Novel Hypertension Management Model of Care Improves Blood Pressure Control in a West African Population

Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their condition, and write electronic prescriptions which could be accessed by participating pharmacies. Average baseline BP was 135±18/84±10 mmHg in the overall cohort and 153±13/90±11 mmHg in the subgroup with uncontrolled hypertension (n=58). After 6 months of voluntary weekly monitoring, systolic blood pressure decreased significantly (p<0.01) in the overall cohort (-4.7±18.7 mmHg) and in the uncontrolled subgroup (-15.2±17.6mmHg). Systolic blood pressure remained constant in the sub group with controlled pressure at baseline. The proportion of the population with uncontrolled hypertension decreased from 39% to 27% (p=0.01). Patient compliance with weekly BP assessments was 61% and 2,855 BP assessments were conducted. During 33 of the 2,855 BP assessments (1% of pharmacy visits), the software application directly referred patients to a health facility (33 visits in 25 patients). Improvement in overall health awareness was reported in 82% of the participants and 95% of participants indicated a desire to continue using this model in the future. Conclusions: Compliance and satisfaction with this multifaceted hypertension care model were high and led to significant and sustained decreases in blood pressure in this West African hypertensive population.

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Abstract P389: Lowered Blood Pressure With Hypertension Management Model in a West African Population: Increased Efficiency and Implications for Improved Outcomes

Hypertension ◽

10.1161/hyp.72.suppl_1.p389 ◽

2018 ◽

Vol 72 (Suppl_1) ◽

Author(s):

Isaac Kofi Owusu ◽

Fred Adomako-Boateng ◽

Fred Kueffer ◽

Molly Guy ◽

Chemuttaai Lang'at ◽

...

Keyword(s):

Blood Pressure ◽

West African ◽

African Population ◽

Management Model ◽

Hypertension Management ◽

Improved Outcomes

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Efficacy of a Culturally and Linguistically Competent Community Health Coach Intervention for Chinese with Hypertension

Asian/Pacific Island Nursing Journal ◽

10.31372/20200503.1087 ◽

2020 ◽

Vol 5 (3) ◽

pp. 111-119

Author(s):

Wen-Wen Li ◽

Donna Lew ◽

Linda Quach

Keyword(s):

Blood Pressure ◽

Community Health ◽

Blood Pressure Control ◽

Chinese Immigrants ◽

Pressure Control ◽

Management Program ◽

Hypertension Management ◽

Health Coach ◽

Cross Sectional ◽

Question And Answer

Purpose: To develop and pilot test the efficacy of a culturally and linguistically sensitive, community health coach (CHC)-based intervention in Chinese immigrants in improving blood pressure control and medication adherence. Design: This study was conducted in 2017 with a cross-sectional design (n = 23). A CHC intervention was implemented using one 25-minute group educational presentation plus one 10-minute question and answer session at baseline, followed by four, 10-minute bi-weekly group question-and-answer sessions. Findings: There was a significant reduction in both systolic and diastolic blood pressure from baseline to week 8: Systolic BP −17.33 (±11.32) (p < 0.005) and diastolic BP −9.58 (±6.57) (p < 0.005). The mean score for medica- tion adherence was 10.56 (±3.24) (possible range 3–15) at baseline and there was no significant change at week 8 (mean 10.89 ± 3.95) (p = 0.86). Conclusion: The CHC-based hypertension management program showed significant reductions in both systolic and diastolic blood pressures in Chinese immigrants. Since the proposed CHC-based hypertension management program is low cost and easy to establish, further investigation is recommended to generate more results for comparison. Practice Implications: There is potential for the CHC intervention to be implemented in clinical settings to help Chinese immigrants at large achieve optimal blood pressure control.

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Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1203-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

J. P. Sibomana ◽

R. L. McNamara ◽

T. D. Walker

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Rural District ◽

World Health ◽

Medication Cost ◽

Hypertension Management ◽

Cross Sectional ◽

Major Barrier ◽

District Hospitals

Abstract Background Hypertension management in rural, resource-poor settings is difficult. Detailed understanding of patient, clinician and logistic factors which pose barriers to effective blood pressure control could enable strategies to improve control to be implemented. Methods This cross-sectional, multifactorial, observational study was conducted at four rural Rwandan district hospitals, examining patient, clinician and logistic factors. Questionnaires were administered to consenting adult outpatient hypertensive patients, obtaining information on sociodemographic factors, past management for hypertension, and adherence (by Morisky Medication Adherence 8-item Scale (MMAS-8). Treating clinicians identified local difficulties in providing hypertension management from a standard World Health Organisation list and nominated their preferred treatment regimens. Blood pressure measurements and other clinical data were collected during the study visit and used to determine blood pressure control, according to goals from JNC-8 guidelines. Medication availability and cost at each hospital’s pharmacy were reviewed as logistic barriers to treatment. Results The 112 participating patients were 80% female, with only 41% having completed primary education. Self-reported adherence by the MMAS-8 was high in 77% (86/112) and significantly associated) with literacy, lack of medication side effects and the particular hospital and pharmacy attended (all p < 0.05). However, of 89 patients with blood pressure data, only 26 (29%) had achieved goal blood pressure. No patient factor were statistically associated with poor blood pressure control. Among 30 participating clinicians, deficiencies in knowledge were evident; 43% (13/30) and 37% (11/30) chose a loop diuretic as their prescribed medication and as an ideal medication, respectively, for a newly diagnosed hypertensive patient without comorbidities, counter to JNC 8 recommendations, and 50% (15/30) identified clinician non-adherence to hypertension guidelines as a barrier. In the pharmacies, common anti-hypertensive medications were affordably available (> 6 out of 8 examined medications available in all pharmacies, cost <US$0.50 per month); however, clinicians perceived medication cost and availability to be barriers to care. Conclusions Clinician-based factors are a major barrier to blood pressure control in rural district hospitals in Rwanda, and blood pressure control overall was poor. Patient and logistic barriers to blood pressure were not evident in this study.

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INCREASED CLINIC EFFICIENCY AND DECREASED BLOOD PRESSURE WITH A NOVEL HYPERTENSION MANAGEMENT MODEL OF CARE IN A WEST AFRICA

Journal of Hypertension ◽

10.1097/01.hjh.0000539740.82278.ad ◽

2018 ◽

Vol 36 (Supplement 1) ◽

pp. e259

Author(s):

I. Owusu ◽

F. Adomako-Boateng ◽

F. Kueffer ◽

M. Guy ◽

C. Lang’at ◽

...

Keyword(s):

Blood Pressure ◽

West Africa ◽

Management Model ◽

Hypertension Management ◽

Model Of Care ◽

Clinic Efficiency

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Hypertension Management Guidelines Update and Research on the Importance of Blood Pressure Control

Home Healthcare Nurse ◽

10.1097/nhh.0000000000000163 ◽

2014 ◽

Vol 32 (10) ◽

pp. 603-609

Author(s):

LaToya Sealy ◽

Arthur Oliva

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Hypertension Management ◽

Management Guidelines

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Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines

Journal of Human Hypertension ◽

10.1038/s41371-020-0334-4 ◽

2020 ◽

Author(s):

Daniela Anker ◽

Brigitte Santos-Eggimann ◽

Marcel Zwahlen ◽

Valérie Santschi ◽

Nicolas Rodondi ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Blood Pressure Control ◽

Pressure Control ◽

Health Conditions ◽

Hypertension Management ◽

Management Guidelines

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Team-Based Hypertension Management to Improve Blood Pressure Control

Journal of Primary Care & Community Health ◽

10.1177/2150131916645580 ◽

2016 ◽

Vol 7 (4) ◽

pp. 272-275 ◽

Cited By ~ 11

Author(s):

Jeffrey D. Kravetz ◽

Robert F. Walsh

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Hypertension Management ◽

Improve Blood Pressure Control

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PREVALENCE AND MANAGEMENT OF HYPERTENSION AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA

Innovation in Aging ◽

10.1093/geroni/igz038.451 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S123-S123

Author(s):

Jianjia Cheng ◽

Jungtae Choi ◽

Lydia Li

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Blood Pressure Monitoring ◽

Pressure Control ◽

Hypertension Management ◽

Lifestyle Advice ◽

Middle Aged ◽

Hypertensive Patients ◽

Undiagnosed Hypertension ◽

To Receive

Abstract The study aimed to examine hypertension prevalence and management in China. Data were from a national survey of a probability sample of 45+ in China (N = 17,047). Self-reported hypertension diagnosis and readings from electronic blood pressure monitors were used to create four variables: diagnosed, measured (>=140/90 as high), undiagnosed, and overall (diagnosed + undiagnosed) hypertension. Respondents with diagnosed hypertension were asked about medication use, blood pressure monitoring, and lifestyle advice from doctors; and were considered inadequate blood pressure control if having measured hypertension. Weighted descriptive statistics and multivariate logistic regression were conducted. The prevalence of diagnosed, measured, undiagnosed and overall hypertension was 27%, 37%, 14%, and 51%, respectively. Across all four, older age adults, women, and urban residents had higher rates. Among hypertensive patients, 82% took anti-hypertensive medications, 91% monitored blood pressure, 60% received lifestyle advice, and 53% had inadequate blood pressure control. Compared to the 45-54 years old, the 75+ was less likely to receive lifestyle advice (OR=0.63, 95% CI=0.43-0.95) and the 65-74 was less likely to have adequate control (OR=0.75, 95% CI=0.73-0.98). Men were less likely to use medications (OR=0.77, 95% CI=0.63-0.95) but more likely to receive lifestyle advice (OR=1.48, 95% CI=1.23-1.78) than women. More education and urban (vs. rural) were associated with better hypertension management and control. In conclusion, hypertension affects half of the middle-aged and older population in China. More than half of hypertensive patients have inadequate blood pressure control. People who are older, women, low-educated, and rural residents are disadvantaged in hypertension management.

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