HTN Update 2015 GREGORY A PARKIN MD INTERNAL MEDICINE - - PowerPoint PPT Presentation
HTN Update 2015 GREGORY A PARKIN MD INTERNAL MEDICINE Intermountain Hypertension Goals 140/90 ( Uncomplicated, CHF, MI, CVA, CKD without proteinuria) 2 Exceptions: Age > 80 150/90 Renal Disease 130/80
GREGORY A PARKIN MD INTERNAL MEDICINE
Intermountain Hypertension Goals
140/90
( Uncomplicated, CHF, MI, CVA, CKD without proteinuria)
§ 2 Exceptions:
§ Age > 80 150/90 § Renal Disease 130/80 § Alb/Cr ratio (ACR) > 300
§ New Change Diabetes 140/90
§ American Diabetes Association new recommendation 2015 § Same as JNC 8
§ Financial Incentives will follow JNC 8
Goal Decrease adverse events Heart attacks CHF CVA Renal Failure …and not just manage blood pressure numbers
Using your team every 2-3 weeks to follow up and to titrate medications will result in better control of blood pressure. Better BP control is associated with less MI, CVA, CHF, CKD Action Point: Discuss rapid cycling with your care manager – Get a plan.
Improved Functionality
PPC / Select Health / PCCP
u Previously there have been multiple different
reports.
u Now all combined into one single report
u New filters now available to get better lists on our
higher risk patients
Let’s explore the report 63% in control
Insurance specific BP > 10 syst / 5 diast
Patient lists with filters (over10/5) + 2 BP’s and target
Rapid Cycling – 3 week report 21%
My Rapid Cycling Report
Large Percent lacking response from me.
u A systematic approach will make it much easier. u Recommended order - u Lisinopril 10, 20 u Amlodipine 5, 10 u Add hct ( Lisinopril 20/12.5 then 2 tabs) u Coreg 6.25. 12.5, 25
u Careful not to go too low (especially the elderly)
u Use Caution for dBP < 60; Falls u Consider standing BP if making a medication change
u We encourage the use of home BP. Studies have shown
correlation of adverse events and home BP’s
u Hedis measure on HTN = Last clinic blood pressure u A NCQA measure u Insurance companies are graded by this measure for
“Quality”
u After we get their home BP controlled bring them in
and enter a controlled clinic BP
u Patients are very willing to have a care manager
recheck a clinic BP.
u New desktop Icon is coming for quick access to all the
handouts – print them off.
u New HTN clinic is starting February 2015 u Designed for those who have resistant HTN u On 3 drugs and still not controlled. u This is NOT for the non-compliant but more a resource
for us when we can’t get it controlled.
u Ambulatory blood pressures available
Kdigo
u Check Urine for protein yearly / Will need to code grade of renal insufficieny u New update - When do you refer to a nephrologist?
u Greater access to Pharmacists who follow the CPM
protocol
u They will assist in titrating patients to control and then
refer back for a clinic visit with the BP in control.
u Lowers the message logs you will get
u Talk to your manager for details
My recommendations for BUSY physicians
Action Points
u Medical Assistants: Good technique. Recheck all BP’s after 5
min if high. We are initiating more training.
u Develop a way for the MA to alert you if repeat BP’s are high u Put HTN in Problem list u Develop Rapid Cycling - talk with your care manager/
managers
u Let your team do the teaching. You are too busy. u Use your team to “scrub” the new list and treat highest risk
patients.
u Two consecutive high BP have a higher risk. u It is easier to catch it initially than after the fact