Safety-net health clinics can use a variety of staff roles, processes, and resources to support patients to manage their blood pressure at home.
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High blood pressure, which affects about 45% of US adults, can increase the risk of heart disease and stroke. In Ohio, adults with low-incomes and those from Black/African American or rural, Appalachian communities experience the largest disparities in heart disease and stroke risk. They also face more barriers to receiving medical treatment and managing their blood pressure compared to other populations. Safety-net health clinics, such as Federally Qualified Health Centers (FQHCs), focus on providing care to these communities and are well-situated to help reduce related health disparities.
Self-Measured Blood Pressure Monitoring (SMBP) is when a person regularly checks their blood pressure outside of the clinic, often at home. When used in collaboration with a medical provider, SMBP can help people control their blood pressure and reduce their risk of heart disease and stroke. Studies suggest that implementing SMBP programs in FQHCs can help patients at highest risk for heart disease and stroke to manage their blood pressure. We recently published an article, “Implementing Self-Measured Blood Pressure Monitoring with Clinical Support: A Qualitative Study of Federally Qualified Health Centers,” in the Journal of Public Health Management and Practice as part of the supplement, Cardiovascular Disease Prevention Efforts through State and Local Health Departments Funded by the Centers for Disease Control and Prevention: Evaluation Findings and Implications for the Field – Volume 2. Our article describes how seven FQHCs implemented SMBP programs across various contexts and settings.
We interviewed staff from seven FQHCs in Ohio that participated in a quality improvement project. The FQHCs were spread across the state and represented urban, rural, suburban, and Appalachian areas. Each FQHC had its own approach to supporting patients with SMBP using a range of staff roles, resources, equipment, and internal programs. Despite the differences in geographies, populations, and sizes, all FQHCs implemented the same basic components (below), as recommended by best practice guidelines:
- Assign specific staff roles (eg, care managers, clinical pharmacists)
- Identify patients eligible for SMBP support
- Refer patients to SMBP support
- Connect patients with home blood pressure monitors
- Track blood pressure data
- Follow up with patients
- Connect patients to additional resources (eg, wellness programs, community health workers)
Throughout the quality improvement project, the FQHCs successfully developed processes to support their patients with SMBP. However, they faced several challenges to creating and maintaining these processes. Even with the latest technology (ie, Bluetooth-enabled blood pressure monitors), most FQHCs struggled to receive patients’ blood pressure data in the electronic health record system due to a variety of technological barriers for both patients and clinics. In addition, this project coincided with the COVID-19 pandemic, and all FQHCs faced staffing shortages and competing clinical priorities that interfered with the SMBP programs.
This study provides real-world examples of how to implement SMBP processes across a variety of FQHC settings. FQHCs and other health systems can use this article to develop their own approach to supporting patients with high blood pressure. We also describe potential challenges and solutions for health systems to consider when planning an SMBP program.
The quality improvement project covered the costs of staff time and equipment for most of the FQHCs, along with various grants and external funding sources. However, outside of this project, under-resourced health systems need ongoing funding to sustain SMBP programs. One way to provide this is through stronger insurance coverage for blood pressure equipment and reimbursement for clinical staff time. Thus, public health and healthcare leaders should advocate for expanded insurance coverage and reimbursement. They should also provide future funding opportunities to develop and expand SMBP programs, particularly for health systems serving a high proportion of people at risk of heart disease and stroke. Health systems can use existing staff roles, internal programs, and resources such as text messaging to provide cost-effective SMBP programs when funding sources are limited.
For more details on this project, read our article in the Journal of Public Health Management and Practice.
Acknowledgements
We would like to thank our co-authors for their work on this study: Rachel S Cruz, MPH, and Melissa Chapman Haynes, PhD.
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