WIHI Chat - JAMA



WIHI Chat – March 13, 2014How High, How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelinesfrom Madge Kaplan & Guests to All Participants:Hi all. Thanks for joining. Enjoy some of the photos from a mobile health tour IHI just completed with wonderful partners ... in Boston, NYC, and DC.from Madge Kaplan & Guests to All Participants: Madge Kaplan & Guests to All Participants:If you didn't get a chance to look at the articles in JAMA, please see the link provided in CHATfrom WIHI admin to All Participants: Here's the link to today's WIHI slides: WIHI admin to All Participants:Tweeting today? Make sure you give us a mention @TheIHI #IHI from Bonnie Roberts to All Participants:any thoughts on pts with significant proteinuria?from Dawn Voss to All Participants:when are the slides available?from Madge Kaplan & Guests to All Participants:Here's the link to today's WIHI slides: Bonnie Roberts to All Participants:please discuss if possible aug 2013 acp journal study on 600000 veterans, bp and mortalityfrom G Pape to All Participants:Craig, could you stare the makeup of your National Guideline Program team?from G Pape to All Participants:excellent. thank you, I'll be in touch. from Teresita Lawson to All Participants:Can you address medication adherence issues and patient driven barriers?from Ronald Adams to All Participants:What recommendations do you have to improve blood pressure measurement in the medical office and the right strategies for cost effective and efficient follow up with attention to blood pressure control?from Sheila Anane to All Participants:What are some successful medication adherence strategies?from vicky minden to All Participants:See the guidelines here, along with a compilation of related articles, published in JAMA online December 28, 2013. robin harris to All Participants:Anyone have a pt and provider tool to explain probability relative to HPN? A visual like a storyboard?from WIHI admin to All Participants:Make sure your chats are directed at ALL PARTICIPANTSfrom Beverly Spivey to All Participants:Can you speak to the fact that there are many medicines for mild to moderate HBP but actually very few for moderate to severe HBP, which is where many of the uncontrolled population is. We settle for combinations that don't always work.from vicky minden to All Participants:Here you’ll find the new guidelines, along with a compilation of related articles, published in JAMA online December 28, 2013. Maria Dunn to All Participants:Hi, regarding med management OR BP monitoring in the home, consider a home health referral for nursing AND/OR Occupational Therapy to work with the homebound patient in their own to independently manage their own medications OR diseases/conditions. Very happy to see consideration given to potential LBP in the elderly considering physiological changes occurring as we age.from Olga Felton to All Participants:Can you speak to the importance of practitioner technique and verification of results with manual blood pressure measurements in establishing and applying treatment?from Chris Sarfaty to All Participants:YES! "How many days this week did you take your medication?, Can you tell me more about that? What things do you think are making it hard to do?" thank you Peter.from William Hewitt to All Participants:How is BMI communicated as a critical factor in BP controlfrom Peter Basch (privately):Thanks Chrisfrom Charbel Khoury to All Participants:Any insight on whether Pulse Wave Velocity measure could eventually be the "HbA1c" of hypertension? or is affected by other metabolic disease too much for it to be specific?from Stephen Martin to All Participants:Changed to All Participants -- Thanks! Please discuss Cochrane 2012 review on mild hypertension and how NICE and Canadian guidelines no longer recommend pharmacological treatment of mild hypertension (and ESC notes it is an open question), how recent Cleveland Clinic review and others find no evidence to treat to a particular target, and how recent JAMA editorial recommends no further management using clinic blood pressure values, but generally only ones from home.from Teresita Lawson to All Participants:In our center we have an integrated medication management program with a clinical pharmacist that is one patient centered approach to address the issue of medication non adherence.from Karol Sue Byers to All Participants:ARBs aren't usually considered along with the other usual 3. Would you please explain ?from Liz Pohlmann to All Participants:Pharmacists, experts in medication related problems, are available in community pharmacies to a large portion of our population. How can we engage community pharmacists in improving awareness of high bp and improving bp management?from Chris Sarfaty to All Participants:You can have the best treatment plan in the world, best evidence in the world, but if the patient is not on board, it will be like blowing in the wind. Patients (and, yes, you and I) drive our own ships. So it is essential to have investment in rapport, listening and understanding what the patients priorities are in order to make progress with applying medication (and lifestyle) guidelines.from Madge Kaplan & Guests to All Participants:initiative: Hair, Heart, and Healthfrom Chris Sarfaty to All Participants:YES! Barbershop, beauty salon, daycare drop off, workplace etc. Thank you IHI.from Ronald Adams to All Participants:Should health plans make the out of pocket cost of HTN medications at zero cost share?from William Hewitt to All Participants:What about diet and weight control specifically fast foods that contain high fat content and GMO foods?from Terry Cyr to All Participants:The American Cancer Society has a program that focuses on client education by barbers and hairdressers that may serve as a model.from Kelley Gordon to All Participants:We have diabetic nutrition educators to help with diet to bring about life style modifications to lower A1c's. We need to consider increasing the medical home team to include diet educators to assist in lowering HTNfrom Lorena de Anda to All Participants:Kaiser Permanente Colorado is working on a Barbershop/Salon Program run by Dr. Terri Richardson. In collaboration with geo-mapping, she has been able to very specifically target those barbershops and salons where there is a HTN is more prevalent.from Terry Cyr to All Participants:Parish Nursing programs have been doing blood pressure screenings and education for years!from Sheila Anane to All Participants:How can medical assistants be engaged to be more active in hypertension care management? Motivational interviewing, medication follow-upfrom Frances Bell Banks to All Participants:As a Parish Nurse in an African American majority congregation I address blood pressure by doing numerous screenings and presenting educational information on diet, exercise and lifestyles changes.from Gail Verschoor to All Participants:I agree with the bundling of chronic care issues - most deal with diet, activity, medication and monitoring. I think we miss opportunities when we focus on only one conditionfrom Lucille Taylor to All Participants:I am a parish nurse in Hartford, CT. Any help with info on latest guidelines (ranges) for all ages, particularly our elderly parishioners would be most helpful. Unfortunately, I just joined this discussion late. So sorry, I was at work & became back logged with patient issues. Would appreciate any guidance for us as parish nurses. I am the BP coordinator & run a BP clinic once a month on a Sunday after Masses. Thank you.from Carolyn Wray-Williams to All Participants: Carolyn Wray-Williams to All Participants:Lucille the new HTN guideline link is above.from Lucille Taylor to All Participants:Forgot to provide my e-mail address: lucille.taylor@from Beverly Spivey to All Participants:We have had some success with teaching people to cook common dishes in their diet in a more healthy way.from Lucille Taylor to All Participants:Thanks Madge, you're the best!!!from Lisa Allen to All Participants:YES! to parish nurses and BP screening clinics. As a parish nurse, we use AHA guidelines and educational resources; encourage follow up with their physicians. from Frances Bell Banks to All Participants:Lucille look at or for guidelines to use as a Parish Nurse.from Eric Peterson to All Participants:Thanks to the Hosts and participants! Great comments and questions! from vicky minden to All Participants:IHI’s Escape Velocity initiative Beverly Spivey to All Participants:Meditation is proven to lower blood pressure in African Americansfrom Lucille Taylor to All Participants:Thanks Frances.from Janet Wright to All Participants:Million Hearts sends its enthusiasm and gratitude for the experts and engaged audience on this topic, so important to US heart Health!from Gillian Baird to All Participants:Excellent presentation! Thanks!from Loretta Kaes to All Participants:Thanks for the great information!from Chris Sarfaty to All Participants:Very informative and well-rounded. Thank you!!from Madge Kaplan & Guests to All Participants:Thanks everyone for joining today's discussion. ................
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