How one practice is using self-measured BP with few resources

Troy Parks , News Writer

Self-measured blood pressure (SMBP) can help physicians confirm a hypertension diagnosis and engage patients in managing their hypertension. Find out how one rural practice began using SMBP with minimal resources to improve patient outcomes.

The U.S. Preventive Services Task Force (USPSTF) in October released recommendations for physicians to screen adults aged 18 years or older for high blood pressure and obtain measurements outside of the clinical setting to confirm a diagnosis before starting treatment.

After joining the Million Hearts initiative around the time the USPSTF recommendations were released, Sterling Health Solutions in the small town of Mount Sterling, Ky., began using SMBP in practice, despite having minimal resources at their disposal.

Richard Hall, MD, an internal medicine and pediatrics physician at Sterling Health Solutions, and his colleagues have already seen the impact SMBP has had on their practice in just four months.

One of the first of Dr. Hall’s patients with hypertension to use SMBP is already seeing some improvements. “He would come into the office and his blood pressure readings would be out of sight, so we had him start doing a pretty intensive [program] with daily checks, sometimes twice a day when we first started,” Dr. Hall said. “He’s been under much better control.”

The patients were receptive from the beginning, Dr. Hall said. The main obstacle has been that not all patients have access to a blood pressure cuff. “We’re trying to see if we can get more blood pressure cuffs to hand out—that’s the next step,” he said.

Dr. Hall and his team developed a wallet-sized card that patients can keep with them. It’s “an educational tool we designed on our own,” he said. “It has information about blood pressure—the signs and symptoms, recommendations on diet and exercise, the importance of taking your medication every day, and finally a log they can use to track their blood pressures and pulse.”

“The logs are for new patients with hypertension, new diagnoses or patients where we’ve made changes in their therapy,” he said.

“If they don’t have a way of [measuring] on their own,” Dr. Hall said, “I encourage them to keep their card with them, and if they happen to go to a specialist appointment or another doctor, they can log their readings. Many of our patients have a relative or a neighbor with a blood pressure cuff that they can use.”

Dr. Hall also encourages his patients to stop by when they’re in town and let the nurses check their blood pressure. “I have some patients who come back for their appointment and have only four readings,” he said, “but I tell them, that’s still four more than we would have [had] otherwise.”

Dr. Hall last summer attended the National Association of Community Health Centers conference, where he heard a physician expert from the AMA’s Improving Health Outcomes initiative speak about the importance of using SMBP to help patients gain better control of their blood pressure.

“I always tell [patients], ‘you spend 99 percent of your life outside of my office, so I want to know what your blood pressure is where you spend your life, not what it is in my office,’” he said. “I ask them when they come in if they did their homework, and they pull out their log and hand it to me. It’s a little joke between me and my patients, but it keeps them thinking about their blood pressure when they’re not in the office.”