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2021 Texas Hypertension Control Summit Series
Session 1 of 4Starting and Growing Self-Measured Blood Pressure (SMBP) Programs
Tuesday, August 17, 2021 – 12pm - 1:30pm
Alison P. Smith, MPH, BA, BSN, RNEmceeProgram Director, Target: BP®
American Heart AssociationAmerican Medical Association
12:00 PM | Welcome & Introduction
12:30 PM | Self-Measured Blood Pressure (SMBP) Monitoring Across Texas
1:00 PM | Panel Q&A
1:20 PM | Call to Action: Optimize Patient Care for Hypertension Control: Empower and equip patients to use self-measured blood pressure monitoring and medication adherence strategies
1:30 PM | Closing
2021 Texas Hypertension Control Summit Series: Session 1 Overview
Eduardo Sanchez, MD, MPH, FAAFPChief Medical Officer for Prevention, American Heart Association
Rank Cause Number Percent
Total – all causes 2,854,838 100%
1 Heart diseases 659,041 23.1%
2 Cancer 599,601 21.0%
3 Accidents 173,040 6.1%
4 Chronic lower resp. disease 156,979 5.5%
5 Stroke 150,005 5.3%
6 Alzheimer’s disease 121,499 4.3%
7 Diabetes mellitus 87,647 3.1%
8 Kidney disease 51,565 1.8%
9 Influenza/pneumonia 49,783 1.7%
10 Intentional self harm (Suicide) 47,511 1.7%
Causes of Death: USA (2019)
Source: Kochanek KD, Xu JQ, Arias E. Mortality in the United States, 2019. NCHS Data Brief, no 395. Hyattsville, MD: National Center for Health Statistics. 2020.
People of any age with certain underlying conditions are at increased risk of severe COVID-19• Chronic kidney disease
• COPD
• Immunocompromised from solid organ transplant
• Obesity (BMI ≥ 30)
• Serious heart conditions (HF, CAD, cardiomyopathies)
• Sickle cell disease
• Type 2 DM
COVID-19
cdc.gov; accessed 7/14/2020
People with the following conditions might be at increased risk of severe COVID-19• Asthma
• Cardiovascular disease
• Cystic fibrosis
• Hypertension
• Other Immunocompromising conditions (including HIV or use of corticosteroids)
• Neurologic conditions
• Liver disease
• Pregnancy
• Pulmonary fibrosis
• Smoking
• Thalassemia
• Type 1 DM
COVID-19
cdc.gov; accessed 7/14/2020
Rank Cause Number Percent
Total – all causes 3,358,814 100%
1 Heart diseases 690,882 20.6%
2 Cancer 598,932 17.8%
3 COVID-19 345,323 10.3%
4 Unintentional injury 192,176 5.7%
5 Stroke 159,050 4.7%
6 Chronic lower resp. disease 151,637 4.5%
7 Alzheimer’s disease 133,382 4.0%
8 Diabetes mellitus 101,106 3.0%
9 Kidney disease 53,495 1.6%
10 Influenza/pneumonia 52,260 1.6%
Causes of Death: USA (2020) Provisional
Source: Ahmad, MMWR, Vol 70, #14, 2021; cdc.gov/nchs/deaths .
COVID-19 Mortality
Compared to Whites, the age-adjusted COVID-19 mortality rate for:
• Blacks is 3.8 times as high
• Indigenous people is 3.2 times as high
• Pacific Islanders is 2.6 times as high
• Latinos is 2.5 times as high
• Asians is 1.5 times as high.
COVID-19 and Disproportionality
https://www.apmresearchlab.org/covid/deaths-by-race; accessed 7/14/2020
Population Attributable Fraction (PAF)
Hypertension - Leading Risk Factor for CVD
10
Rank Risk Factor PAF (95% CI)
1 Hypertension 22.3% (17.4-27.2)
2 High non-HDL cholesterol 8.1% (3.1-13.2)
3 Household air pollution 6.9% (4.7-9.1)
4 Tobacco use 6.1% (4.5-7.6)
5 Poor diet 6.2% (2.8-9.5)
6 Low education 5.8% (2.8-8.8)
7 Abdominal obesity 5.7% (1.7-9.8)
8 Diabetes 5.1% (2.9-7.4)
9 Low grip strength 3.3% (0.9-5.7)
10 Low physical activity 1.5% (0.3-2.7)
Source: Yusuf et al., Lancet, 2020
STATEWIDE GOAL: Achieve >70 percent hypertension control across Texas by 2024.
TEXAS HYPERTENSION CONTROL SUMMIT GOAL: Bring together national hypertension control experts and leaders from across Texas to strategize next steps for collectively driving towards further improvement in blood pressure (BP) control across the state.
SESSION 1 OBJECTIVE: Provide resources and examples for starting or growing a self-measured blood pressure (SMBP) monitoring program.
TEXAS HYPERTENSION CONTROL MOVEMENT
TEXAS HYPERTENSION CONTROL MOVEMENT
GOAL: Achieve >70 percent hypertension control across Texas by 2024.
Statewide Movement Launch at 2018 Summit
Grow impact of regional collaboratives
2021 Summit and Collective ProgressEstablish regional
collaboratives, resources, and sharing capacity. Host 2019 Summit
13
Regional Collaboratives
Houston – Southeast Texas Region – PHR 6Lubbock – Panhandle Region – PHR 1, 2Dallas/Fort Worth – North Texas Region – PHR 2, 3Tyler – East Texas Region – PHR 4 & 5Austin – Central Texas Region – PHR 7San Antonio - South Central Texas Region – PHR 8/11Corpus Christi – South Gulf Texas Region – PHR 8/11Rio Grande Valley – South Texas Region – PHR 11El-Paso/Permian Basin – West Texas Region – PHR 9 & 10
TEXAS HYPERTENSION CONTROL MOVEMENT
GOAL: Achieve >70 percent hypertension control across Texas by 2024.
TARGET BP 2021 RECOGNITION DATA
BenchmarkTotal Adult Population
Performance Rate
All Healthcare Organizations 29,241,387 66.6%
Texas 2,814,852 70.8%
Central Texas Regional Collaborative 209,187 73.7%
Corpus Christi Regional Collaborative 17,350 50.9%
East Texas Regional Collaborative* 16,383 50.7%
El Paso Regional Collaborative 9,825 40.7%
Greater Houston Regional Collaborative 1,135,096 63.8%
North Texas Regional Collaborative 1,312,827 77.3%
Rio Grande Valley Regional Collaborative 39,011 62.9%
San Antonio Regional Collaborative 31,115 53.3%
*2019 data
GOAL: Achieve >70 percent hypertension control across Texas by 2024.
TARGET BP RECOGNITION DATA TRENDS - TEXAS
*Data collected in 2020
GOAL: Achieve >70 percent hypertension control across Texas by 2024.
Michael Rakotz, MD, FAHA, FAAFPVice President Health Outcomes &Clinical Lead of Target: BP®
American Medical Association
© 2021 American Medical Association. All rights reserved.
Kevin McKinney, MDMember since 1989
SMBP: What’s New in 2021
Michael Rakotz, MD FAHA FAAFPVice President, Health OutcomesAmerican Medical Association
17
© 2021 American Medical Association. All rights reserved.
Disclosures
No Relevant Financial Conflicts:Relevant to the content of this activity, I do not have any financial conflicts with commercial interest companies to disclose.
18
© 2021 American Medical Association. All rights reserved.
Agenda
19
• Trends in use of SMBP pre-pandemic• The impact of COVID-19 on assessment of BP in primary care • Challenges encountered in the remote management of high BP • Strategies to enhance management of high BP using self-measured BP
(SMBP) monitoring
© 2021 American Medical Association. All rights reserved.
Out-of-office BP measurement in 2019 (pre-pandemic)
20
Fang J, Luncheon C, Wall HK, Wozniak G, Loustalot F. Self-measured blood pressure monitoring among adults with self-reported hypertension in 20 US states and the District of Columbia, 2019. Am J Hypertens. 2021 Jun 7:hpab091. doi: 10.1093/ajh/hpab091. Epub ahead of print. PMID: 34097724.
© 2021 American Medical Association. All rights reserved.
SMBP at home in 2019 (pre-pandemic)
21
Fang J, Luncheon C, Wall HK, Wozniak G, Loustalot F. Self-measured blood pressure monitoring among adults with self-reported hypertension in 20 US states and the District of Columbia, 2019. Am J Hypertens. 2021 Jun 7:hpab091. doi: 10.1093/ajh/hpab091. Epub ahead of print. PMID: 34097724.
Shared BP readingswith healthcare professional
- via telephone 5% - in-person 74%
© 2021 American Medical Association. All rights reserved.
COVID-19 Pandemic Impact on assessment of BP in primary carein Q2 2020 (compared with Q2 2018 and 2019)
© 2020 American Medical Association. All rights reserved. | 22
Office-based visits - decreased by 59.1 million visits
(50.2%)- BP assessment occurred at 70%
of office visits
Telemedicine visits - increased from 1.4 million to 35
million (35.3% of all visits)- BP assessment occurred at <10%
of telemedicine visits
Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS. Use and Content of Primary Care Office-Based vs Telemedicine Care VisitsDuring the COVID-19 Pandemic in the US. JAMA Netw Open. 2020;3(10):e2021476. doi:10.1001/jamanetworkopen.2020.21476
© 2021 American Medical Association. All rights reserved.
1. Identify people for targeted of SMBP
2. Confirm device validation, cuff sizes needed, and device distribution (if supplying)
3. Provide education and training to patients to accurately measure their BP taking into consideration culture, language and literacy
4. Recommend an evidence-based measurement protocol and detailed plan to relay results
5. Create a process to receive and average SMBP results
6. Interpret results
7. Create a shared treatment plan and document in EHR / communicate to patients
7 Steps for using SMBP to lower BP
23
www.ama-assn.org/smbp-guide
© 2021 American Medical Association. All rights reserved.
Challenges to successful use of SMBP
24
Challenges for Health systems/Health Centers• Procuring validated devices with multiple cuff sizes• Systems to transfer/receive SMBP data• Support for cointerventions• Financial incentives
Challenges for providers and clinical care teams• Inaccuracy of devices• Workload (training patients, averaging results)• Lack of reimbursement for devices purchased /
services
Challenges for people using SMBP• Lack of understanding of benefits / language in tools• Measurement frequency• Out of pocket costs and transportation• Access to and use of technology / sharing results
© 2021 American Medical Association. All rights reserved.
3 critical considerations for SMBP to be effective in the diagnosis and management of hypertension
25
1. Use of a validated BPmeasurement device
2. Guideline-driven patienteducation/user instructions
3. Access and use of SMBPdata
© 2021 American Medical Association. All rights reserved.
1. Use of a validated BP measurement device
26
www.validatebp.org/
© 2021 American Medical Association. All rights reserved.
2. Guideline-driven patient education/user instructions
27
Target: BP’s SMBP resources:https://targetbp.org/tools-
downloads/?keyword=smbp&sort=topic&
Release the Pressure resources:https://releasethepressure.org/
© 2021 American Medical Association. All rights reserved.
3. Access and use of SMBP data
28
SMBP data capture- Stored in device memory- Transmitted to mobile
application, portal or provider- Paper log
Share/relay results to care team- Verbally- EHR or web-based portal- Viewing device storage- Secure email or SMS - Direct cellular transmission
Interpreting resultsDocumenting &
communicating a treatment plan
Ingesting SMBP results- Who receives SMBP data- Averaging SMBP results - Documenting SMBP results- Getting data to provider,
team-based approach/protocol
© 2021 American Medical Association. All rights reserved.
SMBP Challenges Potential solutions
29
• Device procurement plan• Digital health/EHR integration plans• Efficient workflows / Case management / Team-based
approach• SMBP coverage for related services• Controlling High BP Quality Measures allowing SMBP
• Validated BP device list• Tools/resources for training and education, protocols
for team-based approaches -CHW assisted and Pharmacist/RN-driven programs
• Device coverage• CPT code reimbursement / ROI demonstration
• Culturally appropriate educational materials explaining benefits, accounting for health literacy level
• Evidence-based protocols• Device coverage• Free or low-cost access to Cellular/WiFi/Data plans • Easy to use digital devices / mobile apps / portals
Challenges for Health Systems / Health Centers• Procuring validated devices with multiple cuff sizes• Systems to transfer/receive SMBP data• Support for cointerventions• Financial incentives
Challenges for people using SMBP• Lack of understanding of benefits • Measurement frequency• Out of pocket costs and transportation• Access to and use of technology / sharing results
Challenges for providers and clinical care teams• Inaccuracy of devices• Workload (training patients, averaging results)• Lack of reimbursement for devices purchased /
services
© 2021 American Medical Association. All rights reserved.
CPT® Codes for SMBP–99473, 99474
30
99473 - SMBP using a device validated for clinical
accuracy; patient education/training and device
calibration
99474 - SMBP using a device validated for clinical
accuracy; separate self-measurements of two readings,
one minute apart, twice daily over a 30-day period
(minimum of 12 readings), collection of data reported by
the patient and/or caregiver to the physician or other
qualified health care professional, with report of average
systolic and diastolic pressures and subsequent
communication of a treatment plan to the patient
Controlling High BP Quality Measures Allow patient reported BPsCMS 165v10 / UDS 2022HEDIS 2021MIPS 236 2021
Requires transmission of SMBP resultsNQF 0018 TBD – annual update in-progress
Timika SimmonsChief Executive Officer
TOMAGWA Healthcare Ministries
Diana GayleDirector of Nursing
TOMAGWA Healthcare Ministries
2021 Texas Hypertension SummitTimika Simmons, Chief Executive Officer
Diana Gayle, Director of Nursing
Providing Care, Offering Hope, Restoring Dignity
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
TOMAGWA Healthcare Ministries
Mission
• To provide quality health care, offer hope, and restore dignity to vulnerable populations living in northwest Harris, Montgomery, and Waller counties
Providing Care, Offering Hope, Restoring Dignity
2020 Gold Level Recognition
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
TOMAGWA Healthcare MinistriesCommunity Clinic
• Teaching Christian-based organization
• Provide access to residents in northwest Harris, Montgomery, and Waller counties
• Serves patients who are uninsured and have an income of 200% or less of the federal poverty level
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
TOMAGWA Healthcare MinistriesService Lines
• Family Medicine
• Lab
• Pharmacy
• Dental
• Optometry
• Diagnostics
• Case Management
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
TOMAGWA Healthcare MinistriesPartners
• Teaching facility with multiple academic partners
• Significant volunteer involvement
• Support from various hospitals and organizations
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
TOMAGWA Healthcare MinistriesSelf Monitoring Blood Pressure Program
Purpose:
• Provide patients diagnosed with hypertension with a blood pressure machine for home use to be able to track and manage their blood pressure
Workgroup:
• Executive Sponsor: Timika Simmons, CEO
• Medical Director: Dr. Linda Flower
• Team members: Clinical staff including nurse practitioners and nursing
• Extended team members: Patient access and scheduling staff
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
Self Monitoring Blood Pressure (SMBP) ProgramBackground
• Hypertension management in TOMAGWA patients with new diagnosis, complex management due to multiple comorbidities, and dental patients whose services were limited due to uncontrolled hypertension
• American College of Cardiology (ACC) and American Heart Association’s(AHA) hypertension guidelines recommends a target blood pressure of 130/80mmHg and 140/90mmHg for Stage 2 hypertension
• In 2020, 65% of TOMAGWA patients had blood pressure control <140/90mmHg, and 39% with blood pressure control <130/80
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
Self Monitoring Blood Pressure (SMBP) ProgramWorkflow
Patient Identification
Consult Visit Patient Education Follow Up Visits Inventory management
❑ Diagnosed with hypertension
❑ Compliant for at least one year
❑ Complex diagnosis
❑ Discuss blood pressure monitoring
❑ Discuss blood pressure trends
❑ Develop care plan
❑ Bilingual education pamphlets availability (Target: BP)
(How to: measure your blood pressure; self monitor blood pressure instruction sheet)
❑ 3-month loaner program agreement (Target: BP)
❑ Follow up monthly to review BP log
❑ Patient portal access for electronic two-way communication
❑ Loaner device tracking sheet (Target: BP)
❑ Access to new patients
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
Self Monitoring Blood Pressure (SMBP) ProgramPDSA Cycles
• PDSA Cycle #1:• Created and implemented policy and procedures
• PDSA Cycle #2:• Modified patient education on how to take blood pressure at home for obese patients
• Adjusted follow up visits from provider to nurse’s visit to review blood pressure log
• PDSA Cycle #3:• Adjusted process of calling patients at their 3-month trial to assure return of blood pressure
machines and continuation of blood pressure management
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
68%70%
51%
63% 62%60% 60%
79%
69%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
October 2020(n=104)
November(n=57)
December(n=57)
January 2021(n=41)
February(n=29)
March(n=44)
April(n=45)
May(n=42)
June(n=36)
Blood Pressure Percent Satisfied (<140/90 mmHg)October 2020 – June 2021
Goal = 60%
Self Monitoring Blood Pressure (SMBP) ProgramOutcomes
2021 Texas Hypertension Summit – August 2021
Start of SMBP
© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Self Monitoring Blood Pressure (SMBP) ProgramOutcomes
65%62%
69%
36% 38%35%
20%
30%
40%
50%
60%
70%
80%
2020 Q4(n=218)
2021 Q1(n=114)
2021 Q2(n=123)
Blood Pressure Percentage Satisfied2020 Q4 - 2021 Q2
<=140/90 mmHg <=130/80 mmHg
Providing Care, Offering Hope, Restoring Dignity
• Identified specific barriers in patients understanding on how to document blood pressure readings (reading level and comprehension)
• Identified specific barriers to patients' compliance on follow up visits (transportation, work schedules, medication adherence/lifestyle changes)
• Recognized difficulty obtaining blood pressure machines back
Self Monitoring Blood Pressure (SMBP) ProgramDiscussion
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
Providing Care, Offering Hope, Restoring Dignity
• Standardize face-to-face patient education to review how to obtain blood pressure and document readings
• Acquire larger size cuffs for obese patients
• Acquire additional blood pressure machines for patients to keep and continue blood pressure monitoring at home
Self Monitoring Blood Pressure (SMBP) ProgramRecommendations
2021 Texas Hypertension Summit – August 2021© 2021 CONFIDENTIAL. Contains proprietary information not intended for external distribution
TOMAGWA Healthcare Ministries
Providing Care. Offering Hope. Restoring Dignity.
Lydia Best, MDMedical Director
Baylor Scott and White Health and Wellness Center
EMPOWERING UNDER PRESSUREA Self-Monitored Blood Pressure (SMBP) Program
Tuesday, August 17, 202112:00pm-1:30pm
Lydia R. Best, MDMedical Director
HypertensionSelf-Care Program Evaluation
2019 STANDARDS OF CARE:
➢ Written prescriptions for low-cost ($10) blood pressure monitors
➢ Printed instructions on how to self-monitor
➢ PRN pharmacy technician training on self- monitoring
2020 CHALLENGES TO REMOTE CARE:
❑ How to distribute BP monitors to offsite patients
❑ How to train patients in self-monitoring
❑ How to obtain and document BP logs
❑ How to continue self-monitoring, regardless of clinic access
Collaborative team input
Assessment of inventory
Gap analysis
Rapid cycling
Redesign approach
The Goals of the SMBP Program
Access Education AffordabilityUser
friendly
Data retrieval
Data inputRapid cycling
Follow up
Resources and Challenges
Challenges
Uninsured rate
Multiple languages
High disease burden
Internet access and comfort
EMR Patient portal use and access
New challenges
Fear
Essential workers
Transportation
Lack of virtual experience and bandwidth
Ambulatory monitors and education
Existing resources
Integrated Care Team
Low-cost monitors
EMR
Low-cost meds
Untapped resources
Circular drive
Grants
Administrative Support
Program
Access• Distribution of free or
low-cost blood pressure monitors
Education• Pharm Tech or MA
Education on SMBP
• CHW Education on use of digital platforms for care
Assess• CHW and MA Registry
reviews and calls to patients overdue for care
• MA face-to-face blood pressure checks
Management• Chronic medication
management with Pharm D
• PCP virtual visits
Medication• Pharmacist titration
• Pharm Tech adherence calls
Data Input and Retrieval• EMR tracking of blood
pressure control
Rapid Cycling• Learning curve
• All out of comfort zone
• Self-assigned CHW solution
• Reopening plan and pivot
Donor Support• Pharmacy program
• COVID grant
• American Heart Association
Blood Pressure Meters Resources
Community Pharmacy Program
HWC COVID Grant funding
American Heart Association
33 cuffs 20 cuffs 36 cuffs
✓ Unlimited $10 Pharmacy Meters
✓ Free(donated) Meters
Demographics and outcomes
Interventions
4.3 visits per patient
A HIGH PERCENTAGE OF PATIENTS USED THE SMBP DEVICE
61% of all patients with HTN68% of those with uncontrolled HTN
OF THE PATIENTS WITH UNCONTROLLED HTN:
Our data showed a more aggressive response to care61% had an intervention -most often with a pharmacist
USE OF PATIENT PORTALS INCREASED FROM 31% in 2019 to 59% 2020-2021
Access to portal impacted
virtual visits (65% v 41%)
Access to the portal did not impact outcomes
Conclusions
Opportunities
57
Looking to the Future
Video education on:1. Virtual visit login
2. Blood pressure monitoring
Tracking distribution and self-monitoring
Correlating self-monitoring and clinical support with outcomes (control of BP)
Thank You
59
Heather Esquivel, MDChief Medical Officer
Mission East Dallas Family Health Clinic
BUILDING A SELF MEASURED BLOOD PRESSURE
MONITORING PROGRAMDr. Heather Esquivel
Chief Medical Officer
Mission East Dallas Family Health Clinic
STEP 1: EDUCATE AND TRAIN STAFF APPROPRIATELY
• MED has adopted AMA guidelines for clinical staff to follow:• Evidence-based guidelines for the diagnosis and treatment of Hypertension • Clinical protocol for the procedure of blood pressure measurement
• Focus on:• Positioning of the patient• Appropriate resting time• Removing physical barriers on the arm• Choosing appropriate cuff size• Appropriate cuff placement
• Reviewed at orientation and annually with all clinical support staff• Passing a skills observation exam is required for credentialing and
privileging at the time of hire and annually.
STEP 2: TEACH PATIENTS HOW TO SELF-MONITOR
• MED utilizes the patient visit itself to educate the patient.• Using the AHA protocol and handouts, team members talk through the procedure of BP
measurement during the triage process.• Review possible triggers for elevated readings and advise patients to avoid such
circumstances when planning to check their BP (such as not smoking, exercising or drinking alcohol just prior to a BP check).
• We encourage patients to bring their home BP monitors to their visits • Provides the opportunity to check the accuracy of their equipment and review proper
technique.• Results are documented in the patient chart for future reference.
STEP 3: PROVIDE SELF-MONITORING TOOLS & RESOURCES
• Provide reminders for proper BP monitoring technique.• Provide BP logs with normal ranges listed.• Review DASH diet and provide handouts for guidance to make other lifestyle
changes.• Order home monitors or ambulatory monitoring, when appropriate
• MED works with Veritas Home Health for remote patient monitoring services.
STEP 4: FOLLOW UP WITH THE PATIENT
• Stress routine follow-up with the PCP• Q6 months for controlled patients• Q3 months for pre-HTN range patients• Q1-2 months for uncontrolled patients
• Chronic disease reminder system is in place to send audio and text reminders to patients that have not kept follow-up.
• Utilize health care team members to educate and monitor in between PCP visits• MED created the opportunity for patients to return for free MA visits to re-check BP after
medication adjustment.• RN Care Manager conducts virtual and in-person visits with high-risk and complex patients as
frequently as q2-4 weeks.• These contacts allow further opportunity for education and reinforcement of healthy
behaviors, as well as preventing treatment inertia.
• Encourage patients to share BP logs • At visits or by dropping off logs or emailing logs in between visits.
STEP 5: CONSIDER BARRIERS TO SUCCESS
MED patients often struggle with health equity concerns that may be a barrier to blood pressure control.
• Transportation• BP log can be sent in via email or by review with provider during a virtual visit.• We offer assistance with rides to the clinic (DART passes and Lyft rides).
• Financial Limitations• If cost is prohibitive for home BP monitors, we suggest using a machine at a local
drugstore or even a local fire department.• Know where patients can find low cost or free monitors (discounted retailers, church
groups, health fairs).• Low Educational Level/Low Health Literacy
• Consider patient’s reading and comprehension skills • Adjust discussion and educational materials accordingly
• May have to combat poor knowledge or myths about blood pressure control• “I feel fine, so my blood pressure must be normal.”• “All my family has this problem, so its normal for us.”• “My numbers are always high, so that’s normal for me.”
STEP 5: CONSIDER BARRIERS TO SUCCESS
• Culture and Language• Ensure materials are language appropriate and communicate in patient’s native language as
much as possible (language line, bi-lingual staff). • Many cultures highly value the role of other family members in their care—consider recruiting
them onto the care team, so they can offer support and encouragement at home.• Involve them in visits, either in-person or virtually (video or phone)
MED is expanding our efforts at identifying the Social Determinants of Health that may be impacting our patient’s efforts at successful health outcomes.
• A Medical Social Worker position has been added to complete SDOH assessments that will be incorporated into the EMR
• Resource coordination will be initiated by SW• Will allow all team members to be kept abreast of barriers
Panel Q&A
Emran Rouf, MD, MBA, FACPChair of Texas CVD and Stroke Partnership
Texas Cardiovascular Disease and Stroke Partnership
Chair - Emran Rouf, MD, MBA, FACP
Purpose:
The Texas Cardiovascular Disease and Stroke Partnership is a network of individuals and organizations with a shared vision of reducing the burden of heart disease and stroke in Texas. The Partnership's aim is to assess the burden of disease in Texas, align activities with Texas Heart Disease and Stroke Program and Texas Council on Cardiovascular Disease and Stroke, and collaborate with partners from across the state to implement the goals and objectives of the Public Health Strategies for Addressing Heart Disease and Stroke in Texas, 2019-2023.
• Texas Hypertension Conference - 2017; Texas Hypertension Control Summit in partnership with AHA in 2018
• Texas Check Your Blood Pressure Week 2018-2019 (2020/2021 cancelled due to pandemic) an initiative to raise awareness of hypertension and provide educational resources for organizations
• Social media posts; BP screening events here at DSHS/ HHSC; Members organized events at their locations to offer BP screenings
• In 2017-2019, served as the steering committee for Public Health Strategies for Addressing Heart Disease and Stroke in Texas, 2019-2023, in partnership with the Texas Council on Cardiovascular Disease and Stroke.
Partnership Activities
Current Focus: • Control of CVD and stroke during antepartum and postpartum period • Best practices on home BP monitoring
More information on Partnership:• https://www.dshs.texas.gov/heart/partnerships.aspx
Interested in joining:• Dr. Emran Rouf, MD, MBA, FACP - Chair
• Melissa Lamberton, Community Engagement Specialist - DSHS• [email protected]
Texas Cardiovascular Disease and Stroke PartnershipJoin Us!
Nancy Eichner, MUPTexas Department of State Health Services, Heart Disease and Stroke Program Coordinator and Team Lead
Texas Hypertension Control Learning Collaborative
Purpose: To help primary health clinics improve hypertension control rates through the adoption and implementation of self-measured blood pressure (SMBP) monitoring policies and protocols.
Project Components:• Three webinars on evidence-based strategies on developing and implementing SMBP policies and protocols.• Support in developing or enhancing SMBP policies and procedures through technical assistance and sharing resources.
Key Information:• Application process is opening again soon.• Must be a primary health care clinic• Award amount: Up to $3,500• More information: dshs.Texas.gov/heart
Sponsoring Organizations: American Heart Association and Texas Department of State Health Services
Surgeon General’s Call to Action
Goal 3: Optimize Patient Care for Hypertension Control
Strategy C. Empower and equip patients to use self-
measured blood pressure monitoring and medication
adherence strategies.
Texas Hypertension Control Summit Series
1. Please provide feedback on today’s session: Session 1 Survey
2. For More on SMBP and Other Evidenced Based Hypertension Control Strategies: TargetBP.org
• SMBP Quick Start Guide
• https://targetbp.org/tools_downloads/smbp-quick-start-guide/
1. Heart Disease and Stroke Program Website https://www.dshs.texas.gov/heart/resources.aspx
• High Blood Pressure Brochure
• Understanding Blood Pressure. A handy guide to understanding what blood pressure is, how it
affects you, and how to measure it at home.• My Blood Pressure Passport
2. To join a regional collaborative or find your local AHA staff, contact Kassandra Hunt:
Texas Hypertension Control Summit Series
Register for all remaining sessions today!
Recordings and slides will be posted here after each session.
Tuesday, September 21 – Hypertension Control and Social Determinants of Health
Tuesday, October 19 – Hypertension Control Through the Pandemic
Tuesday, November 9 – Celebrate Success: Target: BP Awards and Latest Science
Each session takes place from 12:00 to 1:30pm CT
Thank you, Planning Committee!
American Heart AssociationCatalina Berry, Stephanie Chapman, Jenny Eyer, Emily Gordon, Katharine Guerra, Kassandra Hunt, Lharissa Jacobs, Bry Mabry, Eva Olivas, Melina Quintanilla, Veronica Sanchez, Alison Smith (AMA/AHA), Takiyah Wilson, Emily Zhang
American Medical AssociationSinead Forkan-Kelly, Katelyn Dean, Alison Smith (AMA/AHA), & Lauren Barbian
Texas Cardiovascular Disease and Stroke PartnershipDr. Emran Rouf – Chair & Leon Jerrels – Immediate Past Chair
Texas Department of State Health ServicesNancy Eichner, Cymphoni Campbell, Nicolas Lopez, & Melissa Lamberton
Thank you!
Music: Happy from Spotify