Implementation Strategies for Self-Measured Blood Pressure Monitoring in Racially and Ethnically Diverse Populations

Implementation Strategies for Self-Measured Blood Pressure Monitoring in Racially and Ethnically Diverse Populations

This clinical trial aims to assess the impact of patient-focused and clinical-focused implementation strategies on blood pressure control. The investigators will assess the costs of these strategies and how effective they were at safely and equitably increasing home blood pressure monitoring.

This study will focus on assessing implementation strategies to increase adoption of self-monitored blood pressure (SMBP) monitoring among low-income, culturally and linguistically diverse patients with hypertension in an urban safety net. The investigators propose a hybrid type 1 effectiveness-implementation trial of implementation strategies to increase use of SMBP monitoring with clinical support in an urban safety net system. 330 patients will be randomized to a low-intensity vs high-intensity implementation strategy for SMBP monitoring. The low-intensity strategy will replicate frequently used implementation efforts (provision of BP monitor with training on using a monitor) while the high-intensity strategy will address additional factors identified in prior work (e.g., digital literacy, social support). In six adult primary clinics, the investigators will concurrently provide a stepped-wedge clinic-level implementation strategy (clinical champions, electronic health record [EHR] tools) to increase provision of clinical support for SMBP data. To guide dissemination in other under-resourced settings, an economic evaluation will also be conducted.

Inclusion Criteria:

• 18 years old/order
• Any sex or gender
• Any race or ethnicity
• Must be receiving primary care at any of the six enrolled clinics
• Have uncontrolled hypertension (two clinic BP readings ≥140/90 mmHg within the previous 18 months)
• Can read and write English, Spanish, or Cantonese
• Be able to provide consent
• Must own a cell phone that receives SMS or text messages

Exclusion Criteria:

• Those with conditions that might complicate remote BP monitoring:

  • Pregnancy (and 12 months postpartum)
  • Acute myocardial infarction or stroke in the last 12 months
  • End-stage renal disease on dialysis
  • Stage D heart failure
  • Active treatment for cancer (except for nonmelanoma skin cancers)
  • Pacemaker use

• Those with dementia, in hospice care, or with serious behavioral health conditions impeding participation