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lanai community health center
Photo credit: Lānaʻi Community Health Center

Remote healthcare is increasingly critical in the time of COVID-19. Five health clinics in Hawaiʻi recently launched programs to help patients monitor their blood pressure at home, and these programs were successful in addressing patients’ health and psychosocial needs, according to public health researchers at the University of Hawaiʻi at Mānoa.

The clinics were all federally qualified health centers (FQHCs), which serve many patients below the federal poverty level. The researchers worked in a collaborative partnership to study the programs to find out what barriers the programs faced, and what factors contributed to the programs’ success in enrolling patients. The paper is published in Preventing Chronic Disease.

“We know that these programs can help people to substantially decrease their blood pressure, but there is no clear protocol for starting programs like these,” said David Stupplebeen, who led the study and recently completed his doctoral degree with the UH Mānoa Office of Public Health Studies.

“These programs could provide a great tool for providers to monitor their patients’ health at a distance during the COVID-19 pandemic,” Stupplebeen said.

For the study, the researchers interviewed nine healthcare providers who worked in the blood pressure monitoring programs. They asked how the providers went about identifying and enrolling program participants, and how the patients were monitored.

“Our analysis showed the FQHCs were not just instrumental in supporting these programs, but creative in how they leveraged their existing programs, like exercise or other lifestyle-change programs,” Stupplebeen said. “Their team-based care model allowed for multiple staff touchpoints in order to work toward meeting patients’ needs.”

Clinical changes

Moreover, these programs successfully integrated clinical changes through patients monitoring their blood pressure with important lifestyle education on diet, including menu planning, food preparation demonstrations and nutritionist referrals.

The researchers found that the programs’ main goals were to confirm a hypertension diagnosis and to help patients achieve control over their blood pressure, meaning bring their blood pressure back down into a healthier range. Federal data from health centers show that only about two-thirds (64 percent) of patients at Hawaiʻi FQHCs with high blood pressure had achieved blood pressure control in 2017.

The barriers the programs faced included limited ability to reach patients who were homeless or had mental illness, and the lack of a standardized, pre-written curriculum for such programs. The program staff had built the programs by combining materials from a variety of sources.

“Our study highlights the innovation of FQHCs and their capacity to make the most of limited resources to support the health and well-being of our communities,” said L. Brooke Keliʻikoa, an assistant specialist with the UH Mānoa Office of Public Health Studies who also worked on the study.

This project is part of the Healthy Hawaiʻi Initiative partnership.

Stupplebeen and Keliʻikoa’s co-authors on the paper included Tetine L. Sentell, and Catherine Pirkle, also of the UH Mānoa Office of Public Health Studies; Blythe M. I. Nett and Lindsey S. K. Ilagan, of the Chronic Disease Prevention and Health Promotion Division of the Hawaiʻi State Department of Health; Bryan Juan, of the Hawaiʻi Primary Care Association; and Jared Medeiros, of the Lānaʻi Community Health Center.

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