A call to action:
‘Beat high blood pressure’
WELCOME!
Welcome and agenda for the day
Morning:
•
To gather insight about perceptions of high blood pressure, and how we
might best communicate and deliver proposed actions/changes.
•
To develop an understanding of how to engage the public in any BP
campaigns to improve detection and management
Afternoon:
•
To gather insight from representatives of the health care community about
perceptions of how high blood pressure is currently managed, and how we
might best communicate and deliver proposed actions/changes.
•
To develop an report from the day which will identify support future action
on this topic
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Tackling high blood pressure
Housekeeping
3
Tackling high blood pressure
Why blood pressure?
Councillor Janet Clowes &
Dr Heather Grimabaldeston, Director of Public Health
Cheshire East Council
What is high blood pressure?
Hypertension is the medical term for high blood pressure. It means that there
is too much pressure in your blood vessels, which can damage your blood
vessels and cause health problems
High blood pressure is a major risk factor for stroke, heart attack, heart failure,
chronic kidney disease and dementia
Certain factors can increase your risk of developing high blood pressure, these
include:
being overweight or obese
drinking a lot of alcohol
eating too much salt
being older
not eating enough fruit and
having a family history of
vegetables
high blood pressure
not doing enough exercise
being of African or Caribbean
CAN BE LOWERED
descent
Why do we need a system wide response?
1. High blood pressure is the second biggest risk factor for
premature mortality in the UK.
2. About 30% of adults have hypertension, of which an
estimated 5m are undiagnosed.
3. Hypertension is the biggest QOF disease register locally
(14.8%).
4. Most outcomes related to hypertension are worse in
deprived groups.
Risk factors premature mortality:
Global Burden of Disease
Source:
Source: The
The Lancet,
Lancet, UK
UK health
health performance:
performance: findings
findings of
of the
the Global
Global Burden
Burden of
of Disease
Disease Study
Study 2010
2010
Variation
unwarranted
variation
30% difference
- most/least
deprived
CCGs
achieving BP
control to 140/90
in treated
population
ranges from 6194%
Source: Health Survey for England 2011
Prevalence
Source: QoF 2012-13, Public Health England - General Practice Profiles, 2011
QOF Performance
Source: QoF 2012-13, Public Health England - General Practice Profiles, 2011
Health checks offered
Cardiovascular Disease – in Cheshire East
Cardiovascular Disease: Coronary heart disease (angina and heart attack), stroke
and peripheral artery disease (affecting the blood vessels of arms and legs).
• Cardiovascular disease accounts for approximately a quarter of premature
deaths each year in Cheshire East (approximately 250 deaths/year)
• The premature death rate from cardiovascular disease is lower than the
national average but higher when compared with local authorities with
similar levels of deprivation
Cardiovascular Disease key facts – where and who
Men and women who live in Crewe have a
premature deaths (heart disease) fallen by 40% higher risk of early death from CVD than
( reductions in smoking and better clinical
other people
management); men faster than women
Cardiovascular Disease in Cheshire East
To reduce the number of deaths in the under 75’s from cardiovascular disease
Improve identification of undiagnosed cases
Delivery of a High Standard of Care
• There are estimated to be:
-35,000 people with high blood
pressure
- 20,000 people with kidney disease
- 3,300 people with diabetes
(ALL UNDIAGNOSED)
• Instigate early management and prevention within
the community to prevent premature deaths
• A Health Check is offered every 5 years to
those aged 40-74 who are not diagnosed
with heart disease, kidney disease or
diabetes
-Approximately 100,000 people are
eligible
- The aim of the Health Check is to
identify undiagnosed cases of disease
• Prompt management of an acute event is also
important (e.g. hospital management of a heart
attack, mini and full strokes)
• This includes a high standard of active treatment
in primary care (e.g. aggressive management of high
blood pressure)
In 2011/12 if all cases of high blood pressure
(diagnosed and currently undiagnosed) had been
optimally managed, it is estimated that 100 heart
attacks and strokes could have been avoided
Improvements can be achieved: England vs
Canada
Canada began a systematic initiative to address high blood pressure in the mid-1990s as
their treatment and control rates were 13% in early 90’s (now 66%) – with
reductions in stroke and MI
Source: Joffres et al, BMJ Open 2013
Priority across Cheshire & Merseyside
Support from
•
Directors of Public Health
•
Cardiovascular Disease Strategic Clinical Network
•
Kidney Clinical Network
•
Primary Care Strategic Forum
•
NHS England
High blood pressure steering group:

Prevention, Identification, Management
We Need Your Help to make change happen
Tackling high blood pressure:
from evidence into action
Ben Lumley, Blood Pressure Programme Lead, PHE
BP System Leadership Board
•
England’s Blood Pressure System Leadership Board is a cross-sector
group which oversees the programme of work improve the prevention,
detection and management of high blood pressure, and reduce health
inequalities
NHS England
NHS Improving Quality
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Tackling high blood pressure
The action plan
•
Tackling high blood pressure: from evidence into action (18 Nov 2014)
•
Intended to support partners at all levels to focus upon the work that
will make the biggest impact in tackling high blood pressure.
•
Draws on the best evidence (including new economic analysis) and
professional judgment of our group to:
• Recommend most pressing issues on blood pressure pathway to address
• demonstrate roles for a wide range of organisations to achieve this
• set out what key partners have already pledged to do in support of our ambition
•
Overarching themes:
• Tackling inequalities: identifying approaches and targeting to achieve this
• Partnership: need system leadership at all levels across government, health
system, voluntary sector and beyond
• Local leaders: change and implementation is influenced and driven by local
professionals
www.gov.uk/government/publications/high-blood-pressure-action-plan
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Tackling high blood pressure
Prevention (1 of 2)
•
High blood pressure is preventable, and risk of
cardiovascular disease is reduced down to a threshold
of 115/75mmHg
•
Key risk factors include excess weight/salt/alcohol,
physical inactivity
•
15% reduction in population salt intake achieved in last
decade seen as main contributor to lower population
blood pressure (↓3mmHg systolic)
•
20
Over ten years, an estimated 45,000 quality adjusted
life years could be saved, and £850m not spent on
related health and social care, if England achieved a
5mmHg reduction in the average population
systolic blood pressure
Tackling high blood pressure
Prevention
Detection
Management
What percentage of risk factors associated
with someone having their first heart
attack are modifiable?
90% Men
94% Women
Effect of potentially modifiable risk factors associated with myocardial
infarction in 52 countries (the INTERHEART study): case-control study
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Tackling high blood pressure
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Tackling high blood pressure
Prevention (2 of 2)
Key approaches (plan sets out more fully how different groups
contribute):
Prevention
• reducing salt consumption and improving overall nutrition at
population-level
• improving calorie balance to reduce excess body weight at
population-level
Detection
• personal behaviour change on diet, physical activity, alcohol
and smoking, particularly prompted through individuals’
regular contacts with healthcare & other institutions
• Examples of actions identified:
Management
23
•
PHE dedicated programmes on diet and obesity, physical activity,
alcohol and healthy places
•
Department of Health responsibility deal
•
British Heart Foundation 2014-2020 strategic ambition on prevention
•
Deliver NHS England Making Every Contact Count action plan
Tackling high blood pressure
Detection
• Testing advisable at least every five years, more frequent retesting for those with high-normal blood pressure. Diagnosis
never based on a single test, normally followed by ambulatory
(24 hour monitor) or home testing.
Key approaches (plan sets out more fully how different groups
contribute):
•
more frequent opportunistic testing in primary care, achieved
through using wider staff (nurses, pharmacy etc.), and integrating
testing into the management of long term conditions
•
improving take-up of the NHS Health Check, a systematic
testing and risk assessment offer for 40-74 year olds
•
targeting high-risk and deprived groups, particularly through
general practice records audit and outreach testing
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Tackling high blood pressure
Prevention
Detection
Management
Management
•
Prevention
NICE recommend lifestyle treatment for all with hypertension –
can achieve dramatic reduction. If drug therapy, 80% require
2+ agents to achieve blood pressure control. NICE treatment
target (for adults under 80 years) 140/90mmHg.
Key approaches (plan sets out how different groups contribute):
Detection
•
local leadership and action planning for system change, to
tackle particular areas of local variation, and achieve models of
person-centric care
•
health professional support (communication, tools &
incentives) to bring practice nearer to treatment guidelines
•
support adherence to drug therapy and lifestyle change,
particularly through self-monitoring of blood pressure and
pharmacy medicine support
Management
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Tackling high blood pressure
Resource hub
•
PHE wants to support local leadership in tackling high blood pressure, and
has gathered resources in one hub to help those planning and delivering
high blood pressure services and initiatives
•
Resources include data,
guidance, tools, case studies
and examples of emerging
practice
•
The PHE team welcomes
feedback and ideas for new
resources to include,
particularly any local case
studies – please email
bloodpressure@phe.gov.uk
www.gov.uk/high-blood-pressure-plan-and-deliver-effective-services-and-treatment
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Tackling high blood pressure
The future
What is your role in tackling
high blood pressure?
• Future programme activity will include supporting:
 Clinical leadership, particularly in primary care
 Local leadership, with local government as the hub for public health
and wider local partner networks
 Tools, evidence and economics
 Public and community engagement
• PHE, working with and reporting to the Blood Pressure System Leadership
Board, will continue to pursue this agenda and provide support to local
leaders
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Tackling high blood pressure
Insights about public knowledge
and attitudes to high blood
pressure
Ben Lumley, Blood Pressure Programme Lead, PHE
35% expect symptoms from hypertension
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Tackling high blood pressure
Public informed about disease risks
Spontaneous knowledge of issues
caused by high blood pressure
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Tackling high blood pressure
Confidence in knowledge of issues
caused by high blood pressure
60-70% see hypertension as inevitable
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Tackling high blood pressure
Blood pressure not only affects elderly
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Tackling high blood pressure
70-80% understand immediate risk
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Tackling high blood pressure
Hypertension thought as ‘easy to treat’
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Tackling high blood pressure
Convenience/curiosity motivate testing
What made you decide to have your blood pressure checked today?
%
56
56
I was interested to know what
my blood pressure is
63
43
41
It was convenient
56
14
12
It’s an important thing to
monitor
I was concerned I might have
high blood pressure
I thought I would be able to get
some advice about my health
It was free
26
7
Asda
9
8
19
7
6
BASE: All respondents; Total (362) Mobile testing point (236) Asda (126)
Q6:And what made you decide to have your blood pressure checked today? (Top seven codes shown only)
Tackling high blood pressure
Mobile
14
15
11
35
Total
Views in diagnosed population
After diagnosis – for some nothing
had changed, others viewed
themselves as unhealthy or even
focused on their mortality
Most participants understood that
hypertension caused serious
complications such as stroke
A large number of participants used
the presence or absence of
symptoms to indicate whether
their blood pressure was raised
Deliberately choosing to avoid or
reduce treatment was a theme
recurring in many of the studies
Hypertension was seen by some
participants as a temporary or
curable condition that would not
require long-term treatment
Four in every five people said they
had reservations about taking
anti-hypertensives
NICE. Clinical management of primary hypertension in adults. Clinical Guidance 127 (Full version), 2011
Marshall I, Wolfe C, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012
Benson J, Britten N. Patients' views about taking antihypertensive drugs: questionnaire study. BMJ. 2003; 326(7402):1314-1315
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Tackling high blood pressure
Differences between groups
Socio-economic group
• Lower socio-economic groups (C2DE) less knowledgeable about health
consequences of high blood pressure, and less positive about outcomes
from treating high blood pressure if diagnosed early. (PHE surveys)
•
Economic hardship and linked stress thought to worsen condition (Marshall)
Geographic and ethnic groups (Marshall et al.)
•
Principal themes in attitudes were “remarkably similar”, despite
recommendations for culturally-appropriate education in many studies
•
Traditional diet raised as an exacerbating fact for hypertension by all groups
Segmentation (in context of testing initiative) (PHE research)
• “Not for me” (largest group) firm miss-assumptions, low levels of concern
• “Why not” likely to take a test simply because it is being offered
• “On my mind” (minority) more actively worried about their health
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Tackling high blood pressure
Take-away points
A caveat, studies almost universally small sample-sizes and typically based on
older populations.
Two themes that are not yet consistently understood and could represent
engaging ‘news’ for many people:
High blood
pressure
normally has no
symptoms
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Tackling high blood pressure
High blood
pressure can be
avoided in
many cases
Clinical Leadership
Dr Kieran Murphy, Medical Director, NHS England Cheshire & Merseyside
Reducing premature mortality
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Tackling high blood pressure
Inequalities
Healthier Lives Atlas
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Tackling high blood pressure
Stand up!
Now sit down if…
Cheshire and Merseyside:
Blood pressure/hypertension
Local data and data tools:
Using PHE Healthier Lives data
Caoimhe McKerr, Knowledge and Intelligence Team (NW)
Ben Lumley, Blood Pressure Programme Lead
Risk and
prevention
Detection
Care
High risk
groups
LA
CCG
GP
“ … make England’s data about
many aspects of hypertension
prevalence, diagnosis and
management available to
everyone”
healthierlives.phe.org.uk/topic/hypertension
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BP event - 9 March 2015
Detection
• Recorded hypertension
prevalence
• Estimated hypertension
prevalence
• % of estimated hypertension
detected
• % of patients aged 40+ who
have a record of blood
pressure in last five years
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Prevention
• Deprivation
• % aged 65+ years
• Prevalence of adult healthy
eating
• Prevalence of obesity in
adults
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BP event - 9 March 2015
Care / High Risk Groups
• GP record of blood pressure
reading in previous 9 months in
people with hypertension
• Blood pressure control – e.g.
maintaining ≤140/90 mmHg, with
additional info for diabetes, CHD,
stroke, CKD co-morbidities
• Processes for newly diagnosed GP lifestyle advice, statins for high
CVD risk
• GP physical activity assessment in
people with hypertension
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BP event - 9 March 2015
How does this look locally?
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Hypertension diagnosis
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Hypertension control
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Statins for high CVD risk
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Next steps
• What is the bigger picture?
• What is the overall picture for the area or practice? Are
just one or two, or several, indicators ‘red’?
• How do they compare with areas with similar deprivation
and demography?
• Is there a problem with one or two, or most, of the
practices in the area?
• What is the role of other factors such as deprivation,
obesity and determinants of health?
• Download data for further analyses
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BP event - 9 March 2015
Supplementary data sources
Public Health Outcomes Framework
The outcomes in this framework reflect a focus not only on how long people live, but on
how well they live at all stages of life
http://www.phoutcomes.info/
Cardiovascular disease profiles
These profiles allow you to download a cardiovascular disease (CVD) health profile for
each clinical commissioning group and strategic clinical network in England, with the
interactive version allowing comparisons.
http://www.yhpho.org.uk/ncvinc
Longer Lives
Longer Lives highlights premature mortality across every local authority in England,
giving people important information to help them improve their community’s health.
http://healthierlives.phe.org.uk/topic/mortality
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BP event - 9 March 2015
Acknowledgements
• Knowledge and Intelligence Team (North West)
• Catherine Lagord, NHS Health Checks, PHE
Contact and further support
caoimhe.mckerr@phe.gov.uk; 0151 231 4528
ben.lumley@phe.gov.uk
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BP event - 9 March 2015
Table work
Questions:
•
Do people know and care what their blood pressure is?
•
If no- why?
•
If yes- why?
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Tackling high blood pressure
Insights from local populations:
Halton and Knowsley
Dr Ifeoma Onyia, Halton Borough Council
Dr Sarah McNulty, Knowsley Borough Council
Objectives
Evaluate local residents attitudes to getting their BP checked
and how we can encourage them to do so.
Current behaviour and barriers
Evaluation of messages and existing campaigns
What should a call to action look like?
HALTON
Who did we ask?
408 face to face interviews across Widnes and Runcorn
All lived within Halton
Age range 30 – 70 year olds
Equal M/F ratio
All registered with a GP in Halton
40% employed; 25% retired; 1%Education;
Unemployed/carer/ disabled/ homemaker
What they said about themselves
Half described themselves as overweight
One in three in fair, poor or very poor health
Over one in three disabled
When was last BP check?
Why did they have a BP check?
Part of a check-up
Recommended by GP/nurse
Unwell
Underlying health problems
In hospital
Every time see GP
Checked regularly
Where was last BP check?
Links with NHS Health Checks
72% had heard of NHS HealthChecks
37% could recall an invite
Of those invited 82% attended
Younger females and working less likely
Most expected BP would be checked
Some expected checks on eyes/ feet/ cancer
Inertia largest barrier to going for check
Understanding of BP factors
Symptoms
Light-headedness (40%)
Causes
Stress (40%)
Hot/flushes
Unhealthy lifestyle (20%)
Headaches
Overweight
Blurred vision
Not eating enough Fruit and Veg
None ( 5%)
Excess Alcohol
Hereditary
Other illness
Salt
Understanding of Impacts
Heart attack @ 76%
Stroke @ 58%
Next danger @ 4%
( kidney/ diabetes/ nosebleeds/ blindness etc)
How concerned were people?
KNOWSLEY
Focus groups
Healthy foundations
segment
Town
Age range
Participants
Unconfident fatalists
Huyton
Mixed
9 (5 women and 4
men)
Health conscious
realists
Kirkby
≤ 40
7 (5 women and 2
men)
Live for today
Prescot
41 - 70
9 (5 women and 4
men)
Attitudes
General concern but low understanding about definition, signs
symptoms and treatment.
Better awareness amongst those with long term conditions eg
diabetes or on the pill.
Perception that a diagnosis of high blood pressure is a life
sentence.
Importance of having checks
Prevention
‘It can save your life’ (Health Conscious Realist and Live for
Today)
‘They can prevent you from becoming more ill if you do have
high blood pressure’ (Health Conscious Realist)
Want more info on how to get checked and how often.
Barriers to having checks
Poor access to GP prevents regular checks.
Inertia
‘I’m OK; I’m not at that age right now’ (Unconfident fatalist)
Lack of information
‘People are not aware of how serious high blood pressure is’
(Unconfident fatalist)
Who should do BP measurements?
GPs should offer them to everyone regardless of what they go
to the surgery for
Pharmacies
Walk-in centre
Don’t really mind as long as evidence that person doing the
check had been trained
Mixed views on home testing.
Messaging territory
Headlines that resonated with all groups
‘After cancer, high BP is the second biggest cause of early death
and disability for people aged under 75’
‘Around 12.5 million people in the UK have high BP. Of these,
around 5 million are not aware of it’
Simple messages, tips and information, shock factors, happy with
cartoons.
However people are put off by
Age 75
1:4 or 1:3. They prefer the big numbers.
• Give local stats
Knowsley messaging idea
‘x people in Knowsley have high blood pressure and don’t
know it. Are you one of them? Get checked’
Campaign delivery
Materials discussed
Liked cartoons and
red balloon.
Liked NHS identity.
Recommendations for visuals
Image-based
Shock
List service providers
Communication channels
Ambient media in areas of high footfall – town centre posters,
pharmacies, fliers
Bus sides/internals
Social media inappropriate for health matters
Coffee break
– please return by 11:45
Table work
Questions:
•
What can we do to empower people to know and care about what their
blood pressure is?
•
And what steps will you take to make this happen?
•
Feedback at 12:15
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Tackling high blood pressure
Next steps for this work
•
What will you do next?
•
What’s your pledge? How are you going to contribute to this agenda?
•
Report from the day
•
Steering group – planning and coordinating
•
Wider system ownership and action
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Tackling high blood pressure
Lunch, learning and networking
•
DATA STATION: Check your local data on blood pressure
•
BP CHECKS: Do you know your blood pressure?
•
BHF: Resources available from British Heart Foundation
•
PLEDGE / DIFFICULT QUESTIONS / LIGHTBULB MOMENTS
•
Please return by 13:30 for the afternoon session
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Tackling high blood pressure
A call to action:
‘Beat high blood pressure’
Purpose of the afternoon
•
To gather insight from representatives of the health care community about
perceptions of how high blood pressure is currently managed, and how we
might best communicate and deliver proposed actions/changes.
•
To develop an report from the day which will identify support future action
on this topic
87
Tackling high blood pressure
Quick housekeeping reminder
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Tackling high blood pressure
Impact on health and care system
12%
£850m
45,000
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Tackling high blood pressure
£2
billion
30%
High blood pressure very frequently accompanies
other conditions - relevant to most clinicians regardless of speciality.
Barnet K et al, Lancet 2012
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Links across system
Three key strands:
•
Prevention
•
Detection
•
Management
Overarching themes:
•
Tackling inequalities: the most deprived communities are more likely to
have high blood pressure – great opportunity to reduce variation in
outcomes
•
Partnership: need system leadership at all levels across government,
health system, voluntary sector and beyond
•
Local leaders: change and implementation is influenced and driven by
local professionals
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Tackling high blood pressure
Hypertension clinical guidelines
Dr Matt Kearney
GP Runcorn
National Clinical Advisor NHS England and Public Health England
We have clear evidence based guidance
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Hypertension clinical guidelines
Diagnosing hypertension
• CBPM ≥ 140/90 check up to twice more
• Offer ABPM and ensure correct cuff
• Daytime average of 135/85 mm Hg = HTN
• If ABPM not tolerated use HBPM
• ABPM for 24 hrs, 2 measures/hr during day and at least 1
at night. Average BP needs 14 daytime measurements
• HBPM – 2 readings, twice a day for 4-7 days, discard day
one and take average of remaining measures
• CVD risk assessment core to diagnosis
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Hypertension clinical guidelines
Thresholds for diagnosis
• Stage 1: 140/90mm Hg (135/85 ABPM or HBPM)
• Stage 2: 160/100mm Hg (150/95 ABPM or HBPM)
(Studies show ABPM and HBPM give values on average
10/5 lower than in the office)
95
Hypertension clinical guidelines
Drug treatment
• Stage 2 Hypertension
• Patients under 80 with Stage 1 and:
•
•
•
•
•
96
Target organ damage
CVD
Renal Disease
Diabetes
10 yr CV Risk 20% or more
Hypertension clinical guidelines
Summary of anti-hypertensive
Aged under
drug treatment
55 years
Key
A – ACE inhibitor or
low-cost
angiotensin II
receptor blocker
(ARB)
C – Calcium-channel
blocker (CCB)
D – Thiazide-like
diuretic
Step 1
Aged over 55 years
or black person of
African or Caribbean
family origin of any
age
C
A
Step 2
A+C
Step 3
A+C+D
Step 4
Resistant hypertension
A + C + D + consider further
diuretic, or alpha- or
beta-blocker
97
Hypertension clinical guidelines
Consider seeking expert advice
We have clear evidence based guidance
But…
98
Hypertension clinical guidelines
Implementing guidelines in real world
primary care brings challenges
It’s not just about knowledge
transfer
• Consultations structure
• Time pressures
• Multimorbidity
• Polypharmacy
• Patient knowledge, expectations,
activation, adherence
• (Lack of) follow up systems
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Hypertension clinical guidelines
Multi-morbidity is the norm
100
Hypertension clinical guidelines
Most people with hypertension have other conditions
Tackling high blood pressure
Implementing guidelines in real world
primary care brings challenges
But there are new
opportunities
• Wider primary care staff
• Other settings
• New models of care
• Automation
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Hypertension clinical guidelines
Improving detection of high blood pressure
1. More BP testing in practices
• More opportunistic testing by clinicians
• More routine testing in people being seen for other long term
conditions
• More waiting room testing eg automated systems
2. NHS Health Check – improving uptake and clinical follow up
3. More systematic audit of practice records to regularly detect people
at high risk of undiagnosed hypertension – eg high last reading not
followed up, other risk factors but no recent BP
4. More testing by pharmacies – eg on request and routine in MURs,
NMS etc
5. More self-testing
103
Hypertension clinical guidelines
Improving management of high blood
pressure
1. Systematic primary care audit
• Detecting people with inadequately controlled hypertension
• More frequent routine and opportunistic testing in people with
hypertension
2. Integrating BP testing into management long term conditions
3. Improved implementation of NICE guidance
4. Support adherence
• Shared decision making and patient activation
5. Expand community pharmacist role
• Monitoring BP in people with hypertension
• Supporting adherence to medication and lifestyle
5. Expand self-monitoring and telehealth options
104
Hypertension clinical guidelines
It’s quite easy to measure blood
pressure inaccurately
World Hypertension League Video
https://www.youtube.com/watch?v=egBmUw0Y0IE
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Hypertension clinical guidelines
106
Thank you
Matt.Kearney@nhs.net
Hypertension and NHS Health
Checks
Jamie Waterall,
Head of NHS Health Checks and Blood Programme
Hypertension Project Brookvale
Practice 2015
June Rhodes and Dawn Heggarty
Santa checking in for his NHS “Elf”
Check
Waiting Patiently!!!
Santa passed his “Elf” check with
flying colours!!
The Vision
•
For all patients over the age of 18 years to have had a
blood pressure recording documented within the
preceding 3-years.
•
For all patients with an initial reading >140/85 to have
follow up reviews and appropriate management as
defined in the Hypertension guidelines.
•
For patients newly diagnosed with hypertension who are
under the age of 40 years, to be referred to secondary
care for full investigations
•
For all patients diagnosed with hypertension to be
monitored on a 6-monthly basis and their blood pressure
to be maintained under 140/85.
•
For all patients to receive education on the risks of
uncontrolled hypertension on cardiovascular disease.
•
All patients should receive advice and support on lifestyle
changes to promote health, to include diet, exercise and
alcohol management and smoking cessation.
The Challenge
•
We have an 8,150 practice population
•
We have 1,333 Patients diagnosed with hypertension
•
We have 111 Hypertensive patients who are above
target
•
We have 128 Patients over 45 years that have not had
a Blood pressure recorded in the last 5-years
•
We have 508 Patients aged 18-44 who have not had a
blood pressure recorded in the last 5 years.
•
We have 314 Patients who have a raised blood
pressure reading but no diagnosis of hypertension in
the last 3-years.
•
How do we engage these people who have not had a
blood pressure check or who have been found to
have a raised blood pressure reading but not come
back for a recheck.
•
How do we educate this population and inform them
of their potential risk of cardiovascular disease.
The Plan
•
•
•
•
The practice IT team would concentrate on calling for the
hypertensive patients who have not attended for review
and encourage them to come in.
The practice nurse and health care assistant would
contact the patients with uncontrolled hypertension and
book them in for review.
A Saturday morning clinic was set up for the 7th February
to target those 128 patients over the age of 45 with no
blood pressure reading in the last 5 years. These patients
could also be booked in with the practice nurse or health
care assistant any day of the working week for a health
check. Letters were sent to all of the patients that could
not be contacted by phone 18 patients attended and had
a full health check and 9 patients dna’d.
Patients aged 18-44 years, who have not had a blood
pressure recorded in the last 5 years (508) will be sent
letters to inform them of the importance of having a
blood pressure taken and will be asked to book an
appointment with the practice nurse or health care
assistant.
The Plan continued
•
Those patients who have not responded
or made an appointment after their
invite letters will be informed that the
nurses will be calling to their homes
week beginning 23rd March to record
their blood pressure and weight.
•
Brookvale practice will then audit the
results and provide feedback to the
Halton CCG
•
If successful we hope to roll the
program out to the other practices in
Halton from June 2015.
Thank you
SWOT Analysis
SWOB of effective BP identification and
management
 Strengths
 Weaknesses
 Opportunities
 Barriers
•
Move stations – 10 minutes at first then 5 minutes to add to others
•
Complete all four stations
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Tackling high blood pressure
Coffee break
– please return by 15:00
Action planning
What steps can we take to make a
change?
•
Work on tables to produce action plans
•
What can you do to make a difference?
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Tackling high blood pressure
Panel Q&A
Thank you
•
124
Next steps for this work
Tackling high blood pressure