improvement in the blood pressure control. This study shows that this intervention can lead to better control of hypertension, and this strategy may help address the adverse outcomes associated with uncontrolled hypertension. Large studies are needed to further evaluate these findings.
