A team-based approach to the treatment of hypertension led to a 30 percent improvement in blood pressure control in patients receiving care at a clinic in the city of Rochester. The intervention, highlighted in a study in the Journal of the American Society of Hypertension, helped a population that typically faces many barriers to treatment: low-income, minority patients.
In the United States, approximately one-third of the adult population has high blood pressure. Despite the high prevalence and known benefits of treatment, only about half of patients have their blood pressure under control, according to the National Center for Health Statistics. Thomas A. Rocco, M.D., senior study author and associate professor in the Department of Medicine at the University of Rochester School of Medicine and Dentistry, says that control rates are even lower in minorities.
John D. Bisognano, M.D., Ph.D., director of UR Medicine’s Comprehensive Hypertension Center and a member of the UR Medicine Heart & Vascular team believes that the findings are important because improving the treatment of high blood pressure can have a profound effect on public health.
“By controlling high blood pressure you are preventing heart attacks, strokes, and kidney disease, which translates to lower health care costs in the long run,” noted Bisognano, a study author and incoming president of the American Society of Hypertension. “You are also decreasing the emotional, physical, and financial burdens that these conditions place on families.”
The team-based approach to treatment began with the development of clinical teams, including physicians, pharmacists, and nurses who worked together to help patients best manage high blood pressure. Pharmacists recommended strategies like the use of pill boxes and set up automatic pharmacy refills to make it easier for patients to stick with prescribed medication regimens. They also consulted with treating physicians to ensure patients received the optimal combination of medications.
Nurses ensured that patients were able to obtain medications; addressed barriers to care, such as a lack of insurance or transportation to appointments; followed up with patients with reminders about blood pressure checks; and reviewed home blood pressure readings for patients with a home monitor.
“Health care providers are accustomed to working with patients one-on-one, but it is hard to address a patient’s needs in a 15 minute clinic visit,” said Rocco, former chief of Cardiology at UR Medicine’s Highland Hospital. “Working together, a team of providers can cover a wide range of issues and minimize roadblocks to treatment.”
The study took place between August 2010 and February 2014 and researchers, headed by lead study author Robert J. Fortuna, M.D., M.P.H., collected and analyzed blood pressure data from each patient’s electronic health record every four months. In addition to the 30 percent improvement in hypertension control amongst the clinic’s patients, researchers observed improvements in the severity of hypertension: the number of patients with Stage 2 hypertension dropped from 11 percent of hypertensive patients to 6 percent following the intervention.
“Prior studies have demonstrated the benefits of multidisciplinary teams in highly controlled settings, but our study demonstrates that these benefits translate to real-world primary care settings,” said Fortuna, assistant professor of Medicine and Pediatrics in Primary Care at the University of Rochester Medical Center. “Team-based medicine is vital to the future of health care and is currently being implemented in clinics across the Rochester community.”
The project, which took place at UR Medicine Primary Care Culver Medical Group, was supported by a grant from the Greater Rochester Health Foundation and the University of Rochester Clinical and Translational Science Institute. Experts from St. John Fisher College, the Greater Rochester Health Foundation, the Canandaigua VA Medical Center and RAND Corporation contributed to the research. The Culver Medical Group received the Greater Rochester Health Foundation’s 2011 Robert Oppenheimer Impact Award for this work.
“The Greater Rochester Health Foundation was pleased to provide funding for this project, which focused on helping patients lower their blood pressure levels,” said Sharon Legette-Sobers, Senior Program Officer, Greater Rochester Health Foundation. “This project shows how a team-based approach can improve the health of our community by breaking down barriers to high-quality treatment for patients.”
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