Chronic Conditions - Key Activity 13

KEY ACTIVITY #13:

Manage Treatment of Comorbid Hypertension and Diabetes

 

This key activity involves all seven elements of person-centered population-based care: operationalize clinical guidelines; pre-visit planning and care gap reduction; care coordination; address social needs.

Overview

It is not uncommon that a patient may struggle with comorbid hypertension and diabetes. Hypertension is twice as common in patients who are diabetic compared to those who are not.[1] Therefore, it is fairly likely that clinicians who are treating diabetes will also be treating hypertension. Both of these diagnoses are commonly treated through pharmacological interventions combined with lifestyle change recommendations. Due to the close relationship between the two chronic diseases, it is essential to coordinate and streamline treatments in order to provide high-quality care to patients while also optimizing treatment.

Treating hypertension and diabetes as a group of diagnoses rather than individually is important for the overall health of patients. Having an optimized rather than a separate approach to care reduces the patient’s burden of maintaining complicated care regimes. Due to the nature of these diseases as lifelong illnesses, the treatment plans for these types of care need to be in concordance with, and manageable for, patients to incorporate into their everyday lives. The more a care plan is tailored to a patient’s existing lifestyle and needs, the more likely they will be able to follow it.

To improve social health and equity in relation to diabetes and hypertension management, accounting for social needs and working to minimize the effects of unmet needs will assist in reducing inequities in related health outcomes.

A family unit approach to care, which provides the patient with more support, is a significant asset for achieving effective management of diabetes and hypertension. Involvement from family and caregivers is a crucial aspect of successful management, and it can make interventions more effective. When clinicians develop care plans with patients, caregiver involvement should be considered to ensure that the medication regimen and lifestyle changes are sustainable to the patient.

Relevant health information technology (HIT capabilities to support this activity include care guidelines, EHR medication lists and alerts, clinical decision support and medication adherence assessments. Additional tools include condition-specific resources for optimizing medical therapy. When available, clinical pharmacists are an excellent resource for compliance and prescribing recommendations. guidance.

Action steps and roles

1. Streamline medication regime to ensure that the patient has the most effective treatment with the least amount of medication possible.

Suggested team member(s) responsible: clinician, pharmacist and patient.

Fixed-dose combination medications should be considered to achieve more effective hypertension management.[2] Fixed-dose combination medications help to improve patient adherence, condition control and time to control. Many fixed-dose combination medications are covered by Medi-Cal (on formulary). This may also include employing use of interventions such as bubble packaging, medication delivery and others in order to reduce barriers to care.

 

2. Determine, in consultation with the patient, which healthy lifestyle changes are acceptable to them that they feel they can reasonably implement.

Suggested team member(s) responsible: clinician, patient and behavioral health consultant (if available).

Examples may include, but are not limited to:

  • Increasing exercise.
  • Switching to healthier food options (e.g., from white rice to brown rice, from cereal to oatmeal made with rolled oats, etc.).
  • Incorporating more fruits and vegetables into the patient’s regular diet.
  • Switching to fruits that have lower levels of natural sugar (e.g., switching from oranges to berries).

 

3. Consult, or refer the patient to, a behavioral health clinician who can assist with change management.

Suggested team member(s) responsible: clinician, patient and behavioral health consultant (if available).

The Shasta Community Health Center Quality Improvement Storyboard provides an example of integrating behavioral healthcare into diabetes care.

 

4. Refer the patient to other education or intervention options, as appropriate, for further assistance, such as case management, diabetes education or medically tailored meals.

Suggested team member(s) responsible: clinician, patient, and care coordination staff (or equivalent).

Evidence base for this activity

Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. The Canadian journal of cardiology. 2018 May;34(5):575–84.

Endnotes

  1. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: Clinical insights and vascular mechanisms. Canadian Journal of Cardiology. 2018;34(5):575–84. doi:10.1016/j.cjca.2017.12.005  
  2. Derington CG, Bress AP, Herrick JS, Jacobs JA, Zheutlin AR, Berchie RO, et al. Antihypertensive medication regimens used by US adults with hypertension and the potential for fixed‐dose combination products: The National Health and Nutrition Examination Surveys 2015 to 2020. Journal of the American Heart Association. 2023 May 6;12(11). doi:10.1161/jaha.122.028573