In rural areas across the Southeast with longstanding primary care shortages, more than half of Black adults have hypertension, which can result in higher rates of cardiovascular disease and kidney failure and shortened life expectancy. Travel distance and costs associated with traveling to primary care clinics make regular physician visits difficult. Knowing this, researchers at UAB collaborated with Weill Cornell Medicine, New York-Presbyterian, the University of North Carolina at Chapel Hill and East Carolina University to determine effective strategies to overcome these barriers and improve outcomes for Black individuals living with hypertension in these areas.
“Almost half of all adults in Alabama have hypertension, and those rates are higher for Black adults and higher in rural counties,” said Andrea Cherrington, M.D., interim director of the UAB Division of Preventive Medicine and the principal investigator for the study. “These numbers contribute to Alabama’s having the second-highest preventable cardiovascular death rate in the country. It is imperative that we find practical solutions to improve blood pressure control.”
Researchers conducted a randomized clinical trial involving 1,592 Black patients with persistently uncontrolled high blood pressure at 69 rural primary care practices located in a region referred to as the “Black Belt” of Alabama and North Carolina.
“We utilized a systematic, structured and comprehensive approach to recruiting rural primary care practices for this study, utilizing multiple practice recruitment strategies,” said James Shikany, DrPH, a professor in the UAB Division of Preventive Medicine and a co-investigator for the study. “This enabled us to successfully recruit the practices and retain them for the duration of the study.”
Primary care practices were randomized, and patients enrolled in the study received either enhanced usual care alone or in combination with peer coaching, practice facilitation, or a combination of both for one year. With the enhanced usual care, each practice distributed educational information and blood pressure monitors to each patient. Peer coaching consisted of a structured educational/behavioral intervention provided over the phone. Practice facilitation consisted of a coach who helped staff at the clinic implement at least four hypertensive-focused quality improvement activities. The peer coaches were people within these communities who were trained to help educate patients on how to monitor and reduce blood pressure.
While all groups showed some improvement, there was no significant difference across the four groups (ages 18-85). However, in pre-planned subgroup analyses, participants between the ages of 18 and 60 who received peer coaching and peer coaching plus practice facilitation showed significant reduction in systolic blood pressure compared to other groups. These results could indicate that peer coaching is valuable when teaching patients how to manage chronic conditions.
“Peer coaching was delivered by community health workers: individuals who are knowledgeable about the strengths and assets, as well as barriers, within their own communities and can help translate advice that patients get in the clinic,” Cherrington said. “We couldn’t have done this study without our community partner, Connection Health, an Alabama nonprofit that trains and deploys CHWs.”
