By Kevin McKeough
High blood pressure is the greatest risk factor for heart disease, the leading cause of death in the United States, but it often goes undetected, especially in people living in underserved communities.
Rush University Medical Center is helping lead an initiative that brings together partners, programs and resources from across the healthcare ecosystem to improve heart health for everyone in the Chicago area.
Named Live Healthy Chicago, the effort launched in February and to date has provided blood pressure screenings for more than 4,000 residents on Chicago’s South and West sides at community- and faith-based organizations and workplaces.
More than 60% of the people screened so far have been found to have high blood pressure — that is, a reading of blood pressure of 130/80 or higher.
Live Healthy Chicago is activating a citywide coalition to close the gap in life expectancy in Chicago, where residents of the city’s underserved neighborhoods on average live as much as 16 years less than Chicagoans living in the wealthiest areas.
Led jointly by Rush and University of Chicago Medicine, the coalition is working in the South and West Side neighborhoods where cardiovascular disease hits hardest. In addition to the blood pressure screenings, Live Healthy Chicago provides partner health clinics with tools, training, and pharmacist support to catch and control high blood pressure before it becomes a crisis. On the West Side, its mobile health team partners with community organizations to treat residents right in their neighborhoods.
Guarding against a silent killer
Black Chicagoans have a significantly higher rate of high blood pressure (42.7%) than the city’s population in general (32%), according to the Chicago Health Atlas.
“It is a chronic disease that especially affects people that are under-resourced,” says Laurie Ouding, RN, LHC mobile health project director. “Hypertension is one of those chronic illnesses that often goes very long unnoticed because it doesn't have a lot of symptoms until it gets to the point where it's causing a lot of cardiovascular risks, which is one of the reasons why it's notoriously called the silent killer.”
Fortunately, high blood pressure can be lowered with better diet, more exercise, medications and other interventions. Reducing a systolic blood pressure reading (the top number) by just five or 10 points could decrease the risk of a major health event by 10% or 20%.
“If we catch it early, we can really decrease the cardiovascular risk for patients,” Ouding says.
To find and help people at risk, Live Healthy Chicago sends a mobile unit to places that are both easily accessible and trusted in the communities the program serves. The Rush mobile unit team serving the West Side includes a pharmacist, nurse and medical assistant or community health worker who are available to measure blood pressure on request, without an appointment needed.
They also counsel people about the results of their screening, initiate or adjust medication treatments, direct them to care and other needed resources, and help with insurance issues.
“We're able to address issues right away in the community,”Ouding says.
The Rush mobile unit currently is providing free screenings at locations on the West Side every Monday, Tuesday, Thursday and Friday.
UChicago Medicine’s effort on the South Side is being led by community health workers, who will be embedded in community organizations. At each location, a community health worker will screen people for high blood pressure and enroll those with elevated levels in a brief intervention focusing on patient education. Participants in the invention will receive a needs assessment, a pharmacist consult, medication education and referrals. UChicago Medicine expects to begin providing services at their first site, Imagine Englewood If, by the end of October.
Overcoming barriers and building trust
By going into the communities to provide these services, Live Healthy Chicago is reducing common barriers to healthcare access. “A lot of people don't go to the doctor or don't go to see their primary care physicians because they sometimes don't have the transportation to get there,” says Isaac Jlaka, a community health worker at one of Live Healthy Chicago’s partner community organizations.
“For so long, we have had a model where if there was a need, you had to make an appointment and you had to go to the doctor, but now we're bringing those resources right to the community,” says Steve M. Epting Sr., senior pastor of Hope Community Church in the Austin neighborhood on Chicago’s far West Side. Live Healthy Chicago’s mobile unit has provided screenings for people using the church’s food pantry.
“We don't just say go to the doctor,” Epting adds. “We're bringing the resources to you.”
In addition to making screenings and support more accessible, bringing the mobile unit teams into familiar places also builds trust among community members, making them more receptive to health information and recommendations.
“Where people are already feeling safe, it is easier to hear the information,” Epting says. “What's exciting about this opportunity with Live Healthy Chicago is that we're a trusted source in our community.”
“Once people decide that they can trust us, we find that people will really open up a lot more about what's going on in their life that is causing some of the issues for their blood pressure to be high and also, to trust us enough to make medication changes,” Ouding says.
Partnering to build a citywide health protection network
Rush and UChicago Medicine share responsibility for providing Live Healthy Chicago’s screenings on the West and South sides, respectively. The Live Healthy Chicago coalition also combines the capabilities and resources of other hospitals, the Chicago and Illinois departments of public health, Northwestern University, the American Heart Association and American Medical Association, healthcare networks, community health centers, churches and other community organizations. A community advisory board of leaders and other residents in the communities served by Live Healthy Chicago offers guidance in the endeavor.
“By working with partners, we reach more people and bring together the expertise it takes to make real change in Chicago's health,” says Rebecca Dawar, MPH, director of research operations and evaluation at the RUSH BMO Institute for Health Equity, who oversees Rush’s part of Live Healthy Chicago. “Our partners also include the people in the communities we’re reaching. The people who live in these neighborhoods know best what their communities need.”
“There’s a lot of expertise that both institutions bring. It’s beneficial for each organization, and we’re also learning from each other in a way that historically is not done. It’s allowing us to de-silo this clinical work and put all our experts in the same room to solve this problem,” says Alexandra Sontag, DNP. As the director of community initiatives at the University of Chicago’s Urban Health Initiative, Sontag is responsible for the University’s involvement in Live Healthy Chicago.
Little changes can produce big results
Live Healthy Chicago has helped participants achieve big improvements in their blood pressure and health in general. Ouding recalls a woman in her 70s who had not seen a doctor in two years due to a bad experience at a clinic, and who had stopped taking her blood pressure medication. “When we first saw her, her blood pressure was 185/102,” she says. That blood pressure level is considered a hypertensive crisis.
The team connected the woman with a physician and got her to resume her medication. “The last time we saw her, her blood pressure was in the 130s,” Ouding reports. “It’s just really little things that we did that made such a big difference and an impact in her blood pressure and her risk overall. She feels better and she's healthier and she's happy.”
Charlene, a West Side resident, was seeing a doctor for her high blood pressure regularly but unwilling to add a second pill to her treatment as he recommended. She met with the Live Healthy Chicago team, and the team’s pharmacist suggested an alternative prescription that would combine the two recommended medications in a single pill, then helped arrange for Charlene’s insurance to cover it. The team also advised her about lifestyle changes she could make to reduce her blood pressure and gave her a monitor so she could check it at home.
“I feel better and I'm eating better,” Charlene says. “I got my pressure down. I want to keep it down.”
These kinds of results require more than just providing people with their reading. “It’s not just measuring people’s blood pressure. It’s about engaging in a complicated conversation.” Sontag says. “We need to move back to shared decision-making: ‘I’m an expert in medicine, you’re an expert in you, let’s figure out how we’re going to solve his problem.’”
Ouding similarly observes that helping Live Healthy Chicago participants make changes begins by asking them questions and listening to them.
“People motivate and change for very different reasons, so in getting to know the person, we can find out what those motivations are, but also really encouraging people to make very small changes a little bit at a time, which we know is much more sustainable.”
Live Healthy Chicago aims to close the life expectancy gap on the South and West Sides of Chicago by working to reduce atherosclerotic cardiovascular risk in the next three years to include more than 100 community health centers, a citywide awareness campaign, and partnerships with hundreds of community health workers and community- and faith-based organizations to connect high-risk residents to screening, treatment, and ongoing care. To learn more about how you can support this effort, please contact livehealthychicago@rush.edu.
