Rheumatology High Blood Pressure Protocol Reduces Disparities, But Delays Remain for External Primary Care
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND/OBJECTIVE: To address high blood pressure (BP) in rheumatology patients, we previously implemented BP Connect, a brief staff-driven protocol to address high BP. Although timely follow-up and hypertension rates improved for patients with in-system primary care (PC), many receive PC and rheumatology care in separate health systems. In this cohort study, we compared rates of timely PC follow-up for high BP across-system health maintenance organizations (HMOs) before and after BP Connect implementation.
METHODS: All adult patients with high rheumatology clinic BP and PC in that HMO were eligible. BP Connect's protocol engaged the staff in remeasuring high BP (≥140/90 mm Hg), advising cardiovascular disease risk, and connecting timely PC follow-up, which for patients with PC across system includes written follow-up instructions. After an eligible rheumatology visit, the next HMO PC visit with BP was used to determine rates and odds of timely follow-up before and after using multivariable logistic regression.
RESULTS: Across 1327 rheumatology visits with high BP and across-system PC (2013-2019), 951 occurred after 2015 BP Connect implementation; 400 had confirmed high BP. Primary care follow-up rose from 20.5% to 23.5%. The odds of timely PC BP follow-up insignificantly changed (odds ratio, 1.19; confidence interval, 0.85-1.68). For visits with Black patients, the odds of timely follow-up did significantly increase (1.95; confidence interval, 1.02-3.79).
CONCLUSIONS: Timely follow-up for Black patients did improve, highlighting protocol interventions for more equitable health care. In contrast to our prior in-system study, BP Connect did not significantly improve follow-up with an across-system PC, indicating a need for direct scheduling. Future directions include piloting direct across-system scheduling.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases - (2024) vom: 05. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ferguson, Sancia [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 02.05.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1097/RHU.0000000000002065 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369363272 |
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| 245 | 1 | 0 | |a Rheumatology High Blood Pressure Protocol Reduces Disparities, But Delays Remain for External Primary Care |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND/OBJECTIVE: To address high blood pressure (BP) in rheumatology patients, we previously implemented BP Connect, a brief staff-driven protocol to address high BP. Although timely follow-up and hypertension rates improved for patients with in-system primary care (PC), many receive PC and rheumatology care in separate health systems. In this cohort study, we compared rates of timely PC follow-up for high BP across-system health maintenance organizations (HMOs) before and after BP Connect implementation | ||
| 520 | |a METHODS: All adult patients with high rheumatology clinic BP and PC in that HMO were eligible. BP Connect's protocol engaged the staff in remeasuring high BP (≥140/90 mm Hg), advising cardiovascular disease risk, and connecting timely PC follow-up, which for patients with PC across system includes written follow-up instructions. After an eligible rheumatology visit, the next HMO PC visit with BP was used to determine rates and odds of timely follow-up before and after using multivariable logistic regression | ||
| 520 | |a RESULTS: Across 1327 rheumatology visits with high BP and across-system PC (2013-2019), 951 occurred after 2015 BP Connect implementation; 400 had confirmed high BP. Primary care follow-up rose from 20.5% to 23.5%. The odds of timely PC BP follow-up insignificantly changed (odds ratio, 1.19; confidence interval, 0.85-1.68). For visits with Black patients, the odds of timely follow-up did significantly increase (1.95; confidence interval, 1.02-3.79) | ||
| 520 | |a CONCLUSIONS: Timely follow-up for Black patients did improve, highlighting protocol interventions for more equitable health care. In contrast to our prior in-system study, BP Connect did not significantly improve follow-up with an across-system PC, indicating a need for direct scheduling. Future directions include piloting direct across-system scheduling | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Hanlon, Bret M |e verfasserin |4 aut | |
| 700 | 1 | |a Ramly, Edmond |e verfasserin |4 aut | |
| 700 | 1 | |a Messina, Monica L |e verfasserin |4 aut | |
| 700 | 1 | |a Ibrahim, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Rake, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Bartels, Christie M |e verfasserin |4 aut | |
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