What physicians are saying and doing to control hypertension

AMA Wire
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Many physicians’ office workflows include a standard way of measuring blood pressure, making it part of the daily routine. But over the past year, physicians across the country have been discussing how minor, easy changes in the way they measure blood pressure have had a positive impact on their patients’ hypertension control.

Seemingly minor issues can impact blood pressure measurement. For example, if a patient talks during the measurement, has a full bladder or if the patient’s feet aren’t flat on the floor, there’s a chance that blood pressure measurement will give a falsely high reading. This could lead to a prescription for an unnecessary—and potentially harmful—medication. At the same time, other factors can contribute to unidentified and untreated hypertension, which can be deadly.

Helping physicians and their practice staff incorporate these standardized principles into their practice workflow is a key element of the AMA’s Improving Health Outcomes initiative. A pilot program involving multiple clinical sites in Maryland and Illinois is implementing principles of safe design into the ambulatory setting to improve outcomes around hypertension.

Physicians who made these minor changes in measurement have seen positive results. For example, one family medicine physician, a Wisconsin doctor named Kim Hardy, MD, heard about the pilot work and standardized measurement principles. She implemented some changes, and shared what enabled her to immediately improve a patient’s blood pressure measurement so the patient’s medication didn’t need to be adjusted. That prompted a conversation in which physicians from across the country weighed in on how they manage blood pressure in their practices.

After making improvements to measure accurately, practices involved in the AMA’s pilot sites are acting rapidly to help bring blood pressure under control. This involves making explicit changes to a patient’s care plan, ensuring follow-up interactions and using evidence-based protocols to guide the selection of antihypertensive medications.

It also involves using community resources to help patients get home blood pressure devices or directing patients to local programs that could measure their blood pressure and provide feedback to physicians. Practices in the AMA pilot are establishing these clinical community linkages now.

Physicians in the pilot program are having success controlling blood pressure without adding to their practice’s workflow burden. For example, Chicago-area physician Michael K. Rakotz, MD, in the past year has achieved a 90 percent control rate for his patients with hypertension by working with his medical assistant, nurse and other staff members to execute standardized blood pressure protocols in the practice.

Using a team-based care approach, Dr. Rakotz also implemented a strong home-monitoring program for patients whose blood pressure management requires more clinical data, and his practice relies on its electronic health record system to immediately give them actionable information.

Implementing checklists and protocols into practices, such as the ones the AMA’s pilot program has developed, can help physicians dedicate more time to caring for patients.

Working alongside the pilot practices, the AMA also has partnered with researchers at Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to develop a full suite of hypertension control tools, which will soon be available to physicians across the country..

Join the discussion: Share what methods you’ve found successful in improving outcomes around hypertension in your practice in a comment below at AMA Wire® or on the AMA’s Facebook page.

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Comments

In this article it states "after making improvements to measure accurately" what measures have been taken to improve accurate BP measurements? I am a paramedic / RN with 20 years of pre-hospital and ER experience. It has been my observation over the years that most staff (whether it be prehospital in the ER or in the office setting) blood pressures are not taken accurately. Often times the wrong size cuff is used, the bladder of the cuff is not pumped up high enough, and more often than not the air is let out of the cuff so rapidly that there is no way one could get an accurate reading. This has been my observation both professionally and from a patient perspective. Physicians make decisions that affect patients everyday based on these readings. I was wondering if staff training on accurate manual blood pressure taking was part of "after making improvements to measure accurately" Thank you<br/> Respectfully,<br/> Maryann
The pilot practices in the AMA's Improving Health Outcomes initiative are working on ways to train staff to take accurate manual blood pressure. Those results will be shared in the coming year, including resources for physicians and other health care professionals. In the meantime, you can check out these ways to improve blood pressure readings (1), and read about how one physician made changes in his practice (2). <br/> <br/> (1): <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/accurate-blood-pressure-measurement">http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/accurate-blood-pressure-measurement</a><br/> <br/> (2): <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/better-blood-pressure-added-burden-one-practices-story">http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/better-blood-pressure-added-burden-one-practices-story</a>
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