Impact of a mobile hypertension program in four rural Dominican bateyes

2018 ◽  
Author(s):  
◽  
Tammie M. Conley
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Blood Pressure Control ◽  
Migrant Workers ◽  
Repeated Measures ◽  
Large Population ◽  
Pressure Control ◽  
Academic Community ◽  
Self Report ◽  
The Impact

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Hypertension contributes significantly to cardiovascular risk and overall mortality worldwide. Among Haitians, uncontrolled hypertension is a leading contributing cause of death. The Dominican Republic is home to a large population of Haitian migrant workers who are living in poverty in sugar cane villages called bateyes. Like other rural impoverished communities, batey residents often lack access to basic health and education services which can result in poor cardiovascular health outcomes. This dissertation examined the impact of the first 12 months of an ongoing mobile hypertension program. The program, developed via an academic-community partnership, was delivered by a local Dominican non-governmental organization (NGO) in four rural bateyes. A ‘promotora’ (lay health promoter) who is a resident of each batey works closely with the team to enhance community participation in the program. Descriptive statistics were used to describe the study sample (n=70). A within-group, repeated-measures, pre-/post design examined the impact of the program on the main outcome measure of blood pressure control. Other outcome measures of interest were body mass index (BMI) and self-reported salt, alcohol, and smoking behaviors, and medication adherence (measured by self-report and pill counts). Results from analyses of 5 visits over a 12-month period showed a decrease in mean systolic and diastolic blood pressure over time (p less than .005). Of note, 68% of the participants were >80% adherent to their antihypertensive medications. A Pearson’s correlation showed that individuals with increased medication adherence also had clinically and statistically significant reductions in SBP and DBP. Findings from this analysis of the first 12 months of the program indicate that the mobile hypertension screening and treatment program has a positive impact on blood pressure control. Evaluation of the program is ongoing and could serve as a model that has widespread implication in other isolated communities worldwide.

scholarly journals Acceptability and feasibility of a mobile health application for blood pressure monitoring in rural Uganda

JAMIA Open ◽  
2021 ◽  
Author(s):  
Beatrice Mugabirwe ◽  
Tabor Flickinger ◽  
Lauren Cox ◽  
Pius Ariho ◽  
Rebecca Dillingham ◽  
...  
Keyword(s):  
Social Support ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Mobile App ◽  
People Living With Hiv ◽  
Resource Limited Settings ◽  
Self Monitoring ◽  
Resource Limited

Abstract Background Mobile technologies to improve blood pressure control in resource-limited settings are needed. We adapted and evaluated the acceptability and feasibility of PositiveLinks, a mobile phone application for self-monitoring, social support, and engagement in care for people living with HIV, among patients with hypertension in rural Uganda. Methods We enrolled adults on treatment for hypertension at Mbarara Regional Referral Hospital and Mbarara Municipal health center IV, southwestern Uganda. We provided and educated all participants on the use of PositiveLinks application and automated blood pressure monitors. We administered a baseline questionnaire and performed in-depth interviews 30 days later to explore acceptability, feasibility, medication adherence, social support, and blood pressure control. Results A total of 37 participants completed the interviews, mean age of 58 years (SD 10.8) and 28 (75.7%) were female. All participants embraced the PositiveLinks mobile app and were enthusiastic about self-monitoring of blood pressure, 35 (94.6%) experienced peer to peer support. Among the 35 participants non-adherent to medications at baseline, 31 had improved medication adherence. All except 1 of the 31(83.8%) who had uncontrolled blood pressure at baseline, had self-reported controlled blood pressure after 30 days of use of PositiveLinks. Conclusion Patients with hypertension in rural Uganda embraced the PositiveLinks mobile application and had improved medication adherence, social support, and blood pressure control. Further assessment of cost-effectiveness of the application in blood pressure control in resource-limited settings will be pursued in future studies.

Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Kerrilynn C Hennessey ◽  
Carolyn Hickman ◽  
Brianne Krawczyk ◽  
Michelle Opare ◽  
Leslie Churchwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
Low Income ◽  
Health Workers ◽  
Pressure Control ◽  
Low Income Population ◽  
Early Results ◽  
Patient Reported ◽  
The Impact

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

scholarly journals Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Theresa Tiffe ◽  
Caroline Morbach ◽  
Viktoria Rücker ◽  
Götz Gelbrich ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Pressure Control ◽  
Population Based ◽  
Blood Pressure Target ◽  
Successful Implementation ◽  
Inverse Association ◽  
The Impact

Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.

scholarly journals Patient–physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence

2013 ◽  
Vol 19 (5) ◽  
pp. 565-578 ◽  
Author(s):  
Antoinette Schoenthaler ◽  
Enid Montague ◽  
Linda Baier Manwell ◽  
Roger Brown ◽  
Mark D. Schwartz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Racial Ethnic
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