Monday, November 18, 2013
QD: News Every Day--Team-based approaches needed to fight high blood pressure
Collaborative approaches can be effective in handling uncontrolled high blood pressure rates that are prevalent despite proven treatments, according to a science advisory from the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention.
“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,” said Alan S. Go, MD, ACP Member, Director of the Comprehensive Clinical Research Unit at Kaiser Permanente Northern California and lead author of the advisory.
The advisory recommends that health care, industry and communities prioritize people with high blood pressure who are receiving treatment but haven’t achieved their target blood pressure. The writing group members noted that of those with uncontrolled hypertension, nearly 90% see a health care provider regularly, and 85% have health insurance.
The report, “An Effective Approach to High Blood Pressure Control,” is online at the ACC website and AHA website, and will appear in print editions of the Journal of the American College of Cardiology and Hypertension.
According to the advisory, educating patients and providers hasn’t been enough and 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,” said John G. Harold, MD, MACP, president of the American College of Cardiology. “We are advocating a team approach that reduces barriers for patients and leverages the power of electronic health records to improve cardiovascular health.”
The advisory also provides examples of successful programs that could be emulated. One is a Kaiser Permanente program that increased the proportion of its patients with hypertension with well-controlled blood pressure from 44% in 2001 to more than 87% in 2011. The program focused on 5 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 in order to help patients receive necessary treatment adjustments efficiently. Lifestyle changes for patients were strongly recommended as well.
The advisory provides 8 principles for developing an effective high blood pressure treatment algorithm (and uses them to provide a usable example of such an algorithm):
1. Base the components and processes on the best available science;
2. Format the algorithm in a manner that is simple to update as new evidence becomes available;
3. Use a feasible, simple implementation strategy;
4. Include a patient version at appropriate scientific and language literacy level;
5. Consider costs of diagnosis, monitoring and treatment;
6. Use a format easily incorporated within a team approach to health care;
7. Use a format able to be incorporated into electronic health records for clinical decision support; and
8. Include a disclaimer to ensure that the algorithm is not used to counter the treating health care provider’s best clinical judgment.
Several existing algorithms for hypertension treatment in large health care settings are available for public use in the resources and tools section of the Million Hearts initiative website.
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Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.