Health Promotion Research Center, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington.
J Public Health Manag Pract. 2024;30:S167-S174. doi: 10.1097/PHH.0000000000001937. Epub 2024 Jul 22.
Uncontrolled hypertension can lead to an increased risk of cardiovascular disease, myocardial infarction, stroke, or death. Self-monitoring blood pressure (SMBP) programs have been associated with blood pressure (BP) reduction, particularly among rural, minority, and low-income individuals. There is limited literature about nonphysician SMBP programs.
To evaluate the effectiveness of an SMBP program designed to engage nonphysician team members in hypertension management within a federally qualified health center (FQHC).
Self-monitoring blood pressure program activities were implemented using a Plan, Do, Study, Act model. The University of Washington Health Promotion Research Center evaluated processes and patient-level outcomes in a mixed-methods design. Quantitative analysis examined clinical outcomes related to hypertension, and qualitative analysis relied on interviews with clinical staff examining program implementation, adoption, and sustainability.
Family Health Centers (FHCs), a FQHC located in rural Washington, serving medically underserved populations.
Two hundred five active SMBP patients out of 2600 adult patients (over 18 years old) who had a diagnosis of hypertension within the last 12 months.
Patients with uncontrolled hypertension were given a BP cuff to log their daily BP. Patients met with community health workers (CHWs) and medical staff to review logs and set self-management goals over 3 to 4 months.
Controlled BP measurements and factors to implementation and sustainment.
Facilitators to implementation included expanded telehealth reimbursement during the COVID-19 pandemic, integration of CHWs, and linguistically adapted resources. Barriers included a lack of reimbursement for nonphysician time and BP monitors. Quantitative results demonstrated an effort to reach minoritized populations but did not show an improvement in BP outcomes.
Family Health Center implemented an SMBP program adapted to meet the linguistic and social needs of their patients. The successful integration of CHWs and the need for reimbursement policies to support SMBP programs were key factors for implementation and sustainability.
未控制的高血压会增加心血管疾病、心肌梗死、中风或死亡的风险。自我监测血压（SMBP）计划与血压降低有关，特别是在农村、少数民族和低收入人群中。关于非医师 SMBP 计划的文献有限。
评估一项 SMBP 计划的有效性，该计划旨在让非医师团队成员参与农村华盛顿州的合格联邦健康中心（FQHC）的高血压管理。
使用计划-执行-研究-行动模型实施 SMBP 计划活动。华盛顿大学健康促进研究中心采用混合方法设计评估了过程和患者水平的结果。定量分析检查了与高血压相关的临床结果，定性分析依赖于对临床工作人员的访谈，以检查计划的实施、采用和可持续性。
家庭健康中心（FHCs），位于华盛顿农村的 FQHC，为医疗服务不足的人群提供服务。
205 名活跃的 SMBP 患者，从 2600 名成年患者中挑选（年龄超过 18 岁），他们在过去 12 个月内被诊断患有高血压。
血压控制不佳的患者被给予血压袖带来记录他们的日常血压。患者与社区卫生工作者（CHWs）和医务人员会面，在 3 到 4 个月内回顾记录并制定自我管理目标。
控制血压测量和实施和维持的因素。
实施的促进因素包括在 COVID-19 大流行期间扩大远程医疗报销、整合 CHWs 和语言适应资源。障碍包括非医师时间和血压监测器缺乏报销。定量结果表明努力接触少数族裔人群，但没有显示血压结果的改善。
家庭健康中心实施了一项 SMBP 计划，以满足患者的语言和社会需求。CHWs 的成功整合和支持 SMBP 计划的报销政策需求是实施和可持续性的关键因素。
