Mid and South Essex
Hypertension Detect Programme
In partnership with Mid and South Essex NHS Foundation Trust and
ECLIPSE (Equality of Care Led Insights for Patient Safety & Engagement)
Practice Pro-Forma
Project overview:
Hypertension is a significant and independent risk factor for the development and progression of cardiovascular disease, mediated through associations with high BMI, dyslipidaemia, and metabolic disorders such as type 2 diabetes. Additional complications include cancer (breast, colon and endometrial), arthritis and fatty liver disease. An up-to-date blood pressure reading is also important for identifying those who may benefit from onward referral and for hypertensive-adjusted medication dosing.
Around 5.5million people in England have undiagnosed high blood pressure, a usually symptomless condition that significantly increases the risk of heart attacks, stroke, and dementia. NHS ambitions are that by 2029, 80% of the expected number of people with hypertension are diagnosed, and that 80% of the total number of people diagnosed with hypertension receive treatment.
Objectives
To ensure that patients with a previous high blood pressure reading, not coded with hypertension, have an up-to-date blood pressure (within 12 months).
To ensure that patients with an elevated up-to-date blood pressure are appropriately followed-up and, where appropriate, coded with hypertension.
To ensure patients currently prescribed blood pressure lowering therapy, not coded with hypertension, are coded where appropriate.
To identify and monitor blood pressure for high-risk individuals, based on deprivation, comorbidities, and lifestyle parameters (e.g. smoking, obesity etc.)
There are two tiers of support on offer to improve the for eligible patients at your practice:
Eclipse Detect – Activation of this programme will activate the Hypertension Detect pathway within Eclipse, providing a list of all eligible patients, alongside additional priority groups, which can be further filtered and prioritised by parameters such as levels of deprivation, ethnicity, comorbidities, and risk.
Eclipse Complete – will then automatically engage with these priority patient groups via the PEGASUS platform to inform, educate, counsel, and consent patients to have a blood pressure undertaken. A dynamic questionnaire will capture additional risk factors and preferences related to this – and they can then be booked into a community pharmacy or equivalent provider to have a blood pressure performed or have a home blood pressure monitor provided. The result will be captured within Eclipse, and through integration with the GP clinical system will code this updated blood pressure for the patient, and where relevant, a code of hypertension applied. A patient PDF report will be produced, recommending any further action or medication optimisation that should be considered in managing this patient. This can then be reviewed and implemented by the GP practice, as seen fit.
The solution being offered utilises Eclipse’s digital patient engagement platform which will automatically identify your eligible patients, engage with them via SMS, educate and counsel them using a lander page and consenting them to provide their home blood pressure reading or opt for an appointment via access to their secure questionnaire portal.
EVALUATION: As well as quantitative data, which will be collected via Eclipse, patient reported outcomes and perceptions of the new pathway will be collected through patient questionnaires.
If your practice would like to take part: Please complete the below pro forma, expressing your interest and permissions for patient engagement.
Please note that you will be notified prior to any active patient engagement, and your practice will be issued with a guide on how to view patient lists and document patient reviews.