Rheumatology High Blood Pressure Protocol Reduces Disparities, But Delays Remain for External Primary Care

Area of Science:

• Rheumatology
• Cardiology
• Health Services Research

Background:

• High blood pressure (BP) management in rheumatology patients is crucial.
• The BP Connect protocol was implemented to improve BP follow-up.
• Many patients receive primary care (PC) and rheumatology care in separate health systems, complicating follow-up.

Purpose of the Study:

• To compare rates of timely PC follow-up for high BP in across-system health maintenance organizations (HMOs) before and after BP Connect implementation.
• To assess the impact of BP Connect on hypertension management for patients receiving care across different healthcare systems.

Main Methods:

• A cohort study evaluated adult patients with high rheumatology clinic BP and PC within the same HMO.
• BP Connect involved staff in remeasuring BP, discussing cardiovascular risk, and providing follow-up instructions.
• Multivariable logistic regression analyzed timely PC follow-up rates before and after BP Connect implementation.

Main Results:

• Among 1327 eligible rheumatology visits, 400 had confirmed high BP.
• Overall primary care follow-up for high BP increased from 20.5% to 23.5% after BP Connect, but this change was not statistically significant.
• For Black patients, the odds of timely PC follow-up significantly increased (OR, 1.95; CI, 1.02-3.79).

Conclusions:

• BP Connect interventions led to more equitable healthcare by improving timely follow-up for Black patients.
• The protocol did not significantly improve timely follow-up for patients with across-system PC, unlike in-system care.
• Direct scheduling for across-system PC follow-up is recommended for future interventions.