Scott Anders, MD, Chief Medical Officer, CareSouth Carolina,
Inc.
Marsharika Moody, Director of Education and Research, USC School of Medicine/CareSouth Carolina

To improve the patient self-confidence levels and hypertension treatment compliance rates of patients in the panel of Dr. Scott Anders through the use of a visual aid to assist with understanding of HbA1c and blood pressure levels, as well as, the importance of managing to their treatment goals.

• Percentage of patients reaching blood pressure goals as defined by the JNC-7
• Percentage of patients answering “very confident” about managing their health care (increased from 42 percent to 86 percent) 
• Hypertension control rates (changed from 62 percent to 56 percent [Note: Redefinition of control for DM patients to <130/80 resulted in a downward adjustment; however, taking the adjustment into account, there was a continued upward trend of the percent of patients in blood pressure control as defined by the JNC-7]
• Patient interviews for qualitative data on use of visual aids

Three visual handouts, created based on principles of health literacy, were tested on the pilot population during this project.  One example is the blood pressure visual aid handout that consists of a color thermometer and recognizable faces from smiling to frowning to indicate the patient's current blood pressure. There is also a very brief description of the importance of not only blood pressure goals, but also why it is important for patients to treat their blood pressure and how patients can help in their own care. Microsoft analysis using the Flesch-Kincaid grade level demonstrated a level of 7.4.

Patient self-confidence is an important factor to activate patients in their own self-care. Early results from this pilot indicate that the visual handouts impacted both patient self-confidence levels and hypertension control rates. Patients also indicated through interviews that the visual handouts helped them understand the importance of treating their blood pressure and the importance of increasing doses even when they felt good. 

The educational handouts provided the patients with an easy tool to understand not only what their blood pressure measurement was currently, but also what their treatment goals were and why it was important to obtain these goals. They enhanced the patient-physician communication and facilitated a working partnership between the providers and patients in the treatment of their hypertension.

Lessons Learned (Successful):

• Handouts need to be not only at the patient’s education level, but at their health literacy level as well. This is critical to patient understanding and acceptance.
• Handouts need to be simple with easily identified visual cues.
• Handouts need to be easy to understand.
• Handouts need to have 1 to 3 main points only.
• Patient focus groups can be very beneficial in helping define and redefine a patient handout.
• As the patients became familiar with the handouts and the goals, recommended changes in medications became faster (less time needed to address the reason for the change) and more efficient.
• The handouts proved to be very helpful during the initial treatment of uncontrolled hypertension when frequent medication adjustments are necessary.

Lessons Learned (Unsuccessful):

• What providers/nurses/etc. assume common knowledge, but it may be, and most likely is, completely foreign to the patient.
• Patients can easily get overwhelmed and confused by too much information.
• Too many handouts tend to dilute the pertinent information. This increases the likelihood that the patient will throw the information away and the most important points are then lost.
• With time, the handouts become unnecessary and even annoying to the patients as they become familiar and comfortable with their hypertension treatment.

Scott Anders, MD, Chief Medical Officer
CareSouth Carolina
Scott.Anders@caresouth-carolina.com