Nationwide, approximately 75 million — or one in every three — American adults have high blood pressure or hypertension, according to the Centers for Disease Control and Prevention. States are also feeling the burden of this disease. In New Hampshire, one in four adults has hypertension, and only 33 percent of these individuals have their condition under control according to the Health Resources & Services Administration.
Evidence suggests, however, that blood pressure self-monitoring programs — when combined with clinical support — can help improve cardiac health outcomes and potentially reduce emergency room visits and hospitalizations.
Specifically, the American Heart Association has found that blood pressure self-monitoring can help patients ensure their blood pressure reduction treatments are effective, by providing a “time-lapse” picture of blood pressure readings to their physicians.
According to the New England Quality Innovation Network-Quality Improvement Organization—the QIN-QIO for Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont — insurance coverage for monitors is often inconsistent, which results in few patients having access to them.
To support the wider use of blood pressure self-monitors, the New England QIN-QIO partnered with the New Hampshire Department of Health and Human Services (NH DHHS) to develop a statewide Self-Measured Blood Pressure Program.
Initially, the program engaged 13 clinics that received monitors courtesy of the NH DHHS, and education on best practices for self-monitoring and management from the New England QIN-QIO cardiac lead in New Hampshire.
In turn, participating clinics were required to develop a procedure document detailing how they were going to use the monitors, how they would identify patients who would receive the monitors, how they would be stored, and how they would be calibrated. They were required to report data to the New England QIN-QIO and NH DHHS every six months after starting the program.
A number of patients and families in New Hampshire experienced positive health outcomes as a result of this project.
One program participant used her borrowed self-monitor to check the blood pressure of her husband and found it to be unusually high. As a result, the patient was able to schedule an emergency appointment with a health care professional and was prescribed critical medication. The patient proceeded to enroll in the program and is working to control his blood pressure.
Another patient in the program was periodically logging her blood pressure rates at the request of her doctor; however, her blood pressure machine at home was unreliable, and she could not afford to buy a new one. The program allocated a new machine to the patient, and nurses informed her about how to take her blood pressure accurately and when to call her provider. The patient has since been able to successfully manage her blood pressure.
Initial data from the project has shown an overall improvement in hypertension rates since implementing the program in respective practices. One New Hampshire clinic saw 24 of 31 enrolled patients experience a reduction in blood pressure within six months, and 15 of those patients now have their condition under control. Another clinic saw 20 of 26 enrolled patients reduce their blood pressure. Approximately 50 percent of participants were able to control their blood pressure rates within the first six months of participation.