Reducing Disparities in Hypertension with a Practice-Based Enhanced Care Program Principal Investigator: Darren A. DeWalt, MD, MPH Many racial and ethnic groups and individuals of low socioeconomic status have worse control of hypertension, higher prevalence of cardiovascular disease, and eariier mortality from cardiovascular causes compared to other groups. Potential causes of these disparities have been elucidated, but few studies have investigated interventions specifically designed to narrow the disparity gap and improve outcomes. We will use a community-based participatory research approach to understand the barriers and facilitators faced by both patients and providers and to carefully design and test a practice-based, sustainable, enhanced care intervention for hypertension. The intervention will target medication and lifestyle management at both the patient and practice level, and is designed to narrow disparities in BP control. We will include patients from local primary care practices, including a large community health center and rural practices. The intervention will include an innovative partnership with a nonprofit call center, Connectinc, adding a lifestyle and medication adherence coaching component to their current focus on jobs, employment, and benefits counseling. Although we anticipate improving BP control for everyone, the study focuses on narrowing the racial gap in BP between Whites and African Americans. We will use community-based participatory research approaches to identify the key issues from the patient and practice perspective and invite patients and practices to work with the research team to design the intervention. We will then conduct a cohort study, enrolling 600 participants to determine the effectiveness of the program and its ability to reduce disparities by race and by health literacy status. Lastly, we will rigorously evaluate the costs of implementing and sustaining this practice-based intervention. Assuming it is an effective program, we will begin the process of dissemination using quality improvement strategies as part ofthe North Carolina and national programs for Improving Performance in Practice (IPIP)?a project in 7 states to implement state-based infrastructure facilitating primary care practice-based improvement. Web based training will be made available through the Shared Resource Core internet resource: Center of Excellence for Training and Resource Translation. This study will inform the implementation of evidence-based hypertension quality improvement programs so that sustainable models of care can exist to help reduce health disparities.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Specialized Center (P50)
Project #
5P50HL105184-04
Application #
8467037
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
4
Fiscal Year
2013
Total Cost
$638,700
Indirect Cost
$193,150
Name
University of North Carolina Chapel Hill
Department
Type
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Hohl, Sarah D; Thompson, Beti; Krok-Schoen, Jessica L et al. (2016) Characterizing Community Health Workers on Research Teams: Results From the Centers for Population Health and Health Disparities. Am J Public Health 106:664-70
Cummings, Doyle M; Wu, Jia-Rong; Cene, Crystal et al. (2016) Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South. J Rural Health 32:156-63
Halladay, Jacqueline R; Donahue, Katrina E; Cené, Crystal W et al. (2016) The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Educ Couns :
Keyserling, Thomas C; Samuel-Hodge, Carmen D; Pitts, Stephanie Jilcott et al. (2016) A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 16:732
Smith, Caren E; Fullerton, Stephanie M; Dookeran, Keith A et al. (2016) Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities. Health Aff (Millwood) 35:1367-73
Golden, Sherita Hill; Ferketich, Amy; Boyington, Josephine et al. (2015) Transdisciplinary cardiovascular and cancer health disparities training: experiences of the centers for population health and health disparities. Am J Public Health 105 Suppl 3:S395-402
Skinner, Harlyn G; Calancie, Larissa; Vu, Maihan B et al. (2015) Using community-based participatory research principles to develop more understandable recruitment and informed consent documents in genomic research. PLoS One 10:e0125466
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2015) Associations between subjective social status and physical and mental health functioning among patients with hypertension. J Health Psychol :
Jilcott Pitts, Stephanie B; Keyserling, Thomas C; Johnston, Larry F et al. (2015) Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults. J Community Health 40:276-84
Kowitt, Sarah; Woods-Jaeger, Briana; Lomas, Jesse et al. (2015) Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011-2012. Prev Chronic Dis 12:E164

Showing the most recent 10 out of 15 publications