Hbp Stategy Hypertension Management Initiative Feb07

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  • Hbp Stategy Hypertension Management Initiative Feb07

    1. 1. Heart & Stroke High Blood Pressure Strategy: Hypertension Management Initiative Margaret Moy Lum-Kwong [email_address] February 2007
    2. 2. An urgent and important issue for the health of Canadians <ul><li>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. </li></ul><ul><li>High blood pressure is the number one modifiable risk factor for stroke and affects nearly 22% (about five million) of adult Canadians. </li></ul><ul><li>According to the World Health Organization, hypertension contributes to about half of all cardiovascular disease. </li></ul>
    3. 3. An urgent and important issue for the health of Canadians <ul><li>Among those afflicted with hypertension, the statistics are alarming: </li></ul><ul><ul><li>16% are treated and controlled </li></ul></ul><ul><ul><li>23% are treated and not controlled </li></ul></ul><ul><ul><li>19% are not treated and therefore not controlled </li></ul></ul><ul><ul><li>A staggering 42% of those with hypertension are unaware of their condition </li></ul></ul><ul><li>Source: Canadian Heart Health Surveys 1986- 1992 </li></ul>
    4. 4. 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  
    5. 5. 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.”
    6. 6. <ul><li>To pave the way towards optimal blood pressure management that will result in a dramatic improvement in the future health of Canadians. </li></ul>Our Vision
    7. 7. 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
    8. 8. 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
    9. 9. What Success Looks Like <ul><li>Impact on mission! </li></ul><ul><li>Improved HBP management practices among participating primary health care providers </li></ul><ul><li>Improved patient adherence with pharmacologic and non-pharmacologic therapies in affected patients at participating sites </li></ul><ul><li>Improved BP readings in affected patients at participating sites </li></ul><ul><li>New understandings in 2 emerging HPB issues </li></ul><ul><li>Updated data on the prevalence of hypertension in Ontario, with the first ever data on key ethnic groups in Ontario </li></ul>
    10. 10. Heart & Stroke Hypertension Management Initiative
    11. 11. Key Elements of the Hypertension Management Initiative <ul><li>interactive, inter-professional education workshops, reflective exercises </li></ul><ul><li>practice outreach and support to healthcare providers to support and assist in the integration of the tools and interventions in their practices </li></ul><ul><li>inter-professional, evidence-informed healthcare provider toolkit that incorporates clinical reminders and prompts and practice audit feedback and aids inter-professional communication </li></ul><ul><li>evidence-informed, leading edge patient toolkit that provides information and education and supports patient self-management. </li></ul>
    12. 12. Alpha Phase <ul><li>Objective: develop, test and refine a toolkit aimed at improving hypertension management and control using the Quality Improvement methodology (PDSA) </li></ul><ul><li>June 2005 to June 2006 </li></ul><ul><li>3 Pilot Sites: 20 MDs, 3 Nurses, 31 Community Pharmacists </li></ul><ul><ul><li>Kingston - Family Health Network (3 office locations) </li></ul></ul><ul><ul><li>Toronto - Health Services Organization (1 office location) </li></ul></ul><ul><ul><li>Huntsville - Family Health Network (1 office location) </li></ul></ul>
    13. 14. Alpha Evaluation Components – Chart Reviews <ul><li>Chart Reviews for Participating Physicians </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>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). </li></ul></ul><ul><ul><li>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. </li></ul></ul>
    14. 15. Results <ul><li>Significant increase in screening: </li></ul><ul><ul><li>BP measured documented in twice as many visits during program period (45.7%) vs. pre-program period (27.8%). </li></ul></ul><ul><li>Significant increase in patients diagnosed with HTN: </li></ul><ul><ul><li>Newly diagnosed patients twice as high in program period (11%) vs. pre-program period (4.8%) </li></ul></ul><ul><li>Directional increase in patients with HTN controlled to target: </li></ul><ul><ul><li>In non-diabetic HTN patients, 31% controlled in program period vs. 25% in pre-program period </li></ul></ul><ul><ul><li>In diabetic HTN patients, 58% controlled in program period vs. 46% in pre-program period </li></ul></ul>
    15. 16. Results cont’d <ul><li>Significant decrease in elapsed time from diagnosis to target BP: </li></ul><ul><ul><li>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 </li></ul></ul><ul><li>Significant decrease in elapsed time from 1 st elevated BP reading to follow up visit: </li></ul><ul><ul><li>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 </li></ul></ul>
    16. 17. Results cont’d <ul><li>92% of physicians & pharmacists rated Strategy as somewhat/very effective in helping them manage patients with HTN overall </li></ul><ul><ul><li>Perceived to be most effective in promoting communication with patients, counseling patients re. lifestyle issues, diagnosing HTN (physicians) </li></ul></ul><ul><li>83% of physicians & 92% of pharmacists agreed strongly/somewhat that participation in Strategy had positive impact on knowledge re. management of patients with HTN </li></ul>
    17. 18. Results cont’d <ul><li>100% of physicians & 84% of pharmacists agreed strongly/somewhat that participation in Strategy had positive impact on management of patients with HTN </li></ul><ul><li>Significant increase in physicians’ familiarity with CHEP Recommendations (62% pre vs. 92% post) </li></ul><ul><li>84% of physicians & 60% of pharmacists indicated they were spending more time speaking with patients about lifestyle issues </li></ul>
    18. 19. Beta Sites
    19. 22. 1. Register patients 3. Diagnosis - BpTRU - Waist Circumference Tape Measure - CHEP Recommendations - CHEP Recommendations 2. Subjective/Objective Assessment+ labs
    20. 23. 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
    21. 24. 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
    22. 26. Scope <ul><li>The diagram below illustrates the scope of the systems development initiative. </li></ul>Patient Physician Consent Examination Encounter 3. Web Data Entry 2. Fax 1. EMR Extraction Database Reports and Analysis EMR
    23. 27. Export to web based dataset Examples: - Patient Profile - % of hypertension patients with BP controlled to target Confidential Practice Audit Reports
    24. 28. RNAO-HSFO Nursing Best Practice Guideline, Nursing Management of Hypertension
    25. 29. - 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
    26. 30. Tools for Pharmacists: 1. Patient Interaction Guide 2. Reach Your Goal Fact Sheet 3. Dash Diet Fact Sheet
    27. 31. E-health Tool for Patients Blood Pressure Action Plan/Heart and Stroke Risk Assessment
    28. 32. Finding answers. For life. See what happens when you put your heart into it.

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