The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study
| Autor: | Katherine B. Dietz, Mekam T. Okoye, Lisa A. Cooper, Tanvir Hussain, Athena Wing Ga Kan, Jill A. Marsteller, Kathryn A. Carson, Michael Albert, Kara Taylor, Romsai T. Boonyasai, Cheryl A.M. Anderson, Arlene Dalcin, Emily Brown, Jennifer P. Halbert, Whitney K. Franz |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Quality management Epidemiology Population MEDLINE Black People Blood Pressure Primary care Population health 030204 cardiovascular system & hematology White People 03 medical and health sciences 0302 clinical medicine Intervention (counseling) medicine Humans 030212 general & internal medicine Healthcare Disparities education Antihypertensive Agents Aged education.field_of_study Population Health Primary Health Care business.industry Original Report: Health Inequities in Hypertension and Related Organ Damage General Medicine Middle Aged 3. Good health Blood pressure Family medicine Baltimore Hypertension Emergency medicine Patient Compliance Female Observational study business |
| Zdroj: | Ethnicity & Disease. 26:285 |
| ISSN: | 1945-0826 1049-510X |
| DOI: | 10.18865/ed.26.3.285 |
| Popis: | Objective: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. Design: Quasi-experimental, observational study. Setting and Participants: 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. Intervention: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities related barriers. Main Measures: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. Results: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (PConclusion: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities. Ethn Dis. 2016;26(3):285-294; doi:10.18865/ed.26.3.285 |
| Databáze: | OpenAIRE |
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