An electronic health record-based strategy to optimize blood pressure among pregnancy-capable adults in primary care: The REACH-OUT Trial - ABSTRACT We will test the effectiveness of a technology-enabled strategy to optimize blood pressure among reproductive-aged women with hypertension receiving care in Federally Qualified Health Centers. Nearly 1 in 6 women of reproductive age have chronic hypertension (HTN) and are at increased risk of premature cardiovascular disease (CVD) and death. Women with HTN who become pregnant also face higher risks of maternal morbidity and mortality. Ensuring appropriate medication use can help young women achieve optimal blood pressure (BP) and reduce cardiovascular and reproductive risks. This includes not only selecting and adhering to appropriate antihypertensives (antiHTN) but also avoiding use of combined hormonal contraceptives which can increase BP. Yet few systems exist to improve medication use and BP in this high-risk population. In response, our team has worked with our FQHC partners to co-develop a multicomponent, technology-based strategy to promote the REproductive And Cardiovascular Health Of Underserved Patients with HyperTension (REACH-OUT). Our strategy seeks to promote safe antiHTN and contraceptive use among women with HTN and to create an infrastructure to monitor antiHTN adherence and BP to inform clinical decision-making. For clinicians, REACH-OUT includes [1] EHR-based clinical decision support that: a) elicits pregnancy intention in a non-judgmental manner, b) facilitates review of prescribed antiHTNs and contraceptives to identify contraindications, and c) prompts targeted counseling on medication safety, adherence, and BP for young women with HTN. For patients, REACH-OUT provides [2] educational materials, printed with after visit paperwork, to reinforce clinician counseling, [3] a BP monitor, training, and access to a patient portal-based tool where home BP measures can be recorded, and [4] a brief, portal-based survey to assess antiHTN use and ‘phenotype’ causes of poor adherence for clinic review. For patients who have difficulty monitoring their BP and adherence at home, [5] a patient navigator will provide tailored support and help troubleshoot any challenges. We will test REACH-OUT vs. usual care in a clinic-randomized trial among 12 FQHCs in Chicago, IL. We will enroll 350 English or Spanish-speaking, non-pregnant women on antiHTN therapy with elevated BP. Our aims are to: 1) Test the effectiveness of REACH-OUT, compared to usual care, to lower systolic BP, improve antiHTN adherence, and reduce use of contraindicated medications within 3 months; 2) Assess the reach, adoption, implementation, maintenance, and costs of REACH-OUT components; and 3) Explore the dose-response effect of REACH-OUT on BP, antiHTN adherence, and use of contraindicated medications over 12 months.
