Dr. Chris Tonozzi is Mountain Family's Director of Data Quality.

By Mountain Family Health Centers

We’re in an era in which all of us, health care providers and patients alike, are expected to understand what tests are available and which should be ordered. Every day we have new medical studies indicating which tests are worthwhile (with evidence behind them) and which tests are not. Some are complicated, like screening for aneurysms of the aorta. Some are slightly complicated, but we’re used to using them—like testing cholesterol levels.

Fortunately, some tests are simple and have proven benefits, like screening for high blood pressure. Medical studies have found, time and again, that blood pressure control is worthwhile in preventing heart attacks and stroke, which is the leading cause of death in the U.S.

The U.S. Preventive Services Task Force recommends the following screening for high blood pressure:

•             Adults aged 18 – 39 years should be screened every 3 to 5 years

•             Adults over 40 years should be screened yearly

•             Persons at risk should be screened yearly, including people who:

                              o Had previous “high normal” blood pressure
                              o Are overweight
                              o Are African American

Why, you may ask, is my blood pressure taken every time I see my health care provider, if I only need to be screened every three to five years? That’s a good question! We take blood pressure at each visit mostly because we feel it’s more reliable to check it at every time, rather than having to decide when a patient needs to be screened and when they don’t. It creates an ingrained habit to look at it every visit.

Medical leaders at Mountain Family Health Centers recently engaged all providers and nurses in a process to create a guideline for providers and nurses to follow so that we would have a more uniform process for controlling high blood pressure. Having a guideline for providers and nurses also allows us to do more of what’s called “Team-Based Care.” In this scenario, doing more Team-Based Care means being able to pass a significant amount of the care of hypertension patients from doctors, nurse practitioners and physician assistants to nurses. This will give nurses an opportunity to do more face-to-face patient care, use their teaching and patient motivation skills, and ultimately expand the amount of hypertension care we are able to do. To develop this high blood pressure management guideline, we relied on guidelines that others have already developed, especially one that was published earlier this year by Kaiser Permanente.

An interesting development in guideline-based care is that we are realizing that the blood pressure measurements we make in the medical office are often not very reliable, especially the first blood pressure that we check.

The more reliable blood pressure measurements are home blood pressure measurements (done with specific recommendations) and “automated office blood pressure,” or AOBP. AOBP is using a blood pressure monitor that will allow the patient to relax in a room alone, and after waiting a few minutes, check the blood pressure three times, then report an average of those blood pressures.

Mountain Family Health Centers data show we have significant growth in the number of patients with high blood pressure. The number has grown from 1,587 patients to 1,768 patients in the last year. We are meeting the goal of a controlling high blood pressure in 65 percent of those patients. This is the same as the state and national average for Community Health Centers. We’re implementing our new provider and nurse blood pressure guideline with the goal of doing better, more objective and evidence-based care, and extend that care to more patients. I’ll report back next year with the data.