"Advocates for Each Other": The creation and evaluation of a pragmatic peer navigation program for black patients in primary care with uncontrolled hypertension.
Anna M Morenz, Jessica Bender, Babette Hairston and 2 others
PMID 38723337WHAT IT FOUND
Black patients with uncontrolled hypertension who received a phone-based peer navigation program had systolic blood pressure fall from 155.9 to 142.4 mmHg.
Comparison patients with paired records fell from 139.1 to 137.1 mmHg. Only 17 of 53 enrolled patients had paired data.
Key findings
01Among patients with paired records, mean systolic blood pressure decreased from 155.9 mmHg to 142.4 mmHg in enrolled patients and from 139.1 mmHg to 137.1 mmHg in comparison patients, and the changes differed significantly.
02The blood-pressure analysis included only 17 of 53 enrolled participants and 183 of 446 comparison patients.
03Of 33 participants who completed the exit survey, 26 rated working with a peer navigator as very good or excellent.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The primary blood pressure result rested on 17 of 53 enrolled participants, because many patients did not have both baseline and follow-up records. The comparison group was not randomised. It consisted of eligible patients who declined or could not be reached, so the groups may have differed in ways that affected blood pressure. Enrolled patients had higher baseline body mass index scores, systolic blood pressure measures, and rates of diabetes than comparison patients, which suggests possible selection bias. The program combined phone support, education, help with barriers, home blood pressure review, resource connections, home blood pressure cuffs when needed, and help with technology or telemedicine, so the study cannot separate the contribution of any single component. The study took place during early COVID-19 restrictions, with a shift from in-person to phone-based care, navigator turnover, and fewer routine clinic blood pressure checks. Home blood pressure readings taken by patients were often recorded in navigator notes but not entered as patient-reported vital signs in the medical record, so usable data were limited. The exit survey was completed by 33 of 53 participants, so satisfaction and self-reported behavior findings may reflect selection bias. Participation was low at 10.6% of eligible patients, and the study was conducted at one centre, so results may not generalise.
Declared interests
The authors declared no known competing financial interests or personal relationships. The peer navigation program was funded by a local grant from July 2019 to June 2022 to support 1.5 full-time equivalents for peer navigators.
The easy way to misread this
Do not read the blood pressure drop as proof that peer navigation works. Only 17 of 53 enrolled patients had paired blood pressure records, the comparison group was not randomised, and the program mixed phone support, education, help with barriers, home blood pressure review, resource connections, home blood pressure cuffs when needed, and help with technology or telemedicine. The study cannot separate these parts or rule out selection.