Improving rates of blood pressure control can be difficult because of the number of variables – patient compliance with treatment, affordability and availability of medications, availability of a healthy diet, staff blood pressure measurement techniques, external stressors for the patient, late physicians making patients angry on the date of their visit, and so on. As part of a comprehensive effort that included ensuring that patients with hypertension have their blood pressure measured at least once a year, Jen Brull, MD’s small practice in Plainville, Kansas, was able to raise its rate from 73% to 87% by focusing efforts on four key changes:
1. Ensuring that all staff members know how to accurately take a patient's blood pressure. They also placed a complete set of blood pressure cuff sizes in each room with a stethoscope to ensure that insufficient equipment did not become a barrier to accurate measurement.
2. Formalizing a policy for when repeat measurements are necessary. From the time the patient is checked in to the time the patient is seen by the provider, the nursing staff often has time to perform one or more repeat blood pressure measurements. They obtain at least two measurements if a patient's initial measurement is abnormal, and document all blood pressures measured at a visit.
3. Identifying patients whose last blood pressure showed a lack of control. Nursing staff highlighted this information to draw the provider's attention to it. This approach often meant the difference between providers thinking, “It's just one high blood pressure; next time it will be fine,” and identifying a problematic trend.
4. Developing provider expectations for treating elevated blood pressure at the visit. If a patient's blood pressure was still high after repeated testing, the provider was expected to take action at that visit. The action could be adjusting medication, recommending a modified diet, suggesting increased exercise or weight loss, or scheduling a short interval follow-up visit. Patients resistant to medication change could often be persuaded to return in seven to 10 days to see if their blood pressure had improved. If it remained high, they were often willing to make a medication adjustment.
Brull advises starting small, picking a single measure you have an interest in changing and on which you have data, and committing to a sustained effort.
Read the full FPM article: “Controlling Hypertension: Focusing on ‘Why’ Makes ‘How’ a Lot Easier.”
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