There is no easy pathway to prevention, it seems. A healthcare system needs not only resources but also willpower and analytic might to make a dent in hypertension, diabetes, obesity and other heart-unhealthy conditions.
This week a research team from Kaiser Permanente Northern California published results in JAMA from an ambitious, multipronged intervention designed to improve blood pressure control. They used not one but four strategies layered on top of each other to get members in line with recommended blood pressure levels. The program, initiated in 2001, followed these steps:
- Creation of a registry of all hypertensive patients to track control rates;
- Development of evidence-based treatment guidelines;
- Regular patient follow-ups after the patient had started medication; and
- Using a one-pill combo of a thiazide diuretic and an ACE inhibitor.
They reported that the rate of hypertension control increased from 43.6 in 2001 to 80.4 percent in 2009, beating national and state gains over the time period. Kaiser Permanente Northern California’s rate continued to increase after the study period, rising to 87.1 percent in 2011.
This kind of large-scale initiative provides potential strategies for others to follow, in both the clinical and research realms. It also underscores the importance of building and linking resources, some foundational such as the registry, topped by interventions such as the one-pill approach.
Prevention may require big picture thinking and patience. Niteesh K. Choudhry, MD, PhD, of Brigham and Women’s Hospital in Boston, emphasized that with MI FREEE, a randomized study that assessed the effect of costs on adherence in insured patients discharged with an MI.
“We think cost is a simple and scalable intervention but there could be other things like reminder systems, education, outreach, easy access, simplifying treatment and dosing regimens,” Choudhry told Cardiovascular Business in 2012. He suggested “a suite of interventions—four, five, six different interventions” to achieve adherence and ultimately improve outcomes.
The Kaiser Permanente study shows it can be done, and be effective. They have resources but more critically they have shown the vision and commitment to apply them in a way that helps patients and cost-conscious providers.
Can and will others follow?
Cardiovascular Business, editor