{"id":2410,"date":"2020-10-28T13:58:35","date_gmt":"2020-10-28T20:58:35","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=2410"},"modified":"2020-10-28T13:58:35","modified_gmt":"2020-10-28T20:58:35","slug":"a-call-to-action-on-hypertension-control","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=2410","title":{"rendered":"A Call to Action on Hypertension Control"},"content":{"rendered":"

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer<\/strong><\/p>\n

\n

\u201cJoin me in taking control of hypertension across our nation. Together, we\u2019ve got this.\u201d<\/p>\n

–Jerome M. Adams, Surgeon General of the United States<\/p>\n<\/blockquote>\n

Control of hypertension has been shown to reduce heart attacks and strokes, reducing both morbidity and mortality.<\/p>\n

On a population basis, blood pressure control in the US has worsened from 53.8% under control in 2014, to 43.7% under control in 2018 (JAMA, September 22\/29, 2020). This has led the U.S. surgeon general to declare a Call to Action on Hypertension Control<\/a>. The goal of the U.S. Department of Health and Human Service\u2019s Million Hearts campaign<\/a> is to have 80% of patients with hypertension under good control, defined as a blood pressure of under 140\/90.<\/p>\n

Unfortunately, COVID-19 is likely carrying us further away from this goal. Patients with telemedicine visits only have their blood pressure assessed only 9.6% of the time, compared to 69.7% of the time during office-based visits. (October 2, 2020 edition of JAMA Network Open Access)<\/p>\n

About 25% of adult PHC members have a diagnosis of hypertension. From pharmacy data, 17% are taking at least one blood pressure (BP) medication. Their level of blood pressure control, in 2019, averaged around 65%, much better than the 43.7% rate found nationally by JAMA, but far below the 80% goal of the Million Hearts campaign. This 80% goal is achievable, as shown by six of our larger primary care providers whose hypertension control rates were better than 80% last year:<\/p>\n

Fairchild Medical Center (Yreka, Siskiyou county):\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 89%<\/p>\n

Northbay Center for Primary Care (Solano county):\u00a0\u00a0\u00a0\u00a0\u00a0 84%<\/p>\n

Kaiser Permanente, in Marin and Sonoma counties:\u00a0\u00a0\u00a0 82%<\/p>\n

Shasta Community Health Centers (Shasta county):\u00a0\u00a0\u00a0 82%<\/p>\n

Petaluma Health Centers (Sonoma county):\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 82%<\/p>\n

Sutter Lakeside (Lake county):\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a081%<\/p>\n

Before the 1980s, diabetes self-management (including patient monitoring of their own blood sugar), was NOT the standard of care. Patients had their blood sugar measured in the laboratory or in the doctor\u2019s office. Since the 1980s, it has become standard of care for all persons with diabetes to monitor their own blood sugars.<\/p>\n

Blood pressure monitoring today is where blood sugar monitoring was in the 1970s. It is time to empower patients to monitor their own blood pressure at home. One of the strategies listed by the Surgeon General is to \u201cEmpower and equip patients to use self-measured blood pressure monitoring.\u201d The Million Hearts campaign describes the evidence base showing better blood pressure control with home monitoring, combined with a medical team that uses this data to take action.<\/p>\n

Partnership HealthPlan of California (PHC) covers home blood pressure monitors for our members. These can be obtained from a community pharmacy with a prescription\/order from the Primary Care Physician (PCP), until December 31, when the state pharmacy carve out kicks in. Medi-Cal Rx will be administered through the Fee-For-Service (FFS) delivery system. For more information and to apply for your Practice ID number, visit their website<\/a>. Additionally, we have a direct distribution pilot for BP monitors on a first-come, first-served basis. Interested providers will need to complete the DME Request Form on our website<\/a>. This program will be continued and expanded in the year to come.<\/p>\n

Petaluma Health Center had a best practice with us. Instead of reminding their clinicians to remember to prescribe BP monitors, they sent a text message to all their PHC patients with hypertension and asked them to respond if they wanted a home BP monitor. This was an effort to reduce the exposure to COVID-19, by reducing the trips into the office to check their blood pressure. About 10% of those texted responded with a request for a BP monitor. Petaluma Health Center set up a streamlined system to send the orders to PHC (through our direct distribution pilot), and we delivered the devices directly to the patients\u2019 home.<\/p>\n

We hope you will consider an active outreach campaign like this, for your patients with hypertension. As our Surgeon General says, \u201cTogether, we\u2019ve got this!\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer \u201cJoin me in taking control of hypertension across our nation. Together, we\u2019ve got this.\u201d –Jerome M. 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