Controlling hypertension requires a new primary care model.
About 32 million Americans have uncontrolled hypertension, and the impending shortage of primary care physicians could result in worsening blood pressure control. The "Treat to Target" approach to hypertension in primary care has the potential to increase hypertension control while off-loading a portion of hypertension management from physicians to other team members. "Treat to Target" involves 3 components: home self-monitoring of blood pressure, regular health coaching for patients with elevated blood pressure, and home titration of blood pressure medications based on standing orders from the patient's physician. To implement "Treat to Target" in primary care, public and private health insurance plans and primary care practices should receive payment for health coaching sessions that train patients to take their blood pressure, teach patients about hypertension and its medications, and assist patients by telephone in home titration. Reimbursing primary care practices that implement effective blood pressure programs and save physician time is a logical step to reducing long-term costs from stroke, heart attack, and kidney failure.
Margolius
David
D
Warren Alpert Medical School, Brown University, Providence, RI, USA.
Bodenheimer
Thomas
T
D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008962:Models, Theoretical; D011320:Primary Health Care / Q000458:organization & administration*