Hypertension Outreach Program Humber River Regional Hospital

1. Hypertension Outreach ProgramHumber River Regional Hospital Sherry Mariash, RN, CNephC, BScN Gavril Hercz, MD, FRCPC

2. ESRD in GTA (rate/millions) * Above started on dialysis 10 years earlier than Caucasians Source: International Interdisciplinary Conference on Hypertension in Blacks

4. Visible Minorities in HRRH catchment area

5. Encourage regular follow-up and enhance continuum of care Reduce modifiable risk factors for vascular disease • Provide high-risk population with clinical information and educational resources in the community Build community relationships

6. Methods • Visible minorities at high risk of ESRD • Develop program in the community • Liaise with community outreach • Empower community in identification and ongoing care • Address issue at source • Linkages with churches, community centres and schools • Word of mouth

7. Venues • Community Churches • Community Centres • Shopping Malls

8. Team • Volunteers • Registered Nurses • Physician • Dieititians • Health Ministries

9. Lecture/materials • Identification of risk factors • Hypertension • Diabetes • Diet/lifestyle modification • Treatment modalities • Followup with family physician and Health Ministries • Pamphlets

10. Health Promotion Awareness • Blood pressure check • Blood glucose check • Record of results • Counseling • Pamphlets

11. Measuring Success • 9 programs delivered to date • Average attendance at each session 50-150 • Majority are female- carriers of health care information • Some clients diagnosed de novo with diabetes and hypertension • Large group on therapy and not controlled

12. Measuring Successes (cont’d) • Partnership with Health Ministries • Validates health ministry in congregations • Empower clients for regular followup

13. 7%

14. 29%

15. Future • Motivate other health care facilities to create similar programs in their catchment • Enhance education internally of allied health • Data collection

16. Classification of Hypertension (Pre Hypertension) 120-139 -- 80-89 *ISH=International Society of Hypertension. Chalmers J et al. J Hypertens 1999;17:151-85. The category pertains to the highest risk blood pressure

17. Benefits of Treating Hypertension • Younger than 60 • reduces the risk of stroke by 42% • reduces the risk of coronary event by 14% • Older than 60 • reduces overall mortality by 20% • reduces cardiovascular mortality by 33% • reduces incidence of stroke by 40% • reduces coronary artery disease by 15%

19. Leading diagnoses resulting in visits to physician offices in Canada 20 25 20 Routine medical exams Depression Acute respiratory tract infection Million visits/year Diabetes 15 Hypertension 10 10 5 5 0 0 Source: IMS HEALTH Canada 2002. http://www.imshealthcanada.com/

20. Hypertensive patients who are treated and BP controlled Hypertensive patients who are treated but BP uncontrolled 13% 9% 21% Diabetic patients who are treated and BP controlled 43% 22% Patients who are aware but remain untreated and BP uncontrolled Hypertensive patients who are unaware Joffres et al. Am J Hyper 2001;14:1099 –1105 The Challenge In Canada 22% of Canadians 18-70 years of age have hypertension 50% of Canadians >65 years of age have hypertension