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A clinic and community-based approach to hypertension control for an underserved minority population: design and
H J Ward1, D E Morisky, N B Lees
1Department of Medicine, King/Drew Medical Center, Los Angeles, California 90059, USA. haward@cdrew.edu
Insights
The Community Hypertension Intervention Project (CHIP) studied interventions to improve high blood pressure treatment adherence in minority populations. Targeted strategies, alongside clinic changes, can enhance patient satisfaction and blood pressure control.
Area of Science:
- Public Health
- Cardiovascular Disease Research
- Health Disparities
Background:
- Hypertension management is challenging in underserved minority populations.
- Environmental and psychosocial factors significantly impact treatment adherence.
- High blood pressure control remains suboptimal in many inner-city communities.
Purpose of the Study:
- To investigate environmental and psychosocial factors influencing hypertension treatment adherence.
- To evaluate the effectiveness of interventions combined with usual care for high blood pressure management.
- To improve patient compliance and blood pressure control in a high-risk, underserved minority population.
Main Methods:
- A 4-year longitudinal study involving 1367 inner-city patients (75% Black, 25% Hispanic).
- Randomization to usual care or one of three interventions: counseling, home visits/discussion groups, or computerized tracking.
- Assessment of patient satisfaction, treatment adherence, and blood pressure control.
Main Results:
- Approximately 65% of participants presented with uncontrolled blood pressure levels.
- Interventions were designed to address barriers in a predominantly low-income minority community.
- The study included participants from both hospital-based and private community clinics.
Conclusions:
- Structural clinic changes and targeted interventions can improve patient satisfaction.
- Interventions are effective in increasing treatment adherence for hypertension.
- Combined strategies lead to improved blood pressure control in vulnerable populations.
Abstract:
This paper describes the design and methodology of the Community Hypertension Intervention Project (CHIP). CHIP is investigating the environmental and psychosocial factors related to treatment adherence and examining the effects of combining usual hypertension care with the effects of three interventions designed to improve patient compliance with treatment for high blood pressure in a high-risk, underserved minority population. Thirteen hundred and sixty-seven inner-city hypertension patients (75% black and 25% Hispanic) have agreed to participate in the 4-year longitudinal study. These participants were randomized to usual care or one of three intervention groups: individualized counseling sessions; home visits/discussion groups; or computerized appointment-tracking system. Participants are representative of the surrounding, predominantly low-income minority community and are treated in a hospital-based clinic and in a private clinic in the community. About 65% have blood pressure levels considered to be out of control. It was concluded that structural changes at the clinic site, along with the targeted interventions, would improve patient satisfaction, increase treatment adherence, and improve blood pressure control.