The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study.

OBJECTIVE: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. DESIGN: Quasi-experimental, observational study. SETTING AND PARTICIPANTS: 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. INTERVENTION: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers. MAIN MEASURES: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. RESULTS: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. CONCLUSIONS: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.

The Contribution of Age and Weight to Blood Pressure Levels Among Blacks and Whites Receiving Care in Community-Based Primary Care Practices.

We examined whether race and age, risk factors for obesity and hypertension, affect the association of obesity with elevated blood pressure (BP). Using electronic medical record data, we conducted a cross-sectional study of adult patients seen at 6 Maryland primary care clinics from September 2011 through June 2012. The risk for higher BP among patients younger than 65 years and in an elevated weight category was greater for both races but was higher for whites than blacks. For patients aged 65 years or older, weight had little impact on systolic BP, suggesting that approaches involving weight loss to address elevated BP should focus on populations younger than 65.