Sunday, September 09, 2012

Attached a link to a provocative editorial titled "Simple Treatments, Ignored" focusing on the poor outcome of hypertension treatment. The editorial reflects on the findings of a recent federal health analysis which found that nearly one-third of all American adults have high blood pressure and more than half of them don’t have it under control. The new analysis, issued last Tuesday by the Centers for Disease Control and Prevention, found that 67 million Americans had high blood pressure and that 31 million of them were being treated with medicines that reduced their blood pressure to a safe level. The remaining 36 million fell into three groups: people who were not aware of their hypertension, people who were aware but were not taking medication, and those who were aware and were treated with medication but still had hypertension.There are many missed opportunities for people with high blood pressure to gain control. Doctors, nurses and others in health care systems should identify and treat high blood pressure at every visit. The editorial not only points out that this is an abysmal record for a medical condition that is easy to detect and treat but also features solutions. Kaiser Permanente says that in Northern California it increased the percentage of patients whose hypertension was under control from 44 percent in 2001 to 87 percent in 2010. Over approximately the same period, stroke mortality declined by 42 percent, heart attacks by 24 percent and the most serious type of heart attack by 62 percent. The organization created a hypertension registry to track patients and the care they were getting; eased the burden on doctors by using pharmacists to initiate drug therapy and medical assistants to monitor patients’ progress; made it easy for patients to get free blood pressure checks; and showed doctors how their record on controlling blood pressure compared with others in the system. In my opinion our healthcare system is dysfunctional and deeply flawed. The system is still characterized by the separation of functions and tasks delivered by a plethora of healthcare providers who collect mountains of paper, or now Terabyte of data, but fail to share such data efficiently to coordinate care. We must break down these walls of isolation and collaborate in teams. Patient Centered Medical Homes can provide solutions to this problem but we need to accelerate its implementation and deploy community-based healthcare teams comprised of doctors, nurses, social workers, pharmacists, community activists etc. We have to break down the barriers built by professional organizations which protect the interest of its members, but lost their focus on public health. Such a local, regional and national strategy can control healthcare costs, improve quality of care and decrease debilitating morbidity related to chronic diseases. What are we waiting for? Yours Bernd