Single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much, according to a study at Kaiser Permanente, as reported in the Journal of the American Medical Association (JAMA).
Through one of the largest community-based hypertension programs in the nation, Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009, helping to reduce the risk of stroke and heart attack for patients.
The rate of hypertension control throughout Kaiser Permanente Northern California increased from 43.6 in 2001 to 80.4 percent in 2009, as measured by the HEDIS set by the National Committee for Quality Assurance.
In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent for the same period. Control rates throughout California, available since 2006, were similar but slightly higher than the national average — 63.4 percent versus 69.4 percent from 2006 to 2009.
The program encouraged single-pill combination therapy — combining multiple drugs into one pill, a strategy that improved adherence, lowered patient cost and improved blood pressure control. Medical assistants also followed up with patients two to four weeks after medication adjustments and informed the primary care physician, who then directed treatment decisions and follow-up planning. This process helped to accelerate treatment intensification without significantly increasing the need for repeat clinician visits, while simultaneously improving patient convenience and affordability.
Kaiser Permanente Northern California introduced the hypertension program in 2001 as a multifaceted approach to blood pressure control and quality improvement. A number of differentiating practices drove the program’s success, including a comprehensive hypertension patient registry, which increased from 349,937 or 15.4 percent of adult membership to 652,763 or 27.5 percent of adult membership between 2001 and 2009. By using frequent hypertension control quality reports, Kaiser Permanente was able to quickly identify high-performing medical centers and implement their successful practices and innovations system-wide. The program also supplied clinicians with a frequently updated evidence-based, four-step hypertension control algorithm.
Hypertension affects 65 million adults in the United States, or 29 percent of Americans age 18 years or older, and is a major contributor to cardiovascular disease. Blood pressure control remains elusive nationally, despite widespread availability of effective therapies, and limited data exist about the implementation and results of large, sustained hypertension programs.
Source: Kaiser Permanente, HHS , August 6, 2013
Guide to Improving Medication Adherence analyzes trends in improving medication adherence at more than 160 healthcare companies, and takes an in-depth look at pioneering efforts by Kaiser Permanente Colorado and CIGNA Pharmacy Management to improve medication compliance levels in their populations.