Evolution of an academic-public library partnership.

A partnership to improve access to health information via an urban public library system was established in St. Louis, Missouri, in 2011. A multiyear project was outlined that included an information needs assessment, a training class for public library staff, information kiosks at library branches for delivering printed consumer health materials, and a series of health-related programming. The partnership evolved to include social service and community organizations to carry out project goals and establish a sustainable program that met the health and wellness interests of the community.

Success in the Achieving CARdiovascular Excellence in Colorado (A CARE) Home Blood Pressure Monitoring Program: A Report from the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

BACKGROUND: Blood pressure (BP) control among primary care patients with hypertension is suboptimal. Home BP monitoring (HBPM) has been shown to be effective but is underused. METHODS: This study was a quasi-experimental evaluation of the impact of the A CARE HBPM program on hypertension control. Nonpregnant adults with hypertension or cardiovascular disease risk factors were given validated home BP monitors and reported monthly average home BP readings by Internet or phone. Patients and providers received feedback. Change in average home and office BP and the percentage of patients achieving target BP were assessed based on patient HBPM reports and a chart audit of office BPs. RESULTS: A total of 3578 patients were enrolled at 26 urban and rural primary care practices. Of these, 36% of participants submitted ≥2 HBPM reports. These active participants submitted a mean of 13.5 average HBPM reports, with a mean of 19.3 BP readings per report. The mean difference in home BP between initial and final HBPM reports for active participants was -6.5/-4.4 mmHg (P < .001) and -6.7/-4.7 mmHg (P < .001) for those with diabetes. The percentage of active participants at or below target BP increased from 34.5% to 53.3% (P < .001) and increased 24.6% to 40.0% (P < .001) for those with diabetes. The mean difference in office BP over 1 year between participants and nonparticipants was -5.4/-2.7 mmHg (P < .001 for systolic BP, P = .01 for diastolic BP) for all participants and -8.5/-1.5 mmHg (P = .014 for systolic BP, P = .405 for diastolic BP) for those with diabetes. CONCLUSIONS: An HBPM program with patient and provider feedback can be successfully implemented in a range of primary care practices and can play a significant role in BP control and decreased cardiovascular disease risk in patients with hypertension.

What keeps patients from adhering to a home blood pressure program?

BACKGROUND: Home blood pressure monitoring (HBPM) predicts cardiovascular risk and increases hypertension control. Non-participation in HBPM is prevalent and decreases the potential benefit. METHODS: Telephone surveys were conducted with a random quota sample of non-participants in a HBPM program, which supplied a complimentary automated blood pressure cuff and utilized a centralized reporting system. Questioning assessed use of monitors, perceived benefit, communication with providers, and barriers. RESULTS: There were 320 completed surveys (response rate 53%). Of non-participants, 70.2% still used HBPM cuffs and 58% communicated values to providers. Spanish-speakers were 4.4 times more likely to not use cuffs (95% CI, 2.22-8.885). Barriers to participation were largely personal (forgetting, not having time, or self-described laziness). Reasons for not communicating readings with providers were largely clinic factors (no doctor visit, doctor didn't ask, thinking doctor wouldn't care). Lack of knowledge of HBPM and program design also contributed. After being surveyed, patients were over three times more likely to use the central reporting system. DISCUSSION: Most non-participants still used HBPM and communicated values to providers, suggesting many "drop-outs" may still receive clinical benefit. However, much valuable information is not utilized. Future programs should focus on reminder systems, patient motivation, education, and minimizing time involvement.