Check It. Change It. Control It. High Blood Pressure and High Cholesterol

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Ohio

States/Territories Involved: Ohio

Domain Addressed:

Health Systems Strategies

Public Health Issue:

African-American men in Ohio have a stroke mortality rate that is 53% higher than any other group.  They also have the highest rate of hypertension of all groups and tend to develop it at younger ages.  Nearly 45 percent of African-American men have borderline to high cholesterol levels.  Data from the BRFSS indicate that African-American men are least likely to have their high blood pressure and/or high cholesterol controlled.  Both of these conditions greatly increase the risk of stroke and heart attack for African-American men.  Studies conducted by ODH in 2008 and 2011 with physicians and African-American men showed that there were large differences in perceptions about HBP/HBC treatment effectiveness and patient-physician relationships.

Project Objectives:

1. To develop culturally-appropriate, guideline-based materials for African-American men that would help them improve blood pressure and cholesterol control practices.
2. To provide physicians with resources to help their African-American male patients comply with recommended preventive behaviors and treatments for high blood pressure, cholesterol and lifestyle modifications.
3. To provide guidelines for patient-centered communication and positive interactions with African-American male patients.

Program Action:

This project targets African-American men with, or at risk for, high blood pressure and high cholesterol and their physicians.

 

Based on focus group findings from African-American men and physicians with at least 10% of their patients from this demographic, a toolkit with culturally-specific tip sheets and other patient resources to improve blood pressure/cholesterol control practices was developed and piloted.  The toolkit also contains resources for physicians to help them implement patient-centered communication in their practices to foster positive interactions with their African-American male patients as well as lifestyle counseling guidelines on changing diet and increasing physical activity.

Partners included the Ohio Department of Health,  the Ohio Academy of Family Physicians (OAFP) and Fahlgren Mortine Communications.

 

–Phase 1 of the project involved focus groups with African-American men on knowledge, attitudes and beliefs about high blood pressure/cholesterol prevention, treatment and control and their feelings on interactions with physicians on these issues. Focus groups were also conducted with physicians on their experiences and practices in treating African-American men with HBP/HBC.

–Phase 2, implemented in collaboration with the Ohio Academy of Family Physicians, was a limited pilot with selected physician practices (those using an EHR) to train physicians and office staff to improve interactions with African-American men and increase treatment adherence.  Practices provided pre/post data on blood pressure/cholesterol for patients participating in the pilot.

Data/Other Information Collected:

Focus group information was gather during Phase I on:

• African-American men’s knowledge, attitudes and beliefs about high blood pressure/cholesterol prevention, treatment and control and their feelings on interactions with physicians on these issues.
• Physicians experiences and practices in treating African-American men with HBP/HBC

Pre/post data on blood pressure/cholesterol for patients participating in the pilot was gathered during Phase 2.

Impact/Accomplishments:

— Toolkit materials for patients and physicians were developed, pilot tested and are available on the Ohio Academy of Family Physicians website at: http://www.ohioafp.org/practice-transformation/practice-tools-resources/#Checkit

— The Ohio Academy of Family Physicians later created an app that physicians & patients can download to help track, monitor, and control blood pressure. See more at: http://www.ohioafp.org/wfmu-article/check-it-change-it-control-it-phone/#sthash.FuX3Tf4J.dpuf

— ODH and OAFP have strengthened the relationship and dialogue between them.

— The project increased opportunities for better communication between physicians and patients at the pilot practices on the topic of blood pressure and cholesterol management with the hope that patients’ families will benefit as well.

— Patient pilot post-test results on 102 patients who completed both the pre√¢‚Ǩ¬êtest and post√¢‚Ǩ¬êtest surveys revealed:

• Improvement of 179% over baseline in number reporting that they know the correct target number for a healthy blood pressure
• Improvement of 132% over baseline in number reporting that they know the target number for healthy cholesterol
• Improvement of 23% over baseline in number reporting that they knew their individual blood pressure level or that they knew their individual cholesterol level
• 76% reported that the “Check It. Change It. Control It.” toolkit helped them learn more about their risk for high blood pressure and high cholesterol and what steps that can be taken to overcome the risks.
• 74% reported that they felt confident or very confident that they had a good understanding of their risk

Practice pilot post-test results from the 9 practices & 18 individuals completing the survey revealed:

• 100% percent of practices have a way to download patient education materials electronically.
• 66% of practices would be willing to print these materials at their own expense; 22% are unsure; 22% would not be willing
• 11 out of 18 practice team members thought the materials were a helpful tool in discussing high cholesterol and hypertension with their patients.

Challenges/Lessons Learned:

Lessons learned include:

• Develop a good understanding of the key health issues for the community and the state, such as priority health issues, populations at higher risk, and factors related to higher risk.

• Identify existing resources and partners; get them actively involved. Move beyond the familiar professional resources and settings.

• Target healthcare professionals and patients because supporting the patient/professional partnership requires addressing the needs of both.

• Involve the target audience in planning and development, including potential barriers and identified needs. This assures development of effective, relevant tools and materials.

• Cultural sensitivity is vital. The time and effort devoted to making materials culturally appropriate will pay off in better communication.

Next Steps:

ODH and OAFP will use the patient and practice survey results to guide any

additional modifications to the toolkit and disseminate the toolkit statewide. A copy of the toolkit will be mailed to every OAFP member (more than 4,000 practicing physicians, andresidents) with the fall 2013 issue of OAFP’s quarterly magazine, The Ohio Family Physician. OAFP is also developing a website and converting the toolkit materials to electronic form so practices may upload them to their electronic medical record (EMR) system and easily print materials for their patients.

Program Areas:

Heart Disease and Stroke

State Contact Information:

OH
Barbara Pryor, MS, RD, LD
Ohio Department of Health
614-644-6963
barbara.pryor@odh.ohio.gov

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