Nurses "Treat to Target" to Lower Risk of Heart Attacks, Strokes
||Eduvina Hernandez, RN, of Gouverneur Health.
Nurse Eduvina Hernandez doesn't mind getting bombarded with questions from patients who want to know which foods have too much sodium, how often they'll have to see the doctor and if their new blood pressure medicines could cause other health problems.
As one of the New York City Health and Hospitals Corporation's nurses working on a new pilot program to help patients lower blood pressure, Nurse Hernandez knows the importance of nurturing relationships built on trust, which she does with small gestures like arranging for a wheelchair, helping a patient fill his pill box for the week, or securing a pharmacy home delivery for an 108-year-old.
"Patients have to be comfortable with me to talk about why they aren't following their treatment plan," says Hernandez, of HHC's Gouverneur Health in Manhattan. "The more I know about why, the better I can help them."
A strong nurse-patient relationship is one of the cornerstones of the HHC "Treat to Target" program, which increases the role of registered nurses and allows for more frequent and focused clinic visits to help patients with hypertension achieve healthier blood pressure levels, which in turn reduces their risk of heart attacks, strokes and kidney disease. The nurse-led pilot, which was implemented at seven HHC facilities in 2012, already has resulted in better blood pressure management among hypertensive patients in all participating facilities.
In just one year, the number of hypertension patients managing their high blood pressure effectively increased more than 18% at Harlem Hospital Center and more than 15% at the East New York Diagnostic & Treatment Center in Brooklyn. HHC will now expand the "Treat to Target" program to all 11 public hospitals and six Diagnostic & Treatment Centers.
Lauren Johnston, HHC's Chief Nursing Officer said, "The nurse-led visits allow for more frequent and longer visits than primary care physicians are typically able to provide."
Traditionally, primary care physicians have been the ones to prescribe medication and lifestyle changes to manage high blood pressure. Unfortunately, a significant number of people with hypertension do not take their prescribed medications, while others do not receive a sufficient dose of medication to achieve their target blood pressure. These patients may benefit from more frequent monitoring and medication adjustments.
"By partnering with patients to manage their hypertension, we aren't only helping them live healthier lives, but we are also using system resources wisely by preventing unnecessary hospitalizations," said Dr. David Stevens, Senior Director of HHC's Office of Healthcare Improvement.
"Ultimately, our patients feel empowered, they see real progress in a short period of time, and they become more active participants in achieving blood pressure goals that they themselves helped to set."
Hypertension brings more people to the doctor's office than any other chronic disease. Nationwide, 68 million people have hypertension, a chronic condition with no symptoms but serious consequences if it is not managed. More than half of hypertensive Americans don't have their condition under control.
HHC's patient population reflects this trend. Its primary-care practices treat about 120,000 hypertensive patients, 43 percent of whom are able to maintain their blood pressure below thresholds considered dangerous. HHC officials estimate that for every one percent improvement in the rate of patients with controlled hypertension across HHC's patient population, 60 heart attacks and 24 strokes could be prevented each year.
Under HHC's "Treat to Target" program strategy, hypertensive patients initially visit a physician to set a goal for desired blood pressure levels and receive a medication plan to achieve it. Patients then work closely with a nurse, who monitors and assists with necessary medication adjustments, and helps with other issues like finding healthier foods or substance abuse counseling. Patients in the program will typically be in contact with a nurse every 2-3 weeks until the target blood pressure goal is reached.
"When patients get their blood pressure under control, they always ask me, 'that's it? I don't have to see you again?' I tell them it's good they don't have to see me, they're healthier!" Nurse Hernandez says. "Patients really do like having someone looking out for them."