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Helping Hypertensive Patients with Tax Day Stress and Everyday Care

Posted Apr 12 2013 1:01pm

Are you experiencing tax stress with tax day looming?  As you know, for some patients, stress, along with other contributing factors like genetics, obesity, smoking, and diet, is one of the contributing factors towards high blood pressure (HBP), also known as hypertension.

Hypertension is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems,[i] but because many of these factors go hand-in-hand, it can be better managed through the use of electronic health records (EHRs).

Primary Care Providers and Hypertensive Patients

If you are a primary care provider, you know that you are on the front lines of caring, and are challenged with helping your patients control their blood pressure. As with treatment of many chronic diseases, you know that it’s important to create hypertensive patient education materials and strategies.

Here at ONC we have interviewed a primary care provider who has made great strides with providing patient education and care for his hypertensive patients through using an electronic health record.

Managing Hypertensive Patients is a Team Effort

Dr. Nilesh V Patel, a solo practitioner in a Pennsylvania suburb, has been conducting a clinical review of hypertensive patients to help his hypertensive patients control their blood pressure. Dr. Patel and his staff pharmacist/office manager work with their team to try to differentiate their patients into the following areas:

1) Patients with co-morbidities such as renal, neurologic, or cardiac disease

2) Older hypertensives

3) Younger, uncomplicated hypertensives (these patients they see every six months)

How EHR Automation Makes Identifying and Treating Hypertensive Patients Easier

The process of identifying and tracking these patients has gone from manual to automated after he adopted his EHR in late 2011. His EHR allows his team to identify, treat, and recall hypertensive patients as well as schedule necessary follow-ups.

With the help of PA REACH, the local Regional Extension Center, Dr. Patel has used his EHR to accommodate the treatment of hypertensive patients. While he admits that the implementation was challenging at the beginning, he now believes the use of the EHR was the best path to take to help him more efficiently provide targeted patient care.

Frequent Contact with Hypertensive Patients

Now, once every three months, Dr. Patel’s team reaches out to their hypertensive patients, those with co-morbidities and older patients with hypertension. Younger patients may be contacted once every six months but it is a practice-wide rule of thumb that all hypertensive patients should come in at least twice a year.

Through the practice management component of the EHR, alerts remind team members about patients that need to come in. And thanks to the well-trained staff that helps to educate patients about the importance of follow-up, Dr. Patel is able to set aside more time for patients with more complicated disease states. Patients with complicating co-morbidities have color-coded files in the system, which help Dr. Patel and his team prepare to best serve and educate their patients.

While compliance with their individual treatment regimens is ultimately up to the patients, the identification and dissemination of hypertensive patient education is a team sport, which the Patel practice knows very well.

Automated Provider Notification of High Blood Pressure Allows Providers to Focus on Patient Education

While the bad news is that hypertension prevalence has not significantly changed in 1999-2008, the good news is that among adults with high blood pressure, the overall percentage that have controlled their blood pressure increased from 31.6% in 1999–2000 to 48.4% in 2007–2008.[ii]

Tracking success in blood pressure control is key and utilizing EHR tools such as quality measure tracking or automated provider notification of high blood pressure reading helps make the process of tracking easier and faster for providers, allowing them to focus on their patients.[iii]

Increases in Hypertension Treatment Could Save Lives

We believe that with the use and optimization of EHRs and the dedication of the thousands of providers nationwide like Dr. Patel, who make it their mission to encourage better self-health and ultimately save patient lives, we will see even more improvement.

The results of hypertension treatment speak for themselves but there are still many more lives that can be saved. A 2010 prediction model showed that every 10% increase in hypertension treatment could prevent an additional 14,000 deaths per year in the adult population ages 25–79.[iv]

The stress that plagues so many of us on Tax Day comes once a year but providers with EHRs everywhere can leverage their system on a regular basis to treat high blood pressure.

Figure 1: Age-Adjusted Prevalence of High Blood Pressure among US Adults (18 and older) with High Blood Pressure by Race & Ethnicity: 1999-2008

Tax Day Figure 1

Figure 2: Age-Specific & Age-Adjusted Control of High Blood Pressure among US Adults with High Blood Pressure: 1999-2008

Tax Day Figure 2

Figure3: Tracking Success in Blood Pressure Control [v]

Tax Day Figure 3

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[i] National Heart, Blood, and Lung Institute, National Institutes of Health. Explore High Blood Pressure. Downloaded 3/27/2013 from  http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/

[ii] Yoon S, Ostchega Y, Louis T. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS data brief, no 48. Hyattsville, MD: National Center for Health Statistics. 2010.

[iii] Centers for Disease Control. Getting Blood Pressure Under Control. Downloaded 4/11/2013 from http://www.cdc.gov/vitalsigns/Hypertension/index.html

[iv] Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med 38(6):600–9. 2010.

[v] Centers for Disease Control. Getting Blood Pressure Under Control. Downloaded 4/11/2013 from http://www.cdc.gov/vitalsigns/Hypertension/index.html

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