Determinants of Successful Implementation: A Mixed-Methods Evaluation of a Team-Based Telehealth Hypertension Management Program for Underserved Patients

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative implementation study

• Effect Size: High acceptability (4.42-4.56/5), appropriateness (4.42-4.61/5), and feasibility (4.40-4.44/5) scores

• Primary Outcome: Five implementation themes: staffing barriers/coordinated teamwork, patient-provider centeredness, ease of home BP monitoring, personalized self-management calls, and social support

• Nnt Or Sensitivity: Patient Assessment of Chronic Illness Care: 4.22±1.01; Organizational Readiness: 4.11±0.78

• Confidence Interval: Not reported for qualitative themes

Clinical Application

High feasibility scores (4.40-4.44/5) suggest program implementable in similar safety-net settings with appropriate staffing and technology support Relevant to Australian primary healthcare networks and Aboriginal Community Controlled Health Services. Could align with PBS telehealth items and RACGP hypertension guidelines emphasizing home BP monitoring Underserved patients with hypertension in safety-net healthcare settings requiring team-based care approaches

Abstract

BACKGROUND: Hypertension management using home blood pressure monitoring-guided pharmacotherapy is more effective than clinic-based care, but the benefit is attenuated in underserved patients. We evaluated implementation determinants of a team-based telehealth hypertension management program providing home blood pressure monitoring-guided pharmacotherapy and self-management and social support. METHODS: We used Exploration, Preparation, Implementation and Sustainment, and Health Equity Implementation Frameworks for semistructured interviews and inductive/deductive coding using thematic analysis of qualitative data and quantitative analysis to evaluate team-based telehealth hypertension management program implementation facilitators, barriers, acceptability, appropriateness, and feasibility. We purposefully sampled 20 patients with hypertension and 16 clinic key players from 2 safety-net clinics in North Carolina. Quantitative measures were Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, Patient Assessment of Chronic Illness Care, Organizational Readiness for Implementing Change (all measures' score ranged 1-5; higher score is better). We used concurrent embedded mixed methods (qualitative + quantitative) for convergence and complementarity. RESULTS: Five qualitative themes emerged around (1) staffing barriers, coordinated teamwork, and friendly study tools; (2) the program's patient and provider centeredness; (3) ease of home blood pressure monitoring; (4) personalized, comprehensive self-management calls; and (5) social support. Patients and clinic key players found the program acceptable (mean±SD, 4.42±0.84 and 4.56±0.59), appropriate (4.42±0.86 and 4.61±0.50), and feasible (4.40±0.89 and 4.44±0.53), respectively. Patient Assessment of Chronic Illness Care and Organizational Readiness for Implementing Change scores were 4.22±1.01 and 4.11±0.78, respectively. CONCLUSIONS: Implementing a team-based telehealth hypertension management program depends on its tailoring to patients and providers and having their endorsement; a user-friendly and trust-promoting model; and having a viable financial plan. Future studies should assess clinical and cost effectiveness of the program. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05424744.

References

1. 1.Chhetri, S., Manandhar, S., Seals, A. L., Kramer, J., & Pokharel, Y. (2026). Determinants of Successful Implementation: A Mixed-Methods Evaluation of a Team-Based Telehealth Hypertension Management Program for Underserved Patients. Journal of the American Heart Association, 15(10), e047236. https://doi.org/10.1161/JAHA.125.047236