Feasibility of Implementing a Clinical Integration Package to Support Self-Measured Blood Pressure Monitoring in Primary Care: A Qualitative Study.

backgroundDespite strong evidence, self-measured blood pressure (SMBP) remains underutilized in under-resourced primary care settings. We evaluated barriers and facilitators to implementing a multicomponent SMBP delivery package in a diverse community clinic.

methodsWe examined barriers and facilitators to implementing the ASPIRE (Adapting Self-Measured Blood Pressure Monitoring among Underserved Communities) package, designed to support SMBP adoption in primary care. After an ASPIRE pilot conducted at a Chicago South Side clinic serving a racially diverse population with high social needs, we conducted semistructured interviews with patients and care team members. ASPIRE components consisted of the provision of a free SMBP device, training, a paper tracking log, reminders, resources to address social needs, and documentation workflows. Eligible patients had a hypertension diagnosis, were prescribed 1 or more blood pressure medications, and had elevated blood pressure (blood pressure ≥) between January and May 2024. All 25 patients randomized to the intervention arm were invited to participate. Care team members engaged with the pilot were also invited to participate (N=40). Interviews explored domains impacting implementation, guided by the Consolidated Framework for Implementation Research and analyzed using directed content analysis.

resultsInterviews were conducted with 20 patients and 11 care team members (2 attending physicians, 7 residents, and 2 medical assistants). Among patients, 18 (90%) were over the age of 50, 17 (85%) identified as Black, and the median systolic blood pressure at baseline was 142.0 mm Hg (interquartile range, 137.0-153.0). Key facilitators of ASPIRE implementation included in-person SMBP training, which enhanced patient self-efficacy and positive beliefs about SMBP, and reminders and ongoing support, which were viewed as strengths in intervention design. Barriers emerged related to social needs screening processes and self-monitoring log usability, highlighting challenges in execution, planning, and resource alignment.

conclusionsASPIRE shows promise for supporting SMBP adoption in under-resourced primary care settings and actionable insights for refining implementation strategies. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06175793.