In this post we examine the role BProactive can play in a clinical hypertension management framework presented in a paper entitled “Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control” by Boonyasai, Rakotz, Lubomski, Daniel, Marstellar, Taylor, Cooper, Hasan and Wynia (2017), and that is discussed in the AMA Wire here. The framework introduces a practical guide to improve hypertension control that can be used by a multidisciplinary team of healthcare workers.
BProactive is designed for use by patients and practitioners in the treatment of hypertension. The BProactive mobile app is used by patients to regularly self-measure blood pressure away from the clinic and is able to track their progress towards healthy blood pressure while providing information personalized for them. BProactive Clinic Assist automatically monitors patient blood pressure measurements, along with the patient’s treatment plan, and identifies cases where control has not been achieved. Using the BProactive Clinician Portal, clinicians can quickly select patients requiring follow-up, as well as lookup detailed patient data.
Both M.A.P. and BProactive target three key deterrents to hypertension control: sub-optimal blood pressure data; therapeutic or clinical inertia, which is the failure to modify or intensify treatment when outcomes are not being achieved; and lack of patient adherence to prescribed treatment. This article explores the ways in which BProactive can be used to help a healthcare team to implement M.A.P. effectively with almost no additional time burden on the team.
The first tenet of M.A.P. is accurate blood pressure measurement. The developers of M.A.P. explain that poor quality measurements can impair a clinician’s ability to make accurate treatment decisions. A patient with an in-office measurement that only appears to be high can lead to treatment that is too intense. Conversely, inaccurate measurements that appear low can deter a clinician from starting or intensifying treatment. The M.A.P. authors recommend allowing the patient to self-measure several times while in the office to get a more accurate reading.
BProactive takes this concept further by having patients perform regular self-measurement from home while being assessed or undergoing treatment. Patients are encouraged to measure daily. The app provides indicators of the last measurement submitted as well as the number of days during the current week that a measurement was taken. Measurements over several time periods, including four weeks, are averaged by BProactive and presented to the patient and healthcare team. To ensure that a sufficient number of measurements are available to make treatment decisions, BProactive monitors the frequency and number of submitted measurements and identifies cases where measurement numbers are inadequate. This allows a member of the care team to take action to encourage the patient to measure more often. Additionally, the patient is gently encouraged to record measurements via an indicator on the app showing how many days during the current week a measurement has been taken and recorded.
With reliable blood pressure measurements available, the healthcare team is in a position to “Act rapidly” to determine a patient’s treatment. Typically, the prescribed therapy will need to be adjusted until BP control is reached. The M.A.P. guideline states that “most hypertensive patients require treatment with two or more medication classes”. However, therapeutic inertia often prevents achieving the correct combination of medications. There are a number of contributing causes to this inertia, but the two most significant appear to be lack of clarity of the patient’s real BP and de-prioritizing of BP control during office visits by primary care practitioners. The M.A.P. guideline suggests two steps to reduce inertia: adopt a standardized algorithm for zeroing in on the right treatment, and follow-up early after each treatment change.
BProactive is designed to reduce inertia by providing a large number of blood pressure measurements, taken several times per week by patients at home. This gives clinicians the data they need to determine each patient’s real blood pressure, eliminating doubt over whether the true BP is known. In addition, BProactive allows clinicians to define a treatment algorithm, which can be used to navigate through different treatments until BP control is reached. BProactive automatically correlates BP outcomes to duration of treatment on each step of the algorithm and identifies patients that require review when the prescribed duration of a step (typically 2 to 4 weeks) has been reached and the patient has not achieved control. Using the BProactive Clinician Portal, healthcare team members can identify patients at a glance that need a follow-up and potentially a transition to the next step in the treatment algorithm. With this automation in place, patients can reach control quickly. Using a team-based approach, as described in the M.A.P. guideline, a clinic can decide on an algorithm and follow-ups can be arranged and performed by a medical assistant or nurse.
The third pillar of M.A.P. recommends that clinicians “partner with patients, families, and communities” in order to strengthen patient adherence to prescribed treatments. Patients adhering to treatment and managing their own health is desired, and engaged patients “experience better outcomes”. Patient engagement is enhanced when they are involved in decision-making.
BProactive promotes patient engagement in a number of ways. First, self-measuring blood pressure directly involves the patient in their own care, and helps to identify any differences in perception of true blood pressure between them and their clinician. It is not uncommon for patients to experience so-called white coat syndrome, elevated blood pressure when taken in the clinician’s office and lower at home (or conversely, masked hypertension). Self-measuring requires proper technique and measuring devices, and BProactive provides instructions within the app, as well as guidance on how to obtain a validated blood pressure monitor. BProactive supports patients between visits by presenting their progress to clinicians, and monitoring whether a follow-up is required. This gives patients a feeling of connectivity with their healthcare provider, even when not in the office. Lifestyle changes, including exercise and diet are other strategies that can be employed to lower blood pressure. BProactive endeavours to provide patients with relevant information to help them choose healthier habits.
By addressing three of the largest factors that limit treatment effectiveness, the M.A.P. framework provides a compelling guide for clinicians to use in improving hypertension control. BProactive, which also aims to address these factors can be used as part of a clinic’s M.A.P. implementation to substantially automate the processes recommended by the framework.
To find out more about BProactive, visit http://www.unboxedhealth.com.