School of Medicine, Stanford University, Stanford, CA, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241278836. doi: 10.1177/21501319241278836.
Hypertension affects approximately 1 in 2 adults in the US. Home blood pressure (BP) monitoring programs are effective in the diagnosis and management of hypertension. Free clinics serve as an integral safety net for millions of uninsured and economically disadvantaged patients in the US. The feasibility and effects of a free home BP monitoring and follow-up program in a free clinic setting is not well characterized.
This was a prospective study of the implementation of a pilot BP monitoring and follow-up program between March 2021 and August 2023 at 2 free clinics in the San Francisco Bay Area. A total of 78 hypertensive patients were enrolled in the program and given a free BP monitor. We surveyed via telephone the change in systolic and diastolic BPs and BP monitor use and comfort at 3 weeks. Volunteers in clinic roles involved in the BP monitoring program were surveyed to assess their time spent and perceptions of the program.
Of the 78 patients, 37 provided responses to the 3-week survey. A total of 36 of 37 (97%) patients reported using their BP monitor. A total of 35 patients reported using it at least once a week (95%), with the majority reporting at least four uses a week (68%). A total of 36 patients (97%) planned on continuing to use their BP monitor. At 3 weeks, the mean systolic and diastolic BP changed by -6.40 mmHg (95% CI, -10.8 to -2.01 mmHg; P = .00577) and -2.72 mmHg (95% CI, -5.62 to 0.188 mmHg; P = .0657), respectively. The time commitment for this program ranged from 130 ± 51 min for program leaders to 16 ± 14 min per week for patient-facing roles. All volunteer roles (patient-facing, phone follow-up, program leaders) expressed that they had a clear understanding of their responsibilities in the program (median 4 on Likert scale, IQR 3-5).
Home BP monitoring and follow-up is feasible to implement in free clinics, resulting in high rates of patient engagement among respondents. Our findings suggest that home BP monitoring and follow-up programs may be beneficial in vulnerable patient populations.
高血压影响了美国约 1/2 的成年人。家庭血压（BP）监测计划在高血压的诊断和管理中非常有效。免费诊所是美国数百万未参保和经济困难患者的重要安全网。在免费诊所环境中，免费家庭 BP 监测和随访计划的可行性和效果尚未得到充分描述。
这是一项前瞻性研究，于 2021 年 3 月至 2023 年 8 月在旧金山湾区的 2 家免费诊所实施了一项试点 BP 监测和随访计划。共有 78 名高血压患者参加了该计划，并获得了免费的血压计。我们通过电话调查了 3 周时收缩压和舒张压的变化以及血压计的使用情况和舒适度。参与 BP 监测计划的诊所志愿者的调查评估了他们的时间投入和对该计划的看法。
在 78 名患者中，有 37 名患者对 3 周调查做出了回应。共有 36 名患者（97%）报告使用了他们的血压计。共有 35 名患者报告每周至少使用一次（95%），其中大多数报告每周至少使用四次（68%）。共有 36 名患者（97%）计划继续使用他们的血压计。在 3 周时，收缩压和舒张压分别平均下降了-6.40mmHg（95%CI，-10.8 至-2.01mmHg；P=0.00577）和-2.72mmHg（95%CI，-5.62 至 0.188mmHg；P=0.0657）。该计划的时间投入范围从计划负责人的 130±51 分钟到患者面对面角色的每周 16±14 分钟。所有志愿者角色（患者面对面、电话随访、计划负责人）都表示他们清楚地了解自己在计划中的职责（Likert 量表中位数为 4，IQR 为 3-5）。
家庭血压监测和随访在免费诊所中是可行的，在受访者中实现了高参与率。我们的研究结果表明，家庭 BP 监测和随访计划可能对弱势患者群体有益。
