case study:

Overcoming barriers to hypertension treatment for patients, physicians, and pharmacists

The Challenge


The Department of Health enlisted Zebra Strategies to tackle the issue of high blood pressure amongst New Yorkers. 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. This feeling was exacerbated by other barriers such as insurance issues and the high cost of care and medication. Pharmacists tried to take on the role of explaining medications to patients, but are overworked, lacked the resources to adequately meet patient needs, and expressed a clear need for a tool or initiative to take some of the pressure off of their already demanding schedules..

Our Approach

In order to obtain a full, immersive understanding of the barriers to treatment and medication adherence, as well as the potential motivators that would assist with blood pressure control, we conducted five focus groups with distinct demographics of New York City residents: two focus groups composed of New Yorkers with high blood pressure; one of Chinese-speakers; one of Spanish-speakers; a group comprised of New Yorkers aged 18-34 who had not been diagnosed with high blood pressure; and we conducted two groups with pharmacists and pharma technicians working in New York. Once our research was completed, Zebra Strategies presented a comprehensive report to the DOH on our findings.



We discovered additional knowledge and engaging educational materials regarding diet, lifestyle changes, and the importance of adherence to medication regimens would motivate people to take action and better maintain their blood pressure. Our report also highlighted a need 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. The DOH also created a coaching guide for physicians and pharmacists. Pharmacists would be able to share these with high blood pressure patients without adding any additional challenges to their already demanding schedule. The Health Commissioner 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. The insights gleaned from this study informed future media campaigns, patient and physician tools, and high blood pressure initiatives. 


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