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Featured topic and speakers
Who is most likely to develop high blood pressure? What causes hypertension? Can hypertension be cured? What ethnic group has the highest rate of hypertension?
Our guest is Denise White Perkins, MD, PhD, chair of the department of family medicine at Henry Ford Health. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Denise White Perkins, MD, PhD, chair, department of family medicine, Henry Ford Health
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about an innovative approach that Henry Ford Health is taking to treat hypertension in an at-risk group of Black patients and why it's been so successful.
Our guest today is Dr. Denise White Perkins, chair of the Department of Family Medicine at Henry Ford Health in Detroit. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. White Perkins, it's a pleasure to have you with us today.
Dr. White Perkins: Thank you, Todd. It's a pleasure to be here.
Unger: Well, I think many people out there know that hypertension is a significant health disparity for Black patients all across the country. Tell us a little bit about how this disparity is playing out in your community.
Dr. White Perkins: Yes, you're exactly right. Hypertension is a huge problem within the African American community. And we see significant disparities in the prevalence or occurrence of hypertension in the African American community compared to others, and also a much lower rate of control of hypertension. So this is a very big problem when we look at the downstream effects of hypertension—stroke, eye disease, kidney disease and other complications.
Unger: Well, at Henry Ford, you have been working hard to address this issue. One way has been through your Express Blood Pressure Clinics. Tell us a little bit about how that works.
Dr. White Perkins: We're very excited about the work that we're doing through these Express Blood Pressure Clinics. The project began when we noticed that our quality data was showing significant gaps in the rates of hypertension control for African Americans, and in particular for African American men, and even more specifically, for African American men between the ages of 35 and 64. And so we met with system leaders, with providers, with patients, reviewed the literature, trying to understand what is behind this interesting pattern of seeing poorer disease control in the younger population because one might typically expect that it's the older where we see the greater disparity.
We quickly realized that what was probably happening is that we had a host of programs available, ranging from pharmacists and nurses and others to help people learn how to manage their disease. But we weren't seeing as great of a utilization of those programs among men in that 35 to 64 age range. And so we set out to find some ways to improve our processes so that they could become more engaged and more successful in those programs.
Unger: How exactly does an Express Blood Pressure Clinic work relative to another setting?
Dr. White Perkins: So it's really about engagement and outreach and meeting the men where they are. We used our data systems to identify who these men were. And then we had team members outreach to them to say, we know you have hypertension, we care about you and we're realizing that your blood pressure is not in as good control as it should be.
We would invite them to come in for a visit. And we recognize that for men, especially in that age range, they have to take off work, sometimes find someone to help with caregiving responsibilities or navigate transportation concerns. So we wanted to really demonstrate that we valued their time and the effort that it took to get there. And we did that by framing it as a VIP experience.
We promised that if need be, we would get them in and out within 15 minutes. We would meet them at the desk when they arrived. And they would be escorted back by the pharmacist or nurse that would be seeing them so that they could get taken care of right away.
We also recognized that the most essential thing we needed for that visit was a blood pressure reading and that we could potentially call them later to provide education or give advice on medication changes. But we had to get them in for that initial contact. So we said, we'll get you out in 15 minutes or less. What actually happened is that they were fine with staying longer. So we were able to deliver even more services.
Unger: What a great rethinking of the patient experience to help you get to where you need in terms of the outcome. And not surprisingly, you've seen some really strong results from the program. Tell us more about that and why you think it's been so successful.
Dr. White Perkins: I think it's really been successful, again, because of that personalized approach. We found, for example, in looking at some of our data, out of 1,000 or so men that we reached, we were able to successfully engage over a third of them, which at first glance might seem like a low number. But keep in mind this is a population that it can often be very challenging to reach and engage.
And then among that group, we were able to get almost half to control, a little more than half we were able to get to control, within a six-month period and to have them stay in control. And we think a lot of that success was due to the fact that we were improving medication adherence, we were giving them more support in their lifestyle changes, and we were helping them navigate any barriers that they might have faced in getting connected with the services of their primary care provider or ongoing support from our pharmacist or our nurses or our hypertension navigator.
Unger: Well, that's excellent. What great news. And Henry Ford Health has also had a strong commitment to telehealth, which I imagine is going to hit on some of the same dimensions in terms of making that easier to access. Tell us a little bit more about how you're working with telehealth to help people manage their blood pressure and what impact that's had.
Dr. White Perkins: You're right. Telehealth is so very important. It's kind of the new transportation. It's the way that people are getting to their visits. And so we're working to ensure that our patients in general have equitable access to telehealth. We have a lot of initiatives more broadly, where we're partnering with community organizations and other city officials to see if we can move the needle on access.
But specifically to the hypertension project, we do offer virtual care as a means by which our patients can get the education and counseling and medication titration. In an attempt to really build rapport, we often encourage that initial visit be done in person. And that gives us an opportunity, as well, to get them connected with a blood pressure monitor so that they can monitor their progress from home. And then when they meet with us for a virtual visit after we're assured that they know how to use the monitor, that they can access the virtual visit, they have the technology and capability, then we can do much of the care through that virtual format if that's what they choose.
Unger: Now, you've had a lot of great examples in the discussion so far about how you've really focused on particular populations, changed the patient experience to meet their needs. When you think about all the things you've done, is there one thing you'd like people to take away from our discussion today?
Dr. White Perkins: I think it's very important that you continually ask the question, why might this particular segment of our patient population not be reaching the goal in the same way that others are? And keep asking that question, why?
When we began this journey, some of the initial responses were, oh, well, maybe it's because of diet, or maybe it's because they have a sense of fatalism that their blood pressure won't get under control. But as part of our Henry Ford culture and commitment to equity, we weren't satisfied with settling for those answers.
We used a data-driven, team-based approach to dig deeper and try to understand what can we do differently as a health system or as a team to improve care for these patients. And that involves asking tough questions, like why might they not be taking advantages of the services that we offer? What might be some differential unintended impacts of decisions that we're making and the way we deliver care? And frankly, we're continuing to ask those questions as we try to further optimize this program.
Unger: That's great. Well, Dr. White Perkins, thank you so much for joining us today and telling us about your work at Henry Ford Health. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.
That wraps up today's episode. And we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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