student research day - Case Western Reserve University School of ...

Lauren Chmielewski
Barriers to Hypertension Management in an Urban Population in
Santo Domingo
Lauren Chmielewski, Kelly Casteel, Tristan Klosterman, Alexandra Marcotty, Douglas Van Auken, MD
Family Medicine, Community Health, Global Health
FEDOPO, Santo Domingo, Dominican Republic
BACKGROUND: Hypertension is a major public health concern and a profound risk of coronary artery disease,
stroke, heart failure, and renal disease. Elevated blood pressure is often asymptomatic until acute cardiovascular
complications arise. Thus, screening for hypertension is a critical aspect of preventative medicine. Awareness of
blood pressure combined with patient education about modifiable, lifestyle changes can improve management of
blood pressure and lead to better health outcomes. Blood pressure is not routinely checked at the FEDOPO clinic in
Santo Domingo. In the economically disadvantaged population served by the FEDOPO clinic, the consistent practice
of monitoring blood pressure could represent a cost-effective strategy with the potential for significant reductions
in morbidity and mortality. OBJECTIVE: To improve the monitoring and management of blood pressure within the
population served by FEDOPO. METHODS: First, to assess FEDOPO’s blood pressure monitoring protocol. Second,
to implement an intervention consisting of providing necessary equipment and education to the FEDOPO health
care staff and patients. Finally, to reassess blood pressure monitoring post-intervention and compare to previous
FEDOPO protocol. RESULTS: Initially, blood pressures were not routinely taken during patient encounters. It was
also noted that patients were not aware of their blood pressure or how to manage it. There was no way to record
or follow a patient’s blood pressure over time, due to a paucity of medical record keeping. Once appropriate
equipment and education was provided, blood pressure assessment became routine. Record-keeping cards for the
patients with the date and their blood pressure reading were provided with the hope of improving the management
of blood pressure over time. CONCLUSIONS: The lack of blood pressure monitoring at FEDOPO was due to the lack
of necessary equipment for assessing blood pressures. Managing blood pressure requires having the appropriate
equipment and record keeping by the health care worker and patient.
Supported by NIH T35
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