4P Program | Managing High Blood Pressure In Patients | Middlesex Hospital
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4P Program | Managing High Blood Pressure In Patients | Middlesex Hospital

August 29, 2019


(simple music) (moves into energetic music) – Engaging Patients and
Providers in Partnership for Prevention of Heart Disease was a really in interesting
and exciting project. We call it the Middlesex 4P Project. And what was interesting about it is that it was really focused
on empowering patients. We have lots of medicines
and lots of treatments, but none of these things
are very useful if patients aren’t engaged in actively playing a role in managing their illness. – High blood pressure, or hyptertension, is a major risk factor for heart disease, stroke, and kidney disease. Hypertension affects one
in three American adults, and more than half of them
don’t have it under control. Now this also includes people
who do have medical insurance, who are taking medications,
and who have seen a doctor – 127 over 80!
– at least twice within the past year. – The CTG Grant is a CDC initiative that addresses chronic disease. And at it’s heart is the
formation of a coalition of partners from the community
to assess and address policy issues that will impact chronic disease in their community. – Managing high blood pressure in patients can be quite challenging because blood pressure
varies throughout the day, and when a patient comes to the office they’re often running late, they’ve been having parking problems, they’re stressed, and their
blood pressure may be higher than what it normally would be, and it, therefore, means
that we’re making decisions in the office based on
information that may not be the most accurate. So having the opportunity
for patients to monitor their own blood pressure at
home under normal circumstances and come to the visit
with a set of readings that more accurately
reflects their reality allows us to take better care of patients. – This program was
different in that recognized what we’re increasingly
coming to know in healthcare, and that is that primary care
and health care in general is a team sport. No individual provider has the resources or all the skills necessary
to manage every aspect of a patient’s care. So the team, in this
case, included nurses, primary care providers,
medical assistants, and others, all working together in
engaging to help patients. – I think the fact that
there are no symptoms with hypertension often, as much as we try and tell our patients that it’s important to monitor, having someone else go alongside them but also be a cheerleader of sorts to encourage them toward their goals, was something that enabled us as providers to have the help that we need
in order to give hypertension the attention it deserved. – Even the first follow-up
visit, we’d see results because they check their
blood pressure everyday. So instead of them coming to the office, we do one blood pressure
check and maybe a repeat, we’d have about 10 numbers. So being able to look at
those, average those together, it was definitely more accurate, and I would say 80% of them that I saw would have a lower
reading, which was great. – Motivational interviewing is the process where you elicit from the patient what their feelings really are and what they prioritize in their life as important for their health. And then you assist them to make decisions about action plans, such as
eliminate the sugar beverage, or increase a walk, or add a walk or 10 minutes to their walk,
simple things that they can do that are going to help
them reach their goals. – In addition to giving the patient the home blood pressure cuff, we wanted to make sure that they had tools that they could use at home to support them in their journey. This is a booklet that we use called My Path to Healthy Numbers. We ask them to write their
numbers in this book. Once they’re actually
writing those numbers down, and they’re already taught what’s normal and what’s abnormal, it really
helps them to understand a little bit about what’s
a good blood pressure and where they fall. I had people write, “I ate a salty meal,” you know, “I had canned
soup the night before.” So they could correlate what they did and what their health habits were that affected their blood pressure. – Nine times out of 10,
they were gonna choose the healthier behavior
’cause they could see, they could see it. – They set goals, they
achieved those goals, and most importantly, they
improved their blood pressure. Over 75% of the patients
who took part in our project showed an improvement
in their blood pressure. And these weren’t just any patients, these were some of the toughest patients, patients who hadn’t been able to improve their blood pressure in the past, so we’re really very excited
to continue the approach that we took with hypertension, to expand it across the state, and to expand it to
other conditions as well. – [Alan] I think the Middlesex 4P Program was a beautiful example
of how we can engage the multidisciplinary team in providing better care to our patients. (energetic music)

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