This is first of a multi-part series on a patient’s experience managing a chronic condition, in this case hypertension.
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We’ll start with the patient story, told by Gilles Frydman, followed by clinical and public health commentary by Nancy Houston-Miller, RN, BSN, FSHA. At the bottom of this post, I have added information about our patient and clinical expert.
Patient story (Frydman)
I have always had at least a yearly checkup. 3 years ago, while spending a few weeks in the Texas portion of the Chihuaha desert, I noticed that I experienced growing moments of dizziness whenever I would stand up, tie my shoes or leave my bed. During my stay in Texas, a family member had a bicycle accident and ended up in the hospital, located 30 miles away because everybody feared a serious concussion or even worse. While waiting for results from the ER I asked to have my blood pressure checked. A nurse did check it and told me the equipment was probably deffective or something else went wrong and wanted to check it again. The second check showed an extremely HBP (200/130). I was instantly seen by a cardiologist and prescribed a drug to lower the HBP, with a warning that I was at high risk to suffer a catastrophic event if I didn’t bring the HBP under control. And then I was sent home, without any additional Information RX. (A medication was prescribed and Frydman was asked to begin taking it)
Clinical and Public Health pearls (Houston-Miller)
- Blood pressure of 200/130 typically requires immediate assessment and treatment, with expedient (within 1 week) follow-up
- 29 % of the U.S. population has hypertension, 76 % are aware of it
- 1/3 of those found to have high blood blood pressure do not follow up
- 10.6 % of Californians are diagnosed with high blood pressure
- 12.4 % of an employee (working) population are typically diagnosed with high blood pressure
Although our patient was uncertain about whether a medical record was created in the Emergency Room, it is possible and likely that one was created, which contained the blood pressure readings and medication administration or prescription records. Because the patient was not given this information on discharge, the data involved in this episode remained with the provider who originally assessed the blood pressure. Patients may learn that they have high blood pressure in a variety of environments – a health fair, a doctor’s office, an employer-based screening program. In these cases, patients are typically asked to visit with their health care provider for diagnosis and treatment. Recommendations for interval monitoring are typically not made in these cases (today).
About our patient
Gilles Frydman was recently cited by CNN as an Empowered Patient Hero for his work developing the Association of Cancer Online Resources , which has provided 12-plus years of experience empowering patients in their health and health care. ACOR currently serves half a million members. He is also a principle on e-patients.net where he regularly discusses issues relative to patient involvement and empowerment.
About our clinical expert
Nancy Houston Miller, RN BSN is the Associate Director of the Stanford Cardiac Rehabilitation Program within the Stanford University School of Medicine and Adjunct Assistant Clinical Professor at the University of San Francisco and Johns Hopkins Schools of Nursing. She served on the NIH National High Blood Pressure Education Program for 10 years representing the American Nurses Association and was part of writing committees for the joint national hypertension guidelines ( JNC 6 and 7). She has directed 4 randomized clinical trials of hypertension and nurse case management using home blood pressure monitoring and is a co-author of the AHA Call to Action Statement on Use and Reimbursement for Home Blood Pressure Monitoring.
Thanks to both for their assistance in promoting the patient voice in health improvement. Tomorrow: Diagnosis made, initial therapy prescribed.
As usual, comments from your own experience or additions are welcome.