To overcome these lifestyle challenges, patients should be able to recognize high-sodium processed foods that are often cheap and inexpensive, but will greatly affect the efficacy of medications. Physicians should offer solutions based on where patients live and the resources available to them, such as alternatives to various food options.
“Salt sensitivity may be more common among African-Americans, but more importantly, the combination of processed foods high in sodium, obesity and physical inactivity can blunt the benefits of blood-pressure medicines,” said Dr. Ferdinand, an AMA member since 1978.
Pay attention to health literacy
While physicians are comfortable using technical terms during a doctor’s visit, many patients may nod approvingly, but often do not understand exactly what clinicians are saying. This creates a barrier to care and communication.
The use of technical language might be needed to communicate among providers in the EHR, but it is more important to talk to patients in plain, direct and easy-to-understand language. This helps patients better understand their conditions, said Dr. Ferdinand.
The few extra minutes it might take to complete this step can make a significant impact on the patient’s care.
Address medication adherence
A primary barrier to control of risk factors is medication nonadherence for treatment of hypertension and cardiometabolic diseases.
“Within our health system itself, provider communication skills and addressing disparities in patients’ health beliefs are very important to adherence—as much as high drug costs and the cost of copayments for patients who are on multiple medicines,” said Dr. Ferdinand.
When physicians order medications they should also recognize a patient’s preference and, even if the medication is generic, have some assessment of the cost. Many health care plans often have a list of formulary generic medications that will be less costly than others.
Include family in the plan
While it is important to recognize the legal constraints of HIPAA in terms of discussing any patient’s condition with another individual, said Dr. Ferdinand, with the patient’s permission, having the significant other or family member present will go a long way with increasing adherence, understanding cardiovascular risk and the need for lifestyle modification.
“Significant others often can help patients interpret what the provider has been saying in terms of cardiovascular risk,” he added. “That second person becomes a partner in care and becomes an assistant to the provider, not a barrier to care.”
Family members can also be a source of inspiration for patients in lifestyle modifications, such as reducing sodium in prepared foods and avoiding processed foods high in sodium. They can also become a partner in an exercise program and ensure patients take their medicines and gets refills when needed. It is a partnership that physicians can encourage to improve care and adherence.
“Programs such as Target: BP™, which focuses on the appropriate identification and early intervention to control blood pressure, may go a long way to reduce the disparities in the outcomes related to elevated blood pressure by race, ethnicity and social class,” said Dr. Ferdinand.