Excellence in Hypertension Control in a Rural Setting
Members of rural populations, which make up 15% of the United States, are at greater risk of dying from heart disease. High blood pressure, smoking, and obesity are more common among rural residents. But two rural family practices have been able to overcome these challenges and achieve blood pressure readings below 140/90 for more than 80% of their patients. These two practices’ strategies of educating patients and leveraging technology can be used anywhere.
High Plains Community Health Center
Established in 1995 and centered in Lamar, Colorado, High Plains is a family practice center surrounded by farms and ranches. High Plains’ six clinics serve about 9,300 patients per year. Its most remote clinic, 30 miles away from Lamar in Holly, achieved a hypertension control rate of 83%. By forming partnerships in their community they have helped facilitate healthy lifestyle changes, and their partnership with the Big Timbers Community Alliance helped develop more outdoor recreational options around town, including an 8.9-mile walking path and a skate park.
Astoria’s Pacific Family Medicine
Established in 2001 on the coast of Oregon, this single clinic serves 3,500 patients that started with an exceptional control rate, and with added support from the Oregon Rural Practice-based Research Network (ORPRN), the practice achieved blood pressure control for an impressive 89% of patients last year.
These results were acheived by investing in patient education. Both High Plains and PFM realized how important it was for patients to understand a chronic condition such as high blood pressure and what was needed to manage it. Both practices make patient education a priority.
“With more education, patients do come to understand about the risks,” said Susanna Storeng, M.P.A.S., PA-C, a physician assistant at High Plains. “If we can take the time to educate our patients on what hypertension is, why it happens, and what the poor outcomes from it are, then it does definitely help.”
High Plains health coaches are trained in motivational interviewing, a counseling method that helps people make healthy lifestyle changes by having them commit to specific, reasonable goals they can achieve in a realistic time frame.
At ORPRN’s recommendation, PFM trained its medical assistants (MAs) to talk with patients about blood pressure, answer common questions, and set patients up with home blood pressure monitors if necessary. By getting the discussion started with the MAs during the check-in process, physicians have more time to discuss the details of diagnosis and treatment.
Leveraged electronic health records
Coordinating team-based care can be tricky, and patients can easily fall through the cracks unless a structure prevents it. That’s why both High Plains and PFM rely on electronic health record (EHR) systems to keep tabs on patients.
For example, PFM programmed its EHRs to alert the provider when a patient qualifies for a different screening or is due for a visit. PFM can also run complex reports to find patients with hypertension and other chronic conditions who may be overdue for a follow-up visit. “We leverage our EHRs and other capabilities to protect patients,” said Janet Mossman, FACMPE, clinic manager for PFM.
At High Plains, care teams use the EHR system to communicate. For example, team members can set up “flags” in EHRs to notify other team members, such as alerting a health coach to call a patient for a home blood pressure measurement. The health coach can then set a flag for the primary care provider to review the measurement at the patient’s next visit.
Both practices emphasize that strong patient relationships are key.
PFM focuses on its culture of communication and mutual responsibility. All new patients sign a “contract” agreeing to meet certain milestones. For example, people who have chronic diseases agree to make at least three visits a year. Patients who miss appointments are contacted personally by Mossman for a frank discussion about their condition and care.
“We have an amazing relationship with our patients,” Mossman said. “They know it’s a two-way street. We’re very communicative about the fact that patients need to be equally engaged in their care. That’s the culture we share with them from the first visit onwards.”
Storeng says High Plains benefits from the small-town atmosphere. The clinic makes sure patients always see the same team members. High Plains also performs quarterly patient satisfaction surveys.
“We are a small community, and that really makes family medicine very important,” Storeng said. “We understand the patient’s culture and values, and this helps the patient to know that they are cared for.”
Although rural practices may face unique challenges, any practice can implement these solutions for improving hypertension control rates. High Plains and PFM recommend the following strategies: