Kaiser Clinic Brings Cultural Sensitivity to Hypertension Treatment

In two years, 66 percent of more than 200 patients treated at the Specialty Blood Pressure Clinic have their high blood pressure under control.


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Danyelle Barker, left, and Dr. Nailah Thompson say the new clinic approach works.

Photo by Saul Bromberger & Sandra Hoover Photography

Oakland resident Danny Keller has dealt with hypertension for the past 20 years. The 55-year-old has taken medication off and on, and his blood pressure has fluctuated up and down. Keller’s primary care physician referred him to the Specialty Blood Pressure Clinic at Kaiser Permanente Oakland Medical Center in July, and within a couple of months, his blood pressure was within normal range.

Dr. Nailah Thompson, a hypertension specialist, founded the Specialty Blood Pressure Clinic, which runs two days a week, in 2015 to treat African Americans with uncontrolled high blood pressure, above 140/90 mm Hg. For Keller, Thompson changed his medication and encouraged him to stick with taking it. “It’s done the trick,” said Keller, adding that the staff at the clinic made him comfortable and calm, not afraid. “They are the reason I keep going back.”

Despite the fact that more patients today are aware that they have hypertension, getting their high blood pressure under control is a different story. But Kaiser’s specialty clinic is turning that around. Keller is one success story, and there are many more. After two years, 66 percent of the more than 200 patients that Thompson has treated at the clinic have gotten their high blood pressure under control.

“Hypertension is more common in the African-American population. It hits blacks at an earlier age, is more difficult to control, and leads to worse outcomes, like heart attack, stroke, and dialysis,” said Thompson. “The idea for the specialty clinic is to provide more personalized care that is culturally humble, appropriate, and respectful.” All of the clinic staff members are African American, and everyone from the physician to the receptionist is trained to address the barriers to effective blood pressure treatment—getting patients to take their medications and follow heart-healthy lifestyle recommendations. The goal is to get all clinic patients to a healthy blood pressure.

Along with the individualized and culturally sensitive approach, establishing a trusting relationship is key to the clinic’s success, according to Thompson. “There’s a strong history in the black community of mistrust of the health care system,” she said.

 

The first voice a patient hears when he or she calls the specialty clinic is that of medical assistant Danyelle Barker. Calls to the clinic don’t go through the hospital call center; the number taps directly to Barker’s line. Barker is also the first person patients see when they come to the clinic, too. She greets each patient in the lobby before he or she reaches the door. From there, Barker takes the patient to an examination room, straps on a blood pressure monitor, and dims the lights. Over the next 10 minutes as the patient rests comfortably, the blood pressure cuff inflates threes times. And if the patient’s blood pressure reading has improved since the last visit, even just a tiny bit, Barker is the first to say good job.

Uncontrolled hypertension can lead to stroke, which is why medication management is critical. Patients don’t take their medications for a variety of reasons, explained Thompson. Cost is one significant factor, but they often don’t believe that the drugs will work or are afraid of potential side effects (like nausea, headache, diarrhea, constipation, fatigue, dizziness). Because high blood pressure often presents with no symptoms, patients question why they need medication. “Yes doesn’t always mean yes,” said Thompson. “A patient may say, ‘Yes, I’ll take the meds,’ but then never fill the prescription. I have to get to the root of why they don’t take the medication.”

When it comes to diet—an important factor in blood-pressure management—just telling patients to lower their sodium, or salt, intake often goes nowhere, explained Thompson. “We ask what they eat first, and then we explore ways to make it more heart-healthy. You have to dig a little and ask questions, like how they prepare their food. If we learn that they’ve always cooked greens with ham hocks, which are high in sodium, then we suggest replacing the ham hocks with smoked turkey.” Sometimes seasonings are the culprits. Lemon pepper and blackened seasoning are used in a lot of soul food cooking, said Thompson. “The No. 1 ingredient in these seasonings is salt, even though salt isn’t in the name. We talk about the fact that salt doesn’t just come from the salt shaker.”

Barker educates patients about what foods contain a lot of sodium like lunchmeat, Spam, sausage, barbecue, soy sauce, fast food, and prepackaged foods. She tries to introduce patients to new foods like kale, fresh herbs for seasoning, and salmon. The clinic has an African-American cookbook that she uses to point patients to heart-healthy recipes. “Patients are often resigned to the idea that they have high blood pressure, and believe there’s no way that will change,” said Barker. “We try to meet people where they are and work toward small steps.”

Barker said her work in the clinic doesn’t feel like work anymore. “We are forming long-term, real relationships with these patients. We work together so they get invested. It works by showing our concern, helping them to find healthy options, and celebrating the incremental changes, a few points lower—it’s important to acknowledge and commend that.”

 

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