Transcript Research Template - UMKC School of Medicine

Viewing blood pressure through the eyes of a patient: a mixed-method study at a student-run
safety-net clinic
Vritti Gupta1, Lakshmi Venkitachalam1, Karen Williams1, Angela Barnett1,2, Miranda Huffman1,2
1UMKC
Introduction
School of Medicine; 2Truman Medical Centers
Results
 High blood pressure (BP) is a leading  Between 08/25/13 and 11/10/13, ten
risk factor for cardiovascular disease
patients were interviewed for a mean (SD)
and affects approximately 68 million
of 13.4 (5.4) minutes
Americans
 Quantitative Characteristics: N (%)*
 This burden is disproportionately high
among patients of low socio
economic status


Objective

 To understand the knowledge,

attitudes and perceived barriers to

optimal BP control among patients
seeking care at Sojourner Free

Health Clinic (SFHC), a weekend

urban safety-net clinic


Methods

 Study Sample
 Inclusion Criteria:
*unless otherwise indicated
9 (90%)
Age ≥50 years
9 (90%)
Male
8 (80%)
African American
6 (60%)
Some college education
7 (70%)
Body mass index ≥30 kg/m2
8 (80%)
Smoking or Alcohol use
6 (60%)
Family history of high BP
10 (100%)
Pharmacological therapy
Systolic BP, mean (SD) mmHg 137 (18)
Diastolic BP, mean (SD) mmHg 89 (10)
Systolic BP ≥140 or Diastolic
6 (60%)
BP ≥ 90 mmHg
 Qualitative Responses: N patients
Patients ≥ 18 years age
 Attributed high BP to
Documented history of high BP
o Hereditary
7
(Systolic BP ≥ 140 mmHg or
o Lifestyle behavior
4
Diastolic BP ≥90 mmHg)
4
 Exclusion Criteria: History of mental o Emotions
 8 patients identified SFHC as the primary
illness
source for medications
o
o
 Data Collection and Analysis
 Semi-structured questionnaire with
open-ended questions
 Audio-recording of the interviews
were transcribed and thematically
analyzed
 3 out of 6 patients reported that lifestyle
modifications were not addressed during
the current visit
 4 patients reported receiving informational
handouts; 3 of these patients could not
recall the information
TABLE 1: Qualitative analysis of participant responses related to High
BP (N responses)
Focus areas
Exemplar Quotes
What does HBP mean to them?
• Negative Consequences “Death sentence“, “Increases the chances of a
(n=4)
stroke"; "Could cause heart disease"
• Physical symptoms, lack "Your head hurts a lot sometimes, when it starts, pills
of control (n=1)
don’t help, you just have to wait until it goes away."
What happens if blood pressure is not under control?
• Fear of death (n=2)
“If it’s not treated, then I could die”
• Health complications
“High blood pressure affects your internal organs, so
(n=6)
that if it’s too high it can damage them, shut them
down"
• Symptoms (n=2)
"It can cause dizziness”;”as a man, it can affect your
manhood a little bit because the blood doesn’t flow
the way it should"
• No perceived
"I do not associate a heart condition... with high blood
cardiovascular risk (n=1) pressure per se"
Why do they think they have HBP?
• Hereditary (n=7)
“Hereditary, stress, number of things, I assume"
• Widespread (n=1)
“Almost like an epidemic or something of some sort,
because a lot people have had it"
 Emotions (n=4)
"I do notice that when I’m stressed, my blood
pressure seems to go up….don’t have to get upset
because that plays a factor too"
• Lifestyle/Behaviors (n=4) “Eating a lot of salty foods...Not eating and
exercising…days at a time drinking and not taking my
medication. Stress. Cigarette, alcohol, drugs"
• Denial (n=1)
"I do like eating potato chips, but I don’t think that
gave me high blood pressure"
Do you know of any lifestyle changes that need to be made to control HBP?
• Stress (n=4)
"Stay away from stress, people who give me stress"
• Diet (n=1)
“Stay away from certain spices, or sugar, food that’s
high in different negative things”
• Alcohol (n=1)
• Physical Activity (n=1)
"I imagine drinking affects it too"
"You have to get out there and walk and if you can
walk for 40 minutes per day, that’s a good thing."
• Workload (n=1)
"Basically I have other problems... with diabetes ..get
my weight down... so much goes not maintaining
your high blood pressure and diabetes... trying to diet
and exercise ...so I might be able to live a couple
more years"
TABLE 2: Domains related to adherence with prescribed
practices for BP management
Domain
Exemplar Quotes
• Misinformation "I do not rely upon this place [SJC] to have
my BP checked. I do not feel I need to need
to check it [BP]. “
• Burden of
Management
“Don’t follow it to the book...when I’m hungry I
eat…isn’t always healthy…certain foods that
are good for are potentially higher priced”
• Denial
“When I’m ready to quit smoking, I’ll
stop…doesn’t affect me…not coughing…not
wheezing…not out of breath...if it starts
bothering me instantly, I’ll stop.."
• Self-efficacy
”Watch my sodium intake…do a little
cardio….trying to watch my soda pop
intake…cut back on the alcohol. I’ve never
done drugs, so I don’t have that problem."
• Unadaptable
"No. Because food just don’t taste right
without salt."
• Accountability "I’m in a situation and I know what causes my
situation and you either do something about it
or you just fall off and die."
• Avoid bad
outcomes
"Yes, I don’t want to get on dialysis."
Summary and Conclusion
 Knowledge and attitudes regarding the high BP
varied among patients seeking care at the
SFHC
 Preliminary results highlight opportunities for
improving the delivery of care
Next steps
 Evaluate student perception of delivery of care
in this vulnerable cohort
 Improve discharge planning process
 Tailor informational handouts to improve
retention and recall by patients
Acknowledgement: Study funded by Sarah Morrison
Student Research Award.