It Takes a Team to Tackle High Blood Pressure
By Janet Wright, M.D., FACC, Million Hearts® 5/9/2013
As the executive director of Million Hearts®, I am privileged to see how critical and creative strategies, including team-based care for improved blood pressure control, are encouraging Americans and their health care professionals to focus attention and energy on achieving the goal of preventing 1 million heart attacks and strokes by 2017.
Let’s set the stage with a few facts about blood pressure from the Centers for Disease Control and Prevention:
♦ 67 million American adults—1 in 3—have high blood pressure, a major risk factor for heart disease and stroke.
♦ About half (47%) of adults with high blood pressure have it under control.
♦ One in 5 American adults smokes.
♦ Fewer than half of us get the recommended 2 hours and 30 minutes of moderate physical activity each week.
Taking a team approach to care could help us ensure that 10 million more Americans get their blood pressure under control. It helps to think of controlling blood pressure as a team sport. You do your part individually, but you also are part of a larger group working diligently toward a goal. Success depends on everyone working together.
How does team-based care translate to controlling blood pressure? Everyone—individuals, health care professionals, community organizations, and health care systems—play a role in achieving control.
Individuals can take many different steps for better blood pressure control:
♦ Become part of the Million Hearts® initiative. That means agreeing to take control of your heart health—learning your risks for heart disease and stroke, knowing the ABCS (Aspirin as appropriate, Blood pressure control, Cholesterol management, and Smoking cessation), eating heart-healthy foods lower in sodium and trans fat, and getting active on most days of the week.
♦ Access and use resources like the online risk assessment quiz My Life Check or the Heart Health Mobile app. Both are great tools for assessing heart attack risk based on age, weight, lifestyle, and blood pressure and cholesterol levels. The mobile app also can connect you with local resources to get more information about what your numbers mean.
♦ Make control your goal. Team up with your doctor, nurse, pharmacist, dietitian, health coach, or community health worker to find the right combination of medication and lifestyle changes that helps you get control.
♦ Take your blood pressure medication as directed. Most people need more than lifestyle changes to control high blood pressure. Talk to your doctor or pharmacist if you have trouble taking your medications or have side effects.
For health care professionals and systems, health information technology has changed the game—for the better. Care teams now have new tools at their fingertips to help coach and support patients, and health systems can generate reports that drive overall progress.
Better blood pressure control results when health care professionals:
♦ Use health information technology to capture and track patterns of blood pressure readings and enhance clinical decision-making.
♦ Collaborate—with pharmacists, nurses, social workers, dietitians, health coaches, and community health workers—to educate patients, provide instruction and support for medication adherence and lifestyle changes, and emphasize the importance of long-term monitoring and self-management.
♦ Recommend resources to patients for tracking blood pressure, diet, and physical activity, and help patients get past barriers to physical activity or healthy foods.
♦ Prepare patients for the reality that trying different medications or combinations of medications may be necessary to achieve and maintain blood pressure control.
Studies show this team-based approach works. A review of 77 studies found that patients’ control of blood pressure improved when a multidisciplinary team coordinated care, assisted patients in self-management, and established regular follow-up mechanisms to monitor patients’ progress.
One example is the Cardiovascular Health Awareness Program (CHAP), which includes 39 communities in Ontario, Canada. In the CHAP study, volunteer community health workers provided blood pressure readings and education to almost 16,000 people in 20 intervention communities. Key elements included community-wide orientation; ongoing sharing of blood pressure results with primary care teams, including doctors, nurses, and pharmacists; convenient community locations for follow-up blood pressure readings; and weekly training sessions in community pharmacies. After 1 year, hospital admissions for cardiovascular disease dropped 9% in the 20 intervention communities.
Here in the United States, the Ellsworth Medical Clinic in western Wisconsin makes every patient visit an opportunity to control blood pressure. Elements of their successful program include a pre-visit chart review, exam room magnets alerting staff to patients with high blood pressure, drop-in blood pressure checks, and between-visit follow-up calls. In August 2012, the Clinic reached a 90% control rate among all patients with high blood pressure.
Getting blood pressure under control is one of the ways we will change the heart health of the nation together and reach the Million Hearts® goal of preventing 1 million heart attacks and strokes by 2017. It will take support, action, and encouragement from all of us. Remember—it takes a team.
Learn more about Million Hearts® at http://millionhearts.hhs.gov.
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Dr. Janet Wright
Janet S. Wright MD, FACC, is the Executive Director of Million Hearts™, an HHS national initiative with the explicit goal to prevent 1 million heart attacks and strokes in the U.S. by 2017.
The Million Hearts™ initiative is co-led by CDC and the Centers for Medicare and Medicaid Services and aligns existing efforts across the public and private sectors to make a long-lasting impact against cardiovascular disease. Before joining CDC in 2011, Dr. Wright served as Senior Vice President for Science and Quality at the American College of Cardiology (ACC), from 2008 to 2011. In that role, she provided medical and scientific oversight of clinical guidelines, performance measures, health policy statements, and appropriate use criteria; quality improvement projects; and the National Cardiovascular Data Registry, a suite of databases containing more than 12 million patient records in both inpatient and outpatient care settings.
Dr. Wright also served on the ACC’s Board of Trustees and chaired the Task Force on Performance Assessment, Recognition, Reinforcement, Reward, and Reporting. She was a member of the National Committee for Quality Assurance’s (NCQA) Clinical Programs Committee and of the Quality Alliance Steering Committee. In addition, she served on the board of the Center for Information Therapy, a non-profit organization committed to the provision of personalized health information during each healthcare encounter.
Prior to her role with the ACC, Dr. Wright practiced cardiology for many years in Chico, Calif. From 2003 until moving to Washington, Dr. Wright served as a founding member of the Independent Citizens’ Oversight Committee, the 29-person board charged with administering the California Institute for Regenerative Medicine. Her primary interests are the design and implementation of systems of care to achieve optimal outcomes for patients.
Dr. Wright received her MD from the University of Tennessee and completed her residency and cardiovascular fellowship in San Francisco, Calif.