From Bedbugs to Better Blood Pressure: CHWs Can Help Health Care Systems Address the Social Determinants of Health

Background: In 2012, The University of Rochester Medical Center developed a Blood Pressure Advocate Program to assist neighborhood clinics in Rochester, NY address hypertension. Community Health Advocates help patients improve their blood pressure through counseling on risk factors for hypertension, teaching them self-management techniques, helping them set goals to improve nutrition, and medication adherence. Yet, before they can address these aspects of blood pressure health, the CHAs may need to address underlying factors that prevent patients from focusing on their health.  In our program, these factors have included accessing affordable health foods, accessing health insurance, and dealing with bed bugs.  One of the authors and potential presenters of this abstract is a CHA.

Methods: Four Community Health Advocates (CHAs) employed in three local health care clinics receive physician referrals of hypertensive patients. During the first patient visit with the CHA, patients are asked their biggest barrier to controlling their blood pressure. CHAs work with patients to address barriers using innovative strategies that include contact with other agencies (such as the county health department) and other community resources.  

Results: In a subset of 357 patients, 20% (71) stated they had too many other pressing priorities that prevented them from focusing on controlling blood pressure.  After joining and participating in the intervention, 85% of patients report positive changes, including reductions in weight, increased physical activity and better nutrition.

Conclusion: As health care evolves to become more patient centered, Community Health Workers can assist clinicians in addressing the social determinants that impact health.