Project Summary  

PCORI has identified high blood pressure as an important research topic. Patients, clinicians, and others want to learn: What are effective ways to improve blood pressure control, especially for minority racial/ethnic groups, individuals with low socioeconomic status, and residents of rural areas? To help answer this question, PCORI launched a funding initiative in 2014 on Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations. This research project is one of the studies PCORI awarded as part of this program.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

About 40 percent of African Americans in the United States have high blood pressure, a leading cause of stroke and heart disease. African Americans with high blood pressure who live on limited incomes in the rural southeast are more at risk of dying from stroke or heart disease than people in other parts of the country. Researchers are comparing four different ways of providing care to reduce high blood pressure in African Americans in the rural South.

Who can this research help?

Results from this study can help health clinic directors and primary care doctors choose ways to treat high blood pressure in rural African Americans with low incomes.

What is the research team doing?

Researchers are working with 80 rural primary care clinics in Alabama and North Carolina. At each clinic, 25 African Americans with high blood pressure are part of the study, for a total of 2,000 people.

The study team is assigning clinics by chance to one of four groups. In all of the groups, doctors, nurses, and other healthcare professionals receive education about how to correctly measure blood pressure. Each clinic also receives a laptop with access to online educational videos for patients about blood pressure treatments. In addition to these interventions, one group of clinics cares for people enrolled in the study in the same way they usually do. In a second group of clinics, a specialist consults with clinic staff to help them make changes in the way they take care of people with high blood pressure. Clinics might choose to create a registry to monitor patients’ blood pressure more closely, for example. This approach to helping clinics improve the care they provide is called practice facilitation. A third group of clinics matches patients with a peer coach to help them improve their high blood pressure. A peer coach is someone who works with patients to help them manage their health. The fourth group of clinics is using both practice facilitation and matching participants with a peer coach. At the beginning and end of one year, researchers are measuring each participant’s blood pressure to see if it improves.

The study team is gathering information about the processes the clinics use to change the way they provide care. They are holding focus groups and interviews with patients, peer coaches, facilitators, clinic staff, and doctors.

The researchers are working with primary care clinics, people with high blood pressure, peer coaches, and groups of patients to develop the plans for practice facilitation and peer coaching that are being tested in this study.

Research methods at a glance

Design Elements	Description
Design	Randomized controlled trial
Population	African American adults ages 18–85 or older who have high blood pressure and get care at a clinic that has been invited to participate
Interventions/ Comparators	Enhanced usual care for controlling high blood pressure Enhanced usual care and practice facilitation Enhanced usual care and peer coaching Enhanced usual care, practice facilitation, and peer coaching
Outcomes	Primary: difference in blood pressure control between trial arms Secondary: difference in change in blood pressure between baseline and follow-up; depressive symptoms; physical and mental functioning; patient, provider, and staff satisfaction
Timeframe	1-year follow-up for primary outcome

Project Details

Principal Investigator

Monika M. Safford, MD

Project Status

Awarded; In progress

Project Title

Collaboration to Improve Blood Pressure in the US Black Belt-Addressing the Triple Threat

Project End Date

September 2020

Organization

University of Alabama at Birmingham

Year Awarded

2015

State

Alabama

Project Type

Research Project

Health Conditions  

Cardiovascular Diseases

Hypertension

Intervention Strategies

Care Coordination
Other Clinical Interventions
Other Health Services Interventions
Technology Interventions
Training and Education Interventions

Populations

Racial/Ethnic Minorities
Low Health Literacy/Numeracy
Rural
Individuals with Multiple Chronic/co-morbid Conditions

Funding Announcement

Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations (UH2/UH3)

Project Budget

$9,494,562

Study Registration Information

HSRP20162135

NCT02866669