How to help patients manage blood pressure outside office visits


In a perfect world, every physician would have ample time to dedicate to each patient—but in reality, sometimes patients’ regular office visits just aren’t long enough, or frequent enough. One physician has found how to get patients the extra help they need managing their high blood pressure, both while they’re in the office and through community resources.

“An office visit is never just about blood pressure,” said Willarda Edwards, MD, an internist in Baltimore. “It’s more than just talking about their medication. It’s about lifestyle changes, the complications that come with living day to day, family, stress.”

Dr. Edwards is participating in a pilot program to improve outcomes around hypertension, which is part of the AMA’s Improving Health Outcomes initiative. In this program, physicians and care teams in Maryland and Illinois are developing and testing evidence-based recommendations to improve high blood pressure, working with researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities.

The pilot practices are making clinical changes, such as how to measure blood pressure accurately and then act rapidly when elevated blood pressure is discovered. They’re also exploring clinical-community linkages, in which physicians refer patients to community resources that can help them improve their blood pressure.

Dr. Edwards recognized that regular office visits with patients were eaten up by clinical work and that her patients with high blood pressure needed extra attention. So her practice staff used her electronic health record system to identify patients with a body mass index of 27 or higher, then sent letters to those patients asking them to come in for a special appointment. The 100 patients that took her up on the offer had a 40-minute visit with Dr. Edwards, set up on a day she normally doesn’t see patients, to completely focus on weight loss, nutrition and exercise. Dr. Edwards used this time to give her patients information about where they can safely exercise in the community.

Participating patients can come back to Dr. Edwards’ office every week to weigh in, and can see Dr. Edwards every two to four weeks for a 20-minute discussion on their progress and challenges to losing weight. Making time for these short appointments with at-risk patients now can help prevent longer appointments and worsening health problems later.

“It’s been really productive because the patients recognize that we care, and when the doctor is focused on them individually, they’re encouraged to take action,” Dr. Edwards said. “When they’re in the office for their 20-minute visit for their blood pressure, or diabetes, I don’t have time to go over that. But when I set the time aside for 20 minutes to just focus on weight loss, we’ve been able to take people off medication, and we’ve seen improvement in their labs.”

A key part of making these improvements was having places to direct patients who were interested in exercising but weren’t sure where to go. Dr. Edwards commonly recommends a local program through which patients can visit their local shopping mall to walk for exercise. The mall walker program also offers monthly blood pressure screenings and weekly exercise programs. She also helps patients figure out the best local places to get fruits and vegetables and high-quality foods to maintain a healthy diet.

“You have to have some tie to the community for [patients] to feel confident in the care, so they trust you,” Dr. Edwards said. “Patients like to be able to see that they’re more than just numbers on a blood pressure reading, that you really care about their surroundings and the environment they’re in.”

The AMA pilot also is exploring ways to get feedback from local programs and incorporate the feedback into patients’ care plans.

Share your community linkages: Does your practice recommend local fitness or health programs to patients? Let us know in the comment section below or on Facebook.