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 § 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

Are you a rapid cycler? 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.

New Reports for HTN 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

How are we doing? Let’s explore the report 63% in control

New Report Features Insurance specific BP > 10 syst / 5 diast

New Report Features Patient lists with filters (over10/5) + 2 BP’s and target

New Report Features Rapid Cycling – 3 week report 21%

New Report Features My Rapid Cycling Report Large Percent lacking response from me.

Reminders 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

Home BP vs. Clinic BP 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.

My Friend Bert

Other New Developments 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

Updated Kidney Referral Chart 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?

Pharmacy Collaboration 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

100 Year Old Best Friends