Remote healthcare is increasingly critical in the time of COVID-19. Five health clinics in Hawaiʻi recently launched programs to help patients monitor their blood pressure at home, and these programs were successful in addressing patients’ health and psychosocial needs, according to public health researchers at the University of Hawaiʻi at Mānoa.
The clinics were all federally qualified health centers (FQHCs), which serve many patients below the federal poverty level. The researchers worked in a collaborative partnership to study the programs to find out what barriers the programs faced, and what factors contributed to the programs’ success in enrolling patients. The paper is published in Preventing Chronic Disease.
“We know that these programs can help people to substantially decrease their blood pressure, but there is no clear protocol for starting programs like these,” said David Stupplebeen, who led the study and recently completed his doctoral degree with the UH Mānoa Office of Public Health Studies.
“These programs could provide a great tool for providers to monitor their patients’ health at a distance during the COVID-19 pandemic,” Stupplebeen said.
For the study, the researchers interviewed nine healthcare providers who worked in the blood pressure monitoring programs. They asked how the providers went about identifying and enrolling program participants, and how the patients were monitored.
“Our analysis showed the FQHCs were not just instrumental in supporting these programs, but creative in how they leveraged their existing programs, like exercise or other lifestyle-change programs,” Stupplebeen said. “Their team-based care model allowed for multiple staff touchpoints in order to work toward meeting patients’ needs.”
Clinical changes
Moreover, these programs successfully integrated clinical changes through patients monitoring their blood pressure with important lifestyle education on diet, including menu planning, food preparation demonstrations and nutritionist referrals.
The researchers found that the programs’ main goals were to confirm a hypertension diagnosis and to help patients achieve control over their blood pressure, meaning bring their blood pressure back down into a healthier range. Federal data from health centers show that only about two-thirds (64 percent) of patients at Hawaiʻi FQHCs with high blood pressure had achieved blood pressure control in 2017.
The barriers the programs faced included limited ability to reach patients who were homeless or had mental illness, and the lack of a standardized, pre-written curriculum for such programs. The program staff had built the programs by combining materials from a variety of sources.
“Our study highlights the innovation of FQHCs and their capacity to make the most of limited resources to support the health and well-being of our communities,” said L. Brooke Keliʻikoa, an assistant specialist with the UH Mānoa Office of Public Health Studies who also worked on the study.
This project is part of the Healthy Hawaiʻi Initiative partnership.
Stupplebeen and Keliʻikoa’s co-authors on the paper included Tetine L. Sentell, and Catherine Pirkle, also of the UH Mānoa Office of Public Health Studies; Blythe M. I. Nett and Lindsey S. K. Ilagan, of the Chronic Disease Prevention and Health Promotion Division of the Hawaiʻi State Department of Health; Bryan Juan, of the Hawaiʻi Primary Care Association; and Jared Medeiros, of the Lānaʻi Community Health Center.
Preventing and managing chronic conditions such as diabetes and heart disease remain especially critical during the COVID-19 pandemic. For 20 years, the Healthy Hawaiʻi Initiative has been working to build healthier, more equitable communities and helping to reduce health disparities related to chronic diseases. Deaths due to heart disease decreased by 34 percent, stroke by 44 percent, and lung cancer by 10 percent during this time. Smoking prevalence among public high school students dropped by 72 percent over two decades, from 29.2 percent to 8.1 percent.
Now, as diabetes, heart disease and other conditions are associated with increased risk for COVID-19, it is important to maintain these gains.
In a paper published in BMC Public Health, researchers from the University of Hawaiʻi at Mānoa Office of Public Health Studies report how the Healthy Hawaiʻi Initiative was created in 2000 with tobacco settlement funds as a statewide effort to promote health-supporting environments through systems and policy change.
The Healthy Hawaiʻi Initiative started with a vision to make “the healthy choice the easiest choice,” for all Hawaiʻi residents, the researchers wrote. The initiative built relationships between community members, lawmakers and stakeholders across the islands and had many notable policy and project successes, including Complete Streets policies, the Choose Healthy Now ad campaign, and the Hawaiʻi Health Data Warehouse.
“Making health a shared value requires a cultural shift, and we believe the Healthy Hawaiʻi Initiative has contributed a new understanding that can be useful to long-term public health initiatives,” said Catherine Pirkle, one of the authors of the report and an associate professor with the UH Mānoa Office of Public Health Studies.
Long-term vision
For the new paper, Pirkle and her co-authors interviewed 10 public health leaders and community members who have worked on the initiative. The goal was to better understand the history, achievements and challenges of the Healthy Hawaiʻi Initiative.
The interviews revealed that a clear, long-term vision of health in the state was essential to the Healthy Hawaiʻi Initiative’s successes. Moreover, by developing long-term relationships with lawmakers, building strong, publically-available data surveillance tools and telling compelling stories, the initiative garnered support for health promotion programs.
“The success of the Healthy Hawaiʻi Initiative over the course of 20 years can be seen through the change and growth of the program since its creation and vision,” said Tetine Sentell, director of the UH Office of Public Health Studies and senior author of the paper.
Today, the Healthy Hawaiʻi Initiative continues to support the prevention and management of chronic disease, including supporting culturally-tailored programs relevant to Hawaiʻi’s diversity and encouraging communities to take care of their chronic disease even in the stress and confusion of COVID-19.
“Addressing health and prevention focusing on our communities will continue to be the Healthy Hawaiʻi Initiative’s focus,” Sentell said. “We want to turn theoretical ideas into health practices and promote and sustain long-term change throughout the islands.”
Pirkle and Sentell’s co-authors on the paper include Opal Vanessa Buchthal, assistant professor of the UH Mānoa Office of Public Health Studies; Joy Agner, of the UH Mānoa Department of Community and Cultural Psychology; Lola Irvin, of the Hawaiʻi State Department of Health; Jay E. Maddock, of Texas A&M University; Jessica Yamauchi, of the Hawaiʻi Public Health Institute; and Ranjani Starr, of the Hawaiʻi State Department of Health and Human Services.
Learn more about the Healthy Hawaiʻi Initiative.
Story originally posted at UH News
