Team-based approach best for BP control

BP uncontrolled in majority of U.S. adults with hypertension
BP uncontrolled in majority of U.S. adults with hypertension

HealthDay News -- To optimize hypertension treatment, the American Heart Association, American College of Cardiology and CDC are advocating a team-based approach that incorporates the use of electronic health records.

In the United States, rates of uncontrolled BP -- greater than 140/90 mm Hg -- remain high despite the availability of effective treatments. About one-third of Americans have hypertension, and although about three-quarters are receiving treatment, only about half have their BP under control.

"Despite access to health care, effective therapies that have been available for 50 years, and various education and quality improvement efforts that have been targeted at patients and health care providers, achieving success in hypertension control is still a challenge," Alan S. Go, MD, of Kaiser Permanente Northern California in San Francisco, said in a statement.

But instituting health system-wide implementation of evidence-based treatment algorithms at local, regional and national levels, along with scheduled performance feedback can improve efforts to control hypertension, he and colleagues noted in a scientific advisory published online Nov. 15 in Hypertension.

They performed a review of system-level approaches to determine elements that should be included in hypertension treatment algorithms to ensure success, and determined five key components in a comprehensive hypertension control program implemented at Kaiser Permanente Northern California in 2001.

Successful aspects of the program include a system-wide hypertension registry, a way to provide feedback to healthcare providers about hypertension control, an evidence-based treatment algorithm, promotion of single-pill anti-hypertensive combinations and follow-up BP visits handled by medical assistants. In it's first year, the program achieved BP control in 44% of patients -- a rate that rose to 87% by 2011.

As part of the analysis, Go and colleagues emphasized the need to further engage individuals in hypertension control, as well as the need for increased presence on the part of pharmacists and other community-based providers.

Furthermore, they determined hypertension treatment algorithms should be: based on the best available evidence, simple to update and implement, include a patient version, be easy to integrate into team-based health care and EHRs and include a disclaimer that the algorithm should not be used to counter the best clinical judgment of the treating clinician.

"Arming healthcare providers, health systems, and communities with proven tools, algorithms, strategies, programs, and other best practices, along with expertise and technical assistance for improving [BP] awareness, treatment, and control, is essential to reducing the tremendous burden of cardiovascular risk," the researchers wrote.


References

  1. Go A et al. Hypertension. 2013; doi: 10.1161/HYP.0000000000000003.
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