Designing Health Center Self-Measured Blood Pressure Program Models to Improve Hypertension Control.

With the aim of achieving higher, equitable hypertension control rates, 350 nationwide federally qualified health centers implemented self-measured blood pressure programs (SMBP) over a three-year grant initiative. Various SMBP program designs with systematic processes, team-based care models, and culturally sensitive approaches with improved BP control are highlighted.

Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications.

PURPOSE OF REVIEW: To provide an overview of recent research assessing the role of physicians and other healthcare providers in facilitating improvements in patient adherence to antihypertensive medications, to provide a framework for addressing patient adherence to antihypertensive therapy, and to propose future directions for assessing the risk of poor adherence in clinical settings. RECENT FINDINGS: Several recent studies have highlighted the role of the healthcare provider in improving patient adherence to antihypertensive therapy. Opportunities exist for providers to improve communication that enhances patients' understanding of their disease and its treatment, to tailor interventions based on whether patients are intentionally or unintentionally non-adherent, to assess and treat side-effects such as erectile dysfunction, to switch to less costly generic alternatives, and to reduce the complexities of medication regimens. SUMMARY: Poor adherence to prescribed therapies is common in patients with hypertension, and should be considered in the evaluation of the hypertensive patient with poor blood pressure control. When initiating treatment in patients newly diagnosed with hypertension and when monitoring patients with existent disease, providers should identify barriers to medication adherence and actively engage patients in shared decision-making regarding their treatment. These activities will facilitate adherence, which may lead to improved outcomes for patients with hypertension and other chronic cardiovascular diseases.

Use of the SF-8 to assess health-related quality of life for a chronically ill, low-income population participating in the Central Louisiana Medication Access Program (CMAP).

OBJECTIVES: The utility of the SF-8 for assessing health-related quality of life (HRQL) is demonstrated. Race and gender differences in physical component (PCS) and mental component (MCS) summary scores among participants in the CENLA Medication Access Program (CMAP), along with comparisons to the United States population are made. METHODS: Age-adjusted multiple linear regression analyses were used to compare 1687 CMAP participants to the US population. Internal race and gender comparisons, adjusting for age and the number of self reported diagnoses, were also obtained. The paired t-test was used to assess 6-month change in PCS and MCS scores for a subset of 342 participants. RESULTS: CMAP participants have PCS and MCS scores that are significantly 10-12 points lower than the US population, indicating lower self-reported HRQL. Females have significantly higher PCS and significantly lower MCS than males. African-Americans have significantly higher MCS than Caucasians. Significant increases in both PCS and MCS were observed for the subset of participants after 6 months of intervention. CONCLUSIONS: The expected lower baseline PCS and MCS measures and the expected associations with age and number of diagnoses indicate that the SF-8 survey is an effective tool for measuring the HRQL of participants in this program. Preliminary results indicate significant increases in both PCS and MCS 6 months after intervention.

Outpatient medication assistance program in a rural setting.

PURPOSE: Efforts to provide medication assistance to the rural poor in central Louisiana are described. SUMMARY: The Central Louisiana Medication Access Program (CMAP) began functioning in 2001 with the objective of providing medication assistance and medication education to the rural poor in the community. The program serves individuals who use the outpatient clinic at the state-run public hospital in central Louisiana. Patients receive prescription drugs for a variety of chronic conditions, paying only a processing fee of dollar 3 per prescription, with a maximum outlay of dollar 15 per visit. A pharmacist counsels the patients about their medications. The medications are funded both through the program and through assistance programs run by pharmaceutical companies. A total of 5307 patients were enrolled in the CMAP between May 2001 and March 2003, and they received over 140,000 prescriptions at a cost saving to them in excess of dollar 2.5 million. CONCLUSION: The CMAP has been able to provide prescription medications and medication counseling to needy patients in a rural environment at little cost to them.