High blood pressure increases the risk for heart disease and stroke, two leading causes of death for Americans. NHRMC is taking steps to further prevent strokes and heart disease in the community by working to help patients control their blood pressure.
Recently a team of NHRMC providers and staff launched a Hypertension Quick Win project to reduce the number of patients with uncontrolled blood pressure.
The team meets biweekly to discuss their efforts, data and plans for implementation of strategies.
“As a quick win project, this is something we’re hoping will have a measurable impact in a fairly short period of time,” said Dr. Timothy Winslow, MD, a cardiologist with Cape Fear Heart Associates – NHRMC Physician Group and physician champion of the project, adding that the project team is still in the planning stages for many ideas they plan to implement. “Ultimately what will come out of the quick win project are some resources, a plan and product that will result in better control of hypertension across the network.”
“With this project, it’s not just about improving the number of patients with controlled blood pressure, but I think our ‘pie in the sky’ hope is that we do a much better job of reducing the rate of stroke for our community,” Mackie King, Pharm D, said.
“Our goal is to reduce the number of patients having strokes and the co-morbidities and lifestyle changes that go along with having strokes. We think the best way to target that is by improving the rates of blood pressure control.”
“Getting the word out that the blood pressure goal is less than 130 over 80 is really important,” Dr. Winslow said. “A lot of times we’re not as good about hitting the goal. Across the network, we range from 70 to low 80 percent blood pressure control and that’s using the 140 over 90 blood pressure (the previous guideline), so if we use the 130 over 80 it would be considerably less than that.”
Key parts of the hypertension quick wins project are patient education, community outreach and education for healthcare providers and staff.
“We’re also hoping to educate providers and standardize care across the network,” Dr. Winslow said. “There are good guidelines in how to approach and treat high blood pressure, and we’re going to try to get back to those guidelines. We want to emphasize the importance of fairly simple lifestyle changes, which can have a big impact on your blood pressure, things like sodium restriction, dietary potassium supplementation, avoiding medications that raise your blood pressure, regular physical activities, maintaining healthy body weight, and avoiding excess alcohol.”
Some of the patient education and community outreach efforts being implemented or expanded as part of this project include:
- Developing various educational materials about how to reduce one’s risk for stroke and improve blood pressure
- Spreading the word about local community gardens as a source of healthy food choices to support heart health
- Helping more patients get blood pressure cuffs to use at home
- Creating a local Walk with a Doc program, where a participating provider educates participant on a health topic and then they spend time enjoying a healthy walk and discussion together.
Dr. Winslow would also like to see a program similar to NHRMC Lifestyle Reset program, part of cardiac rehab, be extended to the community to teach the public about healthy nutrition, exercise, and stress management for heart health. Dr. King said there are also plans to extend NHRMC’s barbershop initiative and other community outreach events to make them even more effective. Instead of giving the individual their numbers and asking them to take initiative, NHRMC has created a new Community Outreach department in the electronic medical record. This will allow us to document patients’ readings and ensure necessary follow-up or referrals can be made.
“In the past, we haven’t known what’s happened to these patients, but now if we can document it, we should be able to follow up with them and make sure that they get into care,” Dr. King said.
Dr. King says the team is working on developing a book for healthcare providers that will offer evidence-based guidance on how to diagnose and treat hypertension. “Hypertension is really a primary care problem and something that we hope most primary care providers feel comfortable trying to address,” he said.
The book will include guidance on diagnosing hypertension, how to take accurate blood pressure readings, maximizing use of medications before referring patients to cardiologists, and providing evidence-based recommendations and guidance on which medications to use for patients with certain medical histories.
The hypertension quick win project team has submitted the project to Million Hearts, a national initiative that focuses on implementing effective interventions in clinical settings and communities to reduce the problem of stroke heart attack and stroke in the country.
If NHRMC receives the Million Hearts recognition it would be the first hospital system in NC to do so.
Using baseline numbers at the start of the project regarding controlled and uncontrolled blood pressure rates, the team plans to track improvement among patients, and outcome data will eventually be submitted to Million Hearts.
While the quick wins group focuses on goals it can reach in a short period of time, the team’s efforts are also laying groundwork for a longer-term goal of having a hypertension clinic.
“We’re still in the early planning stages on how to go about that,” said Dr. Winslow. “But something that has come out of this project is a recognition that we need to have a place for clinicians in the community to refer folks to for better blood pressure control.”
The Covid-19 pandemic is impacting potential spending for some of the project team’s ideas, but they are focusing on strategies and efforts that can be implemented without impacting the budget.
“We’re ensuring that everything we’re pursuing right now doesn’t add an extra cost to the system,” Dr. King said. “There are a lot of things we’d like to do down the road that are currently on pause because of that.”