A new JAMA study details how Kaiser Permanente Northern California drove down the blood pressure (BP) rates of patients with hypertension by adopting a strategy that included easier-to-take medication and no co-payments for checkups.
How the hypertension program worked
Beginning in 2001, researchers implemented a five-step program at Kaiser Permanente Northern California, which operates 21 hospitals and 73 physician offices.
1. Created a registry: Researchers first identified all of Kaiser's Northern California patients who were diagnosed with high BP; the number of patients on the registry increased from 350,000 in 2001—or about 15% of the total adult membership—to 653,000, or about 28%, by 2009. The patients' average age was 63.
2.Shared best practices: The researchers shared hypertension best practices developed by the most successful clinics, as well as evidence-based practice guidelines, with all other clinics and providers in the system.
3. Updated physicians on evidence-based guidelines: Participating physicians regularly were briefed on which BP medications to try first and which to use if the initial choice was unsuccessful.
4. Gave patients easier-to-use medication: Beginning in 2005, patients were prescribed a single generic pill that combined two common BP drugs, lisinopril and a diuretic. The new treatment was less costly and easier to use than separate doses.
5. No-cost follow-up care: The researchers in 2007 began offering patients no-cost follow-up visits with medical assistants that could be scheduled at flexible times. The medical assistants were not physicians or nurses, but specialized personnel who were trained to monitor BP and other vital signs.
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According to the JAMA study, the percentage of hypertension patients whose BP was within a healthy range increased from 44% in 2001 to 80% by 2009. By 2011, that percentage had increased to 87%.
In addition, Marc Jaffe—lead author and an endocrinologist at Kaiser Permanente South San Francisco Medical Center—said that the number of heart attacks declined by 24% and fatal strokes fell by 42% over the same time period, a finding that he believed was related to the improved BP levels.
Meanwhile, the researchers found that the percentage of patients nationwide who had controlled their BP levels increased from 55% in 2001 to 64% in 2009.
In an accompanying editorial in JAMA, Abhinav Goyal—an associate professor of medicine at Emory University School of Medicine—wrote that Kaiser Permanente's program "could work in other settings, provided they are willing to put forth the same long-term commitment and resources that Kaiser did to make the program work" (Allday, San Francisco Chronicle, 8/21; Tanner, AP/USA Today, 8/20; Doheny, HealthDay, 8/20; (Pittman, Reuters, 8/20).