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Tag Archives: blood pressure

Kaiser Permanente Gives Providers Evidence-Based Tools to Increase Adherence

At an industry conference years ago, I met an HIV-positive patient. We spoke about her treatment as well as her adherence program. “Who takes care of you?” I asked. “Kaiser Permanente,” she responded. Afterward, I did a little research and discovered this was one of the first HMOs created in the United States that takes care of millions of patients. Based in Oakland, California, their goal is “supporting preventative medicine and attempting to educate its members about maintaining their own health.”

Joel L. Zive

Joel L. Zive

Adherence remains a capstone in caring for patients after medications are dispensed and is an especially important issue for indigent populations. But now with implementation of health care reform fast approaching, patients will be required to take even more responsibility for their health, including adherence to medication regimens. Although no integrated health care structure is perfect, Kaiser’s integrative model fascinates me and allows its health care teams to implement successful adherence strategies.

For example, a Kaiser physician at the South San Francisco Medical Center conducted a hypertension study (“Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program”) that compared their program’s results to those at the state and national level. The outcomes are startling:

  • The Kaiser Hypertension control rate nearly doubled, skyrocketing from 43.6 percent in 2001 to 80.4 percent in 2009.  
  • In contrast, the national mean of hypertensive control went from 55.4 to only 64.1 percent during the same time period.

One aspect of this program included using single pill combination therapy, which has been shown to boost adherence. In a slightly different approach to adherence in hypertension, Kaiser Permanente Northern California and UC San Francisco were recently awarded an $11 million grant to fund a stroke prevention program by targeting and treating hypertension among African Americans and young adults.

By Googling “Kaiser Permanente adherence” the Kaiser Permanente Division of Research appears. Their published research draws from Kaiser Permanente units throughout their network, collaborations with academic institutions nationwide, and the HMO Research Network – a consortium of 18 health care delivery organizations with both defined patient populations and formal, recognized research capabilities. These resources provide clinicians and pharmacists with a plethora of study designs and disease states from which to choose and evaluate.

In the study “Determination of optimized multidisciplinary care team for maximal antiretroviral therapy adherence,” for example, a multidisciplinary care team was assigned to patients with new antiretroviral drug regimens. Because this model translated to improved adherence rates, clinical teams around the country now use some variation of a multidisciplinary approach, enabling each discipline’s area of expertise to benefit the patient.

Another article from Kaiser — “Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)” – demonstrates that adherence is multifactorial.  This study’s conclusions underscore the importance of health care literacy components, simplifying health communications for treatment options, executing an enhanced public relations campaign around depression and monitoring refill rates.

In my experience, if someone with mental health issues does not take his or her medications, then regardless of disease state, the patient’s treatment falls off the track. I approach these difficult situations by drawing on the conclusions of the above studies:

  • First, is there a different message I could give the patient? Or am I reaching the patient at a level of health care literacy he could understand? For example, I had a deaf patient who found it tiresome writing messages back and forth to me. When I realized he “speaks” to people via a teletype machine, I began communicating with him via word processing software. This made our communications less cumbersome. And this improved adherence to his regime because he was less frustrated.
  • Next, the multidisciplinary approach is quite powerful. When I served HIV-positive patients in the South Bronx, if anything occurred that affected adherence, the prescriber, nurse, social worker or case manager immediately were made aware. Sometimes we would discontinue the regimen and other times we would tweak the regimen and get the patient back on treatment.

The real adherence tragedy for indigent patients is not whether they receive medication, but whether they have access to the tools, education and knowledge they need to take their meds as prescribed. Leveraging articles from resources like Kaiser’s Division of Research may be the solution to reversing the trend of low adherence.

Now we want to hear from you. If you’re a patient, has your doctor or pharmacist worked with you to improve med adherence? If you’re a provider, what resources have you found to be useful when helping patients understand why they should take meds as prescribed? Share your stories in the comments.

Categories: Access to Care

Turning DASH Strategy into Reality for Improved Cardio Wellness Outcomes: Part II

As part of their health & wellness program, the largest health insurer sent me a refrigerator magnet highlighting the National Institutes of Health’s (NIH) Dietary Approach to Stop Hypertension Diet (DASH).  In their accompanying letter, the company stated that the refrigerator magnet is a “tool to help you manage your blood pressure.”

Shawn J. Green

Shawn J. Green

The DASH Eating Plan refrigerator magnet was a nice gesture to remind clients to consume less sodium and incorporate more vegetables and fruits into their diet to lower blood pressure.  However, is this the most effective wellness tool to engage and motivate individuals to change their eating habits?

As we learned in last week’s post, plant-based diets – especially those rich in leafy greens, such as spinach and arugula – elevate cardio-protective nitric oxide.  For many pre-hypertensive individuals, staying with a plant-based diet is a critical driver to prevent elevated blood pressure and the diseases associated with hypertension.

Yet many Americans continue to fall far short of eating recommended daily servings of vegetables that elevate natural nitric oxide levels in our body.

A new model is needed to drive behavioral change. So how do we consistently integrate cardio-protective plant-based diets into our daily dietary lifestyle?

Berkeley Test may be a start.

Berkeley Test’s Saliva Nitric Oxide Test Strips and its iPhone Cardio Diet Tracker are designed to break bad habits and empower folks from various walks of life to incorporate plant-based foods into their daily diets.  These engaging tools provide a model to influence dietary change on a personal level that supports lasting compliance with measurable outcomes.

Designed to detect nitric oxide status in the body throughout the day, Berkeley Test developed the next generation proprietary nitric oxide test strip; for less than 70-cents, an easy-to-use, 1-minute saliva test strip enables consumers to make immediate and real-time dietary lifestyle adjustments.

Once users finish the strip test, they can use Berkeley Test’s Cardio Diet Tracker App to compare their results to a color-coded indicator showing whether nitric oxide levels are on target. After 2-3 hours, the user is alerted to check their nitric oxide status.  Users can leverage the Cardio Diet Tracker App to more effectively adhere to plant-based diets by tracking nitric oxide status in conjunction with the type, frequency, and amount of nitric oxide-potent foods eaten to sustain their levels.

Michael Greger, M.D., of NutritionFacts.org, suggests that Berkeley Test may offer hope by bringing plant-based foods into our dietary lifestyle in an engaging fashion. At the very least, it will remind us to eat our greens on a more frequent basis, he says.

Berkeley’s strip-app bundled technologies demonstrate that self-assessing, analyzing, and fine-tuning wellness outcomes with a shared, open, interactive community can be a catalyst to sustain plant-based cardio-protective diets in our daily lifestyle. The value of Berkeley Test’s model is not only demonstrated in how it equips consumers to make healthier dietary choices, but also in its ability to connect users by allowing them to share dietary successes with their Facebook friends.  In today’s society, wellness outcomes and fitness is highly social and valued.

Individuals – who range from Olympians seeking to boost their physical endurance to baby boomers looking for an easier way to eat healthfully and prevent high blood pressure – are embracing these innovations.  As more people turn to Berkeley’s strip and mobile App to improve adherence to plant-based diets, such as DASH and Ornish, natural communities of mutual support are growing.  These networks offer a unique venue to share experiences, provide strategies for success and a forum to discuss common challenges, refine approaches and achieve desired outcomes.

A dynamically open community to share new knowledge about wellness and create a model for achieving and maintaining healthy living and eating is what we hope Berkeley’s ‘health biomarker’ test strips (such as nitric oxide and mobile App combo) provides.

So, what is your nitric oxide level, today?

More Patients DASH to New Solution to Reduce High Blood Pressure: Part I

Shawn_J_Green

Shawn J. Green

What’s the solution to reversing the tide of hypertension, the most commonly diagnosed condition in the United States?  More evidence indicates that the answer begins with the food choices we make every day.

An underlying cause of heart attacks, strokes and kidney disease, one in three American adults now experiences high blood pressure – the single-largest contributor to death worldwide. It is also becoming more resistant to the pharmaceutical drugs used to lower it. In fact, blood pressure remains elevated in nearly one-third of all treated hypertensive patients on pharmaceutical drugs.

Instead of relying on prescriptions, more patients are turning to a healthier eating approach: Keeping sodium intake low and making consumption of nitric oxide-rich vegetables and leafy greens high. This cardio-protective daily diet, known as the DASH (Dietary Approach to Stop Hypertension) Eating Plan, is emerging as an effective way to delay or prevent high blood pressure altogether.

The value of nitric oxide was spotlighted when the Nobel Prize was awarded in 1998 for discovery of this naturally produced cardio-protective factor. A string of clinical studies underscored that vegetables (like red beet roots) and leafy greens (such as spinach and arugula) are replete with nitric oxide.

Diets known for promoting heart health and lowering rates of diabetes and obesity – like Japanese diets, Mediterranean diets and plant-based diets, such as DASH, among others including TLC, Ornish, and Pritikin – incorporate these natural whole foods. The need to consume more nitric oxide-potent vegetables and leafy greens becomes even more critical as we age because our bodies are less able to synthesize this natural hypertensive-fighting factor.

Reducing hypertension would not only improve health outcomes for individual patients, but would also benefit the health system as a whole. Although the percentage of resistance to antihypertensive drugs is relatively lower in the U.S., elevated blood pressure among a rapidly growing number of baby boomers will mean more challenges for health care in the long run unless we identify tools that work and make them as accessible and user-friendly to the public as possible.

DASH holds great promise to fuel compliance – a critical driver to prevent elevated blood pressure – among those living with hypertension. But a healthful eating strategy alone will not mean better outcomes for patients without a model to help them break bad habits and support dietary changes on a personal level, one day at a time.

So how do we get there?

Join us here next Thursday for the second post in our two-part series. Discover what innovative tools can empower patients to make the DASH Diet a part of their arsenal in the fight against hypertension.

It Takes a Community for Effective Disease Prevention and Management

To help stem the tide and high cost of persisting disparities in U.S. health care, providers are leveraging Community Health Workers (CHWs) as critical players in improving health outcomes by successfully linking “vulnerable” patient populations to better care. Living in the communities where they work, CHWs understand what is meaningful to those communities, communicate in the language of those they serve, and incorporate cultural buffers to help patients cope with stress and promote health outcomes.

As the CDC reports, growing evidence supports the involvement of CHWs as a critical link between providers and patients in the prevention and control of chronic disease:

  • They help high-risk populations, especially African-American men in urban areas, to control their hypertension.
  • They enable diabetic patients to reduce their A1C values, cholesterol triglycerides and diastolic blood pressure.
  • Their interventions improve knowledge about cancer screenings as well as screening outcomes.
  • Their interventions help patients reduce the severity of asthma.

Many Americans – especially those with low incomes, have no insurance or face other socio-economic barriers to primary care – often distrust the health care system, or lack the resources and awareness needed to take charge of their health. As a result, they wait until health issues and chronic disease escalate enough to drive them into the emergency department, where they receive short-term solutions that drive up the total cost of health care.

CHWs are changing that, community by community. Examples of CHW programs – both at home and abroad – abound. One is Penn Medicine’s IMPaCT Program.

IMPaCT (Individualized Management for Patient-Centered Targets) pairs patients in need of extra support with relatable neighbors and peers (people who have shared language, ethnic and geographic backgrounds) to assist them in navigating the medical system and identify the underlying causes of illness.

“Lower income patients tend to poorly manage chronic disease and have worse health outcomes than other patient populations,” explains Dr. Shreya Kangovi, Director of the Penn Center for Community Health Workers, which houses the IMPaCT program. “They are less likely to get preventive care and more likely to end up in the hospital. This scenario leaves health care practitioners frustrated, because they can’t move the needle on health outcomes. And it makes it difficult for the health system to meet its quality targets.”

Dr. Kangovi notes that many patients served by IMPaCT didn’t have a relationship with a primary care physician prior to joining the program.

“There is a lot of focus today on reducing hospital re-admissions,” she says. “But before we can reduce re-admissions, we need to make sure patients have a substitute for the emergency department.”

She shared the story of “Ben,” a young man with a bad case of lupus and no insurance. Ben had been visiting Penn’s Emergency Department regularly for lupus flare-ups. There, he received steroids and pain medications before being sent along his way. Thanks to IMPaCT, Ben was set up with a primary care doctor who understands his health problems, and placed Ben on a better medication regimen. Not only does Ben now feel better, he has more trust in the health care system that he sees as an ally, she says.

IMPaCT currently serves about 500 patients via two programs – one for hospitalized inpatients and one for primary care outpatients. The program’s CHWs meet with patients upon admission to the hospital to set short-term goals and identify pathways to solving their clinical and socioeconomic hurdles. They advocate for patients during their hospitalization, then work with them during discharge and beyond to get them connected to resources in their community. On the primary care side, patients work with their IMPaCT partner over six months to break long-term health goals down into smaller, achievable steps.

“Once patients leave the hospital, real-life issues intervene,” Dr. Kangovi says. “IMPaCT’s community health workers address these health and life issues on the ground, and do so much better and at a much lower cost than clinically trained personnel.”

Are CHWs making a difference where you live? How are they helping to reduce costs and improve access to health care?

Categories: Access to Care

Telehealth Opens Doors to Enhance Health Outcomes and Reduce Costs

Telehealth solutions are making significant inroads to reverse high health care expenditures and reduce noncompliance with prescription therapies – issues that especially impact those living with chronic disease.

By engaging patients in health education through classes, patient portals, real-time patient-provider consultations, online discussion forums and more, telehealth strategies empower providers to monitor disease progression and intervene with patients at an earlier stage, when conditions may be more easily treated.

A digital conduit that delivers medical care, health education, and public health services, telehealth connects multiple users in separate locations. Telehealth services consist of diagnosis, treatment, assessment, monitoring, communications and education. It includes a broad range of telecommunications, health information, videoconferencing, and digital image technologies.

And what’s best of all? Telehealth is working in many situations. Here are a few examples:

Case Study #1: Telehealth plays an instrumental role in supporting the care of veteran patients with chronic conditions. They are part of a national program from the US Veterans Health Administration to coordinate the care of veterans with chronic conditions at home and avoid unnecessary admission to long-term institutional care. The program included the systematic implementation of health informatics, home telehealth, and disease management technologies for six conditions including diabetes mellitus, congestive heart failure, hypertension, posttraumatic stress disorder, chronic obstructive pulmonary disease, and depression.

Patients involved in the program benefitted from a 25 percent reduction in the number of bed days of care and a 20 percent reduction in hospital readmissions. According to a study of the program, the basis for reduced utilization of health care resources for the patients involved was due to the program’s foundation in patient self-management, disease management and the use of virtual visits.

Case Study #2: At Partners HealthCare in Boston, a home telehealth program focusing on cardiac care resulted in a 50 percent reduction in heart failure hospital readmissions, for a total cost savings of more than $10 million since 2006. The Connected Cardiac Care Program is a centralized telemonitoring and self-management and preventive care program for heart failure patients that combines telemonitoring with nurse intervention and care coordination, coaching and education. The daily transmission of weight, heart rate, pulse and blood pressure data by patients enables providers to more effectively assess patient status and provide just-in-time care and patient education.

Patients in the program use equipment – a home monitoring device with peripherals to collect weight, blood pressure, and heat rate measurements, and a touch-screen computer to answer questions about symptoms – on a daily basis for four months. Telemonitoring nurses monitor these vitals, respond to out-of-parameter alerts, and guide patients through structured biweekly heart failure education.

Cost to the patients? Zero.

Case Study #3: A telehealth strategy using webinars had a small but “positive impact on hypertensive patients” in Brazil, in terms of their adherence to antihypertensive drugs, low salt diet and physical activity. The program was managed by Family Health Teams (FHTs) consisting of doctors, nurses, nurse technicians and community health agents. According to researchers studying the program, the vast majority of practitioners do not specialize in primary care, and only recently have specialized courses emerged to provide that training.

“Given the country’s continental dimensions, high demand, and inadequate amount of training and continuing education centers for primary care professionals, telehealth presents itself as a promising strategy to improve access to training, leading to the improvement of hypertension,” they noted.

Despite growing evidence that telehealth is working for more and more patients, concerns remain about security, privacy and medical liability, with critics also arguing that telehealth lacks common standards. Government agencies, they say, have often been slow to reimburse patients for many telehealth services. Further, some health professionals argue that telehealth threatens to compromise the doctor-patient relationship.

Tell us what you think. Do the advantages of telehealth outweigh possible drawbacks? Have you leveraged telehealth services, either as a patient or provider?

For more information on how telehealth is changing the concept of health care delivery, dowload the White Paper from Tunstall Americas: “Telehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs.”

Categories: Cost-Savings