BACKGROUND:

Low income residents of inner city Seattle especially African Americans, have significantly higher rates of cardiovascular mortality and morbidity than other Seattle residents. Hypertension is a major risk factor for these excess deaths. The prevalence of both hypertension and uncontrolled hypertension is also higher among low income and minority residents, especially young men.

The study was in response to a demonstration and education initiative, "Improving Hypertensive Care for Inner City Minorities", which was reviewed and approved by the Clinical Applications and Prevention Advisory Committee in April 1992 and by the National Heart, Lung, and Blood Advisory Council in May 1992. The Request for Applications was released in October 1992.

DESIGN NARRATIVE:

Two interventions were studied, both of which improved upon existing activities and strengthened the relationship between community and clinic-based hypertension control activities. The first intervention improved the identification and entry into care of new and uncontrolled hypertensives in the community with an emphasis on bringing more young males (especially African American) through: (a) screening and education activities (b) a microcomputer-based client tracking system to follow persons with elevated blood pressure (c) an outreach system to improve follow-up into clinical care.

The second intervention enhanced access to and compliance with hypertension care among patients using the participating clinics (both currently registered patients and new patients referred through community screening activities) through: (a) microcomputer-based patient tracking system at each clinic to identify nonadherent and other high risk patients (b) placing a hypertension patient care coordinator at each clinic who created an individualized care plan for each patient and coordinated a wide range of services, including specific strategies to enhance compliance (c) making available outreach workers to assist in efforts to keep patients in care.