Patients with hypertension paired with a community health worker (CHW) through their primary care practice were more than three and a half times as likely to achieve blood pressure control within six months compared to patients who were not. New research, led by researchers at NYU Grossman School of Medicine, suggest that similar CHW inventions could help other underserved, immigrant communities experiencing similar disparities.
Published online today in the journal Circulation: Cardiovascular Quality and Outcomes, the findings focus on community health workers (CHWs), lay members of a community who usually share ethnicity, language, income level, and/or life experiences with the people they serve. While past work has found that CHW-led programs lead to improvements in blood pressure in community-based settings like barbershops and churches frequented by members of the Black community, the new study is the first, the researchers said, to examine the intervention in primary care practices that specifically serve South Asian Americans.
Previous research shows that members of the South Asian community have a greater than average risk for cardiovascular disease (CVD), hypertension, and diabetes—even at lower body weights and at younger ages compared to Whites and other racial/ethnic groups. They also often face social and cultural barriers to managing chronic diseases and accessing healthcare.
The key to the intervention’s success, according to lead study author Nadia Islam, PhD, associate professor in the Department of Population Heath and associate director at the Institute for Excellence in Health Equity at NYU Langone, was the CHWs’ ability to adapt evidence-based practices to offer culturally sensitive and linguistically appropriate health coaching. While New York City is home to the country’s largest South Asian population, many have limited English proficiency, are disconnected from the healthcare system, and lack tailored resources. Working in close partnership with primary care practices serving South Asian practices, the CHWs were uniquely positioned to help patients integrate their physicians’ recommendations into their lives and daily routines.
“As the demand for patient-centered approaches in clinical settings expands, CHW models have growing clinical and public health relevance in the context of hypertension management,” said Islam. “They offer a cost-effective model for chronic disease management among immigrant communities with limited English proficiency who are often underserved by health care systems.”
Co-collaborators of the study include Healthfirst, New York City’s largest insurer of Medicaid patients.
“Making sure primary care practices have the resources they need to support the specific needs of their patients is a top priority for us,” said Susan Beane, MD, Healthfirst’s executive medical director. “As these findings illustrate, making community health workers accessible for our members is an important way to advance health equity. We hope others will learn from, replicate, and scale this intervention.”
How the Study Was Conducted
The team of investigators enrolled 303 South Asian patients ranging in age from 18 to 85 with elevated blood pressure (systolic BP <140 mmHg or diastolic BP <90 mmHg) in 14 primary care practices in Queens, Brooklyn, and the Bronx. All patients received one 60 to 90-minute group education session about hypertension management before randomly being separated into treatment and control groups. The treatment group received an additional four group sessions, as well as biweekly individualized health coaching from a CHW either in person or by phone.
Approximately half the participants were female with a mean age of 57, 45 percent had less than high school education, 88 percent were either married or living with a partner, and 40 percent were employed. More than 70 percent of patients were enrolled in Medicaid.
After six months, 68 percent of the treatment group had controlled blood pressure compared to 42 percent of the control group. In the researchers’ final adjusted analysis, they found that members in the treatment group had a 3.7 times greater likelihood of achieving normal blood pressure at six-month follow-up compared to the control group.
The next phase of Islam’s research will examine the impact of CHW interventions on underserved patients with comorbidities, such as hypertension and diabetes, and eventually on mental health.
“Measuring the effectiveness of CHW interventions on patients with comorbidities is important because blood pressure control is especially critical in individuals with diabetes, and there are very few programs designed to address several chronic conditions,” said Islam. “It is our hope that this highly-effective intervention will soon be covered as a reimbursable expense by health insurance companies.”
The investigators are also working with the NYU Langone Health system to adapt this model for NYU Langone’s faculty group practices.
In addition to Islam, additional co-authors from NYU Grossman School of Medicine are Chau Trinh-Shevrin, DrPH (senior author), Lorna Thorpe, PhD, MPH, Laura C. Wyatt, MPH, Jennifer M. Zanowiak, MA, Sadia Mohaimin, Keith Goldfeld, DrPH, Priscilla Lopez; Susan Beane, MD, FACP, Healthfirst, Rashi Kumar, MUP, Healthfirst, and Shahmir H. Ali, PhD, NYU School of Global Public Health. Funding for the study was provided by the Centers for Disease Control and Prevention, grant number U48DP001904.
Journal
Circulation