Exploring the Social Determinants of Health and Hypertension Control in Three Diverse Montana Practices.


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The quality outcomes in management of hypertension in three Montana Providence St. Joseph Health (PSJH) primary care clinics (Polson, Grant Creek and Florence) were explored in April 2019. I postulated that determining Social Determinants of Health (SDOH) could help guide interventions to improve hypertension control. This paper is a beginning of the investigation to identify and address the SDOH in our clinics so that disease specific outcomes can be affected. Upon investigation, there was a statistically significant variance in the percentage of patients uncontrolled between one of the clinics, Polson, compared to other two clinics. Further evaluation was undertaken by exploring EMR data and public heath reporting through the lens of SDOH to evaluate for health disparities that could explain the variance between clinical outcomes. It was demonstrated that the average SDOH score was higher in Polson than the other clinics, for both controlled and uncontrolled hypertension. There was a statistically significant difference in in the SDOH scores between the uncontrolled and controlled hypertension groups in two clinics, but not the one with the highest SDOH burden. Considering these findings, we explore further the possible mechanisms of variation, consider different SDOH measurement strategies, as well as strategize interventions for uncontrolled hypertension including telehealth, Community Health Workers (CHWs), and Team Based Care (TBC) models.



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