Improving Patient Self-Management of Hypertension in a Rural Primary Care Clinic

Background: Hypertension (HTN) is a leading cause of cardiovascular disease and death in persons aged 35 and older. While pharmacotherapy is required for most patients, lifestyle modifications can also significantly lower blood pressure (BP). Rural populations are more likely to develop HTN, a major risk factor for stroke and myocardial infarction. Decreased access to care due to geographical limitations or socioeconomic status impairs HTN control in rural populations, resulting in poor health outcomes. Given the increasing prevalence of HTN worldwide, a focus on non-pharmacologic methods to lower BP is critical. However, providers recommend lifestyle modifications to only 20% of American adults with HTN. Therefore, providers need to selectively deliver non-pharmacologic care to patients. Team-based care has been shown to improve outcomes in HTN management. Application of team-based care to non- pharmacological management of HTN has the potential to lower patient BP. Team-based, multifactorial interventions that include both provider and patient self-management education via an HTN educational toolkit may help address patient self-efficacy for HTN management compared to provider education alone. Methods: A quality improvement project was initiated to streamline patient education for lifestyle self- management of HTN. As part of the feasibility study, a education-based toolkit to address provider education, but also to give patients information and resources for self-management of HTN. In addition to HTN education, providers received information on the toolkit. In addition to HTN education, providers received a patient-friendly handout to help facilitate discussions on HTN and lifestyle self-management interventions. To assess project feasibility, clinic providers completed anonymous pre-implementation surveys and post-implementation surveys. Results: A total of 8 clinic providers were given information about the project, 5 participated in the pre- survey, and 3 participated in the post-survey (9 weeks of implementation). In addition, 150 handouts were given to the providers, and 142 of the total were utilized for patient education. Post-intervention results show that those providers completing the surveys felt comfortable providing this educational handout to patients with HTN and that the handout positively impacted patient care and clinic workflow. Conclusions: Patient-centered lifestyle modification self-management handouts for HTN proved to be a useful and feasible resource for the clinic. Study results show that clinic healthcare team members are willing and interested in providing their patients with self-management recommendations for lifestyle modifications to manage their condition. Replication of this quality improvement project will help determine if similar methods of team-based care are useful among different clinic settings, and whether this type of intervention has the capacity to change provider experience and patient health outcomes.