One Gloucestershire ICS has introduced a new preventative project called The Blood Pressure Optimisation Programme, targeting people with high blood pressure to reduce the risk of heart attacks and stroke through partnership working with primary care services.
Through the programme, primary care networks stratify risk by running an automated search on their software system to produce a list of patients according to priority. This prompts urgent review for those with high blood pressure readings, and allows for patients who haven’t had a blood pressure reading in 18 months to be contacted to arrange for one.
So far, the project has led to the addition of 67 patients to the hypertension register, as well as allowing for 199 patients with previously high readings to be removed following at-home blood pressure monitoring. 20 blood pressure meters are available for loan to support remote monitoring and self-management of blood pressure from home.
The team are now hopeful that the project will be “used as an example of good practice”, with Richard Lee, lead pharmacist at Gloucester’s Inner City Primary Care Network, saying: “We want to roll this out to the other practices in the PCN so they can get more loan blood pressure meters and we also want one in the reception area so people can come to the practice and check it themselves. There are a wide range of health issues linked to health inequalities and our work won’t stop with hypertension. We are looking at innovative ways to approach areas such as diabetes and respiratory conditions for our patients.”
Noshin Menzies, senior project manager at the West of England AHSN, said: “It’s really positive to see the spread of blood pressure optimisation and have the opportunity to work with clinicians who are passionate about reducing health inequalities, and improving risk, from hypertension and CVD.”
Primary care was one of the main topics discussed in a recent Gloucestershire ICB meeting, which looked at PCN quality improvement projects and proposals for population health management.