Heart & Stroke High Blood Pressure Strategy: Hypertension Management Initiative Margaret Moy Lum-Kwong [email_address] February 2007
An urgent and important issue for the health of Canadians
Cardiovascular disease is the underlying cause of death for one in three Canadians, making it the No.1 cause of death for Canadian men and women.
High blood pressure is the number one modifiable risk factor for stroke and affects nearly 22% (about five million) of adult Canadians.
According to the World Health Organization, hypertension contributes to about half of all cardiovascular disease.
An urgent and important issue for the health of Canadians
Among those afflicted with hypertension, the statistics are alarming:
16% are treated and controlled
23% are treated and not controlled
19% are not treated and therefore not controlled
A staggering 42% of those with hypertension are unaware of their condition
Source: Canadian Heart Health Surveys 1986- 1992
Top 10 Diagnoses in Canada, 2005 General Practice/Dermatology 88% 58% 42% 3,545,000 Contact dermatitis and other eczema General Practice/Paediatrics 76% 48% 52% 3,802,000 Ear infection (otitis media) General Practice/Obstetrics/Gynaecology 19% 100% 0% 5,088,000 Normal pregnancy supervision General Practice/Internal medicine 80% 40% 60% 5,284,000 Hyperlipidemia General Practice/Paediatrics 43% 57% 43% 5,696,000 Acute upper respiratory infection General Practice/Psychiatry 55% 66% 34% 5,746,000 Anxiety General Practice/Internal medicine 69% 45% 55% 8,780,000 Diabetes mellitus w/o complications General Practice/Paediatrics 3% 56% 44% 8,814,000 Health check-up General Practice/Psychiatry 79% 68% 32% 8,900,000 Depression General Practice/Internal medicine 80% 53% 47% 21,829,000 Hypertension General Practice/Family practice 60% 59% 41% 323,537,000 All diagnoses Top 2 specialties most-often seen Patient visits with drug recos % Female % Male Patient visits
High Blood Pressure Strategy “ An area of focus that, with leadership , significant investment and a cross-Foundation approach , has the potential to reduce the risk of premature death and disability from heart disease and stroke in Ontario.”
To pave the way towards optimal blood pressure management that will result in a dramatic improvement in the future health of Canadians.
HBP AIM Cross Foundational Hypertension Management Initiative: Primary Healthcare Providers + Patients Prevalence Study Social Determinants Systolic Blood Pressure Advocacy & Communications Business Development High Blood Pressure Strategy Knowledge Exchange
Key Milestones and Timelines Sept 04 Sept 06 Jan 10 Sept 08 Alpha Phase Beta Phase Hypertension Management Initiative (=Provider Management +Patient Self Management) Research SD Issues Identified SD Interventions Researched HBP Prevalence Study Elevated Systolic Adults 45+ Research
What Success Looks Like
Impact on mission!
Improved HBP management practices among participating primary health care providers
Improved patient adherence with pharmacologic and non-pharmacologic therapies in affected patients at participating sites
Improved BP readings in affected patients at participating sites
New understandings in 2 emerging HPB issues
Updated data on the prevalence of hypertension in Ontario, with the first ever data on key ethnic groups in Ontario
Heart & Stroke Hypertension Management Initiative
Key Elements of the Hypertension Management Initiative
practice outreach and support to healthcare providers to support and assist in the integration of the tools and interventions in their practices
inter-professional, evidence-informed healthcare provider toolkit that incorporates clinical reminders and prompts and practice audit feedback and aids inter-professional communication
evidence-informed, leading edge patient toolkit that provides information and education and supports patient self-management.
Objective: develop, test and refine a toolkit aimed at improving hypertension management and control using the Quality Improvement methodology (PDSA)
June 2005 to June 2006
3 Pilot Sites: 20 MDs, 3 Nurses, 31 Community Pharmacists
Kingston - Family Health Network (3 office locations)
Toronto - Health Services Organization (1 office location)
Huntsville - Family Health Network (1 office location)
Alpha Evaluation Components – Chart Reviews
Chart Reviews for Participating Physicians
Chart Review methodology was designed by consultant and conducted by 3 RNs. Inter-rater reliability based on 10% sample of charts was 0.90. Chart reviews were conducted in March/April 2006.
290 charts of patients enrolled in Strategy (by 20 participating physicians across all sites) were abstracted from each visit occurring between June 2004 and March 2006. Pre-program period (June 2004-May 2005) was compared to program period (June 2005-March 2006).
77 charts of patients diagnosed with HTN but not enrolled in Strategy (by participating physicians at Kingston sites) were abstracted from each visit occurring between October 2004 and May 2005.
Significant increase in screening:
BP measured documented in twice as many visits during program period (45.7%) vs. pre-program period (27.8%).
Significant increase in patients diagnosed with HTN:
Newly diagnosed patients twice as high in program period (11%) vs. pre-program period (4.8%)
Directional increase in patients with HTN controlled to target:
In non-diabetic HTN patients, 31% controlled in program period vs. 25% in pre-program period
In diabetic HTN patients, 58% controlled in program period vs. 46% in pre-program period
Significant decrease in elapsed time from diagnosis to target BP:
Time to target BP was 4 months for patients in pre-program period (who “crossed over” into program period) vs. 6.3 months for patients in historic control group not enrolled in program
Significant decrease in elapsed time from 1 st elevated BP reading to follow up visit:
Time between visits was 64.8 days for patients in pre-program period (who “crossed over” into program period) and 68.4 days for patients in program period vs. 113.8 days for patients in historic control group not enrolled in program
92% of physicians & pharmacists rated Strategy as somewhat/very effective in helping them manage patients with HTN overall
Perceived to be most effective in promoting communication with patients, counseling patients re. lifestyle issues, diagnosing HTN (physicians)
83% of physicians & 92% of pharmacists agreed strongly/somewhat that participation in Strategy had positive impact on knowledge re. management of patients with HTN
100% of physicians & 84% of pharmacists agreed strongly/somewhat that participation in Strategy had positive impact on management of patients with HTN
Significant increase in physicians’ familiarity with CHEP Recommendations (62% pre vs. 92% post)
84% of physicians & 60% of pharmacists indicated they were spending more time speaking with patients about lifestyle issues