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Keeping Hypertension Under Control While Migrating: Health Network Case Study

Woman having blood pressure taken

Hypertension Resources

In the spring of 2019, MCN offered a Project ECHO series for Community Health Workers in Spanish about hypertension. Project ECHO is a “hub-and-spoke” webinar educational model that allows for expert-led conversations, networking, and knowledge sharing by participants. Here are a few of the popular resources from the ECHO series.

Patient education comic books on hypertension: https://bit.ly/2WGfScc

“Control de la presión arterial,” (“Blood pressure control”) from the Centers for Disease Control and Prevention, features info - graphics for clinicians on blood pressure including incidence by region, state, and race and ethnicity: https://bit.ly/2LG2dla

“Cómo tomar la presión arterial correctamente” (“How to correctly take blood pressure”) is an infographic offered up by AXA Health Keeper. https://bit.ly/2E6jcXD

“Desmintiendo 7 mitos del sodio” (“Busting 7 myths about sodium”), from the American Heart Association, is one of several sodium-related infographics in Spanish, available at: https://bit.ly/2vVkxMz

The American Heart Association has numerous additional resources in English and Spanish: https://www.heart.org/en/health-topics/high-blood-pressure

Visit MCN’s Resources and Toolbox for extensive resources on hypertension for patients experiencing vulnerability: https://www.migrantclinician.org/tools-and-resources.html

Health Network, Migrant Clinicians Network’s virtual case management system, has served thousands of patients across the US and around the world. Many published Health Network case studies showcase dramatic and complicated case management: a patient with multidrugresistant tuberculosis who travels to a rural hometown out of the country; a patient whose pregnancy is high risk, yet who moves every three weeks for work; a young family crossing the US-Mexico border on foot. Yet, Health Network is available for any health concern a mobile patient may face. Patients may be signed up to ensure that a pap smear or blood test result is communicated after the patient moves out of the service area. Or, a patient may be enrolled to ensure that a new diabetes diagnosis is followed up with a nutrition class in a new hometown.

Another common concern for which Health Network is utilized is hypertension. Last fall, Renata Gomez*, a 66-year-old mobile agricultural worker, was at a routine appointment for hypertension at a community health center in Florida. Her hypertension was under control but required regular follow-up appointments and prescription refills. She was planning to move to another state further north, so the clinician enrolled Gomez in Health Network, Migrant Clinicians Network’s virtual case management system. Alma Colmenero, a Health Network Associate, received the enrollment form. Because the enrollment form came without medical records, Colmenero started by requesting medical records from the health center. Several calls and three weeks later, Colmenero received the records, and then reached out to Gomez directly.

“I tried to contact the patient: I called her, left voicemails, sent texts,” she recalled. About a month after receiving the medical records, Colmenero finally managed to catch Gomez on the phone. “She said she’s going to the clinic and is under care,” Colmenero found. The health center had enrolled Gomez, anticipating her move, but she hadn’t yet left Florida. The health center had written on the enrollment form the recommended schedule of appointments for Gomez. Gomez confirmed that she was following the schedule, and had attended another appointment in Florida since enrollment, so Colmenero followed up with the health center once more to receive updated medical records.

Hypertension is a common concern among agricultural workers. Data from 174 migrant health centers in 2017 show that almost 12 percent of patients had a diagnosis of hypertension; of the 875,142 patients served at migrant health centers, 101,535 had hypertension.1 Hypertension was the most common diagnosis among the reported health concerns. While fewer agricultural worker patients have a diagnosis of hypertension than the overall US population, foreign-born agricultural workers may be at risk related to acculturation, wherein the length of time spent in the US is associated with a higher risk of hypertension.2

Mobility, particularly among agricultural workers, whose work is unstable and often unpredictable, complicates care for chronic conditions like hypertension. Gomez’s health center took the extra time to enroll Gomez, despite an uncertain date of migration, as an anticipatory step to assure that, whenever she’s ready to move, Gomez will be able to continue her care and keep her hypertension under control. Colmenero will continue to keep up regular communication with Gomez, and, when she needs to move, Colmenero will help her find a new clinic, set up an appointment to keep her recommended schedule of appointments, and transfer her medical records.

This case highlights Health Network’s wide lens of care, and one of the many ways health centers utilize Health Network to anticipate patients’ mobility and assure continuity of care. While some of the case management had to slow down as Colmenero waited for medical records from the enrolling clinic, and waited to hear back from the patient, the high-touch and personal case management provided by Health Network is essential for keeping mobile patients in care, for any ongoing health concern, including hypertension – and, without such case management, patients like Gomez might fall through the cracks.

To learn more about Health Network or to schedule a training for your clinic on how to use Health Network, contact Theressa Lyons-Clampitt, MCN’s Senior Program Manager and Training and Technical Assistance Coordinator, at tlyons@migrantclinician.org.

* Patient's name has been changed to protect patient identity.

References

1 “Table 6A - Selected Diagnoses and Services Rendered.” 2017 National Migrant Health Centers Program Grantee Data. Health Resources and Services Administration. Available at: https://bit.ly/2XJJabo.

2 Boggess B and HO Bogue. The health of US agricultural worker families: A descriptive study of over 790,000 migratory and seasonal agricultural workers and dependents. J Health Care Poor Underserved. 2016;27(2):778-92. doi: 10.1353/hpu.2016.0089.

 

This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,094,709.00 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov

 

Health Network and PRAPARE
In 2016, just as PRAPARE was set to launch, Migrant Clinicians Network was beginning to develop its new database to better serve patients enrolled in Health Network, MCN’s bridge case management program. Over the course of the following year, MCN configured the new database to allow for the integration of PRAPARE data, in which one health center’s PRAPARE data can be transferred to the next health center, as a mobile patient moves.
“When we started thinking about that data and [Health Network] case management work, so much of case management isn’t just ‘are you taking your medication every day?’ It’s more about, ‘How can I help you access care and manage your health in general?’” explained Anna Gard, RN, who assisted MCN in the development of the new database. “One piece of this is: ‘Let me help you find a health center.’ But the larger pieces around effective case management are, ‘How are you going to get there? Is there public transportation? How are you going to pick up your medications if you live in a hostile community and you’re afraid of leaving the house?’ PRAPARE gives a structured format to capture [these] data, in a form that’s been tested and validated.”
As more health centers provide case management and chronic care management to address the social determinants of health, Gard noted, integration of the PRAPARE data with Health Network, a virtual case management, seemed to make sense. Now, the Health Network team is working to fit PRAPARE into their own workflow.
Saul Delgado, Health Network Data Specialist, who has been integral in building and launching Health Network’s new case management system, notes that asking such personal questions over the phone, when a patient doesn’t have transferrable PRAPARE data from a previous health center, can be challenging. “When we call, the patient doesn’t know you. They’re very scared to answer these kinds of personal questions, whereas when you go the clinic, you at least see the nurse or case worker face-to-face,” he explained. But he recognizes the utility of the data, and has developed the PRAPARE data screens within the database to be easily accessed from the main patient information screen. With drop-down menus, Health Network Associates can populate the information they hear from patients, like how many people live with them in their household, or if they’re worried about losing their home. The information, either attained from a previous health center or inputted by a Health Network Associate, will be transferred when the mobile patient gets to his or her next destination, just as the basic medical records do.
“Health centers are doing more to integrate social and behavioral determinants of health, and we’re recognizing that all of those things have to be integrated with care management. So we’re on the forefront,” Gard concluded.

MCN Streamline Summer 2019

Read this article in the Summer 2019 issue of Streamline here!

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Authors

Claire

Seda

Director of Communications

MCN