Online Program

Hypertension Control: Views from Small Practice Providers in NYC

Tuesday, November 3, 2015

Jason Wang, PhD, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Su Chow, NYC Department of Health and Mental Hygiene, Long Island City, NY
Colleen McCullough, BA, Primary Care Information Project, NYC Department of Health & Mental Hygiene, Long Island City, NY
Mandy Smith Ryan, PhD, Primary Care Information Project (PCIP), Division of Healthcare Access and Improvement, NYC Department of Health and Mental Hygiene, Long Island City (Queens), NY
Rupa Gnanapragasam, NYC Department of Health and Mental Hygiene, Long Island City, NY
Mark Alexander, MS, Primary Care Information Project, NYCDOHMH, Long Island City, NY
Sheila Anane, MPH, NYC Department of Health and Mental Hygiene, Long Island City, NY

The Primary Care Information Project (PCIP) within NYC’s health department has a mission to improve population health through the delivery of clinical preventive services. PCIP has implemented several quality improvement initiatives focusing on cardiovascular health. To better understand the issues around hypertension control, we surveyed small practice providers.

Objective/ Purpose

Identify barriers and factors for hypertension control observed by small practice primary care providers.


In late 2014, PCIP conducted a survey of lead clinicians from practices with < 6 providers and that saw more than 250 hypertension patients annually.


Of the 87 respondents (62% response rate), 63% worked in solo practices, and 64% reported that more than half of their patients were black or Hispanic. The biggest barrier for hypertension control was that patients “forgetting to take medication” (76%); practices where English was not the primary language spoken by patients reported greater difficulty with this medication adherence issue (87% vs 67%, p<0.05). Other identified barriers included availability/access/attitudes towards healthy food (52%) and exercise (48%), and medication cost (45%). Leading factors that affect patient engagement for managing hypertension included patient level of education (49%), comorbid conditions (47%), health literacy level (44%), socioeconomic status (40%), excess weight (38%), and age (37%). Practices’ top priorities for chronic disease management were diabetes (44%), hypertension (31%), and coronary artery disease (22%). Multi-provider practices were more likely to report conducting quality improvement activities than the solo providers (84% vs 65%, p<0.05).

Discussion/ Conclusions

Respondents reported medication adherence as the most common barrier for hypertension control, and education level as the leading factor for patients’ engagement. Practices should find ways to meet patient needs that are culturally and linguistically appropriate, especially around medication management, as well as connecting patients to healthier foods and opportunities for physical activity.

Learning Areas:

Clinical medicine applied in public health
Diversity and culture
Program planning
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Describe providers’ views about issues and concerns about hypertension control. Identify factors related to patient hypertension engagement. Discuss the importance of QI activities on hypertension control.

Keyword(s): Hypertension, Survey

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Senior Director of Evaluation, Research and Analysis in NYC Department of Health and Mental Hygiene. I have published over 50 peer-reviewed papers on chronic disease prevention, healthcare economics, statistical methods, and EHR-related topics. I am also an adjunct faculty at SUNY Old Westbury and at Mount Sinai School of Medicine.
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.