Hypertension Project for Care-A-Van

Madison Caudill, Emily Dean, Logan Edwards, Lindsay Winston

Description of the Issue Analysis of the Issue Solution

● Hypertension is a global issue and, despite well-established Implement community health workers into the Care-A-Van
and published approaches to treatment, fewer than half of all ● In 2018, over 1,000 patients, seen by Care-A- process to educate clients on healthy lifestyle choices and
hypertensive patients have adequately controlled blood Van, were diagnosed with hypertension serve as a liaison in assisting clients in maintaining a healthy
pressure (Merai et al., 2016). blood pressure.
● Vulnerable populations are particularly at risk due to macro
● Goal: to increase patient compliance with Hypothesis: If community health workers are used to help
factors that are outside of their control
■ Cost and qualifications of health insurance treatment plan and improve lifestyle choices educate clients on how to live a healthy lifestyle, then clients
■ Limited access to primary healthcare contributing to uncontrolled hypertension will be better able to control their blood pressure.
■ Limited reimbursement of community health care providers ● Barriers specific to Care-A-Van Evidence: Research shows that integrating community
■ Inflated costs of healthy foods and medications
○ Shortage of healthcare providers healthcare workers appears to be effective when compared
■ Low minimum wage rates
● In the population that Care-A-Van serves, micro factors ○ Time constraints for education during visits with alternatives and also cost-effective for certain health
preventing patients from maintaining a healthy blood pressure ○ Limited time/days spent at each Care-A-Van conditions, especially when partnering with underserved and
include: site racially and ethnically diverse minority communities (Kim et
■ Low education levels ○ “First-come, first-serve” basis al., 2016).
■ Low income
■ English is not their primary language ● Barriers specific to patients
● Hiring, orientation and education/training for the
■ Citizenship status and fear of getting caught if they seek out ○ Limited number of nurse navigators to community health workers
medical care provide essential follow-up care ● Educational materials/ tools to provide for the
■ Time and transportation issues ○ Need for increased usage of primary care
patients (I.e. pamphlets, lesson plan, etc.)
● Space at the Care-A-Van site
○ Limited or no insurance coverage
Root Cause ○ Cultural barriers including citizenship status, ● Care-A-Van leadership and staff
● Root cause: Ineffective Health Maintenance limited education, language and diet. ● The Bon Secours Hospital System
● The patients
○ Care-A-Van clients report difficulty living a healthy lifestyle
○ Community Health Needs Assessment identified the following
factors:
● Hiring/training of CHW’s
■ Food environment index
● The educational tools and resources
■ Physical inactivity ● Data collection/evaluation tools
References
■ Access to exercise Bellows, L., Moore, R., Anderson, J., Young, L., & Long, E. (2014). Diet and hypertension.
■ Food insecurity Service in action; no. 9.318. Retrieved from https://extension.colostate.edu/docs/pubs/foodnut/09318.pdf
● 0-6 months: Approval and CHW role creation
○ Hypertension is associated with high sodium intake and excess Kim, K., Choi, J.S., Choi, E., Nieman, C.L., Joo, J.H., Lin, F.R., Gitlin, L.N., and Han, H. (2016). Effects of ● 6-12 months: Hiring and training of CHW
body fat (Bellows et al., 2014) Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care ● 12 months: Implementation and baseline data
Among Vulnerable Populations: A Systematic Review. Am J Public Health, 106(4), e3-e28.
■ Research has shown modest lifestyle and dietary changes ● 18 months: Midterm assessment and outcomes
Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A evaluation
can help treat and often delay or prevent high blood pressure
Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov ● 24 months: Final assessment and outcomes
(Bellows et al., 2014) 18;65(45):1261-1264.
evaluation
■ Dash diet: decreases BP, decreases total cholesterol,
Siervo, M., Lara, J., Chowdhury, S., Ashor, A., Oggioni, C., & Mathers, J. C. (2015). Effects of the Dietary
prevents CVD (Siervo et al., 2015) Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-
analysis. British Journal of Nutrition, 113(1), 1-15. Retrieved from
● Patient surveys for qualitative data
https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/effects-of-the-dietary-approach- ● Blood pressure measurements and trends
to-stop-hypertension-dash-diet-on-cardiovascular-risk-factors-a-systematic-review-and-
metaanalysis/C3B37FC59A6FE257F3750C429C1251E6