Self Management 2 HbA1cs Blood Pressure

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Self Management2 HbA1csBlood Pressure

• What Does the Evidence Say?

2
Self Management

• The number of patients in the clinical
  information system with a documented self
  management goal(s) in the last 12 months.
• HRSA Collaborative goal is 70

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What does the evidence say?

• meta analysis of randomized control trials (RCTs)
  found that didactic education as the primary self
  management intervention for patients with
  diabetes demonstrated increased knowledge, but no
  improvement in glycemic measures.
• Norris, Engelgall, and Narayan (2001)
• RCTs testing physician participation in
  delivering or supporting behavioral strategies
  reported significant improvement in either self
  care or glycemic control. Olivarius, Beck-Nelson,
  Andreasen, Hurder Peterson (2001).
• Patients attending the 7-week Chronic Disease
  Self-Management Program had fewer
  hospitalizations over a 6-month period than
  controls, resulting in a 6-month net savings of
  750 per patient. While the reduction in hospital
  days was not maintained at 2 years following
  course attendance, a lower rate of physician and
  emergency department visits continued at the
  2-year mark. The Health Enhancement Project was
  associated with fewer hospital days and reduced
  costs for the intervention group compared with
  controls.
• Lorig KR, Sobel DS, Stewart AL, et al. Lorig
  KR, Ritter P, Stewart AL, et al. (2001)
• Leveille SG, Wagner EH, Davis C, et al. (1998)

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2 HbA1cs

• The number of diabetic patients in the clinical
  information system who have had two HbA1cs (at
  least 91 days apart) in the last 12 months,
  divided by the total number of diabetic patients
  in the clinical information system.
• HRSA HDC Goal is gt 90

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Reference

• Diabetes Care ADA Standards of Care for Diabetes.
  Volume 30 Supplement 1. January 2007.
• Perform A1c at least twice a year who are meeting
  treatment goals and who have stable glycemic
  control.
• Pefrorm A1c at least quarterly if treatment has
  changed or who are not meeting glycemic goals.

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What Does the Evidence Say?

• UK Prospective Diabetes Study Group Tight blood
  pressure control and risk of macrovascular and
  microvascular complications in Type 2 diabetes
  UKPDS 38. British Medical Journal (BMJ) 317
  703-713, 1998
• Lowering A1c has been associated with
  microvascular and neuropathic complications of
  diabetes and possibly macrovascular disease.

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Hypertensive Patients with 2 BPs in Last Year

• The number of hypertensive patients in the
  clinical information system who have had two BPs
  in the last 12 months, divided by the total
  number of hypertensive patients in the clinical
  information system.
• HRSA Goal gt 90

8
Reference

• JNC VII
• Chobanian AV, et al. The Seventh Report of the
  Joint National Committee on Prevention,
  Detection, Evaluation, and Treatment of High
  Blood Pressure. JAMA 20032892560-72

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What Does the Evidence Say?

• In persons older than 50 years, systolic blood
  pressure (BP) of more than 140 mm Hg is a much
  more important cardiovascular disease (CVD) risk
  factor than diastolic BP
• The risk of CVD, beginning at 115/75 mm Hg,
  doubles with each increment of 20/10 mm Hg
  individuals who are normotensive at 55 years of
  age have a 90 lifetime risk for developing
  hypertension
• Individuals with a systolic BP of 120 to 139 mm
  Hg or a diastolic BP of 80 to 89 mm Hg should be
  considered as prehypertensive and require
  health-promoting lifestyle modifications to
  prevent CVD

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What Does the Evidence Say?

• Thiazide-type diuretics should be used in drug
  treatment for most patients with uncomplicated
  hypertension, either alone or combined with drugs
  from other classes. Certain high-risk conditions
  are compelling indications for the initial use of
  other antihypertensive drug classes
  (angiotensin-converting enzyme inhibitors,
  angiotensin-receptor blockers, beta-blockers,
  calcium channel blockers)
• Most patients with hypertension will require 2 or
  more antihypertensive medications to achieve goal
  BP (lt140/90 mm Hg, or lt130/80 mm Hg for patients
  with diabetes or chronic kidney disease) (6) If
  BP is more than 20/10 mm Hg above goal BP,
  consideration should be given to initiating
  therapy with 2 agents, 1 of which usually should
  be a thiazide-type diuretic and (7) The most
  effective therapy prescribed by the most careful
  clinician will control hypertension only if
  patients are motivated.