Early Intervention for Clients with High Blood Pressure in North Dakota
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For a lot of our patients, we’re often their only care provider—so even though our clinicians are not intending to be their primary care, they are. Hypertension can affect so many body systems; it is an all-encompassing disease. So being able to offer this service—it’s just a can’t miss opportunity.Crystal Arnson DNP, APRN, WHNP-BC, North Dakota Department of Health and Human Services
Just two staff from the North Dakota Department of Health and Human Services administer the state’s sole Title X project across its 23 service sites. Still, this small but mighty team has managed to integrate hypertension prevention, diagnosis, and control into its family planning services.
Their interest in prioritizing hypertension care started when, on a site visit about three years ago, they saw a patient having her blood pressure taken—while talking, with her coat on. Her blood pressure was elevated—but there was no follow up.
They recognized this as a missed opportunity to:
- Accurately measure blood pressure
- Provide patient education about high blood pressure
- Intervene early to manage high blood pressure and reduce the risk of negative short- and long-term individual and maternal health outcomes
Why should hypertension care fall to family planning providers in the first place?
Title X providers are the only source of care for 4 out of 10 Title X clients nationally—if they don’t provide hypertension care to these clients, no one else will. Even when Title X providers refer clients with elevated blood pressure for follow-up care, the clients often don’t go (for cost or other reasons).
Taking into account all of these realities, the North Dakota Title X project launched an initiative to integrate essential hypertension care into family planning services and support staff with this effort. As part of the initiative, they:
- Provided blood pressure education and resources across all Title X clinics, including on the blood pressure protocol, what constitutes a hypertensive emergency, and the ability to use the 340B Drug Pricing Program for hypertension medications
- Identified opportunities for strengthening hypertension care, leveraging data from internal medical audits and client surveys
- Hosted a series of lunch n’ learn sessions, sharing information and resources about how to accurately measure blood pressure (and a clinic poster with these steps), the importance of home blood pressure monitoring to rule out “white coat” hypertension, how to diagnose and manage hypertension in a family planning setting, when and how prescribers can select the appropriate treatment, and more. Many of the resources shared were from the RHNTC's Hypertension Prevention and Control Toolkit.
Site visits and chart audits suggest these efforts are moving the needle: the North Dakota Title X project has seen a marked improvement in blood pressure-related documentation and an uptick in clients receiving hypertension control services.