CME: Counseling Young Adults With Hypertension

CME: Counseling Young Adults With Hypertension
Author Information (click to view)

Heather M. Johnson, MD, MS

Assistant Professor, Division of Cardiovascular Medicine
Co-Director, UW-Health Advanced Hypertension Clinic
University of Wisconsin School of Medicine and Public Health

Heather M. Johnson, MD, MS, has indicated to Physician’s Weekly that she has received grants/research aid from the NIH and the National Heart, Lung, and Blood Institute.

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Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Discuss the findings of a study that sought to determine the presence of any documented lifestyle education in an electronic health record system for young adults with incident hypertension; also patient, provider, and visit predictors of receiving documented education.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwOct3.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Heather M. Johnson, MD, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Heather M. Johnson, MD, MS (click to view)

Heather M. Johnson, MD, MS

Assistant Professor, Division of Cardiovascular Medicine
Co-Director, UW-Health Advanced Hypertension Clinic
University of Wisconsin School of Medicine and Public Health

Heather M. Johnson, MD, MS, has indicated to Physician’s Weekly that she has received grants/research aid from the NIH and the National Heart, Lung, and Blood Institute.

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A study suggests that not enough young adults with incident hypertension receive documented lifestyle education information from their healthcare providers. Interventions are needed to overcome barriers to providing lifestyle education to more patients.
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Published studies show that about 9% of men and 7% of women who fall in the young adult age range—defined as ages 18 to 39—have hypertension. “Although young adults have lower rates of hypertension when compared with those aged 40 and older, only about 38% of these individuals have their hypertension under control,” explains Heather M. Johnson, MD, MS.

Recent guidelines have identified lifestyle modifications as a critical first-line step to controlling hypertension. Several strategies are recommended, including losing weight for overweight and obese individuals; adopting the Dietary Approaches to Stop Hypertension (DASH) plan; reducing dietary sodium; increasing physical activity; consuming alcohol in moderation; and quitting smoking.

“Lifestyle modifications have been shown to be effective in improving hypertension control, reducing cardiovascular risk, and enhancing the efficacy of antihypertensive medications,” says Dr. Johnson. Despite these benefits, research suggests that adults with hypertension receive little physician education about lifestyle modifications. Few studies have assessed lifestyle education among patients who develop incident hypertension.

Examining Current Patterns

An understanding of lifestyle education patterns and the influence of such counseling are needed to develop targeted hypertension interventions. In a study published in the Journal of General Internal Medicine, Dr. Johnson and colleagues sought to determine the presence of any documented lifestyle education in an electronic health record system for young adults with incident hypertension. The study also aimed to identify patient, provider, and visit predictors of receiving documented education.

“Our study results showed that only 55% of the 500 participants received documented lifestyle education from a clinician within 1 year of presenting with incident hypertension,” Dr. Johnson says. Just 23% of participants received an initial hypertension diagnosis and/or an initial antihypertensive prescription within 1 year. Overall, 22% did not have any documentation, a finding that emphasizes a lack of hypertension awareness.

Other Important Trends

When patients received lifestyle education counseling, exercise was the most frequently discussed topic, with about two-thirds reporting such dialogue (Figure). Low-fat diets and other dietary topics were also discussed more than half the time and 71% of current smokers had documented smoking cessation education. However, education about lowering sodium intake and initiating a DASH diet was documented in just 25% of counseled young adults.

Young adult males had a significantly lower likelihood of receiving documented education. Several patient, provider, and visit characteristics predict documented education (Table). Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had higher odds of documented education. Patient age and baseline study year were not significant predictors of documented lifestyle education. Among visit types, chronic disease visits were identified as a predictor of receiving documented lifestyle education, but acute and other preventive visits were not.

Capitalize on Opportunities

Throughout the United States, heart disease and obesity rates continue to increase among young adults despite increased awareness of these conditions and the emergence of therapies to treat them. “Young adults with hypertension will likely have more than one cardiovascular risk factor, meaning they will need recurrent lifestyle education in order to manage multiple comorbidities,” says Dr. Johnson. “That’s why it’s critical to take advantage of the teachable moment when managing young adults with incident hypertension. Our research, however, suggests that many clinicians are missing this opportunity to advise young adults with high blood pressure about lifestyle changes.”

Patients need to understand that hypertension is a chronic but manageable disease when lifestyle interventions are used as directed, according to Dr. Johnson. “They need to be informed about all of the self-care strategies to use in order to get hypertension under control,” she says. “This requires efforts to ensure that support systems are available and that patients are consistently monitored and followed for progress with using lifestyle treatments.”

Addressing Barriers

Published research suggests that team-based interventions may help address the competing clinical demands that can emerge when managing young adults with hypertension and may improve the administration of lifestyle education. “We need to develop interventions that empower clinical staff to provide lifestyle education to patients and overcome the time constraints that often impact busy physicians,” Dr. Johnson says.

“It is also important to address other potential barriers to providing young adults with counseling to manage hypertension,” says Dr. Johnson. “We can’t lose sight of the importance of informing patients about what they can do to control their hypertension. Doing so may reduce the burden of heart disease and enable patients to live longer, healthier lives.”

Readings & Resources (click to view)

Johnson HM, Olson AG, LaMantia JN, et al. Documented lifestyle education among young adults with incident hypertension. J Gen Intern Med. 2014 Nov 6 [Epub ahead of print]. Available at: http://link.springer.com/article/10.1007%2Fs11606-014-3059-7.

Bell RA, Kravitz RL. Physician counseling for hypertension: what do doctors really do? Patient Educ Couns. 2008;72:115-121.

Egede LE, Zheng D. Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling. Arch Intern Med. 2002;162:427-433.

Valderrama AL, Tong X, Ayala C, Keenan NL. Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults—HealthStyles, 2008. J Clin Hypertens (Greenwich). 2010;12:784-792.

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