Taking clinic to patients can help beat hypertension

Washington D.C : If programs to control blood pressure require people to get to a clinic, they might not be that effective, according to a recent study.

The results of the Johns Hopkins Medicine study added to mounting evidence that health and wellness programs work best when medical practitioners go out to people in their communities.

"For people who can come to a clinic-based program, that program may work really well, but it's not enough in and of itself to eliminate the racial disparities we see in efforts to reduce blood pressure and other chronic diseases," said researcher Lisa A. Cooper. "Success requires a broader and more comprehensive strategy."

For the study, Cooper and her team sought to eliminate the so-called "selection bias" that has muddied past studies of racial disparity interventions. Instead of recruiting volunteers, Cooper and her team telephoned 3,964 patients with uncontrolled hypertension or a blood pressure reading higher than 140/90 millimeters of mercury (mm Hg) who had visited one of six Baltimore health clinics (four in underserved areas) in the previous year. The team was able to reach just over half of the patients they telephoned.

When team members reached patients, they asked them if they'd be interested in joining a program to lower blood pressure. Anyone participating, they explained, would have to visit the clinic nearest them three times over three months to meet with a specially trained pharmacist, dietitian or both. The program included one 60-minute session and two 30-minute sessions or approximately 120 minutes of contact time overall.

A total of 629 individuals participated in at least one session in the clinic, some 9 percent of those reached by phone, or 184 individuals along with 445 others who were referred to the program by their physicians. A total of 245 of the patients attending the first session completed all three sessions. Because final blood pressure readings were not available for 10 percent of participants, 229 completers, including 140 women and 89 men, were included in the final analysis, which compared completers with 332 partial completers and 330 nonparticipants. The average age for all those who participated was around the mid-50s. Sixty percent of those who completed all three sessions or 137 individuals were African American.

"To stay healthy or to treat chronic illness is not just about what happens in a 15-20 minute office visit to the doctor. What really matters is a person's ability to follow through on recommendations regarding changes in diet, lifestyle and medication use the rest of the time as they go about their daily lives at home, at work and in the community," said Cooper.

She added, "In addition to addressing medical needs, health system programs should also address patients' social, cultural, and financial needs, using partnerships with other sectors of the community to enhance program effectiveness and outreach to those most in need."

The study appears in journal Ethnicity and Disease.