Georgia Works to Identify and Manage Hypertension

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Submission Date: June 2016

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Georgia

States/Territories Involved: Georgia

Funding Source: CDC, State/local sources, Private Sources

CDC Funding:

Yes

CDC Funding (Specified):

(1305) State Public Health, Other CDC Funding

Other Funding:

State funding

Domain Addressed:

Health Systems Strategies

Public Health Issue:

  • About 1/3 of Georgia adults have been told by their doctor that they have hypertension.
  • Identifying people who have hypertension and getting their blood pressure under control can reduce deaths from heart disease, the leading cause of death in Georgia.
  • Diseases of the cardiovascular system are the second leading cause of premature deaths in Georgia.

Project Objectives:

  • To increase the percentage of adult patients (age 18 to 85) who have a diagnosis of hypertension who are adequately controlled, by 10 percentage points
  • To decrease the percentage of adult patients (age 18 to 85)  with 2 or more BP readings in 12 months at or above 140/90 mm Hg who have not been diagnosed with hypertension, by 10%
  • To reduce emergency room visits for hypertension by 5%
  • To expand the adoption of hypertension management programs and the application of Plan-Do-Study-Act cycles to primary care practices

Program Action:

  • The Georgia Department of Public Health (GDPH) leads a team of state and local partners, called the Georgia Hypertension Collaborative (Collaborative), in working with local health districts to standardize data and referral protocols in order to help health care providers identify patients with undiagnosed hypertension and begin follow up care and referrals to hypertension management programs. This work began as part of the ASTHO Million Hearts Learning Collaborative.
  • GDPH hosts monthly calls on hypertension and heart disease via the Collaborative where stakeholders report their activities and health districts present updates, share concerns, and ask questions. The Georgia Quality Improvement Organization, Alliant Quality, is an integral partner in the Collaborative, assisting GDPH with trainings for public health nurses on improving diagnosis and treatment of hypertension and using a team approach. During these trainings nurses received answers to their questions about blood pressure measurement, data reporting, treatment options using hypertension and hyperlipidemia guidelines and the distinction between diagnosed and undiagnosed hypertension.
  • The Coastal Health District partnered with Curtis V Cooper Primary Health Care (CVC) to create a blood pressure protocol for use by CVC’s federally qualified health center (FQHC). Applying the JNC VIII definition for high blood pressure to a search of the FQHC database of 13,000 patients helped them see how well they were doing in identifying and treating patients with hypertension.
  • Georgia also operates the Hypertension Management and Outreach Initiative in five public health districts, providing case management and clinical services to uninsured and underinsured adults with a primary diagnosis of hypertension in the participating districts.

Data/Other Information Collected:

After conducting an analysis of 14 health districts, GDPH found that out of the 229,311 patients treated at these health departments 1,227 were found to have undiagnosed hypertension in 2015.  Of these patients, 193 are located in the participating Million Hearts health districts and are currently being targeted using GDPH hypertension interventions.  GDPH is currently creating a plan of action to recall patients not being served in the Million Hearts districts.

Impact/Accomplishments:

  • One FQHC found 157 of their patients had undiagnosed hypertension and medical records staff contacted these patients to arrange return visits to verify blood pressure. Health districts in the Hypertension Management and Outreach Initiative also reached out to patients who were potentially hypertensive. In total, 1,285 patients were identified as having undiagnosed hypertension. Of the 200 patients able who returned for a visit to verify blood pressure, at least 30 of these patients now have their blood pressure under control.
  • The South Health District developed a Hypertension Telemedicine Clinic now operating in four rural health departments in an effort to alleviate the identified transportation barriers and improve health outcomes. For example, the initial 30 patients identified as having hypertension now receive follow-up blood pressure care through telehealth methods (using technology to deliver virtual health services to patients who are offsite).
  • The South Health District, Coastal Health District and East Central Health District collectively issued 210 blood pressure monitors to patients for home blood pressure monitoring –  an evidence-based practice that promotes blood pressure control.  The blood pressure monitors were secured using state funds. The home blood pressure monitoring program has been very successful in the South Health District where the program achieved a 100% patient adherence and retention rate.  Of the 30 South Health District participants, 25 experienced and maintained a decrease in their blood pressure.
  • GDPH published the Hypertension Management Action Guide for Health Care Providers to update providers on blood pressure guidelines, self-monitoring of blood pressure, and working with patients and a Standard Nurse Protocol for Primary Hypertension In Adults (HTN Nurse Protocol). In preparation for implementation of the HTN Nurse Protocol in September 2016, the East Central Health District is hosting three HTN Nurse Protocol Workshops.  GDPH launched four online tutorials in January 2016 as prerequisites for the HTN Nurse Protocol Workshops.

Challenges/Lessons Learned:

  • Transportation is a barrier for some patients asked to return for a blood pressure visit after beingidentified as having undiagnosed hypertension since many patients are low income or on a fixed income.  This led to the development of the Hypertension Telemedicine Clinic in the South Health District.
  • Patient follow-up is also a barrier to providing care to the population due to frequent changes in patient contact information.
  • Health centers need funding to continue this work.

Next Steps:

  • The Coastal Health District introduced their undiagnosed hypertension model to a new county in their District and despite limited funding  will expand this model to additional counties in the District.
  • The South Health District will continue operating their Hypertension Telemedicine Clinics.
  • The East Central Health District will continue to plan and host Hypertension and Diabetes Nurse Protocol training sessions and plans to expand implementation of the undiagnosed hypertension model to additional counties.
  • Georgia’s Million Hearts interventions will be integrated into 1305 work plans going forward in order to continue spreading and sustaining these activities.
  • GDPH is creating a plan of action to recall patients not being served in the Million Hearts districts.

Program Areas:

Heart Disease and Stroke

State Contact Information:

GA
Brittany D. Taylor, MPH
Georgia Department of Public Health
404-657-6313
Brittany.Taylor@dph.ga.gov

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