Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE, GA, 30341, Atlanta, USA.
Health Care Evaluation Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, MD, 20814, Bethesda, USA.
Prev Sci. 2024 Apr;25(Suppl 1):10-21. doi: 10.1007/s11121-023-01529-x. Epub 2023 Jun 30.
Team-based care approaches are effective at improving hypertension control and have been used in clinical practice to improve hypertension outcomes. This study implemented and evaluated the Hypertension Management Program (HMP), which was originally developed in a high-resource health setting, in a health system with fewer resources and a patient population disproportionately affected by hypertension. Our objectives were to describe how a health system could adapt HMP to meet their needs and calculate total program costs. HMP uses a team-based, patient-centered approach involving clinical pharmacists who contribute to managing patients who have hypertension and ultimately preventing premature death due to uncontrolled hypertension. HMP has 10 components (e.g., EHR patient registries and outreach lists, no copayment walk-in blood pressure checks). Our project involved implementing the key components of HMP in a federally qualified health center (FQHC) in South Carolina. Adaptations from the key components of HMP were made to fit the participants' settings. A mixed-methods evaluation assessed implementation processes, program costs, and implementation facilitators and barriers. From September 2018 to December 2019, clinical pharmacists conducted 758 hypertension management visits (HMVs) with 316 patients with hypertension. Total program costs for HMP were $325,532 overall and $16,277 per month. Monthly cost per patient was $3.62. The high engagement among clinical pharmacists, along with provider engagements, followed up by the subsequent referral of patients to HMP, facilitated the implementation process. Staff members observed improvements in hypertension control, which increased participation buy-in. Barriers included staff turnover, the perception among some providers that HMP took too much time, as well as perception of HMP as a pharmacy-specific initiative. A team-based, patient-centered approach to hypertension management can be adapted for FQHCs or similar settings that serve patient populations disproportionately affected by hypertension.
基于团队的护理方法在改善高血压控制方面非常有效，并已在临床实践中用于改善高血压的治疗效果。本研究实施并评估了高血压管理计划（HMP），该计划最初是在资源丰富的医疗环境中开发的，然后在资源较少的医疗系统中进行实施，该系统的患者人群中高血压的发病率不成比例。我们的目标是描述医疗系统如何适应 HMP 以满足其需求，并计算总计划成本。HMP 采用以团队为基础、以患者为中心的方法，涉及临床药师，他们参与管理患有高血压的患者，并最终预防因高血压未得到控制而导致的过早死亡。HMP 有 10 个组成部分（例如，EHR 患者登记册和外展清单，无需共付额即可进行血压检查）。我们的项目涉及在南卡罗来纳州的一家合格的联邦健康中心（FQHC）中实施 HMP 的关键组成部分。对 HMP 的关键组成部分进行了调整，以适应参与者的环境。采用混合方法评估了实施过程、计划成本以及实施的促进因素和障碍。从 2018 年 9 月至 2019 年 12 月，临床药师共为 316 名高血压患者进行了 758 次高血压管理就诊（HMV）。HMP 的总计划成本为 325532 美元，每月 16277 美元。每位患者的月成本为 3.62 美元。临床药师的高度参与度，以及医疗服务提供者的参与度，随后是将患者转诊到 HMP，促进了实施过程。工作人员观察到高血压控制的改善，这增加了参与度。障碍包括员工流失、一些医疗服务提供者认为 HMP 花费太多时间，以及将 HMP 视为特定于药房的举措的看法。以团队为基础、以患者为中心的高血压管理方法可以适应服务于高血压发病率不成比例的患者人群的 FQHC 或类似环境。
