case study:

Zebra’s Work with Chronic Diseases

Overcoming Barriers to Hypertension Treatment for Patients, Physicians, and Pharmacists


Zebra is proud of our extensive work in partnership with both health departments and with various private medical institutions. For one such project, the DOH enlisted Zebra to help tackle the issue of high blood pressure amongst New Yorkers.

Through this study, we aimed to understand the barriers to treatment and medication adherence, as well as the potential motivators that would assist with blood pressure control. The insights gleaned from this study would inform future media campaigns, patient and physician tools, and high blood pressure initiatives.

Our Findings

While most patients recognized the seriousness of high blood pressure, many felt they weren’t getting sufficient explanations and support from medical professionals, contributing to a lack of
adherence to medication regimens. Patients felt rushed and over-burdened; this feeling was exacerbated by other barriers such as insurance issues and the high cost of care and medication.

Pharmacists tried to fill the gap and take on the role of explaining medications to patients, but most of the time they were over-worked and had lacked the resources to adequately meet patient needs.

Pharmacists expressed a clear need for a tool or initiative to take some of the pressure off of their already demanding schedules.

Participants agreed on the critical need for more education through detailed plans, not just vague suggestions. Additional knowledge would motivate people to take action and better maintain their blood pressure. Education that addresses side effects would also help ensure patients take their medication.


In order to obtain a full, immersive understanding of the issue, Zebra conducted five focus groups with distinct demographics of New York City residents.

Two focus groups were composed of New Yorkers with high blood pressure; one of Chinese-speakers and one of Spanish-speakers. A third group comprised of New Yorkers aged 18-34 who had not been diagnosed with high blood pressure. Lastly, we conducted two groups with pharmacists and pharma technicians working in New York. Once our research was completed, Zebra presented a comprehensive report to the DOH on our findings.

A number of recommendations made by Zebra have resulted in initiatives and updates to the DOH’s approach for handling high blood pressure in New York.

Our report highlighted a need to find ways to streamline payment systems and referral reminders to make adherence simpler for more patients. New York has since launched a citywide High Blood Pressure Initiative, “Take the Pressure Off, NYC!” which includes a Strategic Payer Initiative to improve and align health insurance coverage of key benefits for high blood pressure control.

We suggested encouraging communication strategies that assist physicians, pharmacists, and patients to understand the importance of consistent use of their Hypertension medication. The DOH has since created a coaching guide for physicians and pharmacists, as well as a question checklist for patients.

We recommended creating simple and engaging educational materials regarding diet, lifestyle changes and the importance of adherence to medication regimens. Pharmacists would be able to share these with high blood pressure patients without adding any additional challenges to their already demanding schedule. Since then, the Health Commissioner has released the Heart Age Calculator as well as a Hypertension Action Kit that provides clinical tools, provider resources, and patient education materials to help optimize hypertension management.


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