April 30, 2019
By Robin L. Flanigan
Although communities of color typically have a more difficult time keeping high blood pressure in check, Gates Medical Associates—where 23% of patients with hypertension are African American—has achieved a high blood pressure control rate of 84%.
That’s just 1 percentage point away from the practice’s target control rate.
Another impressive statistic: Even though at most practices hypertension measures for patients with low socioeconomic status are generally much worse, at Gates Medical Associates, low income patients have reached control rates only 3 percentage points lower than more affluent groups, 82% versus 85%. A quarter of the practice’s patients are low-income.
“It’s not easy to achieve such impressive hypertension results when your practice serves patients who are more at risk,” says Howard Beckman, MD, a consultant for the region’s High Blood Pressure Collaborative which tracks hypertension control rates in nearly 200 practices across the Finger Lakes. “Gates Medical has clearly found a way to effectively serve all patient populations.”
For staff at the University of Rochester Medical Center practice, the secret lies in multiple strategies for improvements, but above all, they credit their teamwork for the results.
“I think some offices are amorphous, and everything falls back on the doctor,” says Dr. John Buckley.
Here, physicians not only expect assistance from the entire staff—they rely on it.
Barb Myers, RN, agrees. “There’s collaboration and communication and the doctors trust my judgment,” she says.
As clinical care manager at the practice, Myers adds, she is “an extra set of eyes. That does make a difference.”
With the treatment of hypertension, patients should be seen at least annually to ensure that their condition is under control. For patients who have a hard time getting to appointments, Myers works to eliminate barriers, like arranging for transportation for those without a ride. She also works closely with the practice’s social worker, reviews hospital admissions and discharges to make sure patients have appropriate follow-up home care, equipment and medication. When there’s a discrepancy with medication, she has the patient come in to see the doctor within three to five days of hospital discharge, and then every three months until they’re stable.
The practice pays close attention to whether patients understand their medication regimen.
“I show them the bottle and say, ‘This is the medication I’m stopping,’ or ‘We’re increasing the dose for this medication,’” explains Dr. Rajendra Singh. “They’re more likely to follow through” than when he simply states a medication’s name without the visual cue.
If physicians are concerned that patients are not taking their medications, a call is placed to the pharmacy to find out how often the prescription has been filled. And if a patient wants a refill but hasn’t been seen in a while, Myers says the practice will approve a one-time replenishment with a caveat: “I say, ‘We’ll give it to you, but let’s work out a day you can come in to check your blood pressure.’”
Knowing that blood pressures can soar just from being in a medical facility, Gates physicians always do a second reading during an appointment if the first reading seems high.
With the help of a data coordinator, Gates Medical Associates uses spreadsheets to easily identify which patients are hospitalized, and which are not keeping up-to-date on their blood pressure medicine or clinical visits. Patients are then contacted to schedule follow-up appointments.
In fact, notifications are a critical aspect of the practice down to the smallest details, such as sending reminders about mammograms on pink stationery, sent in pink envelopes.
That type of attention has helped nourish relationships that span decades. Dr. Buckley, for example, has treated four generations in one family, while Dr. Singh has been working with some of the same patients since the 1980s.
At Gates Medical Associates, stability and confidence are the backbone of its control rate success.
Notes Myers: “It’s all about education and follow-up.”