October 10, 2015
The Blood Pressure Advocate Program (BPAP) was developed by the University of Rochester Medical Center’s Center for Community Health.
Through a $300,000 grant provided by the Finger Lakes Regional Economic Development Council, and additional funding provided by the Rochester Business Alliance/Finger Lakes Health Systems Agency’s High Blood Pressure Collaborative, BPAP began in August 2012 as a partnership between the University of Rochester Medical Center and Rochester Regional Health System. Its goal: To improve blood pressure control among those seeking care at neighborhood clinics by assisting clinic staff in addressing the social and behavioral determinants of patients’ health. A 2012 health survey of Monroe County found that half of adults age 35 and older living in the city of Rochester had high blood pressure. Obesity rates were higher for those urban dwellers, as well.
Recognizing that no one knows patients’ social and behavioral determinants better than those who live in the same neighborhoods, the program has trained local residents as community health advocates (CHAs). Four advocates are embedded in one suburban and three urban primary care centers that serve low-income, ethnic and refugee groups. CHAs support hypertensive patients with resources and strategies for making lifestyle changes, while addressing their personal barriers to achieving optimal health.
“Our patients often lead complicated lives. They need to become self-motivated to address their health – and that is best done by their peers,” said Nancy M. Bennett, M.D., director of the URMC Center for Community Health, which developed the Blood Pressure Advocate Program. “Lots of patient questions come up with community health advocates that don’t come up with physicians.” She attributes that openness not only to peer empathy but also to the greater amount of time CHAs can spend with patients.
The program has involved more than 1,000 patients over the past three years. As of December 2014, there were 409 active patients. Of them, 71.1 percent had their blood pressure in control and 85 percent have reported and/or achieved positive health changes such as losing weight, becoming physically active, taking their medications as prescribed and eating better.
“The clinical sites are excited about the addition of community health advocates to their provider teams, especially as they consider population health management,” said Shaquana Divers, BPAP’s program manager. “The doctors say ‘I don’t have time to sit for an extended length of time and talk with patients, but the CHAs do.’ ”
CHAs set up appointments with patients in each practice who have either been recently identified as having Stage 1 hypertension – blood pressure of 140/90 or higher – as well as those who have been previously diagnosed but have not been seen at a clinic in more than a year. Over three months of appointments, CHAs discuss with patients how to set achievable goals to lower their blood pressure through changes in diet, exercise, smoking cessation and stress management.
“I love what I do,” said Andrea Clarke, who has been a Community Health Advocate from BPAP’s inception. “I struggle with high blood pressure myself, so I practice what I preach and I tell my patients, ‘We will do this together.’ Sometimes people are dealing with so many difficult life situations, I don’t even start with blood pressure control. We start with where they are when I come into the picture.”