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Team-based approaches can be effective against hypertension

Sunday November 17, 2013
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Uncontrolled hypertension rates continue to grow despite the availability of proven treatments, but collaborative approaches can be effective in fighting this deadly disease, according to a science advisory from the American Heart Association, the American College of Cardiology and the CDC.

The advisory is a call to action for healthcare systems and providers to work in closer partnership with patients, and for the establishment of local, regional and national programs that offer coordinated care using multiple resources to achieve better blood pressure control in all patients.

“Despite access to healthcare, effective therapies that have been available for 50 years, and various education and quality improvement efforts that have been targeted at patients and healthcare providers, achieving success in hypertension control is still a challenge,” Alan S. Go, MD, director of the Comprehensive Clinical Research Unit at Kaiser Permanente Northern California and lead author of the advisory, said in a news release.

Hypertension — readings at or above 140/90 millimeters of mercury — affects about one in three Americans and is a major risk factor for heart disease and stroke. Of those who have hypertension, about 75% are being treated, but only half have it controlled to a healthy level, according to national surveys.

The advisory recommends that healthcare, industry and communities prioritize people with hypertension who are receiving treatment but haven’t achieved their target blood pressure. The writing group members note that of those with uncontrolled hypertension, nearly 90% see a healthcare provider regularly and 85% have health insurance.

According to the advisory, efforts to educate patients and providers have not been sufficient in bringing hypertension under control. Similarly, interventions targeting only physicians have not led to sufficiently consistent and meaningful improvements.

“The tools to control blood pressure have long been available, but hypertension control requires patient and physician involvement within a supportive system,” John G. Harold, MD, MACC, president of the American College of Cardiology, said in the news release. “We are advocating a team approach that reduces barriers for patients and leverages the power of electronic health records to improve cardiovascular health.”

Solutions

Recent studies suggest comprehensive hypertension programs that coordinate care using multiple resources may lead to better overall blood pressure control.

The advisory provides examples of successful programs that could be emulated. One is a Kaiser Permanente program that increased the proportion of its patients with hypertension who had well-controlled blood pressure from 44% in 2001 to more than 87% in 2011.

The program focused on five main elements: creating a system-wide hypertension registry, providing regular feedback on hypertension control rates to providers, implementing and frequently updating an evidence-based treatment algorithm, using single-pill combination therapies and using medical assistants for follow-up blood pressure checks to help patients receive necessary treatment adjustments efficiently. Lifestyle changes for patients were strongly recommended as well.

The advisory provides eight principles for developing an effective hypertension treatment algorithm (and uses them to provide a usable example of such an algorithm):

• Base the components and processes on the best available science.

• Format the algorithm in a manner that is simple to update as new evidence becomes available.

• Use a feasible, simple implementation strategy.

• Include a patient version at appropriate scientific and language literacy level.

• Consider costs of diagnosis, monitoring and treatment.

• Use a format easily incorporated within a team approach to healthcare.

• Use a format able to be incorporated into electronic health records for clinical decision support.

• Include a disclaimer to ensure that the algorithm is not used to counter the treating healthcare provider’s best clinical judgment.

“The message for large and small practices and systems is: ‘Use an approach that includes an evidence-based treatment algorithm and you can improve blood pressure control for your patients,’” CDC Director Tom Frieden, MD, MPH, said in the news release. “Pick from any one of a number of available protocols, or develop your own — just use an evidence-based one.”

Several existing algorithms for hypertension treatment in large healthcare settings are available for public use in the resources and tools section of the Million Hearts initiative website: http://millionhearts.hhs.gov/resources/protocols.html.

Full statement: http://bit.ly/17wabhb


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