Chronic Care Management and Prevention: How Will the 2015 USPSTF Blood Pressure Screening Guidelines Impact Care Delivery?
Keeping on top of clinical practice for cardiovascular disease continues to be a challenging prospect for many healthcare providers. Variations in cut-points for blood pressure readings in the treatment of hypertension continue to be debated across national groups and professional associations, making it even more difficult to diagnose and manage the early onset stages of this chronic disease.
In October 2015, the United States Preventive Services Task Force (USPSTF) released updated screening recommendations for high blood pressure in adults. These include:
- Age: Individuals age 18 years and older with no history of known hypertension
- At Risk: Adults with high-normal blood pressure (BP) readings of 120-139/85-89 mm/Hg; Overweight or Obese; or African American
- Screening Interval: Annually for adults age 40 years and over or those who have increased risk factors; Every three to five years for adults age 18 to 39 with normal BP (under 130/85) and no other cardiovascular risk factors
- Screening Tests: Office measurement of BP taken on two separate occasions and (the new breaking-news change) a home or ambulatory measurement to confirm a diagnosis of hypertension after the initial screening
These new recommendations may pose a challenge. In order to begin treatment or to confirm a new diagnosis of hypertension, where do you send your patient to be screened on their own? Many insurance companies will not cover the cost of a home BP monitor without a diagnosis code of hypertension; and, as stated in the USPSTF Clinical Guideline, “Self-use blood pressure measurement kiosks in community settings, such as pharmacies and grocery stores, may be frequently used by the public but are not regulated by the U.S. Food and Drug Administration. More research on the accuracy of these kiosk measurements is needed.”
Partnering with community resources known to have excellence in care may be your solution:
- Community coordinated care programs such as the Rite Aid Health Alliance, which combines trained care coaches who measure BP in a relaxed, non-clinical setting with support from pharmacists on site.
- Retail health clinics, where registered nurses and nurse practitioners provide care in an ambulatory care setting may provide a less stressful experience for some people, potentially decreasing the incidence of falsely elevated readings due to “white coat syndrome”.
- Community health station kiosks known to have proven accuracy. As noted by the USPSTF, many community kiosks do not meet federal accuracy standards but there are notable exceptions For instance the Higi Stations found in many Rite Aid stores across the country are ISO certified and have FDA 510(K) clearance. These kiosks are tested for accuracy in “trueness and precision” meeting regulatory standards to a mean error difference of +/- 5 mmHg or less with a standard deviation of 8mmHg or less.
Want to ensure you are screening your population effectively for cardiometabolic risks? Stay tuned for my next blog on the American Medical Associations strategic focus for improving health outcomes by identifying prediabetes “STAT”.