Co-producing Healthy Blood Pressure Through Nursing and Pharmacy Visits 

Lorky Libaridian

Hypertension (HTN) is an important chronic disease which has significant effects on the morbidity and mortality of our patients. At CHA, we have just over 13,000 patients with HTN, approximately 30% of whom have uncontrolled HTN.  With the aim of improving HTN control across ten primary care clinics, we formed a multidisciplinary team.  Our intent was to improve our partnerships with one another as multidisciplinary healthcare professionals and to improve our partnerships with our patients.  Our strategy was to engage nurses and pharmacists more intentionally as coaches for patients with uncontrolled high blood pressure.  Our work included the utilization of new education materials designed with patients, new workflows for outreaching to and referring patients to nurses and pharmacists, and new documentation templates in the electronic medical record that encourage a co-productive approach to counseling for nurses. 

Our data suggests that our intervention has been successful in improving - incrementally but meaningfully - the percentage of CHA patients with controlled HTN.  While we are only in the preliminary stages of data analysis, it appears that at the level of the clinic there is an association between number of nursing and pharmacy coaching visits and population blood pressure control.  These visits, however, do not tell the whole story.  Two clinics increased their use of nursing and pharmacy visits and did not see an improvement in the proportion of patients with controlled blood pressure; one clinic improved population blood pressure control without increasing nursing and pharmacy visits.  We are currently interviewing nurses at various sites to help elicit a more qualitative understanding of the way in which their own approach to counseling patients has evolved to reflect the importance of partnership and co-production.   Understanding the variation between sites, both in terms of their limitations and successes, will be important in planning and spreading future improvement projects at CHA’s primary care sites.