What Agency for Healthcare Research and Quality (AHRQ) quality lever can support managing hypertension in the homeless population?

From the Guidelines

The AHRQ quality lever that can most effectively support managing hypertension in the homeless is the implementation of a team-based care approach that includes patient educational materials, availability of blood pressure-specific follow-up, and algorithm-driven medication titration, as outlined in the 2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure 1. This approach is crucial for managing hypertension in homeless populations, as it addresses the unique challenges they face, including lack of access to consistent healthcare and medication management. The key elements of this approach include:

• Patient educational materials or sessions on hypertension to empower individuals with knowledge about their condition and its management
• Availability of blood pressure-specific follow-up, such as telephone-based or telehealth services, to ensure consistent monitoring and adjustment of treatment plans
• Algorithm-driven medication titration led by a clinical support team member and supervised by a lead clinician to optimize medication regimens and minimize potential side effects
• Timely follow-up and monitoring of laboratory results to guide medication adjustments and ensure safe and effective treatment
• Use of pharmacy fill data to monitor adherence and identify areas for improvement in medication management
• Provider-specific performance reports with hypertension metrics to track progress and inform quality improvement initiatives

By implementing these elements, healthcare providers can improve blood pressure control, reduce morbidity and mortality, and enhance the quality of life for homeless individuals with hypertension. This approach is supported by the most recent and highest-quality evidence, including the 2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure 1. While other studies, such as the 2018 synopsis of the American College of Cardiology/American Heart Association hypertension guideline 1, provide additional guidance on hypertension management, the 2019 AHA/ACC measures offer the most comprehensive and up-to-date framework for improving hypertension control in vulnerable populations like the homeless.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

AHRQ Quality Lever for Managing Hypertension in the Homeless

• The Agency for Healthcare Research and Quality (AHRQ) quality lever that can support managing hypertension in the homeless includes providing access to healthcare services, improving medication adherence, and addressing social determinants of health 2, 3.
• Studies have shown that homeless individuals with hypertension face unique challenges in managing their condition, including lack of access to healthcare, unstable living situations, and limited social support 2, 3.
• The use of fixed-dose combination therapy, such as angiotensin II receptor blockers, calcium channel blockers, and thiazide diuretics, can improve blood pressure control and reduce the risk of cardiovascular disease in hypertensive patients, including those who are homeless 4, 5, 6.

Barriers to Hypertension Management in the Homeless

• Lack of insurance and access to healthcare services are significant barriers to hypertension management in the homeless population 3.
• Social determinants of health, such as unstable housing, food insecurity, and limited social support, can also exacerbate hypertension and make it more difficult to manage 2, 3.
• The high rate of uncontrolled hypertension among homeless adults is alarming and highlights the need for comprehensive approaches to improve social support, access to medical insurance, and medication adherence 3.

Potential Solutions

• Providing access to healthcare services, including shelter-based clinics, can improve hypertension management in the homeless population 2, 3.
• The use of mobile health strategies and targeted health education can also improve medication adherence and lifestyle modifications in this population 3.
• Fixed-dose combination therapy can simplify treatment regimens and improve blood pressure control, making it a potential solution for managing hypertension in the homeless 4, 5, 6.