UCLA

Background

Millions of Americans have uncontrolled hypertension and are low-income or uninsured populations. Health Resources and Services Administration-funded health centers (HCs) are primary providers of care to these patients and a majority have adopted the patient-centered medical home (PCMH). PCMH includes principles of care coordination or integration and care management-support important to the treatment of hypertension. We examined whether the receipt of PCMH concordant care by HC patients improved hypertension outcomes.

Methods

We used a nationally representative survey of adult HC patients with hypertension (n = 2,280) conducted between October 2014 and April 2015. We included data from the 2013 and 2014 Uniform Data System to include characteristics of the HCs where these patients received their care. Our outcome measures included flu shots, number of primary care visits, normal blood pressure at last visit, emergency department (ED) visits, confidence in self-care, and compliance with provider recommendations. The primary independent variables were (i) whether the HC coordinated and referred patients to specialists; (ii) provided counseling, health education, coaching, treatment plans, and advice on hypertension control; and (iii) helped patients to obtain government benefits, medical transportation, and basic needs such as housing and food. Logistic and negative binomial multivariate regression models were performed.

Results

Hypertension-focused coaching was associated with normal blood pressure at last visit (odds ratio (OR) = 1.47) and fewer ED visits (incidence rate ratio = 0.81). Behavioral health counseling was associated with increased self-efficacy in self-care management (OR = 3.20).

Conclusions

Our findings suggested that increased focus on these practices may lead to better hypertension outcomes among patients who are low-income and uninsured populations.