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Open Access Highly Accessed Study protocol

The heart healthy lenoir project-an intervention to reduce disparities in hypertension control: study protocol

Jacquie R Halladay15*, Katrina E Donahue15, Alan L Hinderliter3, Doyle M Cummings4, Crystal W Cene3, Cassie L Miller2, Beverly A Garcia2, Jim Tillman6, Darren DeWalt35 and for Heart Healthy Lenoir Research Team

Author Affiliations

1 Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA

2 Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC 27599, USA

3 Department of Medicine, UNC Chapel Hill, Chapel Hill, NC 27599, USA

4 Department of Family Medicine, East Carolina University, Greenville, NC 27858, USA

5 Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27599, USA

6 Community Care Plan of Eastern North Carolina, Greenville, NC 27858, USA

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BMC Health Services Research 2013, 13:441  doi:10.1186/1472-6963-13-441

Published: 25 October 2013

Abstract

Background

Racial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol.

Methods/design

Using a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy).

Discussion

Using a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date.

Trial registration

ClinicalTrials.gov NCT01425515.

Keywords:
Hypertension; Methods; Quality improvement; Disparities; Community based participatory research