Strategies for Controlling Blood Pressure Among Low-Income Populations in Georgia

BACKGROUND: In Georgia an estimated 32% of blacks and 28% of whites have high blood pressure. In 2004 the rate of death from stroke in Georgia was 12% higher than the national average, and blacks in the state have a 1.4 times greater rate of death from stroke than that of whites. CONTEXT: The Georgia legislature funds the Stroke and Heart Attack Prevention Program (SHAPP) to provide treatment and medications for indigent Georgians. The median rate of blood pressure (BP) control among SHAPP enrollees is approximately 60%, compared with the national average of 35%. METHODS: SHAPP was evaluated through interviews with key health care and administrative staff and through focus groups of patients in two clinics. CONSEQUENCES: Outcomes for patients were increased knowledge of their BP and improved compliance with taking medication and keeping clinic appointments. INTERPRETATION: Successful components of SHAPP include an easy enrollment process; affordable medication; use of evidence-based, documented protocols and patient tracking systems; routine follow-up of patients; and effective communication between staff and patients. Challenges and recommendations for improvement are identified.