Steve Sisolak Richard Whitley Governor Director State of Nevada Department of Health and Human Services Self-Monitoring Blood Pressure Programs: Raising Patient Engagement While Lowering Blood Pressure Division of Public and Behavioral Health Lisa Sherych, Administrator October 15, 2019 Helping People. It’s who we are and what we do.
Self-Monitoring Blood Pressure Programs: Raising Patient Engagement While Lowering Blood Pressure Lisa Sheretz Policy and Health Systems Manager Chronic Disease Prevention and Health Promotion Section lsheretz@health.nv.gov 2 Helping People. It’s who we are and what we do.
Hypertension Man anagement an and Self Self- Mon onitoring Bloo lood Pressure (SM (SMBP) Ne Nevada Prog ograms Overview Results Ex Expa pansion of of Pati tient t En Engagement Resources Q & A Q 3 3 Helping People. It’s who we are and what we do.
Where are we e wit ith hypertension? • When left untreated, the damage that high blood pressure does to your circulatory system is a significant contributing factor to heart attack, stroke, and other health threats. • Cardiovascular disease (including heart disease, stroke, and other vascular diseases) is the leading cause of death in the United States and Nevada. • High blood pressure is a prevalent condition, affecting approximately 30% of the adult population. (US Preventative Taskforce, 2019) • In Nevada, the prevalence of high blood pressure is 32.7%. (2017, BRFSS) 4 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Modifiable Ca Cardiovascular Dis Disease (CV (CVD) ri risk fact ctors in incl clude: • Current cigarette smoking, secondhand smoke • Diabetes mellitus • Dyslipidemia/hypercholesterolemia • Overweight/obesity • Physical inactivity/low fitness • Unhealthy diet https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack 5 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
2017 Hig High Blo Blood Pressure Cli Clinical Practice Guideline https://youtu.be/IFqDj 3dNN7s heart.org/hbp 6 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Small ch changes can make a big ig dif ifference. • https://www.heart.org/en/healt h-topics/high-blood- pressure/high-blood-pressure- toolkit-resources 7 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Sel Self-Monitorin ring Blood Blood Pressure Impl mplementatio ion https://gethealthyclarkcounty.org /wp- content/uploads/2018/09/SMBP_ Guide-Final-PDF.pdf • Southern Nevada Health District (SNHD), in collaboration with Nevada Health Centers and the Nevada Division of Public and Behavioral Health • Eliminate health care disparities across all racial/ethnic groups. This Self-Monitoring Blood Pressure (SMBP) Program Guide for clinicians is a clinical support resource for implementation with patients at-risk for or diagnosed with hypertension . • Self-monitoring blood pressure programs help empower patients to make hypertension control a priority . 8 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
En Engagement t of of Cl Clin inical Ca Care Tea eam to to Sup Support SM SMBP • https://gethealthyclarkcounty.org/wp- content/uploads/2018/09/SMBP_Guide-Final- PDF.pdf • Develop standarized training tool • Train relevant members of the care team Care Teams • Adopt standarized treatment algorithms Support SMBP • Develop SMBP policies and procedures • Use an existing model • Establish patient/provider feedback loop Integrate • Reach out to partners with health information technology (HIT) expertise Clinical Support Systems • Emphasize the importance of blood pressure management • Select appropriate SMBP devices Empower • Check accuracy of readings patients to Use • Provide SMBP training to patients/caregivers SMBP 9 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Accu ccurate measurement is is key. • Feet flat on the floor • Quiet for 5 minutes • Empty bladder • No caffeine, exercise or smoking for 30 minutes • Remove clothing from arm • No talking during measurement • www.heart.org/- /media/files/health-topics/high- blood-pressure/tylenol- hbp/aha_toolkit_poster_final _ 10 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Hypertension Gui uideline Too oolkit for or Heal ealthcare Providers Am American Hea eart Ass Association http://aha-clinical- review.ascendeventmedia.com /books/aha-high-blood- pressure-toolkit/ 11 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
C lin linic ical l sup support fee eedback loop loop be between pa patients and and cl clin inic icians s in in SM SMBP 12 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Nevada Health Centers • The prevalence of hypertension is significantly higher in the patient population served at NVHCs (66%) when compared to the Nevada ’ s state prevalence (32.7%) (BRFSS 2017) 13 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
14 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Community Health Workers can: • Educate patients that blood pressure may be lowered and controlled by leading a heart healthy lifestyle including following a low- sodium diet, participating in physical activity, limit alcohol consumption, avoid the use of tobacco products and maintaining a healthy weight. • Assist patients with understanding the importance of their prescribed medications, maintaining schedules for taking medications, and the possible effects of other medications on their blood pressure, both over the counter and prescribed. • Encourage patients to play an active role in their health care treatment by asking providers questions, setting goals, and developing a plan to lead a heart healthy lifestyle. Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Training Outline • Lesson 1: Set up and Issue Automatic Blood Pressure Monitor • A. Set the Date and Time • B. Serial Number • C. Test against clinical monitor • Lesson 2: Criteria for Patient Enrollment/Engagement • Review previous readings • Patient Education on the Power of Lifestyle Changes • Lesson 3: Patient Instruction • A. Ways to Accurately Self-Measure Blood Pressure • B. Body positioning for measurement accuracy • C. Proper cuff placement for measurement accuracy Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Pert ertinent CDC CDC 1815 Goal oals and and Obj Objectives Ne Nevada Hea Healt lth h Cen Centers Goal 3: Promote the adoption of evidence-based quality measurement o Monitor health care disparities o Implement appropriate activities Objective 4.1: Implement and report on key quality measures and identify areas for quality improvement o High blood pressure o High cholesterol o Diabetes o Prediabetes 17 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Nevada Health Centers Pilot Program • Patients must be diagnosed with hypertension Table 1. Blood Pressure Severity Classification - ACC according to the NVHC. • Patients must be 18 to 85 years old. BP Category Systolic BP Diastolic BP • During the total 13 quarters, patients must have measured and recorded blood pressures for at least 3 Normal <120 mmHg and <80 mmHg consecutive quarters (six month between pre-test and post-test). • 120-129 If a patient had more than 3 consecutive quarters blood pressure measured and recorded, the first six Elevated mmHg and <80 mmHg months data after enrolled (referred) to the program was used for the analysis. 130-139 • Due to the nature of self-monitoring and possible errors in recording, values of systolic blood pressures Hypertension Stage 1 mmHg or 80-89 mmHg greater than 200 mmHg and less than 90 mmHg were not included. Similarly, diastolic pressures greater than Hypertension Stage 2 ≥140 mmHg or ≥90 mmHg 150 mmHg and less than 30 mmHg were not included. 2017 Report of the American College of Cardiology 18 Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.
Se Sex Di Distrib ributio tions Self-Monitoring Blood Pressure (SMBP) Program Data Analysis and Evaluation 70 CSES-UNR 2019 57.17 60 52.15 47.85 50 42.83 40 % 30 20 10 0 Control Intervention Female Male 19 Helping People. It ’ s who we are and what we do. Helping People. It’s who we are and what we do.
Ag Age e Di Distr trib ibut utio ions 60 Self-Monitoring Blood Pressure (SMBP) Program Data Analysis and Evaluation CSES-UNR 2019 48.16 46.6 50 39.08 37.86 40 30 % 20 15.53 12.76 10 0 Control Intervention age18-45 age45-59 age60-85 20 Helping People. It’s who we are and what we do. Helping People. It ’ s who we are and what we do.
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