Nine Hundred Cuffs: A Pharmacist-Led Telemonitoring Intervention for Uncontrolled Hypertension, With Named Partners, Sites, and Expected Reach
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Doctor of Nursing Practice Program, Aspen University
DNP875: Population Health and Person-Centered Care
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Month Day, Year
Nine Hundred Cuffs: A Pharmacist-Led Telemonitoring Intervention for Uncontrolled Hypertension, With Named Partners, Sites, and Expected Reach
The final step in population health planning is to choose an intervention and say precisely who will deliver it, where, and to how many people. This paper proposes a home blood pressure telemonitoring program with pharmacist management for Delmont County adults whose blood pressure remains above goal, names the partners and sites, estimates reach and expected effect, and defines how the program will be evaluated.
The Target Group
Earlier analysis found 10,250 adults in the county's clinical hypertension population whose most recent blood pressure was not below 140/90. The largest gaps were among uninsured adults, Black adults, and Spanish-speaking adults, and barriers included transportation, work schedules, medication costs, and language. The intervention is designed for adults with uncontrolled hypertension, with enrollment prioritized for these three groups.
The Intervention and Its Evidence
Participants will receive a validated upper-arm blood pressure monitor that transmits readings automatically, training in correct measurement, and management by a clinical pharmacist working under a collaborative practice agreement with their primary care clinicians. The pharmacist will review readings weekly, adjust medications according to a protocol, address side effects and costs, and communicate with the patient by phone or video, with an interpreter when needed.
The model rests on strong evidence. In a cluster-randomized trial, patients receiving home blood pressure telemonitoring with pharmacist management were far more likely than usual-care patients to have controlled blood pressure at both 6 and 12 months, 57.2 percent compared with 30.0 percent, and systolic pressure fell about 10 mm Hg more at 6 and 12 months (Margolis et al., 2013). The intervention works because it moves blood pressure care out of the clinic visit and into the weeks between visits, where most of life happens. Home measurement also addresses a limitation of clinic readings, provided patients use correct technique, which the program will teach using national measurement guidance (Muntner et al., 2019).
Named Partners and Sites
The lead partner is the county's federally qualified health center, which employs two clinical pharmacists and serves most uninsured and many Spanish-speaking patients; its four sites will host enrollment and device training, including two evening sessions a week. The hospital-owned primary care network will refer patients and sign collaborative practice agreements, with one of its pharmacists joining the team. Three congregations, two predominantly Black churches in the city and a Spanish-language parish in the eastern township, will host monthly enrollment and measurement-training sessions after services and identify lay health volunteers to help participants with devices. The county health department will provide funding for devices through a state cardiovascular prevention grant and will lend its community health workers for home visits to participants who need help setting up. The collaborative's data team will manage the registry and evaluation.
Expected Reach
The program's capacity is set by pharmacist time: three pharmacists managing about 300 participants each over a year allows 900 enrollees, or 8.8 percent of the 10,250 adults with uncontrolled hypertension. Enrollment targets reflect the priority groups: 250 uninsured adults, of the 980 uninsured adults who are uncontrolled; 350 Black adults, of 1,970; and 150 Spanish-speaking adults, of 580; with the remaining 150 places open to others. These targets would reach between a fifth and a quarter of each priority group's uncontrolled members, a much larger share than for the population overall, which directs the program's limited capacity toward the largest gaps.
Expected Effect
If local results were half as large as in the trial, a difference of about 13 percentage points in control compared with what would otherwise occur, the program would bring roughly 120 additional adults to control in its first year; if they matched the trial, about 240. These figures are modest relative to the county's 10,250 uncontrolled adults, but concentrated among the groups with the largest gaps they would narrow disparities measurably, and the program's registry will allow expansion if results warrant.
Cost and Sustainability
First-year costs include about 900 connected monitors, the largest single expense, covered by the county's cardiovascular prevention grant; the equivalent of three pharmacist positions, two already employed by the health center and one funded by the hospital network; data platform fees; and small stipends for congregational volunteers. Sustaining the program beyond the grant depends on revenue and savings. Remote physiologic monitoring and pharmacist services can be billed to some payers, and the health center's Medicaid managed care contracts include quality incentives tied to blood pressure control, which the program can help earn. The partners will also track emergency visits and admissions for hypertensive urgency and stroke among participants, to build a case for continued funding. The sustainability plan is part of the design from the start, because a program that ends when its grant does would leave the priority groups where they began, with one more reason to distrust the next initiative.
Evaluation With RE-AIM
Glasgow et al. (1999) proposed judging an intervention's public health value on five fronts, captured in the acronym RE-AIM: how many it reaches, how well it works, how many settings and clinicians adopt it, how closely delivery follows the design, and how long its effects and operations endure. Reach will be measured as the number and proportion of eligible adults enrolled, overall and in each priority group. Effectiveness will be measured as the change in control and mean systolic pressure at 6 and 12 months, compared with matched non-enrolled patients. Adoption will be measured as the proportion of primary care clinicians who refer patients and sign agreements. Implementation will be measured as the proportion of participants transmitting readings at least weekly and receiving pharmacist contact as scheduled. Maintenance will be measured at the individual level as control at 18 months and at the organizational level as whether partners continue the program after the grant year.
Conclusion
The proposed program brings an intervention with strong trial evidence to the groups in Delmont County furthest from blood pressure control, through a health center, a hospital network, three congregations, and the county health department. With 900 participants in its first year, it would reach a small share of all uncontrolled adults but a fifth to a quarter of those in the priority groups, and its RE-AIM evaluation will show whether it narrows the disparities that motivated it.
References
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322
Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., O'Connor, P. J., Pritchard, R. A., Sekenski, J. L., Sperl-Hillen, J. M., & Trower, N. K. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56. https://doi.org/10.1001/jama.2013.6549
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., & Wright, J. T. (2019). Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension, 73(5), e35-e66. https://doi.org/10.1161/HYP.0000000000000087
How this DNP 875 Module 8 example is structured
DNP875 Module 8 typically closes with an intervention naming partner, site and expected reach. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example defines the target group from earlier data, describes an evidence-based intervention, names partners and sites, calculates reach and expected effect and applies a named evaluation framework.
DNP875 Module 8 questions, answered
What does DNP875 Module 8 usually ask for?
The final module typically asks for a population health intervention that names the partner organizations, the sites where it will be delivered and how many people it is expected to reach. Aspen does not publish module deliverables, so your classroom's instructions govern.
Does home blood pressure telemonitoring with pharmacist management work?
In a cluster-randomized trial, 57.2 percent of patients in the telemonitoring and pharmacist group had controlled blood pressure at both 6 and 12 months, compared with 30.0 percent with usual care.
What is the RE-AIM framework?
A framework for evaluating the public health impact of interventions across reach, effectiveness, adoption, implementation and maintenance, at both individual and organizational levels.
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