IMPROVING HYPERTENSION CARE FOR INNER CITY MINORITIES

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Proposed is a multifaceted program to improve long-term blood pressure (BP) control in a predominantly African-American, low SES community of a large city. Components of the program will include a community education campaign, an educational intervention for private physicians, and major modifications in the process of care for hypertensives in a health care system that is the largest single provider to the target area. The intervention area will be compared to a similar community in another part of the city which is served by different private and public providers. Pre and post-intervention random samples of 1050 persons ages 18-74 will be selected from each geographical area to assess the effectiveness of the program in reducing the prevalence of uncontrolled hypertension. The community intervention will focus on improving awareness and need to maintain treatment. The private physician intervention will focus on strategies for promoting long-term patient adherence. The public hospital clinic/systems component will: 1) educate providers, 2) institute an evening clinic for the working poor, 3) provide tailored patient education programs which are culturally sensitive and do not require class attendance, and 4) implement a program in the public hospital emergency center to identify and refer patients with undetected hypertension or hypertension not under regular care. Efforts, including reminders and follow-up by community health center social workers, will be used to keep patients active in treatment programs. The investigators are in a strong position to implement the program. The community intervention will be directed the co-investigator from Texas Southern University (TSU), an historically Black university located in the intervention area, who has extensive experience in community outreach. The intervention toward private physicians will be directed by investigators from Baylor College of Medicine who have established clinical credibility in the physician community. The investigators from Baylor also have direct supervision over the physicians who provide care in the Harris County Hospital District (HCHD) public health care system. The HCHD is also deeply committed to the project and has had a high level of representation in all the planning phases for this proposal.