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Hypertension

Peer and Health Educator Support to Improve Health

University of Pennsylvania
Philadelphia County
Hypertension
African American

Project

Patients receive complementary disease management support from a health educator and peer coach.

This practice-based peer coach and health educator intervention addresses patient cardiovascular disease risk with five monthly contacts; three calls by a peer coach alternating with two clinic visits with a health educator.

The peer coach serves as a role model who provides convenient phone support about the patient’s self-reported barriers while the health educator offers face-to-face information tailored to the patient’s blood pressure, lipids and other cardiovascular disease risk factors. The peer coach and health educator focus on medication adherence, exercise and diet by addressing attitudes, social norms and perceived behavioral control. The health educator and peer coach concurrently monitor patient progress as part of a team-based care model.

Patients also receive American Heart Association brochures and community resources about hypertension and diet that are were developed for African American patients with low literacy.

Rationale

Care from a primary care physician alone may not always meet the broad range of patient needs. Team-based care as part of a patient-centered medical home model has been conceptualized to offer comprehensive care that is accessible, family-centered, continuous, coordinated, compassionate and culturally competent. Adding a trained peer coach and health educator to the care team may help address the barriers to a healthy lifestyle and medication adherence that patients may experience. Several decades of research have shown that peers can be trained to deliver credible, effective messages about health behaviors because they are viewed as successful despite having similar challenges.

Summary Results

Tailored disease management support through health educators (on site) and peer coaches (on-site, phone calls) significantly improved blood pressure (8.6 mmHg drop vs 0.6 mmHg drop in controls). At follow-up, the intervention significantly decreased patients’ 4-year cardiovascular disease risk (-0.6% change in risk vs +0.7% in controls).

Publications

Behavioral Support Intervention for Uncontrolled Hypertension: A Complier Average Causal Effect (CACE) Analysis
Medical Care. 2015;53(2):e9-e15. 
Full Article (subscription may be required)

Cost-effectiveness of a Peer and Practice Staff Support Intervention
American Journal of Managed Care. 2014;20(3):253-260. Published online 2014 Mar 20.
Full Article 

A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension
Journal of General Internal Medicine. 2012;27(10):1258-1264. Published online 2012 May 9.
Full Article 

Principal Investigators

  • Barbara J. Turner, MD, MSED
  • Mark Weiner, MD
  • Susan Day, MD