Joint reporting from Hill Physicians and Sutter Independent Physicians 1

Survey Background Goal: to assess the adult hypertension treatment approaches and challenges faced by Hill/SIP primary care providers Survey Period: 8/17/2015 to 9/25/2015 Total Responses: 73 (45%) Hill Physicians: 61 out of 130 (47%) Sutter Independent Physicians: 12 out of 32 (38%) 2

Do you feel that your medical assistant has the training and experience to consistently measure blood pressure accurately? Answered: 69 Skipped: 4 3 Majority of providers felt well-equipped to monitor & manage hypertensive patients HTN Treatment Capacity Do you feel you have enough knowledge and training to care for the majority of your hypertensive patients? Answered: 69 Skipped: 4

Awareness of HTN Treatment Goals Answered: 73 Skipped: 0 Q: What is the HTN treatment goal for patients in the following age groups? 4

Q. What lifestyle changes do you recommend for your hypertensive patients? Answered: 73 Skipped: 0 5 Consistent Lifestyle Recommendations

Answered: 72 Skipped: 1 6 Q. What proportion of patients is able to control their hypertension to recommended levels with lifestyle changes alone? Common Treatment Outlook

Answered: 73 Skipped: 0 7 Q. What are your first-line antihypertensive agents for people under age 60? Most Utilized Treatment Regimens

Answered: 69 Skipped: 4 8 Q. What are your second and third line antihypertensive agents? Second-Line Treatment Regimens

Answered: 68 Skipped: 5 9 Q. What combination antihypertensives do you regularly use? Combination Treatment Options

Answered: 65 Skipped: 8 10 Q. What percentage of your patients are on combination therapy for HTN? Combination Treatment Uptake

11 Q. What are percentage of your patients in each age group do you estimate have appropriate blood pressure control? Estimated HTN Control Answered: 71 Skipped: 2

Answered: 70 Skipped: 3 12 Q. What are the biggest barriers to achieving blood pressure control in those patients that are not controlled? Perceived Barriers to HTN Control

Have you heard of the “Measure up/Pressure down” campaign? Answered: 68 Skipped: 5 13 Survey identified the opportunity to increase awareness of educational resources Awareness of HTN Educational Resources Have you heard of the “Million Hearts” campaign? Answered: 69 Skipped: 4

Answered: 68 Skipped: 5 14 Nearly 90% of providers normally recommend that patients acquire a home blood pressure monitoring device, but perceived uptake is low Home Blood Pressure Monitoring What percentage of your patients have a home BP monitoring device? Answered: 67 Skipped: 6 Of those with a home BP monitoring device, what % do you feel use it regularly?

Answered: 68 Skipped: 5 15 Q: Do you feel that a better approach to achieving excellent blood pressure control for our primary care population might be a more “coumadin-clinic/ protocol-driven” type of approach? Team-Based Approach to Care

Take Home Points Hill/SIP PCPs are well-informed of appropriate BP goals and Rx treatment recommendations Outstanding challenges to ↑ BP control: Patient Engagement & Adherence Increase utilization of team-based approach (e.g. physician, nurses, pharmacist, dietician, social workers)

Appendix

Answered: 25 Skipped: 48 Dialysis patients are the most challenging Combination trials Combination trials Secondary and resistant hypertension management/evaluation Difficult to control HTN Difficult to control HTN Treatment resistant cases. Systolic HTN in elderly Systolic HTN in elderly Renal Artery Stenosis How to get patients understand basics of hypertension, management and complication Up to date literature and journal Choice of 2nd or 3rd line agents More about physiology of hypertension and how life style changes work. More about physiology of hypertension and how life style changes work. Share more relevant unbiased data Share more relevant unbiased data lifestyle changes Treatment of hypertension in patients with advanced chronic kidney disease. costs of medications for different patient populations JNC 8 Aldosterone physiology Expand educational opportunities to enhance treatment of the multiple drug/difficult to control patients to reduce needless referrals More education is always good 18 Q: If you think you need additional education regarding hypertension, what areas would be most important to you? Education Gaps

Answered: 63 Skipped: Varied use of supplemental resources to assist with patient management Treatment Protocols & Guidelines On a day-to-day basis in the care of your hypertensive patients, what percentage of patients do you refer to the hypertension guideline or protocol? Answered: 27 Skipped: 46 If you use a treatment guideline/ protocol for hypertension, which guideline do you follow?