A Clinical Decision Support Questionnaire to Identify Barriers to Blood Pressure Control - Hypertension, defined as systolic blood pressure (SBP) ≥ 130 mm Hg or diastolic BP (DBP) ≥ 80 mm Hg, is a leading cause of morbidity and mortality in the US and affects nearly half of US adults. Hypertension is also associated with substantial healthcare costs. In 2016, hypertension cost the US healthcare system $71 billion, and the total cost of cardiovascular disease (CVD) was $320 billion. Controlling BP among adults with hypertension can limit these negative consequences. Among adults with hypertension, those with controlled BP, defined as an SBP < 130 mm Hg and DBP < 80 mm Hg, have a lower risk of CVD events and all-cause mortality, and cost the US healthcare system less compared to those with uncontrolled BP. Antihypertensive medication and lifestyle changes (i.e., diet and exercise) have been shown to lower BP and improve BP control among adults with hypertension. Despite the effectiveness of these treatments, barriers to their adoption and utilization exist and contribute to low rates of BP control. Research reports only 43.7% of US adults had controlled BP in 2017-2018. In response to low rates of BP control, the US Surgeon General released a Call-to-Action to Control Hypertension to address the negative consequences of uncontrolled BP in the US. One of the recommendations contained in this Call-to-Action was to identify barriers which may undermine effective treatments for hypertension including antihypertensive medication use, lifestyle changes, and regularly attending visits with a healthcare provider. A vast proportion of US adults face barriers to BP control and the Call-to-Action recognizes that these need to be addressed. To improve rates of BP control for adults in the US, first, tools need to be created for health systems to more easily identify barriers to BP control. To address the gaps in identifying barriers to BP control, the objectives of the major study proposed in this R03 application are to first, develop a clinical decision support (CDS) tool that identifies patient barriers to BP control (i.e., medication nonadherence, diet). To do this, we will use qualitative methods and input from clinicians and patients with hypertension, separately, to develop an easy-to-administer questionnaire that will consist of clinical barriers and patient centered barriers to BP control identified through key informant interviews with clinicians and focus group sessions with patients. Second, we will administer the CDS tool to clinicians and patients in the University of Alabama at Birmingham Health System to determine the feasibility and acceptability of the tool and identify common self-identified barriers to BP control among patients.
