240654 Racial Ethnic Disparities in Hypertension Follow Up Care of Health Center Patients

Wednesday, November 2, 2011: 9:30 AM

Alek Sripipatana, PhD, MPH , Div. of Cancer Prevention & Control Research, UCLA School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Provision of health care to the public

Learning Objectives:
1) Describe the characteristics of patients with hypertension who visit Federally Qualified Health Centers (FQHCs) 2) Identify racial/ethnic disparities in (a) receipt of counseling or training to help manage hypertension (b) hospitalizations or ER visits due to hypertension and (c) self-assessed confidence in ability to self-manage hypertension 3) Assess the policy implications of any apparent disparities.

Keywords: Access to Health Care, Community Health Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conduct research on Asian and Pacific Islander groups.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.