Dr. Jia Hong is a family physician in Flushing, Queens. She sees about 3,000 patients a year, most of whom are newly-arrived Chinese immigrants.The most common conditions her patients have are high blood pressure, diabetes, overweight, and high cholesterol. Dr. Hong’s focus on managing high blood pressure led to a hypertension control rate of 82% among her patients, which made her a 2018 Million Hearts®Hypertension Control Champion! We spoke with Dr. Hong about her approach to patient care and hypertension management.
How did participating in HealthyHearts NYC change your practice?
The program increased our practice’s general awareness of the importance of blood pressure control. Now the staff all know how important it is. I truly believed if we implemented some new methods, we could improve quality measures on blood pressure control, and NYC REACH worked with us to come up with new ideas. And I’ll say ten times: thank you NYC REACH for bringing us to the national level! We were very excited about that. NYC REACH always lets us know what’s new, what’s coming along, what’s the next program. It’s really helpful to have someone come in and remind us of all the stuff we have to do. So thank you for all the effort!
How do you approach in-office visits with patients with hypertension?
One thing we did is come up with our own “logs” for patients. We have a blood sugar log and a blood pressure log. It’s this small piece of paper. They have to write down their blood pressure measure and bring it back in one week or two weeks. If it’s not controlled then they have to see me and I will review and adjust medication with the patient. If it’s good, we usually double check in the office to make sure it is good. It takes the whole team working together. Everybody checks it. And I can tell [patients] look, here’s how you take your medication, you need to exercise, change your diet.
I prescribe all of them blood pressure machines so they can check their blood pressure at home. I tell them to bring it to the office to show me how they use it. Sometimes they say it’s good at home, but they might not be taking it properly. We really want to make sure they can check it on their own correctly. There are a lot of small tricks to make patients understand how to do it. When you explain it to them they actually really appreciate it. They appreciate the effort and they know I care about them.
What is your approach to patient education?
We put a lot of emphasis on it. I do talk to the patients a lot. I truly believe it’s important for quality improvement. My belief is every visit is an opportunity for preventive care.
I think about one of three adults probably has high blood pressure and is undiagnosed. Some patients come to our office and they don’t know because they don’t have symptoms. I’ll talk to them and hand out a small piece of paper with hypertension control/diet/exercise/blood pressure goal. I emphasize complications if blood pressure is not treated – risk for heart attack and stroke, which they may not realize.
What role do office staff play in treating patients?
Team involvement is obviously really the key. I think it’s important for physicians to know that when we educate the front desk, everybody is more aware of patient needs and the quality improvement goal, and it makes the physician’s job much, much easier. It is impossible to be done without the teamwork.
The important thing is right now, with a lot of quality measures, it’s not dependent on the physician only. And you save healthcare expenses by doing all these quality measures. Patients could be here for multiple medical problems: gastric issues, a rash here, a pain there, and I might not remember to check everything whether they have any missing quality measures or not! So every visit the medical assistant will check if preventive care was done and documented in the chart, such as colonoscopy, mammogram, pap smear, eye exam, and more. If they say “Oh I saw the eye doctor already,” but we don’t have the consult, we will request a consultation report right away.
Everybody knows how to explain to patients, “Here’s your goal, what you need to do.” I think that’s the most important. For example I have a sheet in the nurse’s station that breaks it down by age: according to their age, here’s what patients need to do (like a mammo or colonoscopy).
How else do you review quality measures?
We like the NYC REACH dashboards; I read those to check on the percentage rates of different conditions. We pull reports from our own EHR as well to catch up on care gaps. The EHR registry function can analyze a patient’s data and give us a care gap list. Whenever the flow of patients is slow, that’s our time to catch up. In summer we review CIR immunization records, call patients for missing immunizations.
How do you encourage medication adherence?
Sometimes I prescribe something and the patient says “Ok, the doctor ordered it, so I’ll do it.” But sometimes they’ll say, “Ok I checked my blood sugar and its low, then I’ll take half a pill. I’ll take more if it’s high tomorrow.” They do their own thing at home. I will tell patients, “If your meal plan is good, and you take this pill, you don’t have to check it every day. But if you ate something sweet today, tomorrow your blood sugar is going to be high.”
I’ll write down the medications for them in their language so they can understand better. It makes it easier for them to fill prescriptions and makes my life much, much easier as well. With the elderly, sometimes their medication is all over the place. I have them bring back all their medications for every appointment so we can check. And I take the time to explain why they need to take them.
What’s your strategy for getting patients to change their lifestyle?
It’s very important to give them a goal. I’ll talk to them about diet and exercise, what doctor they need to see next. Every sick visit we discuss smoking cessation if the patient still smoking. I think it’s very important to have goals because it gets them involved.
How do you keep in touch with patients?
Once a patient is diagnosed with hypertension, we schedule a follow-up appointment in one or two weeks and put a reminder on our calendar to call them. A lot of the patients don’t understand emails from our EHR because they’re in English, so it’s best to just call. For the patients who speak English, I tell them to sign up for the patient portal! Sometimes if they don’t come we’ll send them a letter to make sure they need to follow up. We also use the dashboard reports to keep up with anyone who is not coming to the office. Whatever works to get them to follow up.