Tools Assignment #5, Chatterjee

Tools Assignment #5, Chatterjee

by Purba Chatterjee -

A. Describe one tool that you will employ in your intervention strategy using the following domains....

  1. Tool—type: Algorithm (pocket and poster) for treatment intensification for HTN control

2. Target Population: GMC Clinicians

 3. Target Behavior: Treatment Intensification by GMC Clinicians for HTN control in GMC patients

4. PRECEDE Category: Enabling

 5. Platform: Pre-clinic conferences for residents, attending, nurses and nurse practitioners.

 

B. For a multi-tool intervention strategy, use the PER worksheet attached to describe how you will address each of the PRECEDE framework components (Predisposing, Enabling and Reinforcing). You may download this PER worksheet and/or copy/paste.

 

PER Worksheet. 

 

Target Behavior

Treatment Intensification for Blood Pressure Control

Target Audience

GMC Clinicians

Other Key Individuals

Clinic Director, Nurse Manager

PREDISPOSING

ENABLING

REINFORCING

KNOW

BE ABLE TO DO (skills)

REMINDED

Too much uncontrolled hypertension nationally

Algorithm will lead to task shifting

Prompts on EHRs

GMC hypertension control rates are poor

 

Reduce burden on physicians

Scheduled visits for blood pressure checks

Kaiser has been highly successful with 84% control rate so possible to do.

Standardized care for general population

Regular check-in meetings about how implementation is going

BELIEVE/VALUE

ACCESS TO

POSITIVE REINFORCEMENT

Titrate up first before adding a second pill

Easy to implement algorithm

Updated HTN registry tracking progress

Combination pills not available in the GMC formulary

Additional nursing staff for monitoring

Feedback from implementers on progress

Kaiser successful in controlling HTN because of active case finding from their registry

Updated HTN registry to track progress

Recognition from Clinic Director and SFGH CEO for goal attainment

INTENTION

ACCESS REMOVED

NEGATIVE REINFORCEMENT

To use algorithm for treatment intensification

Lack of fixed dose combination pills in the GMC formulary

BP control rates for each clinician’s patient panel posted on clinic notice board

To promote fixed dose combination as an effective treatment intensification method and spironolactone or labetalol for resistant HTN

Incomplete registry

Clinicians get penalized for poor control rates

OTHER

 

SOCIAL SUPPORT

 

 

Connecting with a KP primary care provider

 

 

Fellow colleagues

 

 

 

 

Background - my protocol is implementing an adapted version of the Kaiser algorithm for treatment intensification for hypertension control at the GMC in SFGH.

Re: Tools Assignment #5, Chatterjee

by Ralph Gonzales -

Purba,

Your program fits nicely with this framework.

For the Tool Platform, you actually state that it will be a “pocket” and “poster” in your answer to #1.  The pre-clinic conferences may be part of your implementation plan, but the platform would be pocket/poster.  Think hard about the advantages/weaknesses of this approach.  As an enabling strategy, some of the most critical issues are to make the algorithm/decision support available at the point of decision making, and reduce barriers and inertia to using it.  The poster is good—right there. But the pocket may get lost or not accessed.  Physicians sometimes also feel funny “looking things up” in front of the patient during a visit.  Embedding it in the EMR is one way to hide it.

 Your PER worksheet is excellent. Hard to add anything else to this.  You might also think creatively of ways in which patients can provide positive reinforcement if you get them on-board too.  Also think about ways to provide peer-profiling and finding “positive deviants” who do it well to teach/share their secrets with the rest of the group.