Abstract Body (Do not enter title and authors here): Background
Although superior to clinic-based care, existing telemedicine programs to manage hypertension are less effective in Black patients. Programs’ insufficient support of Black patients’ self-care skills and social needs may hinder their effectiveness. We piloted a 12-week, team-based telemedicine intervention by pharmacists, nurses, community health workers (CHW), and social workers (SW) emphasizing frequent and tailored self-care support and social support.
Methods
We conducted semi-structured interviews with Black patients with hypertension (N=15) and clinic key players (N=16; 5 providers, 1 pharmacist, 4 nurses, 1 nurse manager, 1 administrative manager, 2 CHWs, 2 SWs) from two clinics in North Carolina to evaluate the program’s potential at improving hypertension care among Black patients. The Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation frameworks guided the interview. We used inductive and deductive coding strategies to identify emergent themes during the thematic analysis. We considered equity-related constructs about culture, social context, medical mistrust, health literacy, and clinic and health system-related factors and comfort using technology for healthcare.
Results
At baseline, 12 (80%) patients felt comfortable using technology for healthcare, while 3 (20%) felt somewhat uncomfortable. Eight patients (53.3%) reported feeling confident filling out medical forms, while 7 (46.7%) noted being sometimes or occasionally confident. Medical mistrust score was 2.47 ± 0.62 (range 1-4; higher score, more mistrust with providers and health care system). Five health equity-related themes emerged from the interviews. Both patients and key players expressed (1) satisfaction with program-related clinical encounters and felt that the program (2) may improve trust, (3) is likely to treat Black patients fairly, (4) emphasizes the importance of patient-provider racial concordance, and (5) addresses social needs extending beyond housing (Table).
Conclusion
Our team-based telemedicine program may improve equity for hypertension care among Black patients. If shown to be clinically effective, our program has the potential to improve hypertension control in this population.