Racial Ethnic Disparities in Hypertension Follow Up Care of Health Center Patients

Background: Minorities, especially African Americans, are more likely to have hypertension and suffer from increased morbidity and mortality compared to Whites. FQHCs (Health Centers) care for over 18 million patients, 63% of whom are racial/ethnic minorities. For Health Center patients with hypertension, we assessed the presence and magnitude of racial/ethnic disparities in obtaining counseling or training to help manage hypertension, hospitalizations or ER visit(s) due to hypertension, and self-assessed confidence in ability to self-manage hypertension. Method: Cross-sectional analyses using the 2009 Health Center Patient Survey, a nationally-representative sample of 4,558 patients. For patients who report hypertension (n=1,764), we estimated logistic regression models to predict the likelihood of obtaining each of the following: health professional counseling about diet, salt, exercise and alcohol; patient compliance with counseling; training on patient self management by a nurse; hospital or ER episodes in past 2 years due to hypertension; and confidence in capacity to self-manage hypertension. Our models controlled for important patient characteristics including the presence and source of health insurance coverage and comorbidities. Results: In Health Centers, both African Americans and Latinos are more likely to have hypertension compared with White patients. Among patients with hypertension, there are no racial/ethnic disparities in the receipt of counseling on lifestyle (diet, salt, exercise and alcohol) or compliance with counseling. In addition, no disparities exist in receipt of hypertension self-management training by nurses. Relative to other racial/ethnic groups, African Americans are more likely to be hospitalized or visit the ER in the past 2 years due to hypertension, while Latinos are less likely to express confidence in their capacity to self-manage hypertension. Conclusions: Among Health Center patients with hypertension, we did not find racial/ethnic disparities in patients' receipt of counseling or self-management training provided by a health center professional. However, disparities exist for hospitalization/ER use and self-efficacy for hypertension control. Health centers, like other settings, need to address potentially avoidable acute care usage due to hypertension by implementing better care coordination and improving patient self-management. An effective educational outreach program may lead to greater self-efficacy for hypertension self-management.