Arkansas Department of Health’s Quality Improvement Plan for Hypertension in the State of Arkansas

Strategic Plan:

Hypertension Objectives:

1. By 2030, increase the identification of adults with at least two elevated blood pressures within the last 12 months from 38% to 80%.
2. By 2030, refer 80% of individuals with two elevated blood pressures identified in the local health unit to care.
3. By 2030, monitor 80% of individuals with hypertension who receive services at ADH for medication adherence.
4. By 2030, increase the number of counties providing team-based care for chronic disease management (hypertension and diabetes) from 10 counties to 15 counties statewide.

What is Community Team-Based Care for Hypertension?

Community TBC is a quality improvement program that fosters a public – private partnership between the Arkansas Department of Health’s Local Health Unit and a private community physician to provide community team-based care for patients with uncontrolled hypertension.

• Evaluates blood pressure measurements/Teaching self – monitoring of blood pressure, track readings and scan into Greenway.
• Weight and calculation of BMI.
• Medication Adherence: Ensures patient is knowledgeable about the adjustment of medication according to medical plan. Encourage feedback from patient. The nurse will review and discuss adherence and side effects.  The nurse will follow-up with patient’s pharmacist as needed.
• Diabetes monitoring and counseling.
• High Cholesterol monitoring and counseling.
• Tobacco Cessation counseling.
• Clinical Health Coaching: Ensures patient obtain the most optimal outcomes
• Assessment for lifestyle modifications and education toward the goal according to the medical plan
• Assist patient with follow-up appointments and referrals as needed. The nurse will follow-up with patient’s PCP and office nurse on an as-needed basis.

Hypertension Protocol

• Hypertension Protocol Document

Team-Based Care for Hypertension Management Services is provided in the following counties:

• Poinsett
• Craighead
• Nevada
• Madison
• Washington
• Jefferson
• Lincoln
• Desha
• Ouachita
• Hempstead

Blood Pressure Measurement

• Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
• Current JNC Report and Guidelines: Classification of Blood Pressure Screening and Referral, JNC8-Based Guidelines
• Blood Pressure Measurement in Children — Diagnosis, Evaluation of Treatment of High Blood Pressure in Children and Adolescents
• Home Blood Pressure Measurement – How to measure blood pressure using an automatic monitor 
• Tutorial: the Use of the OMRON HEM-907XL Blood Pressure Device (VIDEO)
• American Heart Association’s Guidelines for High Blood Pressure 2021

Sodium and Salt

• Sodium Reduction Toolkit — As part of a broader international effort, the U.S Centers for Disease Control and Prevention (CDC) developed this toolkit, which provides a brief overview of various topics related to population-level sodium reduction. 
• Most Americans Should Consume Less Salt — In this link the CDC discusses the dietary guidelines and points out some hidden sources of salt in our foods. A number of resources are identified to assist patients and the public to reduce their sodium intake.
• Dietary Approaches to Stop Hypertension (DASH) Diet: Healthy eating to lower your blood pressure – A MAYO Clinic Studies reports that the DASH diet is a healthy-eating plan designed to help treat or prevent high blood pressure (hypertension). The DASH diet includes foods that are rich in potassium, calcium, and magnesium. These nutrients help control blood pressure.

Other Resources

• Dietary Guidelines for Americans — New Dietary Guidelines and in particular, information about reducing sodium in the diet. 
• Improving the Food Environment — This document informs professionals, as critical players, about the food system to help slow rising rates of disease, such as coronary heart disease and stroke, which are related to the consumption of foods high in fat and salt, the latter of which is found in most processed foods in excess.
• JNC8 Physician’s Card — A clinical reference card from NHLBI summarizing the evaluation, treatment, and lifestyle interventions recommended in the JNC8.
• A Closer Look at African American Men and High Blood Pressure Control: A Review of Psychosocial Factors and Systems-Level Interventions — This report is a resource for health professionals and public health programs that addresses high blood pressure control in African American men. 
• Awareness and Treatment of Uncontrolled Hypertension Among Adults – United States 2003-2010 — This report uses data from the National Health and Nutrition Examination Survey (NHANES) to examine the prevalence, pharmacologic treatment and control of hypertension among U.S. adults. The examination focuses on indicators of the use of medical care, as well as on demographic characteristics and socioeconomic factors. 
• A Pocket Guide to Blood Pressure Measurement in Children — This summary reviews the national guidelines for measuring blood pressure in children and detection of high risk.
• Associations Between Social Determinants and Hypertension, Stage 2 Hypertension, and Controlled Blood Pressure Among Men and Women in the United States – This report from NHANES (2011-2018) uses data for adults aged 18 and greater included education, income, employment, race/ethnicity, healthcare access, marital status, and nativity status.