Implementation Strategies for Self-Measured Blood Pressure Monitoring in Racially and Ethnically Diverse Populations...

Area of Science:

• Public Health
• Clinical Trials
• Health Services Research

Background:

• Self-measured blood pressure (SMBP) monitoring is effective for hypertension control but challenging to implement in safety-net systems.
• Safety-net systems serve vulnerable populations at higher risk for uncontrolled hypertension.
• This study addresses the need for effective implementation strategies in these settings.

Purpose of the Study:

• To evaluate the effectiveness of multi-level implementation strategies for increasing SMBP monitoring in urban safety-net systems.
• To compare a low-intensity versus a high-intensity patient-level intervention.
• To assess clinic-level implementation strategies supporting SMBP data use.

Main Methods:

• A hybrid effectiveness-implementation randomized controlled trial involving 330 patients with uncontrolled hypertension.
• Patients randomized to low-intensity (education, reminders) or high-intensity (adds group classes, caregiver engagement) interventions.
• Concurrent clinic-level strategies including education, EHR optimization, and feedback.

Main Results:

• Primary outcomes: clinic-measured systolic blood pressure (SBP) for patient and clinic interventions.
• Secondary outcomes: BP control, home SBP, implementation metrics (adoption, reach, costs), and patient activation.
• Data collection to assess the impact of different intervention intensities and clinic strategies.

Conclusions:

• The trial will identify cost-conscious implementation strategies for SMBP adoption in safety-net settings.
• Results aim to improve blood pressure control in low-income, diverse patient populations.
• Addresses critical gaps in implementing evidence-based hypertension management in underserved communities.