WIHI Chat – March 13, 2014
How High, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines
from Madge Kaplan & Guests to All Participants:
Hi all. Thanks for joining. Enjoy some of the photos from a mobile health tour IHI just completed
with wonderful partners ... in Boston, NYC, and DC.
from Madge Kaplan & Guests to All Participants:
http://jnc8.jamanetwork.com/
from Madge Kaplan & Guests to All Participants:
If you didn't get a chance to look at the articles in JAMA, please see the link provided in CHAT
from WIHI admin to All Participants:
Here's the link to today's WIHI slides:
http://app.ihi.org/marketing/program_documents/wihi/WIHISlides_JAMAHypertension_313.pdf
from WIHI admin to All Participants:
Tweeting today? Make sure you give us a mention @TheIHI #IHI
from Bonnie Roberts to All Participants:
any thoughts on pts with significant proteinuria?
from Dawn Voss to All Participants:
when are the slides available?
from Madge Kaplan & Guests to All Participants:
Here's the link to today's WIHI slides:
http://app.ihi.org/marketing/program_documents/wihi/WIHISlides_JAMAHypertension_313.pdf
from Bonnie Roberts to All Participants:
please discuss if possible aug 2013 acp journal study on 600000 veterans, bp and mortality
from G Pape to All Participants:
Craig, could you stare the makeup of your National Guideline Program team?
from G Pape to All Participants:
excellent. thank you, I'll be in touch.
from Teresita Lawson to All Participants:
Can you address medication adherence issues and patient driven barriers?
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 1
March 13, 2014
from Ronald Adams to All Participants:
What recommendations do you have to improve blood pressure measurement in the medical
office and the right strategies for cost effective and efficient follow up with attention to blood
pressure control?
from Sheila Anane to All Participants:
What are some successful medication adherence strategies?
from vicky minden to All Participants:
See the guidelines here, along with a compilation of related articles, published in JAMA online
December 28, 2013.
http://jnc8.jamanetwork.com/
from robin harris to All Participants:
Anyone have a pt and provider tool to explain probability relative to HPN? A visual like a
storyboard?
from WIHI admin to All Participants:
Make sure your chats are directed at ALL PARTICIPANTS
from Beverly Spivey to All Participants:
Can you speak to the fact that there are many medicines for mild to moderate HBP but actually
very few for moderate to severe HBP, which is where many of the uncontrolled population is. We
settle for combinations that don't always work.
from vicky minden to All Participants:
Here you’ll find the new guidelines, along with a compilation of related articles, published in
JAMA online December 28, 2013.
http://jnc8.jamanetwork.com/
from Maria Dunn to All Participants:
Hi, regarding med management OR BP monitoring in the home, consider a home health referral
for nursing AND/OR Occupational Therapy to work with the homebound patient in their own to
independently manage their own medications OR diseases/conditions. Very happy to see
consideration given to potential LBP in the elderly considering physiological changes occurring as
we age.
from Olga Felton to All Participants:
Can you speak to the importance of practitioner technique and verification of results with
manual blood pressure measurements in establishing and applying treatment?
from Chris Sarfaty to All Participants:
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 2
March 13, 2014
YES! "How many days this week did you take your medication?, Can you tell me more about
that? What things do you think are making it hard to do?" thank you Peter.
from William Hewitt to All Participants:
How is BMI communicated as a critical factor in BP control
from Peter Basch (privately):
Thanks Chris
from Charbel Khoury to All Participants:
Any insight on whether Pulse Wave Velocity measure could eventually be the "HbA1c" of
hypertension? or is affected by other metabolic disease too much for it to be specific?
from Stephen Martin to All Participants:
Changed to All Participants -- Thanks! Please discuss Cochrane 2012 review on mild
hypertension and how NICE and Canadian guidelines no longer recommend pharmacological
treatment of mild hypertension (and ESC notes it is an open question), how recent Cleveland
Clinic review and others find no evidence to treat to a particular target, and how recent JAMA
editorial recommends no further management using clinic blood pressure values, but generally
only ones from home.
from Teresita Lawson to All Participants:
In our center we have an integrated medication management program with a clinical pharmacist
that is one patient centered approach to address the issue of medication non adherence.
from Karol Sue Byers to All Participants:
ARBs aren't usually considered along with the other usual 3. Would you please explain ?
from Liz Pohlmann to All Participants:
Pharmacists, experts in medication related problems, are available in community pharmacies to a
large portion of our population. How can we engage community pharmacists in improving
awareness of high bp and improving bp management?
from Chris Sarfaty to All Participants:
You can have the best treatment plan in the world, best evidence in the world, but if the patient
is not on board, it will be like blowing in the wind. Patients (and, yes, you and I) drive our own
ships. So it is essential to have investment in rapport, listening and understanding what the
patients priorities are in order to make progress with applying medication (and lifestyle)
guidelines.
from Madge Kaplan & Guests to All Participants:
initiative: Hair, Heart, and Health
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 3
March 13, 2014
from Chris Sarfaty to All Participants:
YES! Barbershop, beauty salon, daycare drop off, workplace etc. Thank you IHI.
from Ronald Adams to All Participants:
Should health plans make the out of pocket cost of HTN medications at zero cost share?
from William Hewitt to All Participants:
What about diet and weight control specifically fast foods that contain high fat content and GMO
foods?
from Terry Cyr to All Participants:
The American Cancer Society has a program that focuses on client education by barbers and
hairdressers that may serve as a model.
from Kelley Gordon to All Participants:
We have diabetic nutrition educators to help with diet to bring about life style modifications to
lower A1c's. We need to consider increasing the medical home team to include diet educators to
assist in lowering HTN
from Lorena de Anda to All Participants:
Kaiser Permanente Colorado is working on a Barbershop/Salon Program run by Dr. Terri
Richardson. In collaboration with geo-mapping, she has been able to very specifically target
those barbershops and salons where there is a HTN is more prevalent.
from Terry Cyr to All Participants:
Parish Nursing programs have been doing blood pressure screenings and education for years!
from Sheila Anane to All Participants:
How can medical assistants be engaged to be more active in hypertension care management?
Motivational interviewing, medication follow-up
from Frances Bell Banks to All Participants:
As a Parish Nurse in an African American majority congregation I address blood pressure by doing
numerous screenings and presenting educational information on diet, exercise and lifestyles
changes.
from Gail Verschoor to All Participants:
I agree with the bundling of chronic care issues - most deal with diet, activity, medication and
monitoring. I think we miss opportunities when we focus on only one condition
from Lucille Taylor to All Participants:
I am a parish nurse in Hartford, CT. Any help with info on latest guidelines (ranges) for all ages,
particularly our elderly parishioners would be most helpful. Unfortunately, I just joined this
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 4
March 13, 2014
discussion late. So sorry, I was at work & became back logged with patient issues. Would
appreciate any guidance for us as parish nurses. I am the BP coordinator & run a BP clinic once a
month on a Sunday after Masses. Thank you.
from Carolyn Wray-Williams to All Participants:
http://jnc8.jamanetwork.com/
from Carolyn Wray-Williams to All Participants:
Lucille the new HTN guideline link is above.
from Lucille Taylor to All Participants:
Forgot to provide my e-mail address: lucille.taylor@hhchealth.org
from Beverly Spivey to All Participants:
We have had some success with teaching people to cook common dishes in their diet in a more
healthy way.
from Lucille Taylor to All Participants:
Thanks Madge, you're the best!!!
from Lisa Allen to All Participants:
YES! to parish nurses and BP screening clinics. As a parish nurse, we use AHA guidelines and
educational resources; encourage follow up with their physicians.
from Frances Bell Banks to All Participants:
Lucille look at www.pmhs.org or www.parishnurses.org for guidelines to use as a Parish Nurse.
from Eric Peterson to All Participants:
Thanks to the Hosts and participants! Great comments and questions!
from vicky minden to All Participants:
IHI’s Escape Velocity initiative
http://www.ihi.org/Engage/Initiatives/EscapeVelocity/Pages/default.aspx
from Beverly Spivey to All Participants:
Meditation is proven to lower blood pressure in African Americans
from Lucille Taylor to All Participants:
Thanks Frances.
from Janet Wright to All Participants:
Million Hearts sends its enthusiasm and gratitude for the experts and engaged audience on this
topic, so important to US heart Health!
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 5
March 13, 2014
from Gillian Baird to All Participants:
Excellent presentation! Thanks!
from Loretta Kaes to All Participants:
Thanks for the great information!
from Chris Sarfaty to All Participants:
Very informative and well-rounded. Thank you!!
from Madge Kaplan & Guests to All Participants:
Thanks everyone for joining today's discussion.
Institute for Healthcare Improvement: WIHI Chat
How Hi, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines –
Page 6
March 13, 2014