A quality-improvement project on the implementation of health coaching for hypertension control in primary care

Abstract

Hypertension is a major contributing factor to cardiovascular disease and stroke (Center for Disease Control and Prevention [CDC], 2021). The prevalence of hypertension in the United States is high and increasing in Montana. Although hypertension is a condition that can be diagnosed and treated easily in primary care settings, a large proportion of individuals live with undiagnosed and uncontrolled hypertension in the United States and in Montana. Given the health disparities among underserved rural populations, there was a need to develop accessible and low-cost improvement efforts (Sharma et al., 2016) in primary healthcare settings in rural Montana. The aim of this quality-improvement project was to implement health coaching, a promising evidence-based improvement strategy to prevent uncontrolled hypertension in a rural primary care clinic in North Central Montana. Health coaching has demonstrated significant improvement in outcomes in patients with chronic disease conditions such as hypertension (Finn & Watson, 2017; Sharma et al., 2016; Singh, 2021). The project helped to create a patient centered, efficient, adoptable, and sustainable improvement effort that supported self-management of hypertension. Health coaching was implemented in this project through members of the healthcare team, such as registered nurses and medical assistants, by four 30-minute visits including face-to-face and telephone calls for a period of 5 weeks. The Donabedian's structure, process, and outcome framework guided the design of the project and measurement of project outcomes. The outcome of the project demonstrated improvement in blood pressure to less than 140/90 mm Hg following 5 weeks of health coaching. This project was implemented in the clinic as a pilot program with the support of healthcare professionals and administrators from multiple levels. Future recommendations for practice were developed from this project to help inform and support sustainability of future health-coaching interventions on a larger-scale basis in rural settings.