Kentucky ranks fifth in the U.S. for adults with hypertension, many of whom cannot control the condition. Untreated high blood pressure increases the risk of heart attack, stroke and other serious health problems.
THE PROBLEM
The traditional approach of seeing a patient in the office, prescribing medications, advising on lifestyle changes, having blood pressure checked at home and reporting back is falling short, says Dr. Brett A. Oliver, chief medical officer . at Baptist Health, which serves Kentucky and Indiana.
“We looked at an alternative method to improve the lives of our patients that was scalable,” Oliver explains. “The main reason for uncontrolled hypertension is lack of medication adherence.”
There could be a number of reasons for this, he added, such as cost, side effects, failure to recognize the severity of the disease, etc. “But our theory was an out-of-office reminder and simple, short educational pieces would improve adherence and ultimately better blood pressure control and better outcomes.”
Healthy lifestyle habits, such as not smoking, exercising, and eating right, can help prevent and improve high blood pressure.
“High blood pressure is sneaky,” Oliver said. “The vast majority of people with high blood pressure have no symptoms, even when blood pressure levels are dangerously high. Although hypertension can cause headaches, nosebleeds, or shortness of breath, these are nonspecific and generally do not occur until high blood pressure has reached its highest levels. a tough phase.”
Baptist Health needed ways to encourage patients to check their blood pressure regularly, even when they are feeling well.
In addition, the Centers for Medicare & Medicaid Services has selected hypertension as one of three quality measures to be submitted electronically in the future. That only reinforced the need for a strategy for the future.
PROPOSAL
Oliver and his team reasoned that they needed more patient touchpoints outside of office visits. Because such a large percentage of the population has a cell phone, the team decided to start with a technology that was readily available to most. With these additional touchpoints and reminders, Baptist Health hopes to empower patients to take charge of their blood pressure problem and become more involved in its management.
“So many people will have problems with medications, but won’t let their doctor know about changes or adjustments,” Oliver noted. ‘They wait until their next appointment, which could easily be six months later. Meanwhile, their blood pressure continues to spiral out of control and wreak silent havoc.
“While other medical specialties provide care for patients with hypertension, we have chosen to start with primary care, where the majority of patients go for the care of their hypertension,” he continued.
Epic’s MyChart Care Companion is an interactive app designed as an extension of a patient’s support system. It is very individual and user-friendly. Many Baptist Health patients were already using MyChart; Adding this functionality was a simple extension of what patients were already doing.
“The interactive care plan allows a patient to upload their blood pressure readings (manually or via BlueTooth integration with their blood pressure cuff) and data provided by questionnaires/symptom checkers,” he said. “If symptoms or blood pressure numbers warranted, messages were sent to members of the patient’s care team so patients did not have to wait until their next visit to address important issues.”
RESULTS
Baptist Health has only been live with this program for just over 90 days, so much of the follow-up is still to come.
“We can report that we have enrolled 143 patients to date,” Oliver said. “For those who complete the program, our initial data shows a 10-11 mmHg drop in systolic pressure and a 3-4 mmHg drop in diastolic pressure. That would be similar to adding a new drug to a patient’s regimen.
“Our team knows that without this technology, along with the ability to provide a blood pressure cuff for some, we would not see this improvement,” he continued. “We have years of data supporting the challenge of uncontrolled hypertension.”
USE OF GRANT FUNDS
Baptist Health received a grant from the American Heart Association for this program.
“The grant opportunity was a specific opportunity to improve the health of McCracken County, Kentucky,” said Jordan Ellis, director of operations for value-based care at Baptist Health. “The Baptist Health Foundation has received $87,200 in grants to support this project.
“85% of the grant funding was used to complete construction of the Epic MyChart Care Companion application (specific to hypertension) so that patients could upload their self-reported blood pressure measurements to their electronic health record,” he continued. “The remaining 15% of the grant funding was used to provide blood pressure equipment for patients.”
Initial findings are that the grant-funded blood pressure equipment is very important to support the necessary IT construction. The ability to provide a patient with a blood pressure machine accelerated the project because the provider knows a blood pressure machine is available, Ellis concluded.
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