What physicians are saying and doing to control hypertension


Many physicians’ office workflows include a standard way of measuring blood pressure, making it part of the daily routine. But over the past year, physicians across the country have been discussing how minor, easy changes in the way they measure blood pressure have had a positive impact on their patients’ hypertension control.

Seemingly minor issues can impact blood pressure measurement. For example, if a patient talks during the measurement, has a full bladder or if the patient’s feet aren’t flat on the floor, there’s a chance that blood pressure measurement will give a falsely high reading. This could lead to a prescription for an unnecessary—and potentially harmful—medication. At the same time, other factors can contribute to unidentified and untreated hypertension, which can be deadly.

Helping physicians and their practice staff incorporate these standardized principles into their practice workflow is a key element of the AMA’s Improving Health Outcomes initiative. A pilot program involving multiple clinical sites in Maryland and Illinois is implementing principles of safe design into the ambulatory setting to improve outcomes around hypertension.

Physicians who made these minor changes in measurement have seen positive results. For example, one family medicine physician, a Wisconsin doctor named Kim Hardy, MD, heard about the pilot work and standardized measurement principles. She implemented some changes, and shared what enabled her to immediately improve a patient’s blood pressure measurement so the patient’s medication didn’t need to be adjusted. That prompted a conversation in which physicians from across the country weighed in on how they manage blood pressure in their practices.

After making improvements to measure accurately, practices involved in the AMA’s pilot sites are acting rapidly to help bring blood pressure under control. This involves making explicit changes to a patient’s care plan, ensuring follow-up interactions and using evidence-based protocols to guide the selection of antihypertensive medications.

It also involves using community resources to help patients get home blood pressure devices or directing patients to local programs that could measure their blood pressure and provide feedback to physicians. Practices in the AMA pilot are establishing these clinical community linkages now.

Physicians in the pilot program are having success controlling blood pressure without adding to their practice’s workflow burden. For example, Chicago-area physician Michael K. Rakotz, MD, in the past year has achieved a 90 percent control rate for his patients with hypertension by working with his medical assistant, nurse and other staff members to execute standardized blood pressure protocols in the practice.

Using a team-based care approach, Dr. Rakotz also implemented a strong home-monitoring program for patients whose blood pressure management requires more clinical data, and his practice relies on its electronic health record system to immediately give them actionable information.

Implementing checklists and protocols into practices, such as the ones the AMA’s pilot program has developed, can help physicians dedicate more time to caring for patients.

Working alongside the pilot practices, the AMA also has partnered with researchers at Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to develop a full suite of hypertension control tools, which will soon be available to physicians across the country..

Join the discussion: Share what methods you’ve found successful in improving outcomes around hypertension in your practice in a comment below at AMA Wire® or on the AMA’s Facebook page.