What s New in HBP Management For 2015? Gregory A. Parkin, MD Physician, Department Chair, Bryner Group at Salt Lake Clinic, Intermountain Healthcare

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1 What s New in HBP Management For 2015? Gregory A. Parkin, MD Physician, Department Chair, Bryner Group at Salt Lake Clinic, Intermountain Healthcare Objectives: Describe current goal levels for HTN Review the new HTN tool report Discuss the HTN clinic Review and improve HTN reports

2 HTN Update 2015 GREGORY A PARKIN MD INTERNAL MEDICINE

3 Intermountain Hypertension Goals 140/90 ( Uncomplicated, CHF, MI, CVA, CKD without proteinuria) 2 Exceptions: Age > /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

4 Goal Decrease adverse events Heart attacks CHF CVA Renal Failure and not just manage blood pressure numbers

5 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.

6 Reminders A systematic approach will make it much easier. Recommended order - Lisinopril 10, 20 Amlodipine 5, 10 (Accomplish trial : benazapril/amlodipine superior to benz/hct) Add hct ( Lisinopril 20/12.5 then 2 tabs) Coreg , 25 Careful not to go too low (especially the elderly) Use Caution for dbp < 60; Falls Consider standing BP if making a medication change

7 New Reports for HTN Improved Functionality PPC / Select Health / PCCP Previously there have been multiple different reports. Now all combined into one single report New filters now available to get better lists on our higher risk patients

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

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

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

11 New Report Features Rapid Cycling 3 week report 21%

12 Home BP vs. Clinic BP Hedis Measure We encourage the use of home BP. Studies have shown correlation of adverse events and home BP s Hedis measure on HTN = Last clinic blood pressure A NCQA measure Insurance companies are graded by this measure for Quality After we get their home BP controlled bring them in and enter a controlled clinic BP Patients are very willing to have a care manager recheck a clinic BP.

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

14 Why won t my BP results go up? Greg Parkin s BP results All cases with HTN Uncontrolled HTN 11% 5% 4% 4% Rapid cycled / Compliance issues 7% Rapid cycled/ controlled at home 7% 72% 2% 2% Active Rapid cycling 14% Controlled / needs 12 m recheck 40% Controlled / needs 12 m recheck Physician - No recheck done BP at Other Specialties Active Rapid cycling Rapid cycled / Compliance issues Rapid cycled/ controlled at home Controlled BP BP at Other Specialties 13% Physician - No recheck done 19%

15 HTN Hearts HTN reminder stop sign Entering Leaving

16 My Friend Bert

17 Updated Kidney Referral Chart Kdigo Check Urine for protein yearly / Will need to code grade of renal insufficiency New update - When do you refer to a nephrologist?

18 Greater Support Pharmacy Collaboration: Pharmacists using the CPM protocol Assist in titrating patients to control and then refer back for a clinic visit with the BP in control. Lowers the message logs you will get Talk to your manager for details New HTN clinic Designed for those who have resistant HTN On 3 drugs and still not controlled. This is NOT for the non-compliant but more a resource for us when we can t get it controlled. Ambulatory blood pressures available Message Log referral: Refheart (universal cardiology referral form)

19 My recommendations for BUSY physicians Action Points Medical Assistants: Good technique. Recheck all BP s after 5 min if high. We are initiating more training. MA alerts if repeat BP s are high HTN Hearts It is far easier to catch it initially than after the fact Put HTN in Problem list Develop Rapid Cycling - talk with your care manager/ managers Let your team do the teaching. You are too busy. Use your team to scrub the new list and treat highest risk patients. Two consecutive high BP have a higher risk.