Experiences and Beliefs of Low-Income Patients With Hypertension in Louisiana and Mississippi During the COVID-19 Pandemic
Katherine T Mills, Erin Peacock, Jing Chen, Amanda Zimmerman, Hua He, Alecia Cyprian, Gerrelda Davis, Sonja R Fuqua, Darie S Gilliam, Angelique Greer, Lea Gray-Winfrey, Shondra Williams, Gary M Wiltz, Keith L Winfrey, Paul K Whelton, Marie Krousel-Wood, Jiang He, Katherine T Mills, Erin Peacock, Jing Chen, Amanda Zimmerman, Hua He, Alecia Cyprian, Gerrelda Davis, Sonja R Fuqua, Darie S Gilliam, Angelique Greer, Lea Gray-Winfrey, Shondra Williams, Gary M Wiltz, Keith L Winfrey, Paul K Whelton, Marie Krousel-Wood, Jiang He
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic disproportionately affects individuals with hypertension and health disparities. Methods and Results We assessed the experiences and beliefs of low-income and minority patients with hypertension during the COVID-19 pandemic. Participants (N=587) from the IMPACTS-BP (Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control) study completed a telephone survey in May and June of 2020. Participants were 65.1% Black and 59.7% female, and 57.7% reported an income below the federal poverty level. Overall, 2.7% tested positive and 15.3% had lost a family member or friend to COVID-19. These experiences were significantly more common in Black (3.9% and 19.4%, respectively) than in non-Black participants (0.5% and 7.8%, respectively). In addition, 14.5% lost a job and 15.9% reported food shortages during the pandemic. Most participants complied with stay-at-home orders (98.3%), social distancing (97.8%), and always wearing a mask outside their home (74.6%). Participants also reported high access to needed health care (94.7%) and prescription medications (97.6%). Furthermore, 95.7% of respondents reported that they continued to take their regular dosage of antihypertensive medications. Among the 44.5% of participants receiving a healthcare appointment by telehealth, 96.6% got the help they needed, and 80.8% reported that the appointment quality was as good as or better than in-person visits. Finally, 88.9% were willing to return to their primary care clinic. Conclusions These data suggest that low-income patients, especially Black patients, were negatively impacted by COVID-19. However, most patients were able to access needed healthcare services and were willing to return to their primary care clinic for hypertension management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03483662.
Keywords: COVID‐19; access to care; health disparities; hypertension; telemedicine.
Conflict of interest statement
None.
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References
- Webb Hooper M, Nápoles AM, Pérez‐Stable EJ. COVID‐19 and racial/ethnic disparities. JAMA. 2020;323:2466–2467. 10.1001/jama.2020.8598
- Azar KMJ, Shen Z, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR. Disparities in outcomes among COVID‐19 patients in a large health care system In California. Health Aff. 2020;39:1253–1262. 10.1377/hlthaff.2020.00598
- Price‐Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID‐19. N Engl J Med. 2020;382:2534–2543. 10.1056/NEJMsa2011686
- Razavi AC, Kelly TN, He J, Fernandez C, Whelton PK, Krousel‐Wood M, Bazzano LA. Cardiovascular disease prevention and implications of COVID‐19: an Evolving Case Study in THE Crescent City. J Am Heart Assoc. 2020;9:e016997. 10.1161/JAHA.120.016997
- Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, Barnaby DP, Becker LB, Chelico JD, Cohen SL, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID‐19 in the New York City area. JAMA. 2020;323:2052–2059. 10.1001/jama.2020.6775
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. 10.1016/S0140-6736(20)30566-3
- Li X, Xu S, Yu M, Wang KE, Tao YU, Zhou Y, Shi J, Zhou M, Wu BO, Yang Z, et al. Risk factors for severity and mortality in adult COVID‐19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146:110–118. 10.1016/j.jaci.2020.04.006
- Gao C, Cai Y, Zhang K, Zhou L, Zhang Y, Zhang X, Li QI, Li W, Yang S, Zhao X, et al. Association of hypertension and antihypertensive treatment with COVID‐19 mortality: a retrospective observational study. Eur Heart J. 2020;41:2058–2066. 10.1093/eurheartj/ehaa433
- Mehrotra A, Ray K, Brockmeyer DM, Barnett ML, Bender JA. Rapidly converting to “virtual practices”: outpatient care in the era of Covid‐19. NEJM Catal. 2020;1:1–5.
- Nouri S, Khoong E, Lyles C, Karliner L. Addressing equity in telemedicine for chronic disease management during the Covid‐19 pandemic. NEJM Catal. 2020;3:e20049.
- Health Resources & Services Administration . What is a Health Center? Bureau of Primary Health Care. Available at: . Accessed July 7, 2020.
- Moreland A, Herlihy C, Tynan MA, Sunshine G, McCord RF, Hilton C, Poovey J, Werner AK, Jones CD, Fulmer EB, et al. Timing of state and territorial covid‐19 stay‐at‐home orders and changes in population movement — United States, March 1–May 31, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1198–1203.
- Wolf MS, Serper M, Opsasnick L, O’Conor RM, Curtis LM, Benavente JY, Wismer G, Batio S, Eifler M, Zheng P, et al. Awareness, attitudes, and actions related to COVID‐19 among adults with chronic conditions at the onset of the U.S. Outbreak. Ann Intern Med. 2020;173:100–109.
- Centers for Disease Control and Prevention (CDC) . Community Assessment for Public Health Emergency Response (CASPER) Toolkit, 3rd edition. Atlanta, GA: CDC; 2019.
- Laforge K, Gold R, Cottrell E, Bunce AE, Proser M, Hollombe C, Dambrun K, Cohen DJ, Clark KD. How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview. J Ambul Care Manage. 2018;41:2–14.
- Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertens. 2019;73:e35–e66.
- Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz‐Flores S, Davey‐Smith G, Dennison‐Himmelfarb CR, Lauer MS, Lockwood DW, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132:873–898.
- Yancy CW. COVID‐19 and African Americans. JAMA. 2020;323:1891–1892.
- Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, Chu DK, Akl EA, El‐harakeh A, Bognanni A, et al. Physical distancing, face masks, and eye protection to prevent person‐to‐person transmission of SARS‐CoV‐2 and COVID‐19: a systematic review and meta‐analysis. Lancet. 2020;395:1973–1987.
- Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory‐confirmed coronavirus disease 2019 — COVID‐net, 14 states, March 1–30, 2020. Morb Mortal Wkly Rep. 2020;69:458–464.
- Centers for Medicare and Medicaid Services . Coronavirus Waivers & Flexibilities. June 25, 2020. Available at: . Accessed June 29, 2020.
- Voils CI, Venne VL, Weidenbacher H, Sperber N, Datta S. Comparison of telephone and televideo modes for delivery of genetic counseling: a randomized trial. J Genet Couns. 2018;27:339–348. 10.1007/s10897-017-0189-1
- Casey Lion K, Brown JC, Ebel BE, Klein EJ, Strelitz B, Gutman CK, Hencz P, Fernandez J, Mangione‐Smith R. Effect of telephone vs video interpretation on parent comprehension, communication, and utilization in the pediatric emergency department a randomized clinical trial. JAMA Pediatr. 2015;169:1117–1125. 10.1001/jamapediatrics.2015.2630
Source: PubMed