Transcript ALABAMA DEPARTMENT OF PUBLIC HEALTH

HYPERTENSION
The Alabama Department of Public
Health’s Hypertension Program
What is Blood Pressure?
Blood pressure is the result of two forces.
One is created by the heart as it pushes
blood into the arteries and through the
circulatory system. The other is the force
of the arteries as they resist the blood
flow
What Do the Pressure Numbers
Mean?
• The higher (systolic) number represents the pressure
while the heart is beating
• The lower (diastolic) number represents the pressure
when the heart is resting between beats
• The systolic number is always stated first and the
diastolic number is listed second. For example: 122/76
(122 over 76); systolic =m 122, diastolic = 76
What is High Blood Pressure
(Hypertension)?
• Blood pressure of less than 140 over 90 is
considered a normal blood pressure reading
for adults. A diastolic pressure of 85 to 89
needs to be watched carefully
• A blood pressure reading equal to or greater
than 140 over 90 is considered elevated or
high
Why is Hypertension Bad?
Elevated blood pressure indicates that the
heart is working harder than normal,
putting both the heart and arteries under a
great strain. This increases the risk of
having attacks, strokes, kidney failure,
damage to the eyes and atherosclerosis
HYPERTENSION LINKED TO HEART
ATTACKS, KIDNEY FAILURE, &
STROKES
National Costs
(Direct & Indirect)
Alabama Costs
(Direct & Indirect)
• Cardiovascular
• Cardiovascular
Disease - $326 Billion
Disease - $5.2 Billion
• Stroke - $30 Billion
• Stroke - $48 Million
Hypertension is a major contributing factor
for up to 70% of
strokes
National Trends in the Awareness, Treatment, and
Control of High Blood Pressure in Adults, U. S. A..,
1976-1994
70
60
50
40
Awareness
Treatment
Control
30
20
10
0
19761980
19881991
19911994
Risk of Cardiovascular Events in
Subjects with Hypertension
CARDIOVASCULAR EVENTS
Coronary Heart Disease
Stroke
Peripheral Arterial
Disease
Cardiac Failure
Cardiovascular Events
AGE-ADJUSTED RISK RATIO
MEN
WOMEN
2.0
3.8
2.0
2.2
2.6
3.7
4.0
2.2
3.0
2.5
•Kannel WB, et. Al. Hypertension Primer 2nd ed. AHA; 199-202.
ALABAMA OVERVIEW
•
PROGRAM BEGAN IN 1974 IN EAST
CENTRAL ALABAMA
•
SINGLE COUNTY DEMONSTRATION
•
FULL CARE SERVICES OFFERED
FULL CARE HYPERTENSION
SERVICE
• BP > 140/90
• < 150% poverty level
• Not under private care
• Non – Medicaid
- Nursing Workup w/Lab
- Contract Physician Physical, EKG & Rx
- Nurse Monitoring & Education
- Return to HD Quarterly & As Needed
JOINT CARE OR JOINT
MANAGEMENT (1977)
• BP > 140/90
• < 150% poverty
• Private care referral with Rx for
program medication
• Non - Medicaid
-
Nursing Workup
Program Medications
Nurse Monitoring & Education
Return to Private Physician Every
Six Months & As Needed
PATIENT LOAD HISTORY
1975
1980
1985
1990
1995
2000
HYPERTENSION PATIENT
PROFILE
• Average number of client visits to Health
Department is 4.8 per year
• 56% of clients with controlled blood
pressure
• Average clinic staff costs per visit is
$16 ($78 per year)
•
Annual drug cost per client is under $100
• Average clients direct coverage cost for
clinic and medications is approximately
$178 annually
ELIGIBLE POPULATION
SERVED
• Approximately 15,000 patients were
served in Fiscal Year 2001
• Estimated eligible in state are 233,456
• Presently serving less than 10% of “in-need”
population
Expenditures
$64,382.00
Loc a
A
dm
$483,766.00
DECLINING PATIENT
LOAD
Obstacles
Potential Solutions
• Strong local clinic
• Outsource services to
support for HTN
FQHC clinics or local
program, yet accept
hospitals
no new clients
• Lack of local funds • Outsource drug dispensing
for clinic staff
to local pharmacists
• Allocate additional funds
for program expansion
FUTURE OF THE
HYPERTENSION PROGRAM
(DUAL STRATEGY)
• Drug therapy
• Community health
……….Improve dietary intake
……….Increase physical activity
..……..Discourage tobacco use
Community Health (continued)
• ……….Limit alcohol intake
• ……….Reduce sodium intake
• ……….Maintain adequate intake of dietary
potassium, calcium, and magnesium
• ……….Reduce intake of saturated fat and
cholesterol
Community Health Teaches the Role of
Personal Responsibility in Maintaining Good
Health
• The daily decisions
we make – lifestyle
modifications - can
play a significant
role in maintaining
good health
FUTURE (continued)
•
Uphill Financial Climb for Hypertension
Program
•
Price of Medication doubles in Fiscal Year 2002
•
Provide increased state funds to help
defray drug price increases
•
In the Fiscal year 2002 the Hypertension
Program goal is to hold the patient population
at 15,000
ALABAMA HTN 2005 GOAL
1975
1980
1985
1990
1995
2000
2005
If you have questions about
this presentation contact
the Bureau of Health
Promotion and Chronic
Disease
Hypertension Division
at
334/206-5627