Peer Coaching May Help Support Blood Pressure Control

Hypertension, also known as high blood pressure (BP), is a serious condition that can lead to heart disease, kidney failure, and early death. It is very common in the United States, particularly among Black adults.

Although high BP is treatable, treatment can be difficult to access, especially in rural areas with few doctors’ offices. In the rural Southeastern United States, where more than half of Black adults have been diagnosed with hypertension, distance and high transportation costs make it difficult for patients to attend regular doctor’s visits to manage their BP.

Two approaches have been successful in helping to manage chronic conditions in other parts of the United States:

• Peer coaching (PC) is a form of support in which trained lay (nonclinical) community members give patients guidance and encouragement to help manage their condition.
• On the clinical side, practice facilitation (PF) helps doctors’ offices become more effective in improving patients’ health outcomes through a range of quality improvement techniques.

Researchers wanted to find out if these methods could help with BP control among Black patients in rural communities. After gathering input from the community on how to design the study, the research team began a randomized clinical trial of 69 medical practices in Alabama and North Carolina to determine which methods were more effective in supporting BP control and BP levels in Black participants with persistently uncontrolled BP.

The study had 1,209 participants between the ages of 19 years and 85 years old and ran from 2016 to 2019. All practices were given educational materials and home BP monitors for patients in order to provide “enhanced usual care (EUC).” Each practice was assigned to an intervention:

• PC plus EUC
• PF plus EUC
• PC and PF plus EUC
• EUC alone

For 8 weeks, patients in the PC groups had weekly phone calls with their coaches to talk about healthy eating, exercise, taking their medication, working with their care team, and managing stress. After that, they had monthly follow-up calls for a year.

Medical practices in the PF groups met with facilitators in person each month for a year and stayed in touch between visits. The facilitators helped with at least one BP-related quality improvement project to improve BP control across the practices.

The results showed that, while neither PC nor PF helped improve overall BP control more than enhanced regular care, some patients in the PC group had significantly better systolic BP at the end of the trial. (Systolic BP is the first number in a blood pressure measurement, and diastolic is the second.)

PC was especially beneficial in helping patients under 60 years make behavior changes like remembering to take their BP medication, which improved adherence. These patients were also very satisfied with the PC experience; in a survey, 96% said it was helpful for their coach to remind them to exercise and take their medication, and 97% said they felt it was a good idea for people with high BP to have a PC.

The research team concluded that the results from these methods show how difficult it can be to support patients with high BP in these parts of the country, but that PC may help fill some of these gaps for younger Black patients.

Citation
Safford, M. M., Cummings, D. M., Halladay, J. R., Shikany, J. M., Richman, J., Oparil, S., Hollenberg, J., Adams, A., Anabtawi, M., Andreae, L., Baquero, E., Bryan, J., Sanders-Clark, D., Johnson, E., Richman, E., Soroka, O., Tillman, J., Cherrington, A. L. (2024). Practice facilitation and peer coaching for uncontrolled hypertension among Black individuals: A randomized clinical trial. JAMA Internal Medicine, 184. https://doi.org/10.1001/jamainternmed.2024.0047

Page published Oct. 31, 2024