A Mixed-Methods Approach for Evaluating Implementation Processes and Program Costs for a Hypertension Management Program Implemented in a Federally Qualified Health Center

Aisha Tucker-Brown; Michelle Spafford; John Wittenborn; David Rein; Ashley Marshall; Kincaid Lowe Beasley; Marla Vaughan; Natalie Nelson; Michelle Dougherty; Roy Ahn

doi:10.1007/s11121-023-01529-x

A Mixed-Methods Approach for Evaluating Implementation Processes and Program Costs for a Hypertension Management Program Implemented in a Federally Qualified Health Center

Prev Sci. 2023 Jun 30. doi: 10.1007/s11121-023-01529-x. Online ahead of print.

Authors

Affiliations

¹ Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE, GA, 30341, Atlanta, USA. htj1@cdc.gov.
² Health Care Evaluation Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, MD, 20814, Bethesda, USA.
³ Public Health Department, NORC at the University of Chicago, 55 East Monroe, 31st Floor, IL, 60603, Chicago, USA.
⁴ Public Health Department, NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA.
⁵ Division of Laboratory Systems (DLS), Centers for Disease Control and Prevention, 2400 Century Center, Atlanta, GA, 30345, United States.
⁶ Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE, GA, 30341, Atlanta, USA.
⁷ Family Health Centers, Inc, 3310 Magnolia St, Orangeburg, SC, 29115, USA.
⁸ Public Health Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, MD, 20814, Bethesda, USA.

PMID: 37389780
DOI: 10.1007/s11121-023-01529-x

Abstract

Team-based care approaches are effective at improving hypertension control and have been used in clinical practice to improve hypertension outcomes. This study implemented and evaluated the Hypertension Management Program (HMP), which was originally developed in a high-resource health setting, in a health system with fewer resources and a patient population disproportionately affected by hypertension. Our objectives were to describe how a health system could adapt HMP to meet their needs and calculate total program costs. HMP uses a team-based, patient-centered approach involving clinical pharmacists who contribute to managing patients who have hypertension and ultimately preventing premature death due to uncontrolled hypertension. HMP has 10 components (e.g., EHR patient registries and outreach lists, no copayment walk-in blood pressure checks). Our project involved implementing the key components of HMP in a federally qualified health center (FQHC) in South Carolina. Adaptations from the key components of HMP were made to fit the participants' settings. A mixed-methods evaluation assessed implementation processes, program costs, and implementation facilitators and barriers. From September 2018 to December 2019, clinical pharmacists conducted 758 hypertension management visits (HMVs) with 316 patients with hypertension. Total program costs for HMP were $325,532 overall and $16,277 per month. Monthly cost per patient was $3.62. The high engagement among clinical pharmacists, along with provider engagements, followed up by the subsequent referral of patients to HMP, facilitated the implementation process. Staff members observed improvements in hypertension control, which increased participation buy-in. Barriers included staff turnover, the perception among some providers that HMP took too much time, as well as perception of HMP as a pharmacy-specific initiative. A team-based, patient-centered approach to hypertension management can be adapted for FQHCs or similar settings that serve patient populations disproportionately affected by hypertension.

Keywords: Evaluation; Federally qualified health center; Hypertension; Pharmacy; Team-based care.

Abstract

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