Lown Right Care

Reducing Overuse and Underuse

Coaching Patients About Successful Blood Pressure Management

 

Am Fam Physician. 2019 Mar 15;99(6):357-358.

Related article: Counseling Patients in Primary Care: Evidence-Based Strategies.

Case Scenario

Joe is a 40-year-old insurance salesman who has been married for three years. He presents as a new patient with a mild ankle sprain. His blood pressure is 154/80 mm Hg, and he has a body mass index of 35 kg per m2. Joe's in-office A1C level is 5.4%. His father had type 2 diabetes mellitus and died from a myocardial infarction at 65 years of age. Joe tells you that he usually skips breakfast and eats fast food for lunch. He and his wife eat out three times per week and otherwise have canned soup and bread for dinner. Joe adamantly refuses to take medication for his high blood pressure despite his physician's warnings of the consequences. Unknown to the physician, Joe's father experienced erectile dysfunction while taking blood pressure medication and “had a heart attack anyway.”

The physician recommends that Joe exercise 150 minutes per week, eat more vegetables and whole grains, choose low-sodium soups, lose 10 pounds, and follow up in three months. Sound familiar? The physician does not notice that Joe rolls his eyes at these recommendations.

Odds are that Joe will not make the recommended lifestyle changes or return in three months. Why would someone not do everything necessary to be healthy?

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TAKE-HOME MESSAGES FOR RIGHT CARE

Typical one-year medication adherence rates for conditions such as hypertension are 50% to 60%.

The rate of adherence to a treatment plan is more than two times higher if the patient feels the physician is a good communicator and takes time to listen carefully to the patient.

Develop an action plan with the patient that is consistent with the patient's expressed goals and what he or she is willing to do. The plan should be a new behavior that the patient is confident that he or she can accomplish. Small, achievable action steps instill hope that sustained change is possible.

Nonpharmacologic treatment of mild to moderate hypertension is a reasonable first step, especially with frequent follow-up to support change.

Peer support programs, such as Better Choices, Better Health or the Chronic Disease Self-Management Program, have been shown to promote healthy behavior.

TAKE-HOME MESSAGES FOR RIGHT CARE

Typical one-year medication adherence rates for conditions such as hypertension are 50% to 60%.

The rate of adherence to a treatment plan is more than two times higher if the patient feels the physician is a good communicator and takes time to listen carefully to the patient.

Develop an action plan with the patient that is consistent with the patient's expressed goals and what he or she is willing to do. The plan should be a new behavior that the patient is confident that he or she can accomplish. Small, achievable action steps instill hope that sustained change is possible.

Nonpharmacologic treatment of mild to moderate hypertension is a reasonable first step, especially with frequent follow-up to support change.

Peer support programs, such as Better Choices, Better Health or the Chronic Disease Self-Management Program, have been shown to promote healthy behavior.

C

Address correspondence to Ann Lindsay, MD, at adlindsa@stanford.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

3. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288(22):2880–2883.

4. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47(3):213–220.

5. Schroeder SA. Shattuck Lecture. We can do better—improving the health of the American people. N Engl J Med. 2007;357(12):1221–1228.

6. Greene J, Hibbard JH, Alvarez C, Overton V. Supporting patient behavior change: approaches used by primary care clinicians whose patients have an increase in activation levels. Ann Fam Med. 2016;14(2):148–154.

7. Bosworth HB, Fortmann SP, Kuntz J, et al. Recommendations for providers on person-centered approaches to assess and improve medication adherence. J Gen Intern Med. 2017;32(1):93–100.

8. Searight R. Realistic approaches to counseling in the office setting. Am Fam Physician. 2009;79(4):277–284.

9. Reims K, Ernst D. Using motivational interviewing to promote healthy weight. Fam Pract Manag. 2016;23(5):32–38.

10. Lorig K. Chronic Disease Self-Management Program: insights from the eye of the storm [published correction appears in Front Public Health. 2015;3:153]. Front Public Health. 2015;2:253.

11. National Council on Aging. Better choices, better health. https://www.ncoa.org/healthy-aging/chronic-disease/better-choices-better-health/. Accessed December 3, 2018.

12. Ory MG, Ahn S, Jiang L, et al. National study of chronic disease self-management: six-month outcome findings. J Aging Health. 2013;25(7):1258–1274.

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor.

 

 

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