Vet-COACH Intervention
ELEVATED BLOOD PRESSURE
Of the 7 peer health coaches, 1 was assigned to a participant in each intervention arm and made 5 home visits and 5 telephone visits over 12 months. Telephone visits were used between in-home visits as check-ins on goal setting and progress. The protocol was modified to telephone-only visits after the start of the COVID-19 pandemic in March 2020.Peer health coaches assessed blood pressure control, provided social support, targeted health education, assisted participants with health goal setting, and linked participants to clinic and community-based resources. Five required modules were completed during health coaching sessions: blood pressure, physical activity, nutrition, medication adherence, and communication with medical team or physician. Participants could review nonmandatory modules, such as weight management, smoking cessation, limiting alcohol intake, and managing stress, according to their personal interests and needs. Participants received a manual of educational materials, an automatic blood pressure monitor, a scale, a pill organizer, and healthy nutrition tools.To monitor intervention fidelity, peer health coaches completed an encounter form at each visit to document the educational content, progress toward previously set goals, and referrals. Ongoing assessments were used to ensure that the content delivered by the peer health coach adhered to 80% or more of the intervention components. Each peer health coach audio recorded the first home visit for each participant until the study team ensured fidelity. A 5% random sample of visits were audio recorded and transcribed for continued fidelity assessment and peer health coach training.The intervention was linked to VHA primary care in several ways. All participants were required to be enrolled in and active users of VHA primary care. We used VHA criteria to define study eligibility criteria for veterans with out-of-range blood pressure levels. Peer health coaches communicated with the study team regarding urgent issues in addition to attending meetings every other week to present cases. The peer health coaches encouraged participants to follow-up with their primary care clinic for routine care and when their blood pressure was elevated beyond the normal range. The study team communicated elevated blood pressure readings and other clinical needs (eg, appointment requests, medication refills, or other referrals) to primary care clinical staff via the electronic health record or direct contact.Participants in the control group received usual medical care plus the same educational materials provided to the intervention group. Elevated blood pressure readings at study enrollment and exit visits were reported to their primary care team.