Achieving Quality Hypertension Care: Missing the “Low-Hanging Fruit” in Quality Improvement

• CME Information
• Faculty Biographies & Disclosures
• References
• Course Presentations
• CME Posttest

CME Information

Course Overview

Among adults over age 18 in the U.S., data from the period 2005-2008 indicate that 29.9% have hypertension, with variations across population subsets related to a number of factors, including age group, race and ethnicity, education, family income, foreign-born status, health insurance status, diabetes, obesity, and disability status.  Of those diagnosed with hypertension during the surveillance period indicated above, a projected 43.7% had their hypertension under control, which is defined as blood pressure (BP) <140 mm Hg and diastolic BP (DBP) <90 mm Hg.

Hypertension poses a major public health challenge in the United States, increasing risks for heart disease and stroke, the first and fourth leading causes of death in the US, according to final data for that year published by the CDC’s Division of Vital Statistics.  Hypertension was estimated to cost the United States $93.5 billion in health care services, medications, and missed work days in 2010. These are the impacts of a condition that the Institute of Medicine has characterized as relatively easy to prevent and inexpensive to treat.

The issue of poor control of hypertension was highlighted in a recent study of patients treated in cardiology clinic for heart and vascular disease.  In the clinic where the study occurred, patient blood pressures for 65% of visits were deemed sufficiently high to make the patient eligible for medical adjustment. However, in only 47% of visits in which BP levels were sufficiently elevated to warrant medication adjustment were such adjustments documented in the patient record.  In 38% of visits in which elevated BPs were noted in the record, there was no documented response from the cardiologists responsible for screening and treatment.

These findings are consistent with those of other studies that examined clinical practice in management of hypertension.  They suggest that clinicians, including cardiologists and primary care providers, must be more diligent in addressing the challenge posed by hypertension.  Greater attention to documentation of elevated BP, actions taken to address the issue (or reasons for inaction), and evidence of active monitoring and response when BP is not sufficiently controlled should all be part of the clinician repertoire in managing this common chronic health problem.  This CME activity offers information about the problem of inadequate hypertension management, suggests strategies for enhancing hypertension management, and summarizes benefits to clinicians that include improved care quality, as well as opportunities for revenue enhancements through quality care incentives offered by a growing number of third-party payers.

Educational Objectives

At the conclusion of this activity, the participant should be able to:

• Cite data-based indicators of suboptimal control of blood pressure.
• Articulate consequence of poor blood pressure control for individual patients and for larger societal subsets.
• Prompt physicians to change behaviors related to document actions and/or reasons for inaction when out-of-range blood.
• Describe accepted methods of treatment intensifications in management of elevated blood pressure and how to implement such techniques in practice.
• Discuss three factors involving patient behavior, whether voluntary or involuntary, that may contribute to elevated blood pressure during the clinical exam.

Target Audience

This CME activity is designed to meet the educational needs of primary care and internal medicine clinicians who treat patients with hypertension.

Method of Participation

This activity is in a commentary format and includes references linked to PubMed abstracts.

To receive a maximum of .75 AMA PRA Category 1 Credit(s)™ you should:

• View the presentations in this enduring material.
• Complete the posttest (you must answer 8 out of 10 questions correctly).
• Complete and submit the CME registration and evaluation forms.

The estimated time to complete this activity, including review of the materials, is .75 hour(s).

Hardware/software requirements: Activities should be run with recent versions of common browsers, including Internet Explorer, Firefox, and Google Chrome.

If you have questions about the participation process, please e-mail the Office of Continuing Medical Education, cme@bcm.edu or phone 713.798.8237.

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of .75 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.    

Term of Approval

December 2012 through December 2013. Original release date: December 2012

Peer Review

In September 2012, this continuing medical education online enduring material was reviewed by Omar G. Awar, MD, Clinical Postdoc Fellow, Department of Medicine-Cardiology, Baylor College of Medicine, Houston, Texas. To ensure the continued scientific relevance of this enduring material, its content will be reviewed again in December 2013.

Disclosures:  Nothing to disclose.

Program Director

Michael Fordis, MD
Sr. Associate Dean
Director, Center for Collaborative and Interactive Technologies
Director, John M. Eisenberg Center for Clinical Decisions and Communications Science
Baylor College of Medicine
Houston, Texas

Disclosures: Nothing to disclose.

Disclaimer

This CME activity is designed for use by healthcare professionals for educational purposes only. Information and opinion offered by the contributors represent their viewpoints. Conclusions drawn by the participant should be derived from careful consideration of all available scientific information. Prescription information and use of medical devices should be undertaken only after confirmation of information by consulting the FDA-approved uses and information.

Baylor College of Medicine makes every effort to have accurate information presented, no warranty, expressed or implied, is offered. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.

Links are provided to other Internet sites solely for the convenience of users. Once you link to another site, you are subject to the site's terms and conditions of use including copyright and licensing restrictions.

Disclosure

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial Support ^SM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: l) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.

The following individual(s) has/have reported no financial or other relationships with commercial entities whose products/services may relate to the educational content of this activity:

Omar G. Awar, MD, Peer Reviewer: Nothing to disclose.
Michael Fordis, MD, Activity Director: Nothing to disclose.
Ann Marie Navar-Boggan, MD, PhD, Contributor: Nothing to disclose.
Quentin W. Smith, Medical Writer: Nothing to disclose.
Louise O. Zimmer, MPH, Contributor: Nothing to disclose.

Some drugs/devices identified during this activity may have United States Food and Drug Administration (FDA) clearance for specific purposes only or for use in restricted research settings. The FDA has stated that it is the responsibility of the individual physician to determine the FDA status of each drug or device that he/she wishes to use in clinical practice and to use the products in compliance with the applicable law.

Baylor College of Medicine requires that all contributors disclose an unlabeled use or investigational use (not yet approved for any purpose) of pharmaceutical and medical device products, and provide adequate scientific and clinical justification for such use. Physicians are urged to fully review all the available data on products or procedures before using them to treat patients.

Acknowledgement of Support

This CME activity is supported by contracts Ul9HS021107-01 and U19HS021092 from the Agency for Healthcare Research and Quality, Rockville, MD.

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