Hbp Stategy Hypertension Management Initiative Feb07
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Hbp Stategy Hypertension Management Initiative Feb07

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Hbp Stategy Hypertension Management Initiative Feb07 Hbp Stategy Hypertension Management Initiative Feb07 Presentation Transcript

  • 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.
    Our Vision
  • 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
    • interactive, inter-professional education workshops, reflective exercises
    • 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.
  • Alpha Phase
    • 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.
  • Results
    • 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
  • Results cont’d
    • 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
  • Results cont’d
    • 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
  • Results cont’d
    • 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
  • Beta Sites
  •  
  •  
  • 1. Register patients 3. Diagnosis - BpTRU - Waist Circumference Tape Measure - CHEP Recommendations - CHEP Recommendations 2. Subjective/Objective Assessment+ labs
  • 1. Register patients 3. Diagnosis 4. Counsel and Meds - BP/CV Guide - Flow sheet to document lifestyle and readiness to change - Rx Dx pads 2. Subjective/Objective Assessment+ labs
  • 1. Consent Date 2. Baseline info and date of visit 3. Medical Hx, Family Hx, and Physical Measures/Lab 4. Lifestyle Counseling 5. Meds 6. Plan
  •  
  • Scope
    • The diagram below illustrates the scope of the systems development initiative.
    Patient Physician Consent Examination Encounter 3. Web Data Entry 2. Fax 1. EMR Extraction Database Reports and Analysis EMR
  • Export to web based dataset Examples: - Patient Profile - % of hypertension patients with BP controlled to target Confidential Practice Audit Reports
  • RNAO-HSFO Nursing Best Practice Guideline, Nursing Management of Hypertension
  • - BpTRU - Tape Measure - CHEP Recommendations - CHEP Recommendations 1. Register patients 3. Diagnosis 4. Counsel and Meds - BP/CV Guide - Flow sheet to document lifestyle and readiness to change 5. Plan - Take The Pressure Off Book - Patient Provider Agreement - Patient Log Book - BPAP - Rx Dx pads 2. Subjective/Objective Assessment+ labs
  • Tools for Pharmacists: 1. Patient Interaction Guide 2. Reach Your Goal Fact Sheet 3. Dash Diet Fact Sheet
  • E-health Tool for Patients Blood Pressure Action Plan/Heart and Stroke Risk Assessment
  • Finding answers. For life. See what happens when you put your heart into it.