Roane County Hypertension Control
- Need: Nearly one in three Americans has hypertension, and rural community members lack access to clinics and means for monitoring and treatment of their high blood pressure.
- Intervention: West Virginia's Roane County Family Health Care (RCFHC) uses community-oriented, outcome- and team-based care to combat their rural community members' high rates of hypertension.
- Results: In 2014, RCFHC succeeded in achieving hypertension control rates in at least 70% of patients, and was named a 2014 Hypertension Control Champion by the U.S. Department of Health and Human Services.
Roane County Family Health Care (RCFHC), located in Spencer, West Virginia, is taking action to control its rural community’s high rates of hypertension by using an outcome-measures approach to address this widespread health problem.
Approximately 27% of RCFHC’s population has hypertension. Hypertension is also commonly present in patients with other conditions such as diabetes, high cholesterol, and obesity. Furthermore, 75% of these patients live at or below the federal poverty level by 200%.
Since RCFHC is a Federally Qualified Health Center (FQHC) and receives annual funding from the Health Resources and Services Administration (HRSA), quality performance is measured. One such measure is reaching target blood pressure.
Previously, RCFHC was listed as a Level 2 Patient-Centered Medical Home (PCMH), signifying dedication to serving each patient in a personal and individualized manner by maintaining proper team-based care, population health management, and care coordination. Due to a 2016 electronic health record change, the Level 2 designation is now altered.
In order to closely monitor effects of hypertension on patients' health status, visits with an RCFHC clinician are scheduled every 3-4 months. A Chronic Disease Electronic Management System (CDEMS), supported by West Virginia University Office of Health Services Research, is utilized as a way of managing treatment efforts and identifying the patients who are not making or attending appointments. For example, this system can track patients with hypertension who have not had a visit with a clinician in the past year.
In an effort to decrease hypertension medication costs for community members, Roane County Family Health Care participates in a variety of different programs. One such program, the 340B Drug Pricing Program, requires drug manufacturers to lower the prices of their outpatient medications for the center's patients. Many of the generic hypertensive medications prescribed by clinic physicians are also on a discounted list (often $4 for a 30-day supply) at local pharmacies.
RCFHC additionally participates in a Sample Medication Program in order to decrease medication costs by providing patients with a short-term supply of their prescribed medications. These are medications that have been distributed to the clinic by pharmaceutical representatives.
By utilizing a sliding scale fee Medication Assistance Program for sliding fee rural community members and those eligible based on low income parameters, medication adherence is further improved.
All these efforts are ways to increase hypertension medication compliance in order to improve high blood pressure control rates in the rural population.
Roane County Family Health Care was one of 30 total healthcare practices nationwide to be named a 2014 Hypertension Control Champion by the U.S. Department of Health and Human Services as part of the Million Hearts Initiative for reaching blood pressure control in at least 70% of their patients.
In 2015, RCFHC received the U.S. Department of Health and Human Services award for Quality Improvement. RCFHC was also one of 57 clinics in the nation to be recognized for their efforts in chronic disease management, preventative care, and prenatal care. For more information on recognition and awards received, visit their News section.
RCFHC attempts to avoid the phrase “noncompliant patient.” In every patient population, there are patients with poor health literacy, lack of home support, or depression as a result of dealing with a chronic disease. These issues are certainly examples of barriers. RCFHC leverages the small, close-knit community dynamics which sometimes helps to engage children or grandchildren to encourage patients to take care of themselves to the best of their ability. The art of medicine takes teamwork and the center of the team must be the patient.
RCFHC nurses are trained to take a blood pressure correctly, use the proper size cuff, and repeat the blood pressure if it is greater than 140/90. It is also important for staff to get to know the population they are serving and use appropriate education materials accommodating the community's literacy level. Ensuring timely follow-up and contacting patients who do not keep appointments are also keys to successful outcomes.
Emma White, RN, Director of Quality Improvement
Roane County Family Health Care
Chronic disease management
Federally Qualified Health Centers
Pharmacy and prescription drugs
Wellness, health promotion, and disease prevention
May 27, 2015
July 6, 2017
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