The Care Collaborative

A statewide education and engagement tool that is helping patients take control of their hypertension.

Allison Merritt, MPH, Epidemiologist – Kentucky Heart Disease and Stroke Prevention Program

As a healthcare professional, you are most likely aware that hypertension is a serious medical condition that increases one’s risk of heart disease, stroke, and kidney disease1. But did you also know that 1 in 3 Kentuckians have hypertension2 and that heart disease is the number one cause of death and stroke the number five cause of death in Kentucky? The Kentucky Heart Disease and Stroke Prevention Program at the Kentucky Department for Public Health (DPH) has a simple yet effective tool designed to increase patients’ engagement in their health and work towards improving their blood pressure to address the high burden of hypertension in Kentucky patients.

The Cardiovascular, Assessment, Risk-reduction, and Education (CARE) Collaborative is a free, easy-to-use tool that works to reduce hypertension by: increasing the number of adults aged 18 years and older who have had their blood pressure measured and who can state whether it was normal, elevated, or high;

increasing the number of adults appropriately counseled about healthy behaviors and/or lifestyle modifications; and
increasing the number of adults who are taking action to control their elevated blood pressure.

The CARE Collaborative can be used in any setting where a blood pressure is taken or can be taken. The CARE Collaborative is in use at community clinics, health care systems, FQHCs, local health departments, and home visiting programs across the state.

In the CARE Collaborative “Educational Encounter,” the patient’s blood pressure is measured, and then the patient is asked to identify which blood pressure zone they fall in: normal (green), elevated (yellow), or high (red).

CARE coaches are health care providers or lay health professionals trained by the Heart Disease and Stroke Prevention Program to engage with the patient about their blood pressure. In the CARE Collaborative “Educational Encounter,” the patient’s blood pressure is measured, and then the patient is asked to identify which blood pressure zone they fall in: normal (green), elevated (yellow), or high (red). This identification and ownership of their blood pressure zone is crucial for patients to become engaged in their health and begin healthy behaviors and/or lifestyle modifications to reduce their blood pressure. The CARE coach then works with the patient to find one simple step they can take to reduce their blood pressure. Possible health behaviors discussed during the CARE Educational Encounter include reducing sodium, reducing tobacco use, increasing physical activity, eating healthier, or increasing blood pressure medication adherence. At subsequent CARE visits, the coach discusses any blood pressure change since the previous visit and works with the patient to determine if additional healthy behaviors or lifestyle modifications can be made.

While the CARE Collaborative addresses complex health behaviors, it is a very simple tool to use, and the data shows it is making a difference. Most CARE coaches report that the average encounter takes only 1–2 minutes to complete. When Connie White, MD, senior deputy commissioner at DPH, first learned of the CARE Collaborative, she was skeptical. She said, “When I first heard of this program I couldn’t believe it could be successful … it was so simple. But the data proved me wrong.”

To date, the CARE Collaborative has been in use in Kentucky for over 10 years. In 2018, over 100,000 CARE Educational Encounters occurred with the help of 51 CARE Partners located throughout Kentucky. On average, for all Educational Encounters in 2018, 94% of patients were able to identify their blood pressure zone, showing the ability of participants to be engaged in their health through blood pressure zone literacy. For the same year, 32% of returning CARE patients reported that they made a lifestyle change to help lower their blood pressure, which shows that returning CARE patients are engaged in improving their health. Furthermore, 8% of returning CARE patients improved their blood pressure to the yellow color zone (from high to elevated) and 11% of returning CARE patients improved their blood pressure to the green (normal) color zone3. Additionally, many returning patients had blood pressure improvements within their zone.

These positive outcomes show the CARE Collaborative is making a difference for patients with high blood pressure in Kentucky. There is still much work to be done to reduce the burden of hypertension, but when patients are supported, empowered, and engaged in their health, positive change occurs.

Anyone interested in learning more about the CARE Collaborative, including how to implement the CARE Collaborative at your organization, is invited to contact the Heart Disease and Stroke Prevention Program Manager, Bonita Bobo, at bonitaa.bobo@ky.gov, or at 502.564.7996.

References:

1. Valderrama AL, Gillespie C, King SC, George MG, Hong Y, Gregg E. Vital signs: awareness and treatment of uncontrolled hypertension among adults – United States, 2003–2010. MMWR. 2012; 61: 703–9.

2. Kentucky Behavioral Risk Factor Surveillance System, 2017. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online].

3. The CARE Collaborative. Kentucky Heart Disease and Stroke Prevention Program. Kentucky Department for Public Health. 2018.