Management of Hypertension and Cardiometabolic Risk in Primary Care: A novel model of Care for better outcome

Transcription

1

2 الرحيم الرحمن بسم هللا Management of Hypertension and Cardiometabolic Risk in Primary Care: A novel model of Care for better outcome Bader Ali Almustafa et al, Chronic Care Quality Improvement Project, CCCQI

3

4 CVR: Global Prevalence-1

5 CVR: Global Prevalence-2

6 CardioMetabolic Risks CoExist % Veg< 5 /dy Hyperchol-Dx Pre-High Cholesterol High Cholesterol Low Exercise No Exercise HTN-Not controlled HTN-Rx HTN-Dx Pre-HTN HTN Morbid Obesity Obesity Smoking DM Not controlled DM-Rx Pre-DM DM 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Mokdad AH. The Global Burden of Disease: A critical resource for informed policy making in the Gulf region. J Health Spec 2016;4:162-72

7 O M A N I R A N S. A R A B I A K U W A I T P A K I S T A N U A E METABOLIC SYNDROME: PREVALENCE

8 Risk Factor Prevalence Cholesterol 40 % Low HDL 33 % LVH > 30 % Diabetes > 35 % Hyperinsulinemia 50 % Sedentary Lifestyle > 90 % Smoking 35 % Obesity 40 % Cardiovascular Risk Profile, 2003

9 Poor Management in PHC 1. Access to programs targeting HTN below target 2. Small % of expected hypertensives treated in PHC 3. Low referral rates to specialist care. Al-Khaldi Y, Al-Sharif A. Availability of resources of diabetic care in primary healthcare settings in Aseer region, Saudi Arabia. SMJ 2002; 23: Al-Mustafa B, Abularhi H. The role of primary healthcare centres in managing hypertension: how far are they involved? SMJ 2003; 24: Al-Khaldi Y, Khan M. Audit of a diabetic health education program at a large primary healthcare centre in aseer region. SMJ 2000; 21: Siddiqui S, Ogbeide D, Karim A, Al-Khalifa I. Hypertension control in a community centre at Riyadh, Saudi Arabia. SMJ 2001; 22: Al-Khaldi YM, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Audit of referral of diabetic patients. SMJ 2002; 23: Khoja T, Kabbash I. Perception of mid-level health managers about primary healthcare implementation obstacles. Tanta Med J 1997; 26:

10 Al-Khaldi Y, Al-Sharif A. Availability of resources of diabetic care in primary healthcare settings in Aseer region, Saudi Arabia. SMJ 2002; 23: Al-Mustafa B, Abularhi H. The role of primary healthcare centres in managing hypertension: how far are they involved? SMJ 2003; 24: Al-Khaldi Y, Khan M. Audit of a diabetic health education program at a large primary healthcare centre in aseer region. SMJ 2000; 21: Siddiqui S, Ogbeide D, Karim A, Al-Khalifa I. Hypertension control in a community centre at Riyadh, Saudi Arabia. SMJ 2001; 22: Al-Khaldi YM, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Audit of referral of diabetic patients. SMJ 2002; 23: Khoja T, Kabbash I. Perception of mid-level health managers about primary healthcare implementation obstacles. Tanta Med J 1997; 26: Poor Management in Saudi PHC 4. Low Access to health education. 5. Misdiagnosis or mismanagement. 6. Lack of independent decision-making (97%). 7. Poor information management (53%).

11 Chronic Care Model (CCM) A Blueprint for High-Quality, Patient-centered Chronic care. Addresses six elements: 1. Community linkage 2. Health Care Delivery System 3. Self-Management Support 4. Delivery System Design 5. Decision Support 6. Clinical Information System Wagner EH, Austin BT, Von Korff M: Improving outcomes in chronic illness. Managed Care Quarterly 1996, 4(2):12-25.

12 Most current guidelines are: Not meeting CCM needs. Not tailored for PHC. Difficult to follow. Multiple guidelines needed for ONE pt. B Almustafa et al. Approaching cardiometabolic risk: A quality improvement initiative. Proceedings of the 1st World Congress on Controversies in Diabetes, Obesity and Hypertension (CODHy) Oct 2006;27-A. B Almustafa et al. Quality of management of hypertension and diabetes in PHC, 2006.

13 CMR Management Guideline Provide recommendations in: Pharmacologic therapy Prevention & Dx of Complications Nutrition therapy Physical prescription Self-management

14 CMR Management Guideline Provide suggestions to the management of: The Delivery System the Clinical Information System the Quality of Care Training

15 CMR Management Guideline Primarily for Primary Care Providers including: Physicians Nurses Pharmacists Educators Quality Auditor Practice Managers Bader A. Almustafa, Saudi Arabia

16 Chapters of the Guideline: Bader A. Almustafa, Saudi Arabia

17 Bader A. Almustafa, Saudi Arabia CMR Management Guideline Clinical Algorithms Encounter Forms Registers Dairies Quality Indicators Patient Educational material Self Management material Quick Reference Guide

18

19 Chronic Care Model (CCM) A Blueprint for High-Quality, Patient-centered Chronic care. Addresses six elements: 1. Community linkage (CMR CPG 2. Health Care Delivery System (Empowerment) 3. Self-Management Support (CMR CPG) 4. Delivery System Design (Empowerment, CMR CPG) 5. Decision Support (CMR CPG, Senior Support) 6. Clinical Information System (Decision Support EF, CVDEMS) 7. Continuous Audit. (DPSA) Wagner EH, Austin BT, Von Korff M: Improving outcomes in chronic illness. Managed Care Quarterly 1996, 4(2):12-25.

20 CMR Management Guideline Multidisciplinary Team PCP & disease specialists Physicians Nurses Pharmacists Educators Dietitians

21

22 Saudi Med J 2003, B. Almustafa et al

23 Cross-sectional study in 26 PHCC s in Qatif % Para-Med staff with documented training in Proper BPM 0% % Patient visits with BPM recorded. 55% % Patient visits with BP > 140/90 with documented Plan of Care for HTN. 35% B. Almustafa et al 2007

24 CCCQI PROJECT: RESULTS p Mean Age (Y) 57.2 ± ± Years of HTN (Y) 7.3 ± ± BMI 29.5 ± ± 6.4 <.001 Visits 7.8 ± ± 2.5 <.001 Bader A. Almustafa, Saudi Arabia

25 CCCQI PROJECT: RESULTS p BP Control in HTN 46.6% 72.1% < Mean BP in HTN Mean BP in DM 139.2/84.7 ± 16.1/ /82 ± 17/8 131/80.3 ± 13/ /78 ± 13/8 < < Mean A1c in DM 8.5 ± 2.2% 7.9 ± 2.1% < A1c 7% in DM 4.4% 36.6% < Bader A. Almustafa, Saudi Arabia

26 7000 BP Control, Qatif PHC % % % 56% Treated Control

27 Conclusion Chronic Care Model + CMR Guidelines + Cont. Audit are main components of CCCQI Project. CCCQI Project shows high effectiveness in CMR Control. Team-based Approach is fundamental in CMR Mgx.

28 Thanks