Thomas Kottke, MD, MSPH, HealthPartners Institute of Education and Research; Co-investigator, ESCALATES
In December 2017, the Annals of Internal Medicine published an NIH-funded systematic review and meta-analysis of 8 strategies to control high blood pressure. Basing their analysis on 121 comparisons from 100 articles, the investigators, from Tulane, China, and Johns Hopkins found that team-based care with medication titration by a non-physician was the most effective strategy. Health coaching, electronic decision support, and home monitoring were of intermediate effectiveness, while clinician training or audit and feedback were ineffective. These findings further validate the importance of practice system changes for improving patient outcomes.
The multilevel, multicomponent strategies to improve hypertension control that the investigators recommend can be implemented in any office-based practice if treatment goals, procedures and team member responsibilities are clearly defined. Many of the interventions being conducted by practice facilitators in the national EvidenceNOW initiative include components of the strategies identified in this important study, especially engaging team members in care. These and other team-based approaches help physicians and advanced care providers identify when they are needed to discuss and address patient hypertension, and it frees them to focus on other patient concerns that they are uniquely capable of addressing.