STATEMENT OF NEED: Hypertension (HTN) remains a major contributor to disease burden around the world and a major cause of premature death. Nearly 1 in 5 Americans suffer from hypertension, making it the nation’s #1 most common medical condition [1]. At specific risk are women, persons aged 60 or older, non-Hispanic blacks, the poor, and diabetics [2]. The progression from hypertension to heart failure in the chain of cardiovascular events, however, need not be inevitable and can be prevented with proper treatment. Since only approximately 58% of patients diagnosed with hypertension are receiving adequate treatment [1], primary care physicians are well positioned to improve diagnosis and treatment strategies and potentially improve patient outcomes. However, a 2009 needs assessment of primary care physicians conducted by PennCME/BestPractice revealed the following gaps in disease management:

• Gaps in diagnosis exist, which are partially attributed to a lack of awareness of hypertension among patients [3].
• Barriers to control of hypertension are a function of several factors, including patient management time constraints, physician practice patterns, patient/physician communication challenges, adverse drug effects, and the complexity of prescribing or monitoring drug regimens [4, 5, 6].
• Physicians need to improve their adherence to treatment guidelines, and more aggressively manage their patients’ disease [7, 8, 9, 10].

TARGET AUDIENCE: Physicians in primary care practice, physician assistants, nurse practitioners, and other health care providers and clinical practice teams.

EDUCATIONAL GOALS & OBJECTIVES: After participating in this educational initiative, learners are generally expected to:

• Improve the performance of primary care providers in screening patients for hypertension and pre-hypertension.
• Improve competence and performance of primary care providers in diagnosing hypertension and pre-hypertension.
• Improve knowledge, competence, and performance of primary care providers in treatment of hypertension and patient management according to guidelines.
• Educate and motivate primary care providers to engage their patients in self management of their disease by providing tools and resources for best practices in smoking cessation and other lifestyle changes.

Media Use: This educational initiative was developed as a web-based multimedia self-study educational and resource curriculum using the following formats:

• Interactive minicase studies
• Simulations
• Targeted search at the point of care using the iSEEK search engine
• Internet-based enduring materials
• Evidence-based resources
• References to physician staff and patient education links

FORMATS & METHOD OF LEARNER PARTICIPATION IN THE PennCME/BestPractice HTN CURRICULUM LEARNING PROCESS:

• Clinical reviews in HTN present critical areas of knowledge in the disease organized in a coherent pathway, along with practical approaches to achieving best practices. This section provides a foundation and reference base for other featured interventions.
  • Motivating patients with hypertension to make lifestyle changes and to take medications as prescribed
  • Treating the hypertensive patient: When, how, to what goal? 
     
• Hot Topics are short, newsworthy articles in a focused area of the diagnosis or management of HTN. These articles are designed to engage the participant in the topic area and lead them to content that provides the opportunity for more in-depth learning.
  • Improving blood pressure: How valuable is a team approach?
  • What is prehypertension and what can you do about it?
  • Five common errors in measuring blood pressure
  • Hypertension in women
  • Hypertension in patients with cardiovascular disease
  • Hypertension in patients with CHF
  • When to treat hypertension in the very elderly
  • Hypertension in blacks
  • Hypertension in children and adolescents
  • Hypertension in type 2 diabetes and in chronic kidney disease  
     
• Interactive Minicases offer a valuable learning experience based on real-life scenarios of interactions between primary care physicians, the health practice team, and patients with HTN. This method of engagement allows participants to build their knowledge and competence as they engage and progress through case simulation of  both the clinical management of patients with HTN and some system-specific issues  in their practices.
  • Managing the patient with resistant hypertension 
  • Elderly, hypertensive plus co-morbidities: Not easy to treat   
     
• Simulations place physicians in the active role of problem solvers, letting them learn critical skills in a practical setting. The Patient Simulator provides individually tailored learning, allowing physicians to Increase Competence by applying new knowledge to diagnostic and therapeutic challenges in a non-threatening clinical environment.
  • 72, dizzy on arising: Hypotension or ISH?
     
• Point-of-Care Search CME (PoC) includes structured, self-directed online learning on topics relevant to their clinical practice. Learning for this activity occurs through a reflective process in which physicians document the clinical question, cite the sources consulted, and identify the application of the learning to their practice.
   
• Clinical Resources and References provide a bibliography of cited evidence-based references and links to resources featured in this section.
   
• Building Teamwork provides clinicians and non-clinical staff with resources, educational activities, and tools for promoting teamwork in their practice and collaborative strategies to achieve performance improvement.
   
• Staff Resources Whether you’re a PA, NP, medical assistant, or staff receptionist, this site can help improve your knowledge and management of patients with chronic diseases.
   
• Patient Resources provide patients with practical information and tools about their health and medical conditions to promote patient self-management and patient-physician partnerships.
   
• Patient Centered Medical Home offers a stimulating set of concepts for bringing your practice into the 21st century – including updates on electronic health records and other government-supported programs.

Hypertension Resources from Penn CME/BestPractice