| Description |
High blood pressure, also known as the "silent killer", affects millions of people, or one in three adults in the United States and is costing the nation over $45 billion each year. Untreated high blood pressure leads to cardiovascular disease and strokes, the two leading causes of death for Americans. The use of home blood pressure monitor's (HBPM) are on the rise since 2008 when the American Heart Association (2014) began recommending, home monitoring for all people with high blood pressure to help the healthcare provider determine whether treatments are working. These statistics represent a need for further intervention, where the patient is more involved with their healthcare. Problems identified in treating hypertension include therapeutic inertia, not having accurate blood pressure readings in the clinic, and poor compliance to treatment. Strengths of the HBPM have been shown to improve patients' compliance with treatment and hypertension control rates. By providing a HBPM to patients with treated hypertension, education about the disease and a clinic wide protocol for providers this community health center (CHC) aims to reduce the number of uncontrolled hypertensive patients in the clinic. The purpose of this project was to reduce the incidence of uncontrolled high blood pressure by engaging those who are currently being treated for high blood pressure through the use of a Home Blood Pressure Monitor (HBPM) program and a clinic wide protocol at a large CHC in the Intermountain West. The objectives for this program were accomplished by: (1) implementing a Home Blood Pressure Monitor (HBPM) program at a the CHC, (2) educating patients on how to use the HBPM, (3) assessing and attempting to overcome patient barriers using the HBPM, (4) evaluating the project by assessing patient blood pressures pre and post intervention, (5) disseminating information gathered to the administration of the CHC and the Utah Department of Health (UDOH). To achieve these objectives, the CHC purchased HBPMs, enrolled willing participants with a diagnosis of high blood pressure that remained above goal despite being on one or more blood pressure medications, based on grant requirements, and monitored their HBPM readings over several months. To ensure accuracy, the CHC educated participants on how to use the HBPM and evaluated understanding at follow-up visits by reviewing blood pressure readings. Throughout the program barriers were evaluated by the provider at each visit and addressed during the implementation phase of the program. Results were evaluated by comparing HBPM readings to pre intervention blood pressures at the clinic, with IRB approval for chart review. Last, information gathered throughout the project was disseminated to the clinic administration and UDOH to improve methodology and maintain sustainability. In conclusion, 68% of participants had a blood pressure below goal (<140/90) with their average HBPM readings. Demonstrating the clear benefit of improved blood pressure control using a HBPM in the management of hypertension. The advantages of using a HBPM include improved blood pressure monitoring, removal of the white coat effect and improved adherence to medications. Overall, the program demonstrated the benefits of using a HBPM to help improve control and adherence among participants with previously uncontrolled blood pressure. |
