Evaluation of an Email Blood Pressure Measurement Outreach Program

Background People with hypertension and uncontrolled blood pressure at their last clinic visit often don’t receive follow-up care. We performed a mixed methods evaluation of a healthcare system email and secure message outreach program to improve BP follow-up. Methods In July of 2022, patients with hypertension and high BP at their last clinical encounter were sent secure messages asking them to reply with a home BP measurement (HBPM) or have an in-clinic BP check. We assessed the “reach of the program” defined as the proportion and characteristics of patients with versus without a BP in the electronic health record (EHR) within 3 months; and the proportion and characteristics of patients with HBPM versus clinic BPs. Qualitative assessments included 22 patient interviews and Rapid Group Analysis to understand patient experiences with the BP outreach program. Results Of 6489 patients contacted by e-mail, 3489 (53.8%) patients had a BP recorded in the EHR within 3 months. Follow up rates were lower rates among younger, male, Asian, Black, and Hispanic patients. Most measurements were clinic-based (81.1%) versus home (18.9%), with Black patients having the lowest HBPM use (9.9%). Home BP measurements were more likely to be < 140/90 mmHg than clinic BPs (adjusted relative risk 1.39, 95% Confidence Interval 1.29-1.49). Interview themes highlighted patients wanting more information on BP measurement, targets, and feedback after sending HBPM. Conclusions Outreach was associated with over half of patients having follow-up BPs, with disparities in HBPM use. Patient interviews revealed opportunities to enhance patient engagement in HBPM.