How telehealth connects patients to care

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Through virtual visits we’re helping more people on their path to better health. For many, it’s a new kind of care.

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"As the country reopens, telehealth will play an important role providing health care,” says Adam Pellegrini, Senior Vice President, Transformation Consumer Innovation and Enterprise Virtual Care.

As COVID-19 began to spread, ChuckName changed to protect patient privacy. , a 62-year-old chef with a heart condition, sheltered-in-place at his partner’s remote Colorado ranch. After developing a fever, cough and upper respiratory symptoms, Chuck scheduled a telehealth visit, which allows patients to virtually consult a doctor by video chat or by phone. 

Like 90% of Americans before the pandemic, Chuck had never tried telehealth services. Now, with health insurers temporarily waiving co-pays and the federal government easing regulations, telemedicine may have reached a tipping point.

“I had a lot of anxiety,” says Chuck. “That stress was alleviated knowing that I could be in the middle of nowhere and feel like I have a doctor right there by my side.”

As the country reopens, telehealth will play an important role providing health care, says Adam Pellegrini, Senior Vice President, Transformation Consumer Innovation and Enterprise Virtual Care, CVS Health.

“We are focused on how we can help the consumer navigate to the right care for the right medium in a way that has the best health outcome.”

Like Chuck, nearly three-fourths of respondents in a 2020 survey would consider using a telehealth service if they had COVID-19 symptoms, and two-thirds say the pandemic increased their willingness to try telehealth in the future.

In the first quarter of 2020, virtual visits though MinuteClinic® locations grew about 600% over the same quarter in 2019. Aetna also experienced a dramatic increase in daily telehealth engagements. 

Going forward, telehealth will be an integrated part of an individual’s overall health care journey, says Pellegrini, citing CVS Health’s unique combination of Aetna’s broad network of health care providers and its nearly 10,000 retail pharmacies in communities across the United States. 

“Because of the holistic approach we have with our assets, we can actually map a patient’s entire care process to make it as seamless and as frictionless as possible,” says Pellegrini.

“Early action keeps people healthy, which benefits patients, doctors, and insurers,” says Justin Steinman, Vice President, Commercial Products, for Aetna. “If we can get you to care quickly because telemedicine is convenient, it’s going to be a win-win-win for everybody.”

Chuck, now 100% recovered, expressed enthusiasm for new ways to use telemedicine. “It’s exciting that even during a stressful time, I’ve had an experience like this open me up to a possible paradigm shift in my connection with the medical community,” he says. “Sometimes real good comes out of tough times.”

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New research at ASCO 2020 reinforces the value of CVS Health offerings

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Identifying unaddressed challenges to better ensure quality, cost and access

We believe that in order to improve the health care quadruple aim — better quality, lower cost, and improvements in both patient and provider experience — the important first step is identifying the unaddressed challenges. This helps build a framework for developing strategies and solutions that address the areas of need. While treatments themselves are incredibly important, research that helps identify such gaps is critical, because it enables us to ensure clinically appropriate access and services to improve health outcomes for patients, and to develop comprehensive solutions that help payors manage costs.

Each year, the oncology community comes together at the American Society of Clinical Oncology’s (ASCO) annual meeting to unveil the latest research in cancer care. While the meeting is most known for debuting breaking advancements in cancer treatments, the data presented goes far beyond. At this year’s meeting, we will be presenting data reinforcing the importance of innovative specialty management in cancer care. Here, we share some of the highlights:

Digital engagement helps support patient adherence

It is not uncommon for a patient on specialty medications — especially when they first begin treatment — to experience unpleasant side-effects. Treatment non-adherence as a result of that is all too common, and an ongoing challenge for patients and health care providers. Secure messaging has been shown to improve medication adherence in patients. In one abstract presented at ASCO, we examine how digital engagement in the form of secure two-way messaging from a nurse helped improve patient adherence to an oral chemotherapy known for significant adverse side-effects. Our research found that using CVS Specialty’s secure messaging platform to determine whether patients were experiencing common medication side effects enabled nurses to get involved quickly, leading to an improvement in patients’ symptoms and adherence to therapy. Secure two-way messaging is one of the digital and online engagement tools CVS Specialty uses to help patients better manage their conditions.

Precision treatment: Better outcomes, more cost-effective care

Unfortunately, lung cancer patients are frequently diagnosed late with advanced or metastatic disease. However, it’s been shown that targeted therapies can increase survival when compared to conventional treatments. Broad gene sequencing tests help support use of targeted therapies by identifying the best treatment for a specific patient. A CVS Health analysis found that by identifying the broader genomic landscape of a patient’s tumor early on, doctors armed with this information make timely and precise treatment decisions, which ultimately can lead to better outcomes and are more cost effective. The findings are an example of the types of analytics CVS Health is evaluating consistently to inform programs focused on transforming the oncology experience for patients and their support teams.

The challenge to increasing biosimilar prescribing

Biosimilars are the fastest-growing class of therapeutic products in the United States. Despite the availability and proven efficacy and safety of biosimilars, their uptake has been slow. This is, in part, due to patent litigation and pay-for-delay strategies by brand manufacturers that often delay the launch of many of these products, even after they’ve been approved by the U.S. Food and Drug Administration. As part of the research we are presenting, we surveyed oncologists to evaluate their willingness to prescribe biosimilars. While those surveyed deemed biosimilars to be safe and effective, physicians reported there were still certain factors that affected their willingness to prescribe. Given the potential of biosimilars to create competition and therefore lower cost, we continually monitor the pipeline to optimize the use of lower cost therapies and expand our value-based provider contracts in order to help improve patient access. 

Data can improve patient care journey, payor and provider tools

We will also be presenting data from Novologix, CVS Health’s proprietary technology platform, which demonstrated that by engaging oncology practices through an enhanced payor-provider partnership and training providers on the prior authorization tool, we can help facilitate higher-quality oncology care. As part of another study, we surveyed patients on their cancer treatment history and care experience, as well as how they worked with their health care providers. We also surveyed health care providers for information on their practice, their referral process for their patients to an oncologist, and how they engage with their patients. There were two key findings. First, there is a compelling opportunity to develop a data-driven oncologist selection tool that helps primary care providers direct their patients to high-quality and low-cost oncologists. Second, it is important for providers to initiate the conversation around an advanced directive at the start of a patient’s cancer care in order to help those close to the patient fully understand their desires for end-of-life care.

This research is part of our ongoing focus on helping transform the health care experience for all patients while addressing challenges of oncology management for payors.

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Achieving accreditations for high-quality care

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As a company committed to innovation and helping people on their path to better health, we pursue a range of accreditations from independent organizations. Maintaining these accreditations also helps ensure we are improving patient safety and driving better health outcomes.

CVS Health has long led the industry in seeking independent verification of quality and meeting — or exceeding — such standards. For example, CVS Pharmacy was the first retail pharmacy to receive URAC’s Community Pharmacy accreditation and MinuteClinic was the first retail health care provider to be accredited by The Joint Commission. Given our commitment to reducing costs while improving patient outcomes, achieving third-party accreditations underscores the important work we do every day to ensure patients can access the care they need without overusing resources.

Building on our commitment to delivering high-quality care

CVS Caremark, our Pharmacy Benefit Manager, recently earned the NCQA — or National Committee for Quality Assurance — Utilization Management Accreditation. This marks the fourth consecutive accreditation since 2014 and is a deep testament to the high-quality care we deliver to our clients and members. Achieving this accreditation demonstrates that we have the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards.

The Reaccreditation Survey included a rigorous evaluation conducted by a team of physicians and managed care experts. An independent review oversight committee of physicians analyzes the team’s findings and assigns an accreditation status based on our performance against standards. Based on the score of our most recent survey, the duration of our NCQA Utilization Management Accreditation is in place for three years.

We’re proud to continue to be recognized by highly-respected organizations, such as NCQA.

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Addressing out-of-pocket costs for diabetes patients

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Rising costs are a burden for too many people living with diabetes today. Patients with a high-deductible health plan shoulder all of their medication costs while in the deductible phase of their insurance, which means they may be forced to make difficult decisions about whether they can afford their medications and fill their prescription.

Recent data reveal there is uncertainty on how to manage and predict the out-of-pocket costs associated with diabetes management. For example, nearly one-third of patients (32 percent) do not feel they have the resources needed to manage their own out-of-pocket costs. To address this challenge, CVS Health is working to eliminate member cost as a barrier to medication adherence.

Improving medication affordability and adherence

Improving diabetes outcomes while reducing costs is a priority for CVS Health. We recently launched RxZERO to enable employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members. The new plan design enables plan sponsors to eliminate member out of-pocket costs for the entire diabetes therapeutic area — including oral medications for Type 2 diabetes — and fully adhere to American Diabetes Association standards.

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes. However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications — improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes.”

— Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Health

CVS Caremark analysis shows that members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12 percent spending over $1,000 annually.

A comprehensive approach to diabetes management

A person living with diabetes is required to take many tasks to manage their therapy annually. To make disease management affordable, accessible and local, CVS Health offers numerous programs to help people with diabetes effectively manage their condition and stay on track with their prescribed treatment plan.

We provide supportive care at our HealthHUB locations to complement the care that patients receive from their primary care physicians. Our HealthHUB model provides a first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

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Using data to drive value to our members

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From opioid misuse, gene therapy and chronic care management to end-of-life issues and hospital acquired infections, our Clinical Insights and Analytics (CIA) team is using member data and medical knowledge to make an impact on the lives of the people we serve and set them on a path to better health.

CVS Health’s Clinical Insights and Analytics (CIA) team is using member data and medical knowledge to make an impact on the lives of the people we serve and set them on a path to better health.
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“We are a clinical think tank,” says CIA team member Rebecca Smith, a senior program manager. “We have the clinicians, the project management, the operational expertise and the data analysis all in one place, all working cohesively.

“We're all working towards the same goal, which is to drive better value of care for our members.”

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For diabetes patients, a Care Coach is just a click away

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CVS Health pharmacist Matthew Scarnecchia could see the concern on the face of his patient. Richard, a 59-year-old man who suffered not only from Type 2 diabetes but also high blood pressure and high cholesterol, was alarmed by the results of his latest blood-sugar test. His A1c was 7.5 percent — above his goal range of below 7 percent.

With a few questions, Scarnecchia learned that Richard was worried about also getting low blood sugar from his diabetes medication. It turned out that Richard was taking his diabetes medication in the morning, but not eating until he was at his workplace after a long commute. “I recommended that he take his Glipizide with his breakfast at work to see if that would help,” Scarnecchia says. It did. Just a few months later, Richard’s A1c had dropped to 6.3 percent and he was no longer having low blood sugar readings.

Nearly as satisfying, this one-on-one consult took place without either man leaving his desk, even though they were 2,000 miles apart – one in Arizona, one in Florida. Through his insurance provider, the patient had signed on to CVS Health’s Medication Therapy Management program and met with Scarnecchia face-to-face via an online app that can be accessed through any computer or mobile device.

Personal Consultations from Anywhere

Once enrolled in the program, patients can slot in a video consultation from anywhere. In addition to their regular doctor’s appointments, they can talk with a specialized pharmacist who can advise on medication compliance, interactions and side effects, and, most importantly, suggest some everyday adjustments, such as diet and exercise, that can make an immense difference in controlling diabetes.

CVS Health’s Medication Therapy Management program provides patients with one-on-one care with a specialized pharmacist who can help them better manage their chronic condition from the comfort of home.
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A video meeting benefits patients and pharmacists alike. A patient can show his or her latest blood-sugar results or other medical reports without needing to mail them. If a patient is having issues injecting insulin, the pharmacist can point to possible alternative injection sites on a visual model. The one-on-one view also allows pharmacists to pick up on nonverbal cues. “I can see if a patient seems confused about their results and give explanations that might be helpful,” says Scarnecchia.

Patients can take advantage of this face-to-face coaching even before they might need medication. With diabetes tied to so many other health concerns — high blood pressure, nerve damage, heart disease — it’s especially vital to try to halt or slow down the condition’s progress.

Small Changes Can Make a Big Difference

When an A1c of 5.8 percent tipped him into the prediabetic range, 60-year-old Jeff welcomed the chance for video chats with pharmacist Brian O’Halloran, and has kept those appointments every three to four months. “During our visits, we’ve discussed healthy lifestyle changes,” says O’Halloran. “Jeff decided to stop drinking diet sodas, and reported, nine months later, that he’d stayed off them.” 

Small but attainable goals are easier to meet, explains O’Halloran.

“In March 2018, Jeff said he wanted to lose 5 pounds before his next time we talked. I told him ‘Don’t shop the aisles.’ That’s where grocery stores stock all the processed foods. Instead, I suggested he shop the perimeter — where he could pick up fresh vegetables and meats. When we spoke again in July, he’d lost 6 pounds.”

Both pharmacists find that patients look forward to the on-screen sessions, which often last for 30 minutes. Even a patient’s family member may stop by to wave hello, says Scarnecchia. Patients can also contact the pharmacist in between scheduled sessions. When a patient shares good news about improved bloodwork, O’Halloran warmly congratulates them on their success.

For diabetes patients, a video visit is part of the “big picture” of managing of their condition. Patients can ask questions that may not have occurred to them while in their doctor’s office. “It’s more like a conversation,” says O’Halloran, “and more comfortable for the patients.”

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Helping patients better manage diabetes

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As CVS Health’s Senior Director of Transformation Stella Wong explains, diabetes is a difficult condition to manage. There are a number of things patients need to do on a routine basis, such as checking blood glucose levels, eating right, exercising, or taking the right medications at the right time.

“The list is literally hundreds of items long,” Stella says.

CVS Health is in a unique position to help. From new, innovative programs to in-store screenings at MinuteClinics and HealthHUB locations, learn how we’re helping people with diabetes better manage their condition and lead healthier lives.

From new, innovative programs to in-store screenings at MinuteClinics and HealthHUB locations, watch this video to learn how CVS Health is helping people with diabetes better manage their condition and lead healthier lives.
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“Our tremendous reach into people’s communities (and) our focus on new technologies will allow us to add an entire other layer of support and care for patients,” says Dr. Alan Lotvin, Chief Transformation Officer. “We have the opportunity and the ability to fundamentally reshape and augment the care delivery system in the United States.”

Watch the video above to learn more.

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Why Building Trust is Key to Delivering Crucial Care to Pharmacy Patients

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CVS Health pharmacists are often called on to employ not only clinical services, but a fair amount of detective work as well. Patients often report that their diet, exercise, and medications are all in check, but if they’re not experiencing results to match, then it’s time to dig a little deeper.

Elderly or infirm patients can pose special challenges: They can be mistrustful of medical professionals, stuck in old habits, and might not even be physically able to visit their local CVS for prescription recommendations and tests. Often, all the pharmacist has to go on is phone consultations and lab results. And yet, often that’s enough to produce life-changing results.

Pharmacist Angela Stigliano realizes that building trust with patients is a necessary part of the job. She’s a clinical pharmacist for CVS Health’s Medication Therapy Management (MTM) service, and provides care to members over the phone or via video chat.

She shared a recent success story about a patient with diabetes that demonstrates why trust is so important. The percentage of Americans 65 and older with diabetes is high, at about 25.2 percent or 12.0 million seniors (diagnosed and undiagnosed).https://www.diabetes.org/resources/statistics/statistics-about-diabetes It is a disease that can be well-controlled with diet and lifestyle changes — but they’re not always easy to make and adhere to without a helping hand.

Asking the Right Questions to Get a Diabetes Patient Back on Track

In March 2018 Stigliano began working with Vicki, a woman in her sixties who reported having a stroke that had left her with mild physical impairments. Though she had a long history with diabetes and high cholesterol, her doctors were confident that she would make a full recovery.

In their initial phone call, Vicki insisted that she followed a strict diet and was very mobile, but given the precarious state of her health, that “didn’t make sense,” says Stigliano: She was gaining weight, her A1C was unstable, and she wasn’t taking her cholesterol medication as prescribed. These factors put her at risk not only for another stroke, but heart disease as well.

Through a series of thirty-minute phone calls every few months, Stigliano fostered a friendly relationship with Vicki.

“I would use phrasing like ‘Tell me about your diet these days,’ instead of saying, ‘Have you been dieting?’ This allowed her to tell me about her diet without the feeling I was searching for a ‘correct answer,’” she says. “It can be difficult to be forthcoming with a stranger about a sensitive topic like being overweight or unable to walk and care for yourself properly.”

These days, there’s a lot of confusion about what a “healthy diet” actually means. Vicki reported trying a keto diet, and skipping meals, both unwise choices for a diabetic.

“Purposely not eating enough can be just as unhealthy as eating fast food every day. Not having enough range in your diet can also become unhealthy as well,” says Stigliano. She recommends the easy-to-follow MyPlate tactic to patients like Vicki. “You’re not telling them what to eat and what not to eat, but to focus more on portion sizes; to look at their diet and their plate a little bit differently.”

A CVS Health clinical pharmacist shares a recent diabetes patient success story that demonstrates the importance of relationship-building in her work.
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After several months, Stigliano was pleased to hear that Vicki had begun to be more honest with herself and her medical team. She compromised with her prescriber, and was put on a low-intensity statin three times a week. And, as Stigliano had gently suggested over the course of their interactions, she began a low-carb, high-protein diet, and increased her physical activity.

All of these changes started to pay off. Vicki’s A1C had been steadily improving due to her adjusting her insulin, but after taking the initiative to make lifestyle changes, she had lost approximately twenty-five pounds, reduced her A1C to consistent readings at or around 7 percent, and mentioned that her LDL cholesterol had come down by 100 points on her latest lab test. And she felt positive, healthy, and empowered.

“When we first started talking, Vicki was not in good spirits,” says Stigliano. “She was very upset about her stroke, and really down, very defeatist. But, after Vicki began to take control of her health, Stigliano says, “It sounded like I was speaking to a whole different person. She was excited to tell me about her lifestyle, the change in her as person. She ended our most recent phone call by saying, ‘I’ll talk to you soon. I need someone to stay on top of me!’”

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Supporting the Fight Against HIV/AIDS

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This World AIDS Day, CVS Health is recognizing the progress made in the fight against HIV/AIDS and is teaming up with the U.S. Department of Health and Human Services (HHS) to help further reduce the spread of the HIV virus.

Reducing transmission of HIV

Currently, there are an estimated 1.1 million people in the U.S. living with HIV, and approximately 38,000 people diagnosed annually. Scientific advances over the past few decades have changed the paradigm for the prevention and treatment of the disease. For example, an HIV diagnosis is no longer a death sentence and can now be effectively managed through maintenance medications. In addition, more recent medical breakthroughs have brought to market pre-exposure prophylaxis (PrEP) medications that can prevent at-risk populations, including those who could contract the virus through sexual contact or drug use, from ever getting HIV.

HHS estimates that more than one million people in the U.S. could benefit from taking PrEP medication, however only 100,000 actually have a prescription. That is why CVS Health is teaming up with HHS to help make PrEP medication more accessible and affordable through a new HHS program called Ready, Set, PrEP, which is a key component of the Ending the HIV Epidemic In America initiative, which aims to reduce the number of new HIV infections in the U.S. by 90 percent over the next 10 years.

How it works

The HHS Ready, Set, PrEP program provides at-risk and HIV-negative individuals who do not have prescription drug coverage access to PrEP medication at no cost.  In addition, the program is providing education and awareness materials to help individuals gain more information about PrEP and learn how to access the Ready, Set, PrEP program. Once approved, and with a valid PrEP prescription from a health care provider, individuals can fill the medication at a participating pharmacy, including CVS Pharmacy and CVS Pharmacy Specialty Services locations or by mail. CVS Health has donated prescription dispensing services to HHS as part of Ready, Set, PrEP program. Those interested can learn more about Ready, Set, PrEP and apply online at GetYourPrep.com or calling toll-free 855-447-8410.

CVS Health has donated prescription dispensing services to HHS as part of Ready, Set, PrEP program. Those interested can learn more about Ready, Set, PrEP and apply online at GetYourPrep.com.
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Our enterprise commitment

This is one more way that CVS Health is working to prevent the spread of HIV and help those living with HIV better manage the virus and prevent disease progression.

This includes an ongoing partnership with the Centers for Disease Control and Prevention (CDC) to help Act Against AIDS, which brings mobile HIV screening and testing services to CVS Pharmacy locations throughout the country.

In addition, through the CVS Specialty HIV Care Management program, patients can receive whole-patient management and support from nurses specially trained in HIV care.Nurse support is available to CVS Caremark members whose plans including Accordant Care Management (including CareTeam Choice or CareTeam Advanced) Comprehensive, continuous care can help promote medication adherence, improve outcomes, and reduce overall health costs. Further, at several CVS Pharmacy Specialty Services locations in New York City, HIV patients can receive proactive outreach to improve adherence to and management of HIV medications. This includes face-to-face counseling and/or telephonic outreach for all new-to-therapy patients; refill reminders; and additional co-morbidity and financial support and assistance, as appropriate.

Across CVS Health, we help support the HIV/AIDS community every day. Through high-touch support, screening and care management services, we help those who are at at-risk for or living with HIV/AIDS on their path to better health.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Re-Training Providers to Achieve Proper Blood Pressure Measurement

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Getting your blood pressure checked is a familiar experience at the doctor’s office, but recent research suggests that it may not always be accurate.

According to the American Heart Association (AHA), nearly half of all U.S. adults have high blood pressure, which is a leading risk factor for heart attacks, strokes, and preventable death.  Accurate measurement of a patient’s blood pressure is vital to providing accurate diagnoses and quality care.https://www.ama-assn.org/system/files/2019-11/market-research-survey-bp-measurement.pdf

Given the importance of accurate blood pressure readings, clinical guidelines recommend that health care providers be periodically re-trained on proper BP measurement; however, recent market research conducted by the American Medical Association (AMA) and the AHA indicated this may not always be the case.

Based on this research, the AMA and AHA partnered with MinuteClinic, along with a leading health care organization and leading academic medical centers, to test a new e-learning module. The module, called Achieving Accuracy: BP Measurement, was designed to provide all front-line health care providers with access to consistent training on proper BP measurement and is now available for health care professionals through the AHA.

In the survey of more than two thousand health care providers, half of the physicians and physician assistants (PAs) who responded, and a third of nurse respondents, said they had not received BP measurement re-training since their initial training in school. However, there seems to be broad support among the survey respondents for BP refresher training, with three-quarters or more of the nurses, PAs, primary care providers and pharmacists surveyed noting that it should be required.

Some common BP measurement errors that can result in pushing a patient’s diagnosis from normal to elevated, include:

  • Taking a reading while a patient is sitting with their legs crossed, which can raise systolic pressure by 5 to 8 mm Hghttps://www.ncbi.nlm.nih.gov/pubmed/17496470

  • Using the wrong cuff size, which can raise systolic pressure by approximately 10 mm Hghttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911816

“Being able to test this new BP measurement re-training module with our providers on the front lines reinforces our long-standing commitment to advancing heart health and providing high quality care for our patients,” said David Fairchild, M.D., Chief Medical Officer, MinuteClinic. “Our providers appreciated the opportunity to be involved in this effort and we look forward to integrating this training into our clinical standards moving forward.”

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